Additionally, Cagli et al. (2010), Bilik et al. (2016), Sharma et al. (2017) and Neves et al. (2021) found that levels of IL-1ra, IL-4, IL-6, IL-12, IFN-g, IL-17, IL-23, CCL4, PDGF-BB, TNF-a, and sTNF-R were notably higher in the systemic circulation of RHD patients than in healthy controls [29,30,31,32]. This evidence concerns the gene IL4 and rheumatic heart disease.