THE REACTIVE NATURE OF ACUTE RHEUMATIC FEVER: EVIDENCE FROM STREPTOCOCCAL CELL WALL ANTIGEN DETECTION BY IMMUNOTECHNOLOGY

Yıl 2008, Cilt: 5 Sayı: 1, 27 - 35, 01.03.2008

Öz

-

Anahtar Kelimeler

-

THE REACTIVE NATURE OF ACUTE RHEUMATIC FEVER: EVIDENCE FROM STREPTOCOCCAL CELL WALL ANTIGEN DETECTION BY IMMUNOTECHNOLOGY

Öz

Aim: The life-threatening group A streptococcal (strep) infection and its sequelae, including acute rheumatic fever (ARF), re-emerged as a serious health problem. The fleeting arthritis of ARF is considered a form of reactive arthritis. However, no one has confirmed this by investigating its synovial fluid cells for a possible presence of strep cell wall antigens using western blot in humans. This is the aim of the current study. Methods: Synovial fluid- (SF) and peripheral blood-mononuclear cells (PB-MNCs) from 40 patients with ARF and 10 patients with rheumatoid arthritis (RA), who served as a control group, were examined for strep antigens by immunofluorescence (IF) and western blot (WB) techniques using rabbit polyclonal antiserum and mouse monoclonal antibodies. Results: Extensive bacterial cultures of SF, blood and throat were negative. By IF, a significant proportion (37.5%) of ARF samples (Chi-square=3.72, p=0.048) showed positive staining in SF- as well as PB-MNCs with both rabbit polyclonal antiserum and mouse monoclonal antibodies. Further, IF was significantly higher in ARF- than RA-patients (Mann-Whitney p=0.022) in whom we failed to observe any staining. By immunoblotting, 21 samples from ARF patients (52.2%) were positive with mouse monoclonal antibodies specific for strep peptideglycan-polysaccharide (PG-PS) complex in SF-Cs (a band with a molecular weight of 28 kD) and PB-MNCs (29kD) and its proportion was significant (p=0.0008). With rabbit polyclonal antiserum, significant blots (p=0.027) were noted in 27/40 ARF patients (67.5%) indicating strep PG-PS (24-29kD broad band) in SF-Cs and PB-MNCs. Blots by both monoand poly-clonal antibodies were significantly higher (p=0.003&=0.001, respectively) than control samples that were non-reactive using both types of antibodies. Conclusion: The reactive nature of acute rheumatic fever is suggested by the frequent detection of streptococcal cell wall antigen from affected joints using both, immunofluorescence and western blotting

Anahtar Kelimeler

Streptococcal antigen, Rheumatic fever, Rheumatoid arthritis

Kaynakça

• Gibofsky A, Zabriskie JB. Rheumatic fever and poststreptococcal reactive arthritis. Curr Opin Rheumatol 1995;7: 299-305
• Hosier DM, Craenen JM, Teske DW. Resurgence of acute rheumatic fever. Am J Dis Child 1981;141:730-33
• Groves AM. Rheumatic fever and rheumatic heart disease: an overview. Rheumatic fever and rheumatic heart disease are still major causes of disease in the developing world today. Trop Doct 1999;29:129-32
• Olivier C. Rheumatic fever: is it still a problem? J Antimicrob Chemother 2000; 45: 13- 21
• Eltohami EA, Hajar HA, Folger GM Jr. Acute rheumatic fever in an Arabian Gulf country: effect of climate, advantageous socioeconomic conditions, and access to medical care. Angiology 1997;48:481-89
• Saxena A. Diagnosis of rheumatic fever: current status of Jones Criteria and role of echocardiography. Indian J Pediatr 2000;67: S11-S14
• Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992;268:2069-73
• Ahvonen P, Sievers K, Aho K. Arthritis associated with Yersinia enterocolitica infection. Acta Rheumatol Scan 1969;15: 232-53
• Tiovanen A, Tiovanen P, eds. Reactive arthritis. Boca Raton, Fla.: CRC Press. 1988;1-186
• Granfors K, Jalkanen S, Lindberg A, et al. Salmonella lipopolysaccharide in synovial cells from patients with reactive arthritis. Lancet 1990;335:685-88
• Poole ES, Highton J, Wilkins RJ, Lamont IL. A search for Chlamydia trachomatis in synovial fluids from patients with reactive arthritis using the polymerase chain reaction and antigen detection methods. Br J Rheumatol 1992;31:31-40
• Sieper J, Braun J, Wu P, Hauer R, Laitko S. The possible role of Shigella in sporadic enteric reactive arthritis. Br J Rheumatol 1993;32:582-85
• Fendler C, Wu P, Eggens U, et al. Longitudinal investigation of bacterium-specific synovial lymphocyte proliferation in reactive arthritis and lyme arthritis. Br J Rheumatol 1998;37: 784-88
• Granfors K, Merilahti-Palo R, Luukkainen R, et al. Persistence of Yersinia antigens in peripheral blood cells from patients with Yersinia enterocolitica O:3 infection with or without reactive arthritis. Arthritis Rheum 1998;41:855-62
• Gupta RC, Badhwar AK, Bisno AL, Berrios X. Detection of C-reactive protein, streptolysin O, and anti-streptolysin O antibodies in immune complexes isolated from sera of patients with acute rheumatic fever. J Immunol 1975;137:2173-79
• Storellman GH. Rheumatic fever and streptococcal infection. New York, NY, Grune and Stratton. 1975
• Svartman M, Potter EV, Poon-King T, Earle DP. Immunoglobulins and complement components in synovial fluid of patients with acute rheumatic fever. J Clin Invest 1975;56: 111-17
• Ziff M, Cohen BS. Atherogenicity of streptococcal cell walls. Adv Inflam Res 1985;9:1-17
• Bronze MS, Beachey EH, Dale JB. Protective and heart-crossreactive epitopes located within the NH2 terminus of type 19 streptococcal M protein. J Exp Med 1988;167: 1849-59
• Lancefield RC. New approaches for the laboratory recognition of M types of group A streptococci. J Exo Med 1971;134:1298-315
• Baird RW, Bronze MS, Kraus W, Hill HR, Veasy LG, Dale JB. Epitopes of group A streptococcal M protein shared with antigens of articular cartilage and synovium. J Rhuematol 1991;146:3132-37
• Greenblatt JJ, Hunter N, Schwab JH. Antibody response to streptococcal cell wall antigens associated with experimental arthritis in rats. Clin Exp immunol 1980;42:450-57
• Ferrieri P; Jones Criteria Working Group. Proceedings of the Jones Criteria Workshop. Circulation 2002;106:2521-23
• Chagani HS, Aziz K. Clinical profile of acute rheumatic fever in Pakistan. Cardiol Young 2003;13:28-35
• Report of a WHO Expert Consultation. World Health Organization, Geneva, 2004; Technical Report Series No. 923
• Pereira BA, da Silva NA, Andrade LE, Lima FS, Gurian FC, de Almeida Netto JC. Jones criteria and underdiagnosis of rheumatic fever. Indian J Pediatr 2007;74:117-21
• Shulman ST, Ayoub EM. Poststreptococcal reactive arthritis. Curr Opin Rheumatol 2002;14:562-65
• Sakurai S, Koshino T, Okamoto R, Saito T, Machida J, Takagi T. Clinical features of patients with osteoarthritic knees followed by development of rheumatoid arthritis. Ryumachi 2000; 40: 685-92. Abstract
• Salton MRJ, Horn RW. Studies on the bacterial cell wall I. Methods of preparation and some properties of cell walls. Biochim Biophys Acta 1951, 6: 177-97. Abstract
• Granfors K, Jalkanen S, Von Essen R, et al. Yersinia antigens in synovial fluid cell from patients with reactive arthritis. N Engl J Med 1989;320:216-21
• Stăhlberg TH, Granfors K, Toivanen A. Immunoblot analysis of human IgM, IgG and IgA responses to plasmid-encoded antigens of Yersinia enterocolitica serovar O3. J Med Microbiol 1987;24:157-63
• Hawkes R, Niday E and Gordon J. A dot– immunobinding assay for monoclonal and other antibodies. Anal Biochem 1982; 119: 142-47
• Bisno AL. Group A streptococcal infections and acute rheumatic fever. New England J Med 1991; 325: 783-93
• Stollerman GH. Rheumatic fever. Lancet 1997;349:935-42
• Carapetis JR, Currie BJ, Good M. Towards understanding the pathogenesis of rheumatic fever. Scandinavian J Rheumatol 1996;25: 127-31
• Stollerman GH. Rheumatic fever in the 21st century. Clin Infect Dis 2001;33:806-14
• Stollerman GH. Current issues in the prevention of rheumatic fever. Minerva Med 2002;93:371-87
• Nesher G, Moore TL, Grisanti MW, el-Najdawi E, Osborn TG Correlation of antiperinuclear factor with antibodies to streptococcal cell- wall peptidoglycan-polysaccharide polymers and rheumatoid factor. Clin Exp Rheumatol 1991;9:611-15
• Appel H, Mertz A, Distler A, Sieper J, Braun J. The 19 kDa protein of Yersinia enterocolitica O:3 is recognized on the cellular and humoral level by patients with Yersinia induced reactive arthritis. J Rheumatol 1999;26:1964- 71
• Schnarr S, Putschky N, Jendro MC, et al. Chlamydia and Borrelia DNA in synovial fluid of patients with early undifferentiated oligoarthritis: results of a prospective study. Arthritis Rheum 2001;4:679-85
• Thiel A, Wu P, Lauster R, Braun J, Radbruch A, Sieper J. Analysis of the antigen-specific T cell response in reactive arthritis by flow cytometry. Arthritis Rheum 2000;43:2834-42
• Heymer B, Schleifer KH, Read S, Zabriskie JB, Krause RM. Detection of antibodies to bacterial cell wall peptidoglycan in human sera. J Immunol 1976;117:23-26
• Johnson PM, Phua KK, Perkins HR, Hart CA, Bucknall RC. Antibody to streptococcal cell wall peptidoglycan-polysaccharide polymers in seropositive and seronegative rheumatic disease. Clin Exp Immunol 1984;55:115-24