Rantes in rheumatic pulmonary hypertension: a target for therapeutic decisions

Pulmonary arterial hypertension [PAH] is an important risk factor for morbidity and mortality in patients with mitral valve disease. Recent studies highlighted the possible influence of inflammatory mechanisms in several types of PAH but data about PAH in rheumatic heart disease [RHD] are lacking. The aim of this study was to investigate the circulating level of the chemokine regulated upon activation, normal T-cell expressed and secreted [RANTES] and the cytokine interleukine-6 [IL-6] in patients with rheumatic mitral valve disease associated with pulmonary hypertension. Serum'level of [RANTES] and [IL-6] were measured by enzyme-linked immunosorbent assay [ELISA] in 18 patients with mitral valve disease and 10 matched healthy subjects [control group], All patients had PAH and 7 only [38.9%] had severe pulmonary hypertension. The serum level of RANTES in the patients' group was not statistically different from that in the control group. However, patients with severe pulmonary hypertension have a mean serum level of RANTES of [6138.6 +/- 1572.5 pg/ml] that is significantly greater than that of patients without severe pulmonary hypertension [1818.2 +/- 153,6 pg/ml] [p=0.029]. On the other hand, the serum level of lL-6 in the patients was statistically different from that-of the control [378 +/- 12.7 vs. 262 +/- 28.6 respectively, p<0.005]. Comparison of IL-6 serum level in patients with and without severe pulmonary hypertension showed that the level is higher in patients with severe pulmonary hypertension but without statistical significance [410 +/- 5.77 vs. 370 +/- 15.1 pg/ml respectively p=0.71]. Clarification of the role of inflammatory mediators in the pathobiology of pulmonary hypertension in RHD is required in other studies on a wide scale. Despite of the multifactorial nature and complex mechanisms of pulmonary hypertension in RHD, RANTES and IL-6 should be investigated as potential therapeutic targets in the control of rheumatic severe pulmonary hypertension