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Dahal U, Sharma D, Dahal K. An Unsettled Debate About the Potential Role of Infection in Pathogenesis of Atherosclerosis. J Clin Med Res 2017; 9:547-554. [PMID: 28611853 PMCID: PMC5458650 DOI: 10.14740/jocmr3032w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/12/2022] Open
Abstract
Association of infection with atherosclerosis is by no means new. Several sero-epidemiological and pathologic studies as well as animal models have shown a link between infection and atherosclerosis. Exciting discoveries in recent times related to role of inter-individual genetic variation in modulating inflammatory response to infection have reignited the enthusiasm in proving a causal link between infection and atherosclerosis. The purpose of this article was to review and analyze the available evidence linking infection with atherosclerosis.
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Affiliation(s)
- Udip Dahal
- Department of Medicine, University of Utah, 50 N Medical Drive, Salt Lake City, UT, USA
| | - Dikshya Sharma
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA
| | - Kumud Dahal
- Department of Infectious Disease, University of Illinois College of Medicine at Peoria, 1 Illinoi Drive, Peoria, IL, USA
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2
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CCL19-CCR7-dependent reverse transendothelial migration of myeloid cells clears Chlamydia muridarum from the arterial intima. Nat Immunol 2016; 17:1263-1272. [PMID: 27668800 DOI: 10.1038/ni.3564] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 08/22/2016] [Indexed: 12/12/2022]
Abstract
Regions of the normal arterial intima predisposed to atherosclerosis are sites of ongoing monocyte trafficking and also contain resident myeloid cells with features of dendritic cells. However, the pathophysiological roles of these cells are poorly understood. Here we found that intimal myeloid cells underwent reverse transendothelial migration (RTM) into the arterial circulation after systemic stimulation of pattern-recognition receptors (PRRs). This process was dependent on expression of the chemokine receptor CCR7 and its ligand CCL19 by intimal myeloid cells. In mice infected with the intracellular pathogen Chlamydia muridarum, blood monocytes disseminated infection to the intima. Subsequent CCL19-CCR7-dependent RTM was critical for the clearance of intimal C. muridarum. This process was inhibited by hypercholesterolemia. Thus, RTM protects the normal arterial intima, and compromised RTM during atherogenesis might contribute to the intracellular retention of pathogens in atherosclerotic lesions.
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Abstract
PURPOSE OF REVIEW We have summarized available evidence for and against the presence of a vascular microbiome. Studies that have attempted to detect bacteria and viruses in blood vessels in both health and disease are critiqued in an attempt to explain contrary results that may be due to variations in methodology. RECENT FINDINGS Many studies have demonstrated the presence of both bacteria and viruses within diseased blood vessels. Evidence is most compelling in atherosclerosis; however, recent reports have raised questions about the potential role of microbes in nonatherosclerotic aortic aneurysms and vasculitis. Preliminary evidence also suggests that apparently normal vessels may harbor microbes. With the exception of certain viral infections (e.g. hepatitis C virus, HIV, Epstein-Barr virus, and cytomegalovirus) and infectious endocarditis, systemic vasculitides have not been convincingly associated with infectious agents. However, emerging data suggest that different communities of microbes may be present in noninflammatory and inflammatory large-vessel diseases. Whether variations in vascular microbial communities are the cause or a secondary result (epiphenomena) of vessel injury remains to be determined. SUMMARY Blood vessels may not be sterile. Future studies of microbes in vessel health and disease may provide important insights into disease pathogenesis and suggest new therapies for diseases now considered to be idiopathic and refractory.
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Grayston JT, Belland RJ, Byrne GI, Kuo CC, Schachter J, Stamm WE, Zhong G. Infection with Chlamydia pneumoniae as a cause of coronary heart disease: the hypothesis is still untested. Pathog Dis 2015; 73:1-9. [PMID: 25854002 PMCID: PMC4492408 DOI: 10.1093/femspd/ftu015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022] Open
Abstract
Review of the possible role of Chlamydia pneumoniae infection in the pathogenesis of heart disease.
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Affiliation(s)
- J Thomas Grayston
- Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195-7326, USA
| | - Robert J Belland
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee, Health Science Center, Memphis, TN 38163, USA
| | - Gerald I Byrne
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee, Health Science Center, Memphis, TN 38163, USA
| | - Cho Chou Kuo
- Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195-7326, USA
| | - Julius Schachter
- Department of Laboratory Medicine, UCSF, San Francisco, CA 94143, USA
| | - Walter E Stamm
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Guangming Zhong
- Department of Microbiology and Immunology, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
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5
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Puolakkainen M. Laboratory diagnosis of persistent human chlamydial infection. Front Cell Infect Microbiol 2013; 3:99. [PMID: 24381934 PMCID: PMC3865385 DOI: 10.3389/fcimb.2013.00099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/28/2013] [Indexed: 11/13/2022] Open
Abstract
Diagnostic assays for persistent chlamydial infection are much needed to conduct high-quality, large-scale studies investigating the persistent state in vivo, its disease associations and the response to therapy. Yet in most studies the distinction between acute and persistent infection is based on the interpretation of the data obtained by the assays developed to diagnose acute infections or on complex assays available for research only and/or difficult to establish for clinical use. Novel biomarkers for detection of persistent chlamydial infection are urgently needed. Chlamydial whole genome proteome arrays are now available and they can identify chlamydial antigens that are differentially expressed between acute infection and persistent infection. Utilizing these data will lead to the development of novel diagnostic assays. Carefully selected specimens from well-studied patient populations are clearly needed in the process of translating the proteomic data into assays useful for clinical practice. Before such antigens are identified and validated assays become available, we face a challenge of deciding whether the persistent infection truly induced appearance of the proposed marker or do we just base our diagnosis of persistent infection on the presence of the suggested markers. Consequently, we must bear this in mind when interpreting the available data.
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Affiliation(s)
- Mirja Puolakkainen
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland ; HUSLAB, Department of Virology and Immunology, Helsinki University Central Hospital Helsinki, Finland
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6
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Zhao X, Bu DX, Hayfron K, Pinkerton KE, Bevins CL, Lichtman A, Wiedeman J. A combination of secondhand cigarette smoke and Chlamydia pneumoniae accelerates atherosclerosis. Atherosclerosis 2012; 222:59-66. [DOI: 10.1016/j.atherosclerosis.2012.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 01/18/2012] [Accepted: 02/02/2012] [Indexed: 10/28/2022]
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Heat shock protein 10 of Chlamydophila pneumoniae induces proinflammatory cytokines through Toll-like receptor (TLR) 2 and TLR4 in human monocytes THP-1. In Vitro Cell Dev Biol Anim 2011; 47:541-9. [DOI: 10.1007/s11626-011-9441-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
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8
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Kraml PJ, Roubalová K, Bulvas M, Sommerová Z, PotoČková J, Mandys V, Anděl M. Markers of Chlamydia pneumoniae and human cytomegalovirus infection in patients with chronic peripheral vascular disease and their relation to inflammation, endothelial dysfunction and changes in lipid metabolism. Folia Microbiol (Praha) 2009; 53:551-7. [DOI: 10.1007/s12223-008-0088-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 05/19/2008] [Indexed: 01/09/2023]
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Ikeoka DT, Vieira CZ, Lemos PA, Strabelli TV, da Silva EER, Perin MA, Groselj-Strele A, Tiran B, Tiran A, Caramelli B. Azithromycin does not prevent six-month myointimal proliferation but attenuates the transient systemic inflammation occurring after coronary stenting. Clin Res Cardiol 2008; 98:44-51. [PMID: 18853090 DOI: 10.1007/s00392-008-0722-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 09/09/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Stent implantation produces a systemic increase of inflammatory markers that correlates with Chlamydophila pneumoniae infection in atherosclerotic plaque. We performed a clinical intervention study to investigate the effect of antibiotic treatment on 6-month follow-up angiographic minimal luminal diameter after stenting. METHODS Ninety patients were randomly assigned to oral azithromycin or placebo in a double-blinded and randomized fashion. Medication was initiated 2 weeks before a pre-scheduled stenting procedure and maintained 12 weeks thereafter. Angiographic outcomes were evaluated by a six-month follow-up angiography and laboratorial parameters were accessed by blood sampling 2 weeks before stenting, within the first 24 h after procedure and additional samples after four weeks and 6 months. RESULTS Minimal luminal diameter (1.76 +/- 0.56 mm Vs. 1.70 +/- 0.86 mm; P = 0.7), restenosis rate, diameter stenosis, late loss, and binary restenosis rates were comparable in placebo and azithromycin group in the 6 months follow-up. Serum levels of C-reactive protein presented a three fold significant increase in the control group one day after stenting but did not change in the azithromycin group (8.5 [3.0;16.4] Vs. 2.9 [1.7;6.6]-median [25;75 percentile] P < 0.01). CONCLUSIONS Azithromycin does not improve late angiographic outcomes but attenuates the elevation of C-reactive protein levels after stenting, indicating an anti-inflammatory effect.
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Affiliation(s)
- Dimas T Ikeoka
- Center for Medical Research and Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University Graz, Stiftingtalstrasse, 24, 8010, Graz, Austria
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10
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Blasi C. The autoimmune origin of atherosclerosis. Atherosclerosis 2008; 201:17-32. [PMID: 18585722 DOI: 10.1016/j.atherosclerosis.2008.05.025] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 05/07/2008] [Accepted: 05/13/2008] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is a chronic inflammatory disease. Many studies and observations suggest that it could be caused by an immune reaction against autoantigens at the endothelial level, the most relevant of which are oxidized LDL and heat shock proteins (HSP) 60/65. Endothelial dysfunction plays a fundamental role. The first antigen is related to the increased leakage and oxidation of LDL; the second to cellular reaction to stress. Experimental and clinical observations confirm the pathogenetic role of these antigens. Both innate and adaptive immunity and impaired regulatory mechanisms of the autoimmune reaction are involved. Different triggering factors are examined: infectious agents, smoking, air pollution, diabetes and hypercholesterolemia. Analogies and differences between systemic atherosclerosis and transplant-related coronary atherosclerosis help to understand their respective nature. Immune mechanisms might be responsible for the passage from stable plaque to unstable and rupture-prone plaque. Finally, prospects of treatment and prevention are linked to the induction of tolerance to responsible antigens, activation of immune regulatory response and the use of immunomodulatory drugs.
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11
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Valbuena G, Walker DH. The endothelium as a target for infections. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2007; 1:171-98. [PMID: 18039112 DOI: 10.1146/annurev.pathol.1.110304.100031] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The endothelial cells lining vascular and lymphatic vessels are targets of several infectious agents, including viruses and bacteria, that lead to dramatic changes in their functions. Understanding the pathophysiological mechanisms that cause the clinical manifestations of those infections has been advanced through the use of animal models and in vitro systems; however, there are also abundant studies that explore the consequences of endothelial infection in vitro without supporting evidence that endothelial cells are actual in vivo targets of infection in human diseases. This article defines criteria for considering an infection as truly endothelium-targeted and reviews the literature that offers insights into the pathogenesis of human endothelial-target infections.
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Gérard HC, Fomicheva E, Whittum-Hudson JA, Hudson AP. Apolipoprotein E4 enhances attachment of Chlamydophila (Chlamydia) pneumoniae elementary bodies to host cells. Microb Pathog 2007; 44:279-85. [PMID: 17997273 DOI: 10.1016/j.micpath.2007.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 10/08/2007] [Indexed: 11/17/2022]
Abstract
Chlamydophila (Chlamydia) pneumoniae is an intracellular respiratory pathogen known to cause community-acquired pneumonia. Infection with this organism has been associated with atherosclerosis, inflammatory arthritis, and other chronic diseases, many of which also have been associated with possession of the epsilon4 allele at the APOE locus on (human) chromosome 19. An earlier study from this laboratory suggested that some relationship exists between apolipoprotein E4 (apoE4), the product of the epsilon4 allele, and the pathobiology of C. pneumoniae. A standard attachment assay and real time PCR targeting a sequence on the C. pneumoniae chromosome were used to monitor host cell binding of elementary bodies (EB) of that organism. Our data indicate that 3-fold more EB of strain AR-39 attach to an epsilon3 homozygous human cell line transfected with a plasmid expressing the epsilon4 coding sequence than to the same cell line harboring empty vector, vector containing an irrelevant insert sequence, or vector containing the DNA sequence encoding apoE3. The quantitative real time data were confirmed by immunolabeling of chlamydial inclusions in parallel attachment and infection assays. Experiments using Chlamydophila trachomatis EB showed no enhancement of attachment in the presence of the epsilon4 allele in any assays. These observations indicate that apoE4 enhances attachment of C. pneumoniae EB, but not those of C. trachomatis, to target host cells.
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Affiliation(s)
- Hervé C Gérard
- Department of Immunology and Microbiology, Wayne State University School of Medicine, Wayne State University School of Medicine, Gordon H. Scott Hall, Detroit, MI 48201, USA
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Mrowietz U, Elder JT, Barker J. The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients. Arch Dermatol Res 2006; 298:309-19. [PMID: 17021761 PMCID: PMC1705513 DOI: 10.1007/s00403-006-0707-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 08/31/2006] [Accepted: 09/04/2006] [Indexed: 02/08/2023]
Abstract
It is well established that several inflammatory-type conditions, such as arthritis, diabetes, cardiovascular disease, and irritable bowel disease exist comorbidly and at an increased incidence in patients with psoriasis. Psoriasis and other associated diseases are thought to share common inflammatory pathways. Conditions such as these, with similar pathogenic mechanisms involving cytokine dysregulation, are referred to as immune-mediated inflammatory diseases (IMIDs). Considerable evidence for the genetic basis of comorbidities in psoriasis exists. The WHO has reported that the occurrence of chronic diseases, including IMIDs, are a rising global burden. In addition, conditions linked with psoriasis have been associated with increasing rates of considerable morbidity and mortality. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions. For example, methotrexate is contraindicated in hepatic impairment, while patients on cyclosporin should be monitored for kidney function. In addition, some agents, such as beta blockers, lithium, synthetic antimalarial drugs, NSAIDs and tetracycline antibiotics, have been implicated in the initiation or exacerbation of psoriasis. Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions.
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Affiliation(s)
- Ulrich Mrowietz
- Department of Dermatology, University of Kiel, Schittenhelmstrasse 7, 24105 Kiel, Germany.
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Podsiadły E, Przyłuski J, Kwiatkowski A, Kruk M, Wszoła M, Nosek R, Rowiński W, Ruzyłło W, Tylewska-Wierzbanowska S. Presence of Chlamydia pneumoniae in patients with and without atherosclerosis. Eur J Clin Microbiol Infect Dis 2005; 24:507-13. [PMID: 16133407 DOI: 10.1007/s10096-005-1380-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Data published over the past decade show that Chlamydia pneumoniae is likely associated with the development of atherosclerosis. The aim of this study was to ascertain whether C. pneumoniae infections occur more frequently in patients with atherosclerosis than in healthy subjects. A total of 517 persons were studied. Serum samples, leukocytes, and tissue samples were assayed for the presence of C. pneumoniae-specific IgG and IgA antibodies and C. pneumoniae DNA. C. pneumoniae DNA was found in renal, iliac, and brachial vessels, but it was not detected in radial arteries. C. pneumoniae DNA was found most often in directional coronary atherectomy tissue specimens (11/41, 26.8%), but it was also found in the leukocytes of 14.9% (28/188) of patients with atherosclerosis and 24.6% (28/114) of patients without atheroma changes in vessels. Specific IgG and IgA antibodies were present in 63.8 and 49.9% of atheroma patients, respectively. The prevalence of C. pneumoniae antibodies differs significantly in patients with and without atherosclerosis (for IgG, p=0.002, and for IgA, p=0.006). The identification of persons with chlamydial infection of atherosclerotic arteries necessitates the examination of vascular tissues obtained during revascularization procedures. Serological investigation alone cannot identify individuals with vascular chlamydial infections. Detection of C. pneumoniae DNA in peripheral blood mononuclear cells does not seem to be the exclusive marker of persistent vascular infection. A more easily accessible parameter that allows prediction of chlamydial vascular infection is required.
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Affiliation(s)
- E Podsiadły
- National Institute of Hygiene, Laboratory of Rickettsiae, Chlamydiae and Enzotic Spirochetes, Chocimska 24, 00-791, Warsaw, Poland.
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15
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Kaplan M, Yavuz SS, Cinar B, Koksal V, Kut MS, Yapici F, Gercekoglu H, Demirtas MM. Detection of Chlamydia pneumoniae and Helicobacter pylori in atherosclerotic plaques of carotid artery by polymerase chain reaction. Int J Infect Dis 2005; 10:116-23. [PMID: 16183317 DOI: 10.1016/j.ijid.2004.10.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 08/13/2004] [Accepted: 10/22/2004] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES A possible role of some microorganisms has been proposed in the pathogenesis of atherosclerosis, but it is still an unresolved issue. We investigated the presence of Chlamydia pneumoniae and Helicobacter pylori DNA in carotid artery atherosclerotic plaques by using PCR. METHODS One hundred and four patients with atherosclerotic diseases were included. The study group consisted of 52 atherosclerotic plaque specimens obtained from the carotid arteries of patients who had carotid endarterectomy and the control group consisted of 52 specimens obtained from the macroscopically healthy regions of ascending aorta in patients who had undergone coronary artery bypass grafting. The presence of C. pneumoniae and H. pylori DNA in endarterectomy specimens were demonstrated by PCR. RESULTS C. pneumoniae DNA was detected in 16 of 52 (30.8%) atherosclerotic plaques and 1 of 52 (1.9%) macroscopically healthy ascending aorta wall specimens (P < 0.001). H. pylori DNA was detected in 9 of 52 (17.3%) atherosclerotic plaques and none of the controls (P = 0.003). CONCLUSIONS The higher incidence of C. pneumoniae and H. pylori DNA in atherosclerotic plaques suggests that these microorganisms may play a role in the pathogenesis of atherogenesis.
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Affiliation(s)
- Mehmet Kaplan
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
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16
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Vainas T, Stassen F, Schurink G, Tordoir J, Welten R, van den Akker L, Kurvers H, Bruggeman C, Kitslaar P. Reply to: Effect of Macrolides on Peripheral Arterial Disease Depends on Patient Selection and Adequate Treatment. P.A. Krayenbuehl, P. Wiesli, T. Meier, G. Schulthess. Eur J Vasc Endovasc Surg 2005. [DOI: 10.1016/j.ejvs.2005.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raggam RB, Leitner E, Berg J, Mühlbauer G, Marth E, Kessler HH. Single-run, parallel detection of DNA from three pneumonia-producing bacteria by real-time polymerase chain reaction. J Mol Diagn 2005; 7:133-8. [PMID: 15681485 PMCID: PMC1867508 DOI: 10.1016/s1525-1578(10)60019-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A molecular assay for parallel detection of three bacteria, Chlamydia (C.) pneumoniae, Legionella (L.) spp., and Mycoplasma (M.) pneumoniae, in clinical specimens by a set of real-time polymerase chain reactions (PCRs) in a single run was evaluated. Bacterial DNAs were extracted by an automated DNA extraction protocol on the MagNA Pure LC System. Amplification and detection were done by real-time PCR on the LightCycler (LC) instrument. For amplification, specific oligonucleotides derived from the 16s rRNA genes of C. pneumoniae, L. spp., and M. pneumoniae were used. The three assays were complemented with an internal control (IC), a specially designed DNA fragment which contains the specific primer binding sites for the three PCRs. The IC was added to the samples, co-extracted, and co-amplified. Primers and hybridization probes were designed to suit one LC PCR program. LC PCRs were established, detection limits were determined, and clinical samples were tested. The detection limits were found between 5.0 and 0.5 IFU/CFU per PCR reaction for each of the bacteria. A total number of 100 clinical specimens were tested for validation of the molecular assay. Tested samples included 63 bronchoalveolar lavages (BALs) and 37 induced sputa specimens. The internal control was detected in all negative and low-positive samples; no inhibition was found throughout the whole study. Additionally, samples underwent testing by culture for L. spp., and M. pneumoniae; for C. pneumoniae, the serological microimmunofluorescence (MIF) test was used. In conclusion, the developed set of LC PCR assays permits parallel detection of C. pneumoniae, L. spp., and M. pneumoniae in a single LC run. This molecular assay may lead to accurate and early diagnosis of pneumonia produced by these three types of bacteria. The assay proved to be suitable for the high-throughput routine diagnostic laboratory.
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Affiliation(s)
- Reinhard B Raggam
- Molecular Diagnostics Laboratory, Institute of Hygiene, Medical University Graz, Universitaetsplatz 4, A-8010 Graz, Austria
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18
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Kalayoglu MV, Bula D, Arroyo J, Gragoudas ES, D'Amico D, Miller JW. Identification of Chlamydia pneumoniae within human choroidal neovascular membranes secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2005; 243:1080-90. [PMID: 15909160 DOI: 10.1007/s00417-005-1169-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2004] [Revised: 01/25/2005] [Accepted: 03/03/2005] [Indexed: 12/31/2022] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness in the United States, and increasing evidence suggests that it is an inflammatory disease. The prokaryotic obligate intracellular pathogen Chlamydia pneumoniae is emerging as a novel risk factor in cardiovascular disease, and recent sero-epidemiological data suggest that C. pneumoniae infection is also associated with AMD. In this study, we examined choroidal neovascular membrane (CNV) tissue from patients with neovascular AMD for the presence of C. pneumoniae and determined whether the pathogen can dysregulate the function of key cell types in ways that can cause neovascular AMD. Nine CNV removed from patients with neovascular AMD were examined for the presence of C. pneumoniae by immunohistochemistry (IHC) and polymerase chain reaction (PCR); in addition, we performed PCR on nine non-AMD eyes, and IHC on five non-AMD CNV, seven non-AMD eyes, and one internal limiting membrane specimen. Finally, human monocyte-derived macrophages and retinal pigment epithelial (RPE) cells were exposed to C. pneumoniae and assayed in vitro for the production of pro-angiogenic immunomodulators (VEGF, IL-8, and MCP-1). C. pneumoniae was detected in four of nine AMD CNV by IHC and two of nine AMD CNV by PCR, induced VEGF production by human macrophages, and increased production of IL-8 and MCP-1 by RPE cells. In contrast, none of the 22 non-AMD specimens showed evidence for C. pneumoniae. These data indicate that a pathogen capable of inducing chronic inflammation and pro-angiogenic cytokines can be detected in some AMD CNV, and suggest that infection may contribute to the pathogenesis of AMD.
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Affiliation(s)
- Murat V Kalayoglu
- Angiogenesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Yang X, Coriolan D, Murthy V, Schultz K, Golenbock DT, Beasley D. Proinflammatory phenotype of vascular smooth muscle cells: role of efficient Toll-like receptor 4 signaling. Am J Physiol Heart Circ Physiol 2005; 289:H1069-76. [PMID: 15863460 DOI: 10.1152/ajpheart.00143.2005] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent evidence supports a role of Toll-like receptor (TLR) signaling in the development of atherosclerotic lesions. In this study, we tested whether TLR4 signaling promotes a proinflammatory phenotype in human and mouse arterial smooth muscle cells (SMC), characterized by increased cytokine and chemokine synthesis and increased TLR expression. Human arterial SMC were found to express mRNA encoding TLR4 and the TLR4-associated molecules MD-2 and CD14 but not TLR2 mRNA. Mouse aortic SMC, on the other hand, expressed both TLR2 and TLR4 mRNA constitutively. Human SMC derived from the coronary artery, but not those from the pulmonary artery, were found to express cell surface-associated CD14. Low concentrations (ng/ml) of Escherichia coli LPS, the prototypical TLR4 agonist, markedly stimulated extracellular regulated kinase 1/2 (ERK1/2) activity, induced release of monocyte-chemoattractant protein-1 (MCP-1) and interleukin (IL)-6, and stimulated IL-1alpha expression in human aortic SMC, and exogenous CD14 enhanced these effects. Expression of a dominant negative form of TLR4 in human SMC attenuated LPS-induced ERK1/2 and MCP-1 release. LPS was a potent inducer of NF-kappaB activity, ERK1/2 phosphorylation, MCP-1 release, and TLR2 mRNA expression in wild-type mice but not in TLR4-signaling deficient mouse aortic SMC. These studies show that TLR4 signaling promotes a proinflammatory phenotype in vascular smooth muscle cells (VSMC) and suggest that VSMC may potentially play an active role in vascular inflammation via the release of chemokines, proinflammatory cytokines, and increased expression of TLR2.
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MESH Headings
- Animals
- Antigens, Surface/genetics
- Aorta/cytology
- Carrier Proteins/genetics
- Cells, Cultured
- Chemokine CCL2/metabolism
- Humans
- Interleukin-1/biosynthesis
- Interleukin-6/metabolism
- Lipopolysaccharide Receptors/genetics
- Lipopolysaccharide Receptors/pharmacology
- Lipopolysaccharides/pharmacology
- Lymphocyte Antigen 96
- Membrane Glycoproteins/genetics
- Mice
- Mitogen-Activated Protein Kinase 1/metabolism
- Mitogen-Activated Protein Kinase 3/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiology
- NF-kappa B/metabolism
- Phenotype
- RNA, Messenger/analysis
- Receptors, Cell Surface/genetics
- Signal Transduction/immunology
- Toll-Like Receptor 2
- Toll-Like Receptor 4
- Toll-Like Receptors
- Vasculitis/immunology
- Vasculitis/physiopathology
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Affiliation(s)
- Xin Yang
- Molecular Cardiology Research Institute and Department of Medicine, Tufts-New England Medical Ctr., Box 8486, 750 Washington St., Boston, MA 02111, USA
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20
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Grayston JT. Editorial Commentary:Chlamydia pneumoniaeand Atherosclerosis. Clin Infect Dis 2005; 40:1131-2. [PMID: 15791512 DOI: 10.1086/428739] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 01/04/2005] [Indexed: 11/03/2022] Open
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21
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Little CS, Bowe A, Lin R, Litsky J, Fogel RM, Balin BJ, Fresa-Dillon KL. Age alterations in extent and severity of experimental intranasal infection with Chlamydophila pneumoniae in BALB/c mice. Infect Immun 2005; 73:1723-34. [PMID: 15731073 PMCID: PMC1064908 DOI: 10.1128/iai.73.3.1723-1734.2005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 06/21/2004] [Accepted: 10/28/2004] [Indexed: 11/20/2022] Open
Abstract
The intracellular bacterium Chlamydophila ("Chlamydia") pneumoniae is a pathogen for several respiratory diseases and may be a factor in the pathogenesis of chronic diseases of aging including atherosclerosis and Alzheimer's disease. We assessed whether aging is coupled with increased burden of infection in BALB/c mice after intranasal infection by C. pneumoniae. Six- and twenty-month-old BALB/c mice were infected intranasally with 5 x 10(4) inclusion forming units (IFU) or 5 x 10(5) IFU of C. pneumoniae. Lung, brain, and heart tissue were analyzed for infectious C. pneumoniae and for Chlamydophila antigen by immunohistochemistry. At both doses, aging was associated with a decreased proportion of animals that cleared infection from the lung and greater burden of infectious organism within the lung. We observed dose-dependent spread to the heart/ascending aorta in animals infected with C. pneumoniae. In mice given 5 x 10(4) IFU, spread to the heart by day 14 was only observed in old mice. By day 28, all animals inoculated with 5 x 10(4) IFU showed evidence of spread to the heart, although higher C. pneumoniae titers were observed in the hearts from old mice. In mice inoculated with 5 x 10(5) IFU, spread of C. pneumoniae to the heart was evident by day 14, with no discernible age effect. C. pneumoniae was also recovered from the central nervous system (brain and olfactory bulb) of all mice by day 28 postinfection, with higher C. pneumoniae titers in old animals than in young animals. Our results suggest that infection with C. pneumoniae may be more severe in old animals.
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Affiliation(s)
- C Scott Little
- Department of Pathology, Microbiology, and Immunology, the Philadelphia College of Osteopathic Medicine, 4170 City Ave., Philadelphia, PA 19131, USA
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22
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Ieven MM, Hoymans VY. Involvement of Chlamydia pneumoniae in atherosclerosis: more evidence for lack of evidence. J Clin Microbiol 2005; 43:19-24. [PMID: 15634945 PMCID: PMC540187 DOI: 10.1128/jcm.43.1.19-24.2005] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Margareta M Ieven
- Department of Medical Microbiology, University of Antwerp-UA, B2610 Wilrijk, Belgium.
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23
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Baltch AL, Smith RP, Ritz WJ, Carpenter AN, Bopp LH, Michelsen PB, Carlyn CJ, Hibbs JR. Effect of levofloxacin on the viability of intracellular Chlamydia pneumoniae and modulation of proinflammatory cytokine production by human monocytes. Diagn Microbiol Infect Dis 2004; 50:205-12. [PMID: 15541607 DOI: 10.1016/j.diagmicrobio.2004.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 07/15/2004] [Indexed: 01/22/2023]
Abstract
Although antibiotics are known to affect the intracellular growth of Chlamydia pneumoniae in acute infections, their efficacy in therapy for chronic infections, including atherosclerosis, remains debatable. Human monocyte-derived macrophages (MDM) obtained from monocytes of healthy donors were infected with C. pneumoniae AR-39 and treated with levofloxacin (8 microg/mL) immediately after infection (0 hours) or 24 hours after infection. Levofloxacin treatment at 24 hours, but not at 0 hours, resulted in a significant decrease in the number of C. pneumoniae inclusions within the MDM (p < 0.05). Also decreased were concentrations of proinflammatory cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta, IL-6, and IL-8 in the extracellular medium (p < 0.01). Viable counts in titrations remained similar to those in untreated controls. In summary, levofloxacin administered to MDM at serum-attainable levels 24 hours after C. pneumoniae infection significantly decreased inclusion counts and proinflammatory cytokine production, but did not eliminate the C. pneumoniae infection.
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Affiliation(s)
- Aldona L Baltch
- Stratton Veterans Affairs Medical Center, Albany, NY 12208, USA.
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24
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Meza-Junco J, Montaño-Loza A, Castillo-Martínez L, Orea-Tejeda A, Remes-Troche JM, Villalobos-Zapata I, Ponce-De León-Garduño A, Calva-Mercado J. High prevalence of Chlamydia pneumoniae seropositivity in Mexican patients with ischemic heart disease. Arch Med Res 2004; 35:318-23. [PMID: 15325506 DOI: 10.1016/j.arcmed.2004.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2003] [Accepted: 03/17/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Risk factors for development of atherosclerosis, such as hyperlipidemia, high blood pressure, smoking habit, and diabetes mellitus, have been identified. The possibility that infectious agents may unchain biological and biochemical reactions related to inflammation, atherogenesis, and vascular thromboses events have recently been described. Chlamydia pneumoniae has been associated with coronary artery disease in some seroepidemiology studies. Reports of this association are limited in the Latin American population; therefore, we conducted a case-control study to explore this issue in the Mexican population. METHODS Eighty nine patients with scintigraphic evidence of coronary artery disease compared with a control group of 105 individuals were analyzed. Serum levels of IgA, IgM, and IgG against Chlamydia pneumoniae were determined using enzyme immunoassay method in all subjects. Conventional risk factors were also analyzed. RESULTS High seroprevalence of IgA and IgG with no significant difference between the two groups was found. Prevalence of antibodies was as follows: IgA 56.2% (50/89 patients); IgG 66.3% (59/ 89 patients) in coronary artery disease group; IgA 56.2% (59/105 patients), and IgG 70.5% (74/105 patients) in control group. Among common risk factors for coronary artery disease, significant differences were found in males, in patients with diabetes, and in habitual smokers. CONCLUSIONS These results suggest a high prevalence of C. pneumoniae infection in the studied population. However, in this series seroprevalence was not evidently associated with coronary artery disease (CAD). To clarify the possible relation between C. pneumoniae and coronary atherosclerosis, additional studies must be performed.
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Affiliation(s)
- Judith Meza-Junco
- Departamentos de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14000 Mexico
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25
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Glasz T, Hortoványi E, Mózes G, Kiss A, Lotz G, Nagy PK, Szik A, Kardos M, Sziller I, Nagy B, Bán Z, Tóth A, Kassai I, Horkay F, Dudás G, Kádár A. Chlamydia pneumoniae in coronary bypass grafts of redo patients. The concept of the ‘adventitial baseline infection’. Pathol Res Pract 2004; 200:609-18. [PMID: 15497773 DOI: 10.1016/j.prp.2003.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The pathogenic role of Chlamydia pneumoniae in late coronary bypass graft failure has not yet been extensively investigated. We examined failed and new arterial/venous bypass grafts using immunohistochemistry, polymerase chain reaction (PCR), and serology. Thirty-four long-term failed grafts and 28 new grafts were examined in 21 patients undergoing redo coronary artery bypass grafting (CABG). Immunohistochemically, 28 (82%) failed grafts were positive in the intimal-medial compartment, and 33 grafts (97%) were positive for C. pneumoniae in the adventitia. Thirteen (46%) and 27 (96%) new grafts showed infection in the intima-media and in the adventitia, respectively (p < 0.05). Immunohistochemically, the overall presence of C. pneumoniae in all vessels examined was 66% in the intima-media and 97% in the adventitia (p < 0.05). C. pneumoniae was detected by PCR in 19 (31%) of all the vessels examined. C. pneumoniae seems to be frequently present in grafts of patients considered for redo CABG in Hungary. The adventitia of both failed, and new grafts particularly often contained C. pneumoniae. The results suggest that there exists an adventitial baseline infection from which infection of the inner wall layers develops, depending on local microenvironmental conditions. This is the first study to evaluate chlamydial infection in arterial/venous coronary grafts by immunohistochemistry, PCR, and serology.
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Affiliation(s)
- Tibor Glasz
- 2nd Department of Pathology, Semmelweis University, Ulloi ut 93, 1091 Budapest, Hungary.
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26
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Yetkin G, Yetkin E, Aksoy Y, Gurbuz OA, Mert A. Changes in antibody titers against Chlamydia pneumoniae after coronary angioplasty. Int J Cardiol 2004; 95:293-7. [PMID: 15193835 DOI: 10.1016/j.ijcard.2003.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Accepted: 04/02/2003] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The potential role of common infectious agents in the pathogenesis and progression of atherosclerosis has been studied increasingly over the last decade. The evidence for Chlamydia pneumoniae as a potential causative agent is strong and is based on the findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models. We performed a prospective study in percutaneous transluminal coronary angioplasty (PTCA) patients to investigate whether the angioplasty procedure influenced the specific humoral immune response reaction against C. pneumoniae antigens. METHODS We studied 76 patients who successfully underwent PTCA for de novo lesions. Blood samples were drawn immediately before PTCA and 1 month after PTCA. IgG and IgA antibodies against C. pneumoniae (strain CDC/CWL-029) were determined by an in-house developed enzyme immunoassay. RESULTS At the time of angioplasty 75% and 34% of the patients had seropositive antibodies to elementary bodies (EBs) of classes IgG and IgA, respectively. Mean titers of IgG antibodies before and 1 month after PTCA were 46+/-31 and 50+/-28 relative units (RU/ml) (P>0.05). One month after PTCA, 97% and 34% of the patients had seropositive antibodies to EBs of classes IgG and IgA, respectively. We divided our patients into two groups on the basis of IgG seropositivity (group I: Chlamydia antibody IgG seronegative patients, group II: Chlamydia antibody IgG seropositive) before PTCA. Significant increase in the antibody titers of IgG (12+/-5 vs. 40+/-18, P<0.001) and IgA (0.6+/-0.33 vs. 1.15+/-0.83, P=0.007) was observed in group I patients 1 month after PTCA and 88% of them gained IgG seropositivity. There were no significant changes in IgG and IgA antibody levels in group II after PTCA. CONCLUSION We have demonstrated a statistically significant rise in C. pneumoniae antibodies (especially IgG) induced by PTCA in patients previously seronegative.
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Affiliation(s)
- Gülay Yetkin
- Department of Microbiology, Inonu University Faculty of Medicine, Malatya, Turkey.
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Abstract
Cardiovascular disease, of which atherosclerosis is an important component, is the leading cause of death in the western world. Although there are well-defined risk factors for atherosclerosis, these factors do not account for all incidences of the disease. Because atherosclerotic processes are typified by chronic inflammatory responses, which are similar to those that are elicited by chronic infection, the role of infection in promoting or accelerating atherosclerosis has received renewed attention. This review focuses on the accumulating evidence that chronic infection with Chlamydia pneumoniae, a ubiquitous human respiratory pathogen, might contribute to atherosclerotic lesion progression.
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Affiliation(s)
- Lee Ann Campbell
- Department of Pathobiology, Box 357238, University of Washington, Seattle, Washington 98155, USA.
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28
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Mannonen L, Kamping E, Penttilä T, Puolakkainen M. IFN-gamma induced persistent Chlamydia pneumoniae infection in HL and Mono Mac 6 cells: characterization by real-time quantitative PCR and culture. Microb Pathog 2004; 36:41-50. [PMID: 14643639 DOI: 10.1016/j.micpath.2003.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Growth of Chlamydia pneumoniae during gamma interferon (IFN-gamma) induced persistent infection in epithelial (HL) and monocyte-macrophage (Mono Mac 6) cell lines was studied by a quantitative real-time PCR and passage. When HL cultures were treated with IFN-gamma (25 U/ml), the replication of C. pneumoniae DNA was unaffected while differentiation into infectious elementary bodies (EB) was strongly inhibited, and in contrast to the untreated cultures, no second cycle of infection was observed. The estimated doubling time of C. pneumoniae genomes was 6-7 h in both IFN-gamma treated and untreated HL cultures. At 72 h post inoculation, most infectious EBs were released from untreated cultures, whereas in IFN-gamma treated HL cells >90% of C. pneumoniae genomes were in non-infectious form. A higher dose (1000 U/ml) of IFN-gamma was needed to restrict growth of C. pneumoniae in Mono Mac 6 cells. In untreated Mono Mac 6 cultures, the growth curve of C. pneumoniae resembled that observed in HL cells, except that no second cycle of infection could be detected. In IFN-gamma treated Mono Mac 6 cultures, the number of infectious C. pneumoniae EBs recovered decreased gradually after 3 days post inoculation, while C. pneumoniae genome load remained unaltered suggesting persistence of C. pneumoniae also in these cells.
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Affiliation(s)
- Laura Mannonen
- Department of Virology, Haartman Institute, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
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Hoymans VY, Bosmans JM, Van Renterghem L, Mak R, Ursi D, Wuyts F, Vrints CJ, Ieven M. Importance of methodology in determination of Chlamydia pneumoniae seropositivity in healthy subjects and in patients with coronary atherosclerosis. J Clin Microbiol 2003; 41:4049-53. [PMID: 12958224 PMCID: PMC193860 DOI: 10.1128/jcm.41.9.4049-4053.2003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enzyme immunoassays (EIAs) for the detection of Chlamydia pneumoniae antibodies were compared to the microimmunofluorescence (MIF) test, the reference method. Furthermore, we assessed the hypothesis that a possible relationship between Chlamydia pneumoniae immunoglobulin G (IgG) antibodies and coronary artery disease is dependent on the type of EIA. Sera from 112 healthy men (mean age, 50.1 years) were tested for antibodies against Chlamydia pneumoniae by five commercial test kits: Focus Chlamydia MIF IgG test, Labsystems Chlamydia pneumoniae IgG EIA (LS EIA), R-Biopharm Elegance Chlamydia pneumoniae IgG EIA (RB EIA), Medac Chlamydia pneumoniae IgG sandwich enzyme-linked immunosorbent assay ELISA (MCp sELISA) and Medac Chlamydia IgG recombinant enzyme-linked immunosorbent assay ELISA (MC rELISA). Sera from 106 consecutive male patients (mean age, 63.6 years) undergoing diagnostic coronary angiography were also examined using the Focus MIF, LS EIA, MCp sELISA, and MC rELISA techniques. The agreement between LS EIA (65 to 83% [controls-patients]) or MC rELISA (49 to 61%) and Focus MIF (78 to 83%) was average to fair (kappa = 0.597 and 0.234, respectively). MCp sELISA and RB EIA showed good agreement with MIF (kappa = 0.686 and 0.665, respectively), with 80 to 89 and 79% of individuals reacting positively. A significant difference in seroprevalence between patients and healthy subjects was observed with the LS EIA, while seropositivities in the two study groups appeared equal when the Focus MIF assay was applied. The MC rELISA and MCp sELISA gave statistically significant differences in antibody seroprevalence in patients with two-vessel disease or when the patient group combined individuals with a two- or a three-vessel disease, respectively. The concordance between MIF and other commonly used serological assays for C. pneumoniae IgG antibody detection is good to fair. The choice of serological assay has important implications for C. pneumoniae antibody seroprevalence, as well as for the relationship between C. pneumoniae seropositivity and coronary artery disease.
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Affiliation(s)
- V Y Hoymans
- Department of Cardiology, University of Antwerp, Edegem, Belgium.
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30
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Likitnukul S, Nunthapisud P, Prapphal N. Prevalence of Chlamydia pneumoniae infection in Thai children with community-acquired pneumonia. Pediatr Infect Dis J 2003; 22:749-50. [PMID: 12938677 DOI: 10.1097/01.inf.0000078356.68105.d7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sasithorn Likitnukul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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31
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Rössler MJ, Rappl G, Muche M, Hasselmann DO, Sterry W, Tilgen W, Reinhold U. No evidence of skin infection with Chlamydia pneumoniae in patients with cutaneous T cell lymphoma. Clin Microbiol Infect 2003; 9:721-3. [PMID: 12925116 DOI: 10.1046/j.1469-0691.2003.00594.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recently, Chlamydia pneumoniae-specific DNA and antigens were reported in the skin of patients with Mycosis fungoides (MF), the most common form of cutaneous T-cell lymphomas. In order to revalidate these data we analyzed skin sections of patients with MF for the expression of three different chlamydial antigens and C. pneumoniae DNA by immunohistochemistry and PCR according to previously described protocolls. Neither C. pneumoniae-specific DNA sequences nor antigens were detected in any of the skin biopses from 24 MF patients tested, suggesting that further studies are needed to establish any pathogenetic relevance of C. pneumoniae in MF.
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Affiliation(s)
- M J Rössler
- Department of Dermatology, The Saarland University Hospital, Homburg/Saar, Germany
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Cochrane M, Pospischil A, Walker P, Gibbs H, Timms P. Distribution of Chlamydia pneumoniae DNA in atherosclerotic carotid arteries: significance for sampling procedures. J Clin Microbiol 2003; 41:1454-7. [PMID: 12682129 PMCID: PMC153859 DOI: 10.1128/jcm.41.4.1454-1457.2003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite extensive efforts to confirm a direct association between Chlamydia pneumoniae and atherosclerosis, different laboratories continue to report a large variability in detection rates. In this study, we analyzed multiple sections from atherosclerotic carotid arteries from 10 endartectomy patients to determine the location of C. pneumoniae DNA and the number of sections of the plaque required for analysis to obtain a 95% confidence of detecting the bacterium. A sensitive nested PCR assay detected C. pneumoniae DNA in all patients at one or more locations within the plaque. On average, 42% (ranging from 5 to 91%) of the sections from any single patient had C. pneumoniae DNA present. A patchy distribution of C. pneumoniae in the atherosclerotic lesions was observed, with no area of the carotid having significantly more C. pneumoniae DNA present. If a single random 30- microm-thick section was tested, there was only a 35.6 to 41.6% (95% confidence interval) chance of detecting C. pneumoniae DNA in a patient with carotid artery disease. A minimum of 15 sections would therefore be required to obtain a 95% chance of detecting all true positives. The low concentration and patchy distribution of C. pneumoniae DNA in atherosclerotic plaque appear to be among the reasons for inconsistency between laboratories in the results reported.
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Affiliation(s)
- Melanie Cochrane
- Center for Molecular Biotechnology, Queensland University of Technology, Brisbane, Australia
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34
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Larsen MM, Moern B, Fuller A, Andersen PL, Ostergaard LJ. Chlamydia pneumoniae and cardiovascular disease. Med J Aust 2002; 177:558-62. [PMID: 12429006 DOI: 10.5694/j.1326-5377.2002.tb04953.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2002] [Accepted: 10/05/2002] [Indexed: 11/17/2022]
Abstract
Chlamydia pneumoniae has been detected in atherosclerotic plaques, while seropositivity to this organism confers a slightly increased risk of coronary events. However, no aetiological link has been established; a major difficulty when investigating this link is the lack of a gold standard for diagnosing chronic vessel infection. The outcomes of case-control studies and prospective trials of macrolides in treatment and prevention of cardiovascular disease have been ambiguous but suggest a short-term preventive effect. Whether this is due to the antimicrobial or anti-inflammatory activity of the macrolides is unknown. Larger and longer prospective trials currently under way may provide better insight into the association of C. pneumoniae with cardiovascular disease. At present, there is no justification for treating cardiovascular disease with antibiotics.
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Affiliation(s)
- Mikkel M Larsen
- Research Unit Q, Department of Infectious Diseases, Aarhus University Hospital, Skejby Sygehus, Denmark.
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35
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Abstract
C-reactive protein (CRP) is the prototype acute-phase protein, which can increase up to 1000-fold after the onset of a stimulus. Aside from its disputed role as a marker of infection and/or inflammation in daily clinical practice, the protein has a wide variety of biological properties and functions. Due to its opsonizing abilities and its capability to activate human complement, CRP plays an important role in the innate host defense against different microorganisms, such as bacteria and fungi. The same opsonophagocyting properties can lead to clearance of host cell material, including nuclear constituents. Inflammation is one of the cornerstones in the etiology and pathogenesis of atherosclerosis, which led to worldwide attention being focused on CRP and its role in the process of atherosclerosis. This role may have a dual character. First, CRP levels reflect the 'burden' of inflammation within atherosclerotic lesions, thus reflecting the grade of vulnerability and instability of the plaques. For this reason, an increased level of the protein may be a prelude to rupture of the plaque and, thus, to occlusive arterial disease. Secondly, CRP may play an active role in the atherosclerotic process. CRP plays a role in the expression of different adhesion molecules on endothelial cells and the protein is able to activate human complement within the plaque. Furthermore, the recent discovery of local production of CRP and complement proteins within the plaque suggests an active role for the protein in the inflammatory cascade. Whatever the role for CRP in the atherosclerotic process, it has been proven that an elevated CRP level, with a cut-off point of approximately 3 mg/l, is associated with an increased risk of occlusive arterial disease, especially acute coronary syndromes.
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Affiliation(s)
- Hans Ablij
- Department of General Internal Medicine, Leiden University Medical Center C1-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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36
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Blessing E, Campbell LA, Rosenfeld ME, Kuo CC. Chlamydia pneumoniae and hyperlipidemia are co-risk factors for atherosclerosis: infection prior to induction of hyperlipidemia does not accelerate development of atherosclerotic lesions in C57BL/6J mice. Infect Immun 2002; 70:5332-4. [PMID: 12183595 PMCID: PMC128267 DOI: 10.1128/iai.70.9.5332-5334.2002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chlamydia pneumoniae has been shown to accelerate atherosclerotic lesion development in hyperlipidemic animals. This study showed that C. pneumoniae did not accelerate lesion development in mice if a high-fat/high-cholesterol diet was started after infection, indicating that C. pneumoniae is a co-risk factor with hyperlipidemia for cardiovascular disease.
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Affiliation(s)
- Erwin Blessing
- Department of Pathobiology, University of Washington, Seattle, Washington 98195, USA
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Hortoványi E, Illyés G, Glasz T, Kádár A. Chlamydia pneumoniae in different coronary artery segments in the young. Pathol Res Pract 2002; 198:19-23. [PMID: 11866206 DOI: 10.1078/0344-0338-00179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Chlamydia pneumoniae has emerged as the most likely pathogen to have a causative role in the development and/or for progression of atherosclerosis. Evidence for this is based on epidemiological and pathological studies. In an effort to better understand the significance of finding C. pneumoniae in atheromata, we examined coronary artery segments of young adults (15-34 years) with and without atherosclerosis. Left anterior descending coronary arteries (LAD) of 74 young adults who died suddenly were examined histologically and for the presence of C. pneumoniae by immunohistochemistry. C. pneumoniae was identified in advanced lesions (Stary types III to VI) in 17 of 32 cases (53%), and in early lesions (Stary type I-II) in 8 of 37 cases (21%), mainly at the proximal segments of the LAD. C. pneumoniae was not found in the intimal and medial layer of normal-appearing coronary arteries. C. pneumoniae was detected in the adventitia in 51 (67%) coronary arteries: in 27 of normal arteries and early lesions (64%), and in 24 of atherosclerotic lesions (75%). C. pneumoniae was found most often in macrophages, less offen in smooth muscle cells. We also observed a correlation between C. pneumoniae positivity and cigarette smoking. IN CONCLUSION C. pneumoniae may relate to the severity of atherosclerosis in young people, and it may thus initiate atherosclerotic injury or facilitate its progression with other risk factors.
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Affiliation(s)
- Eszter Hortoványi
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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38
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Higuchi MDL, Ramires JAF. Infectious agents in coronary atheromas: a possible role in the pathogenesis of plaque rupture and acute myocardial infarction. Rev Inst Med Trop Sao Paulo 2002; 44:217-24. [PMID: 12219114 DOI: 10.1590/s0036-46652002000400007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this review we report our recent findings of histopathological features of plaque instability and the association with Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) infection, studying thrombosed coronary artery segments (CAS) of patients who died due to acute myocardial infarction. Vulnerable plaques are known to be associated with fat atheromas and inflammation of the plaque. Here we demonstrated that vulnerability is also related with focal positive vessel remodeling that maintains relatively well preserved lumen even in the presence of large atheromatous plaques. This phenomena may explain why the cinecoronariography may not detect large and dangerous vulnerable plaques. Greater amount of these bacteria in vulnerable plaques is associated with adventitial inflammation and positive vessel remodeling: the mean numbers of lymphocytes were significantly higher in adventitia than in the plaque, good direct correlation was obtained between numbers of CD20 B cells and numbers of CP infected cells in adventitia, and between % area of MP-DNA in the plaque and cross sectional area of the vessel, suggesting a cause-effect relationship. Mycoplasma is a bacterium that needs cholesterol for proliferation and may increase virulence of other infectious agents. In conclusion, co-infection by Mycoplasma pneumoniae and Chlamydia pneumoniae may represent an important co-factor for plaque instability, leading to coronary plaque thrombosis and acute myocardial infarction, since larger amount of these bacteria strongly correlated with histological signs of more vulnerability of the plaque. The search of CMV and Helicobacter pilori in these tissues resulted negative.
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Abstract
BACKGROUND Complications of atherosclerosis are the leading cause of mortality in developed countries, and infections may play a role in the pathogenesis. Numerous studies have addressed this issue in the past decade. TYPES OF STUDIES REVIEWED The author examined peer-reviewed studies and reviews on the role of microbes or infections in atherosclerosis, cardiovascular disease and cerebrovascular disease. He included selected articles on epidemiology, pathology, in vitro experiments, animal models and clinical studies. RESULTS Cross-sectional and retrospective studies have shown an association between Chlamydia pneumoniae antibodies and cardiovascular disease, but prospective studies have not been as convincing. Studies on the association between cardiovascular disease and periodontal disease or loss of teeth have produced conflicting results. Cytomegalovirus infection is associated mainly with accelerated arteriosclerosis after cardiac transplantation. Infectious agents can induce biological mechanisms important for atherogenesis. Mice and rabbit studies have indicated that C. pneumoniae is capable of initiating or accelerating the progression of atherosclerosis. Limited studies on cytomegalovirus also suggest the ability to induce early changes of atherosclerosis in a rodent model. Preliminary clinical trials of treatment for C. pneumoniae infection suggest a possible short-term benefit, but larger randomized trials for longer periods are in progress. CONCLUSION AND CLINICAL IMPLICATIONS Infectious agents may play an important role in atherogenesis, but currently the jury is not in. Further management of cardiovascular disease could change radically if this concept were proven.
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Affiliation(s)
- Ignatius W Fong
- St. Michael's Hospital, Department of Medicine, University of Toronto, 30 Bond St., Room 4-179V, Toronto, Ontario, M5B 1W8 Canada.
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40
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Affiliation(s)
- N V Dhurandhar
- Department of Nutrition and Food Science and the Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
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41
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Dugan JP, Feuge RR, Burgess DS. Review of evidence for a connection between Chlamydia pneumoniae and atherosclerotic disease. Clin Ther 2002; 24:719-35. [PMID: 12075941 DOI: 10.1016/s0149-2918(02)85147-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Established risk factors account for no more than 50% of coronary artery disease cases; therefore, the search continues for other modifiable risk factors. In recent years, there has been renewed interest in the infectious theory of atherosclerosis. Chlamydia pneumoniae has been implicated as a potential cause of atherosclerotic disease. OBJECTIVE This review discusses possible mechanisms of C pneumoniae involvement in atherosclerosis, summarizes the case-control studies and antibiotic trials completed, and identifies remaining questions about future therapy. METHODS Published data were identified by a MEDLINE search of the English-language literature from 1966 through 2001 using the terms Chlamydia, atherosclerosis, and coronary artery disease. Relevant conference presentations and book chapters were also included. RESULTS C pneumoniae antibodies are found in approximately 50% of middle-aged adults world-wide. These antibodies have been detected in atherosclerotic tissue by various methods, including microimmunofluorescence, and several studies have linked high antibody titers with increased risk of cardiovascular events. A few possible mechanisms for this perceived increase in risk have been proposed, such as induction of atheroma through damage to the endothelium, expression of procoagulant factor leading to thrombus formation, and production of cytokines resulting in increased inflammatory response. Results of animal studies suggest that early antibiotic treatment may reduce cardiovascular risk, but the first human studies have not produced conclusive results. CONCLUSIONS Although a connection has been suggested, the precise mechanism by which C pneumoniae affects atherosclerosis has not yet been identified. Large-scale trials are needed to determine whether eradication of C pneumoniae reduces the incidence of cardiovascular events in humans.
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42
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Kalayoglu MV, Perkins BN, Byrne GI. Chlamydia pneumoniae-infected monocytes exhibit increased adherence to human aortic endothelial cells. Microbes Infect 2001; 3:963-9. [PMID: 11580983 DOI: 10.1016/s1286-4579(01)01458-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Interactions between monocytes and endothelial cells play an important role in the pathogenesis of atherosclerosis, and monocyte adhesion to arterial endothelium is one of the earliest events in atherogenesis. Work presented in this study examined human monocyte adherence to primary human aortic endothelial cells following monocyte infection with Chlamydia pneumoniae, an intracellular pathogen associated with atherosclerosis by a variety of sero-epidemiological, pathological and functional studies. Infected monocytes exhibited enhanced adhesion to aortic endothelial cells in a time- and dose-dependent manner. Pre-treatment of C. pneumoniae with heat did not effect the organism's capacity to enhance monocyte adhesion, suggesting that heat-stable chlamydial antigens such as chlamydial lipopolysaccharide (cLPS) mediated monocyte adherence. Indeed, treatment of monocytes with cLPS was sufficient to increase monocyte adherence to endothelial cells, and increased adherence of infected or cLPS-treated monocytes could be inhibited by the LPS antagonist lipid X. Moreover, C. pneumoniae-induced adherence could be inhibited by incubating monocytes with a mAb specific to the human beta 2-integrin chain, suggesting that enhanced adherence resulted from increased expression of these adhesion molecules. These data show that C. pneumoniae can enhance the capacity of monocytes to adhere to primary human aortic endothelial cells. The enhanced adherence exhibited by infected monocytes may increase monocyte residence time in vascular sites with reduced wall shear stress and promote entry of infected cells into lesion-prone locations.
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Affiliation(s)
- M V Kalayoglu
- Department of Medical Microbiology and Immunology, University of Wisconsin Medical School, 436 SMI, 1300 University Avenue, Madison, WI 53706, USA.
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43
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Abstract
Infection with the pathogens human cytomegalovirus (HCMV) or Chlamydia pneumonia (CP) is linked to the development of vascular disease, including atherosclerosis. The role of pathogens in vasculopathies has been controversial. However, animal models have demonstrated a direct link between infection with CP and herpesviruses and the development of vascular disease. Clinical studies have shown a direct association of HCMV and CP with the acceleration of vascular disease. This article will review the evidence supporting the role for CP and HCMV in the development of vascular disease and will suggest a potential mechanism for HCMV acceleration of the disease process. Vascular diseases are the result of either mechanical or immune-related injury followed by inflammation and subsequent smooth muscle cell (SMC) proliferation and/or migration from the vessel media to the intima, which culminates in vessel narrowing. A number of in vitro and in vivo models have provided potential mechanisms involved in pathogen-mediated vascular disease. Recently, we have demonstrated that HCMV infection of arterial but not venous SMC results in significant cellular migration in vitro. Migration was dependent on expression of the HCMV-encoded chemokine receptors, US28, and the presence of the chemokines, RANTES or MCP-1. Migration involved chemotaxis and provided the first evidence that viruses may induce migration of SMC toward sites of chemokine production through the expression of a virally encoded chemokine receptor in infected SMC. Because SMC migration into the neointimal space is the hallmark of vascular disease, these observations provide a molecular link between HCMV and the development of vascular disease.
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Affiliation(s)
- D N Streblow
- Department of Molecular Microbiology and Immunology and The Vaccine and Gene Therapy Institute, Oregon Health Sciences University, Portland OR 97201, USA
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44
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Mygind T, Birkelund S, Falk E, Christiansen G. Evaluation of real-time quantitative PCR for identification and quantification of Chlamydia pneumoniae by comparison with immunohistochemistry. J Microbiol Methods 2001; 46:241-51. [PMID: 11438189 DOI: 10.1016/s0167-7012(01)00282-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia pneumoniae is a common cause of community-acquired pneumonia and it has been associated with atherosclerosis. C. pneumoniae has usually been diagnosed by serology using a microimmunofluorescence test, but more recently polymerase chain reaction (PCR) has been viewed as an advantageous alternative. We developed a quantitative real-time PCR for detection of C. pneumoniae. Primers were targeted for the pmp4 gene, and the PCR fragment was detected real-time with a fluorescence resonance energy transfer probe set using a LightCycler instrument. The PCR was used on DNA released from 50 microm sections of paraffin-embedded formalin-fixed lung tissue from experimentally infected mice. Thereby, the number of C. pneumoniae genomes was determined. To our knowledge this is the first time quantification of C. pneumoniae DNA has been attempted on paraffin-embedded formalin-fixed tissue. C. pneumoniae-specific immunohistochemistry (IHC) was done on 5 microm sections adjacent to the sections used in PCR, and the number of inclusions were counted in each section. Good correlation was found when comparing results from PCR and IHC, which is in contrast to many previous studies.
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Affiliation(s)
- T Mygind
- Department of Medical Microbiology and Immunology, Bartholin Building, Wilhelm Meyers Alle, DK-8000 C, Aarhus, Denmark.
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45
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Dowell SF, Peeling RW, Boman J, Carlone GM, Fields BS, Guarner J, Hammerschlag MR, Jackson LA, Kuo CC, Maass M, Messmer TO, Talkington DF, Tondella ML, Zaki SR. Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clin Infect Dis 2001; 33:492-503. [PMID: 11462186 DOI: 10.1086/322632] [Citation(s) in RCA: 414] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2000] [Revised: 12/28/2000] [Indexed: 11/03/2022] Open
Abstract
Chlamydia pneumoniae has been associated with atherosclerosis and several other chronic diseases, but reports from different laboratories are highly variable and "gold standards" are lacking, which has led to calls for more standardized approaches to diagnostic testing. Using leading researchers in the field, we reviewed the available approaches to serological testing, culture, DNA amplification, and tissue diagnostics to make specific recommendations. With regard to serological testing, only use of microimmunofluorescence is recommended, standardized definitions for "acute infection" and "past exposure" are proposed, and the use of single immunoglobulin (Ig) G titers for determining acute infection and IgA for determining chronic infection are discouraged. Confirmation of a positive culture result requires propagation of the isolate or confirmation by use of polymerase chain reaction (PCR). Four of 18 PCR assays described in published reports met the proposed validation criteria. More consistent use of control antibodies and tissues and improvement in skill at identifying staining artifacts are necessary to avoid false-positive results of immunohistochemical staining. These standards should be applied in future investigations and periodically modified as indicated.
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Affiliation(s)
- S F Dowell
- National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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46
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Smieja M, Mahony JB, Goldsmith CH, Chong S, Petrich A, Chernesky M. Replicate PCR testing and probit analysis for detection and quantitation of Chlamydia pneumoniae in clinical specimens. J Clin Microbiol 2001; 39:1796-801. [PMID: 11325993 PMCID: PMC88028 DOI: 10.1128/jcm.39.5.1796-1801.2001] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nucleic acid amplification of clinical specimens with low target concentration has variable sensitivity. We examined whether testing multiple aliquots of extracted DNA increased the sensitivity and reproducibility of Chlamydia pneumoniae detection by PCR. Nested and non-nested C. pneumoniae PCR assays were compared using 10 replicates of 16 serial dilutions of C. pneumoniae ATCC VR-1310. The proportion positive versus the C. pneumoniae concentration was modeled by probit regression analysis. To validate the model, 10 replicates of 26 previously positive patient specimens of peripheral blood mononuclear cells (PBMC), sputum, or nasopharyngeal swabs (NPS) were tested. The proportion of replicates that were positive varied with the concentration of C. pneumoniae in the sample. At concentrations above 5 infection-forming units (IFU)/ml, both nested and non-nested PCR assay sensitivities were 90% or greater. The nested PCR was more sensitive (median detection, 0.35 versus 0.61 IFU/ml; relative median detection, 0.58; 95% confidence interval, 0.31 to 0.99; P = 0.04). In clinical specimens, replicate PCR detected 15 of 26 (nested) versus 1 of 26 (non-nested, P < 0.001). For PBMC specimens, testing 1, 3, or 5 replicates detected 3, 5, or 9 of 10 positive specimens, respectively. Median C. pneumoniae concentrations were estimated at 0.07 IFU/ml for PBMC and at <0.03 IFU/ml for NPS specimens. We conclude that performing 5 or 10 replicates considerably increased the sensitivity and reproducibility of C. pneumoniae PCR and enabled quantitation for clinical specimens. Due to sampling variability, PCR tests done without replication may miss a large proportion of positive specimens, particularly for specimens with small amounts of target C. pneumoniae DNA present.
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Affiliation(s)
- M Smieja
- Hamilton Regional Laboratory Medicine Programme, McMaster University, Hamilton, Ontario, Canada.
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47
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Maraha B, Berg H, Scheffer GJ, van der Zee A, Bergmans A, Miseré J, Kluytmans J, Peeters M. Correlation between detection methods of Chlamydia pneumoniae in atherosclerotic and non-atherosclerotic tissues. Diagn Microbiol Infect Dis 2001; 39:139-43. [PMID: 11337179 DOI: 10.1016/s0732-8893(01)00212-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polymerase chain reaction (PCR) and immunohistochemistry (IHC) have been used to detect Chlamydia (C.) pneumoniae in vascular tissues. Discrepancies between the results of these two methods have frequently been reported. However, the correlation between PCR and IHC has not been analyzed yet. This study assesses the correlation between the detection of C. pneumoniae by PCR and IHC in 45 atherosclerotic and 50 non-atherosclerotic tissue specimens. Also, the presence of Mycoplasma (M.) pneumoniae in these 95 specimens was investigated. Correlation was found between the detection of C. pneumoniae by PCR and IHC in the atherosclerotic tissues. Both tests were positive in 10 specimens and negative in 17 specimens (p = 0.003). There was no significant correlation between PCR and IHC in non-atherosclerotic specimens (p = ns). M. pneumoniae was detected, by PCR, in one atherosclerotic specimen.The results show correlation between PCR and IHC in the detection of C. pneumoniae in atherosclerotic tissues, emphasize the association between C. pneumoniae and atherosclerosis, and support the specificity of the association between C. pneumoniae and atherosclerosis.
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Affiliation(s)
- B Maraha
- Department of Medical Microbiology, St. Elisabeth Hospital, Tilburg, The Netherlands.
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48
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O'Connor S, Taylor C, Campbell LA, Epstein S, Libby P. Potential infectious etiologies of atherosclerosis: a multifactorial perspective. Emerg Infect Dis 2001; 7:780-8. [PMID: 11747688 PMCID: PMC2631877 DOI: 10.3201/eid0705.010503] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Coronary heart disease (CHD) contributes substantially to illness and death worldwide. Experimental studies demonstrate that infection can stimulate atherogenic processes. This review presents a spectrum of data regarding the link between CHD and infection. In addition, the need for improved diagnostic tools, the significance of multiple pathogens, and potential intervention strategies are discussed.
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Affiliation(s)
- S O'Connor
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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49
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Jackson LA, Campbell LA, Schmidt RA, Kuo C, Cappuccio AL, Lee MJ, Grayston JT. Specificity of detection of Chlamydia pneumoniae in cardiovascular atheroma. J Infect Dis 2000; 181 Suppl 3:S447-8. [PMID: 10839735 DOI: 10.1086/315626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chlamydia pneumoniae is commonly detected in atherosclerotic plaque but the frequency of detection in non-cardiovascular (CV) tissues has not been well determined. In this study, archival autopsy tissue specimens from both CV and non-CV sites from 38 patients were tested by polymerase chain reaction and immunocytochemistry to detect C. pneumoniae. In addition, 33 surgical granuloma biopsy specimens were also tested. C. pneumoniae was detected most frequently in coronary artery tissue (34%) but was also detected in specimens from lung (13%), liver (10%), spleen (5%), bone marrow (10%), and lymph node (8%). The organism was detected in 3 of 33 granuloma specimens. These findings suggest that C. pneumoniae demonstrates a tropism for CV tissues and is either not widely distributed to non-CV tissues or does not persist chronically in those tissues after initial infection.
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Affiliation(s)
- L A Jackson
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98101-1448, USA
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50
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Ouchi K, Fujii B, Kudo S, Shirai M, Yamashita K, Gondo T, Ishihara T, Ito H, Nakazawa T. Chlamydia pneumoniae in atherosclerotic and nonatherosclerotic tissue. J Infect Dis 2000; 181 Suppl 3:S441-3. [PMID: 10839733 DOI: 10.1086/315617] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The positivity rate and localization of Chlamydia pneumoniae were investigated in atherosclerotic and nonatherosclerotic tissues by immunohistochemistry, polymerase chain reaction, and cell culture. In total, 67 atheromatous plaques from Japanese symptomatic patients and 110 nonatherosclerotic tissues and organs were evaluated. Of these, 62% of atherosclerotic plaques from symptomatic patients were infected with C. pneumoniae compared with just 2% of nonatherosclerotic tissues. Immunohistochemically stained C. pneumoniae were found most often in smooth muscle cells, less often in macrophages, and in a few endothelial cells.
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Affiliation(s)
- K Ouchi
- Dept. of Pediatrics, Saiseikai Shimonoseki General Hospital, 3-4-1 Kifune-cho, Shimonoseki, Yamagichi, Japan 751-8502.
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