In contrast to the universal presence of pro-inflammatory cytokines, such as TNF-α, interferon-γ, IL-6, IL-17, and IL-23 in ARF/RHD (1, 8), high levels of anti-inflammatory cytokines such as IL-10 were mainly found in patients with severe valvular diseases (25, 26). This evidence concerns the gene IL10 and rheumatic fever.