VCAM1 and rheumatic heart disease: In rheumatic carditis, attachment of anti-GAS antibodies to the myocardium and valve endothelium leads to the release of inflammatory cytokines that up-regulate vascular cell adhesion molecule-1 (VCAM-1) on the valve surface endothelium; this up-regulation of VCAM-1 promotes lymphocyte adhesion to the endothelium and subsequent infiltration of lymphocytes into the valve.