Effect of Valvular Surgery on Antibody to the Group A Streptococcal Carbohydrate

Abstract

Because previous studies revealed that high levels of antibody to the group A streptococcal carbohydrate (A-antibody) persist in the serum of patients with chronic rheumatic valvular disease, the effect of valvular surgery on the level of this antibody was examined in the present study. Streptococcal antibody titers (ASO, anti-DNAse B, and A-antibody) were determined on 73 patients admitted for cardiac surgery: 36 with chronic rheumatic valvular disease and 37 with nonrheumatic cardiac or coronary disease. While the ASO and anti-DNAse B presurgical titers were similar in rheumatic and nonrheumatic individuals, the levels of A-antibody were significantly higher in rheumatic patients. The effect of blood perfusion during cardiac surgery was reflected by reversion of antibody titers towards the mean value for a normal population. A trend toward a rise in all antibodies was seen in all patients two to seven weeks after surgery. However, after an interval of eight weeks or more following surgery, a significant decline in the A-antibody occurred in rheumatic patients who had undergone excision and replacement of the affected valve, but not in those who had experienced a simple commissurotomy. These findings provide additional evidence to support a relationship between valvular disease and A-antibody level in rheumatic patients.

Cytotoxic mAb from rheumatic carditis recognizes heart valves and laminin

“…Dudding and Ayoub reported anti-group A carbohydrate antibodies persistently elevated in patients with valvulitis (9), and surgical removal of inflamed valves resulted in a significant decrease in levels of anti-group A carbohydrate antibodies present in serum (40). We demonstrated previously that murine anti-streptococcal antibodies recognized valvular endothelium (41).…”

The Group Specific Polysaccharide Antibody in Children with Non-Suppurative Sequelae of Group a Streptococcal Infection

“…Among the cross-reactive antibodies, CHO-Ab is of special interest because, in addition to cross-reactivity with the structural glycoproteins of the human cardiac valves [9,10], it has been reported to persist after an ARF attack only in patients who developed RHD [11][12][13]. The difference, however, could not be confirmed in a large series of patients studied with the agar diffusion precipitation technique [29] rather than the radioimmunoassay.…”

“…These included: cross-reactions between the streptococcal cell membrane and the human heart sarcolemmal sheaths [4,5], streptococcal cell membrane and basal ganglia [6], streptococcal M protein and myosin [7], the hyaluronic acid of the streptococcal capsule and the human synovial tissue [8], and the group A specific polysaccharide and the glycopeptides of the heart valves [9,10]. The latter finding was strengthened by the work of other colleagues who reported that elevated levels of the group A specific polysaccharide antibody (CHO-Ab), in the presence of normal titers of antistreptolysin O (ASO) and anti DNA se B, was only maintained in patients with ARF who developed rheumatic heart disease (RHD) [11][12][13]. Acute rheumatic fever, RHD and acute poststreptococcal glomerulonephritis (AGN) are still common in Arab countries [14][15][16][17][18][19][20][21][22].…”

Update on rheumatic heart disease

“…Group A carbohydrates have also been shown to trigger autoantibodies [32]. Antigroup A carbohydrate antibodies correlated with need for valve replacement and decreased following surgical removal of the diseased valve [33,34].…”