a. After the phagocytosis process the pathogen is processed by antigen presenting cells (macrophages/ monocytes/dendritic cells-DC). Several peptides are generated and presented in combination with HLA molecules to CD4+ T cells activating the immune response.
b. Peripheral T cells and antibodies from RHD patients recognize peptides derived from M5 protein after the infection.
c. During the inflammatory process anti-S.pyogenes antibodies and inflammatory cytokines favor the migration of primed-T cells to heart tissue.
d. These T cells expanded in the heart and recognize human proteins like cardiac myosin, vimentin and other heart tissue proteins leading to autoimmune lesions.
