Identification of mononuclear cells and T cell subsets in rheumatic valvulitis.

The composition of the mononuclear cellular filtrates was investigated in 13 valve specimens from nine patients with rheumatic carditis, some of whom had clinical and laboratory evidence of acute disease at the time of surgery. In acute valvulitis (AV) as well as in chronic active valvulitis (CAV), the cellular infiltrates were primarily composed of T cells and macrophages. In AV the majority of these T cells were of the helper phenotype (Leu 3a). The T cells subsets were more heterogeneous in CAV. In five valves, the helper T cells exceeded the number of suppressor T cells, whereas in three others, helper and cytotoxic/suppressor T cells were present in equal numbers. The HLA-DR antigen was expressed by the majority of the mononuclear cells and by the vascular endothelium. These findings indicate that the valvular injury may at least in part be mediated by delayed-type hypersensitivity mechanisms. Those cells comprising the Aschoff body were primarily positive for the HLA-DR and a novel monoclonal antibody called D8/17 which identifies an antigen known to be present on the B cells of rheumatic fever patients.