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Published VersionCC BY V4.0, Open Access
Journal article
In Search of the Holy Grail: A Specific Diagnostic Test for Rheumatic Fever
Frontiers in Cardiovascular Medicine, Vol.8, pp.1-8
2021
Abstract
Current diagnosis of Acute Rheumatic Fever and Rheumatic Heart Disease (ARF/RHD) relies on a battery of clinical observations aided by technologically advanced diagnostic tools and non-specific laboratory tests. The laboratory-based assays fall into two categories: those that (1) detect “evidence of preceding streptococcal infections” (ASOT, anti-DNAse B, isolation of the Group A Streptococcus from a throat swab) and (2) those that detect an ongoing inflammatory process (ESR and CRP). These laboratory tests are positive during any streptococcal infection and are non-specific for the diagnosis of ARF/RHD. Over the last few decades, we have accumulated considerable knowledge about streptococcal biology and the immunopathological mechanisms that contribute to the development, progression and exacerbation of ARF/RHD. Although our knowledge is incomplete and many more years will be devoted to understanding the exact molecular and cellular mechanisms involved in the spectrum of clinical manifestations of ARF/RHD, in this commentary we contend that there is sufficient understanding of the disease process that using currently available technologies it is possible to identify pathogen associated peptides and develop a specific test for ARF/RHD. It is our view that with collaboration and sharing of well-characterised serial blood samples from patients with ARF/RHD from different regions, antibody array technology and/or T-cell tetramers could be used to identify streptococcal peptides specific to ARF/RHD. The availability of an appropriate animal model for this uniquely human disease can further facilitate the determination as to whether these peptides are pathognomonic. Identification of such peptides will also facilitate testing of potential anti-streptococcal vaccines for safety and avoid potential candidates that may pre-dispose potential vaccine recipients to adverse outcomes. Such peptides can also be readily incorporated into a universally affordable point of care device for both primary and tertiary care.
Details
- Title
- In Search of the Holy Grail: A Specific Diagnostic Test for Rheumatic Fever
- Authors
- David J McMillan (Author) - University of the Sunshine Coast, Queensland, GeneCology Research Centre - LegacyRukshan A. M Rafeek (Author) - University of New EnglandRobert E Norton (Author) - University of New EnglandMichael F Good (Author) - Griffith UniversityKadaba S Sriprakash (Author) - University of New EnglandNatkunam Ketheesan (Author) - University of New England
- Publication details
- Frontiers in Cardiovascular Medicine, Vol.8, pp.1-8
- Publisher
- Frontiers Research Foundation
- Date published
- 2021
- DOI
- 10.3389/fcvm.2021.674805
- ISSN
- 2297-055X
- Copyright note
- Copyright © 2021 McMillan, Rafeek, Norton, Good, Sriprakash and Ketheesan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
- Organisation Unit
- University of the Sunshine Coast, Queensland; School of Science, Technology and Engineering; Centre for Bioinnovation
- Language
- English
- Record Identifier
- 99534603902621
- Output Type
- Journal article
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