Key result
High TGF-β1 expression was identified in 70% of rheumatic mitral valves compared to 20% of control valves, and positively correlated with myofibroblast proliferation and valvular fibrosis.
Case-Control (n=45)
Single-blind
No
Absolute Event Rate: 70% vs 20%
p-value: p=<0.001
TGF-beta 1 overexpression and myofibroblast proliferation are strongly associated with valvular fibrosis and calcification in chronic rheumatic heart disease.
Supports TGF-beta1 as a research target in rheumatic heart disease; hypothesis-generating, should not yet change practice.
For the purpose of determining the pathogenic role of transforming growth factor-beta1 (TGF-beta 1) in the mechanism of chronic rheumatic heart disease, we evaluated the expression of TGF-beta 1, proliferation of myofibroblasts, and changes in extracellular matrix components including collagen and proteoglycan in 30 rheumatic mitral valves and in 15 control valves. High TGF-beta 1 expression was identified in 21 cases (70%) of rheumatic mitral valves, whereas only 3 cases (20%) of the control group showed high TGF-beta 1 expression (p<0.001). Additionally, increased proliferation of myofibroblasts was observed in the rheumatic valves. High TGF-beta1 expression positively correlated with the proliferation of myofibroblasts (p=0.004), valvular fibrosis (p<0.001), inflammatory cell infiltration (p=0.004), neovascularization (p=0.007), and calcification (p<0.001) in the valvular leaflets. The ratio of proteoglycan to collagen deposition inversely correlated with TGF-beta 1 expression in mitral valves (p=0.040). In conclusion, an ongoing inflammatory process, the expression of TGF-beta 1, and proliferation of myofibroblasts within the valves have a potential role in the valvular fibrosis, calcification, and changes in the extracellular matrix that lead to the scarring sequelae of rheumatic heart disease.
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Kim et al. (2008) conducted a case-control in Chronic rheumatic heart disease (n=45). Chronic rheumatic heart disease vs. Normal heart valves was evaluated on High TGF-β1 expression (p=<0.001). High TGF-β1 expression was identified in 70% of rheumatic mitral valves compared to 20% of control valves, and positively correlated with myofibroblast proliferation and valvular fibrosis.
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