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. Author manuscript; available in PMC: 2011 Sep 1.
Published in final edited form as: Scand J Immunol. 2010 Sep;72(3):226–234. doi: 10.1111/j.1365-3083.2010.02439.x

Figure 1.

Figure 1

Schematic representation of maternal antibodies interaction with cardiac Ca channels. The acute events are initiated by binding of the circulating maternal antibodies to surface L-type Ca channels. This leads to cross-linking the antibody-antigen complexes (step 1). As a result of the interaction, the surface complex is internalized and degraded by lysozymes (step 2). In step 3 and 3a, two scenarios are proposed: fetal cells with enough remaining Ca channels will survive (fetal discordance of twins) and secure atrioventricular conduction; those with severe depletion of Ca channels (step 4) will result in Ca dysregulation and apoptosis (step 5). This may lead to the translocation of the intracellular SSA/Ro and SSB/La to the cell surface to bind to their cognate antibodies (step 5). Altogether, this process will eventually trigger inflammation (step 6), cell death, fibrosis and calcification (see text for more details).