Background: Rheumatic fever (RF) is inherited as a single recessive gene. Several genes are Likely to predispose an individual to develop rheumatic fever and rheumatic heart disease (RHD). Polymorphisms of TNF-α gene were associated with susceptibility to develop RF.T cells from all rheumatic fever patients produce significant amounts of TNF-α in response to steptococcal peptides with the highest production attained by the chronic rheumatic heart disease patients,and IL-10 expression was characterized in heart tissue of RHD patients by immuno-histochemistry. Objectives: To test the relation of RHD and gene polymorphisms of pro-inflammatory cytokines TNF-α gene at position -308 and anti–inflammatory IL-10 gene at position -1082. Subjects and Methods: This study included 20 children with chronic rheumatic heart disease (group A) and 10 healthy children as a control group (Group B). Patients group was classified into patients with single and multiple valvular lesions, both of them were classified according to the severity by Echocardiography into: Group I: mild valvular lesion (n=7) Group II: Moderate lesion (n=4) Group III: severe lesion (n=9) Real time PCR was done for both TNF-α at-308 and IL-10 at position – 1082.Results: All cases showed significant higher frequency of TNF-α homozygous genotype G/G compared to control group (
