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The global prevalence of Chlamydia pneumoniae, Helicobacter pylori, Cytomegalovirus and Herpes simplex virus in patients with coronary artery disease: A systematic review and meta-analysis. Microb Pathog 2020; 152:104572. [PMID: 33166619 DOI: 10.1016/j.micpath.2020.104572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Coronary Artery Disease (CAD) is one of the most important causes of death worldwide. The aim of this study was to determine the prevalence of C. pneumoniae, H. pylori, Cytomegalovirus (CMV) and Herpes simplex virus (HSV) in CAD patients based on published serological and molecular studies. METHODS A systematic literature search was conducted in Medline (via PubMed), Embase, Scopus and Web of Science databases (1996-2019). Both molecular and serological studies were analyzed using STATA software (Version 14). RESULTS 145 studies were included for final analysis. We gathered and investigated the prevalence of C. pneumoniae (25.1% [95% confidence interval (CI) 21.5-28.8%]), H. pylori (12.8% [(95% CI) 4.0-22.0%]), CMV (64.4% [(95% CI) 57.7-73.0%]) and HSV (31.8% [(95% CI) 21.5-42.2%]) in CAD patients from the analysis of molecular studies. Additionally, in serological studies, the prevalence of mentioned pathogens were 72.7% [(95% CI) 67.8-77.6%], 63.3% [(95% CI) 60.0-66.5%], 62.2% [(95% CI) 58.0-66.3%] and 34.3% [(95% CI) 23.6-45.1%] respectively. CONCLUSION Interestingly, there was only a significant increase in the prevalence of C. pneumoniae and H. pylori in serological studies compared to the reported data from molecular studies, while the prevalence of CMV and HSV were the same in both types of studies.
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Kalantar K, Farzaneh Z, Eshkevar Vakili M, Karimi MH, Asadi M, Khosropanah S, Doroudchi M. T cell responses to an HLA-A2-restricted adipophilin peptide correlate with BMI in patients with atherosclerosis. Physiol Int 2020; 107:280-293. [PMID: 32692717 DOI: 10.1556/2060.2020.00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/05/2020] [Indexed: 11/19/2022]
Abstract
Introduction Atherosclerosis is an inflammatory disease causing a vast array of cardiovascular diseases. Adipophilin has been reported to be highly expressed in atherosclerotic lesions. This study investigated the possible existence of auto-reactive T cells against an HLA-A02-restricted adipophilin-derived peptide as well as peptides from Epstein-barr virus (EBV), Cytomegalovirus (CMV) and influenza (Flu) virus in patients with atherosclerosis. Methods HLA-A02 expression on peripheral blood mononuclear cells (PBMCs) was examined by flow cytometry. PBMCs from HLA-A02 individuals were stimulated with adipophilin, CMV, EBV, and Flu peptides at a concentration of 10 µM. Interferon (IFN)-γ production was evaluated in the culture supernatant using a commercial ELISA test. Results The levels of IFN-γ production against an HLA-A02-restricted adipophilin peptide and peptides from CMV, EBV, and Flu revealed no statistically significant differences between patients and healthy controls. However, we found a positive correlation between IFN-γ production against adipophilin and Body mass index (BMI) of patients (R = 0.8, P = 0.003), whereas no significant correlation was found in healthy controls (R = -0.267, P = 0.378). No correlation between BMI and IFN-γ production against CMV, EBV, or Flu peptides was found. Discussion Atherosclerotic patients with higher BMIs might have greater numbers of T cells against adipophilin that is highly expressed in atherosclerotic plaques. Therefore, autoimmune reactions may have a greater role in the development of atherosclerosis in individuals with higher BMI.
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Affiliation(s)
- K Kalantar
- 1Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Z Farzaneh
- 1Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - M Eshkevar Vakili
- 1Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - M H Karimi
- 3Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - M Asadi
- 1Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - S Khosropanah
- 2Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - M Doroudchi
- 1Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Rosenfeld ME, Campbell LA. Pathogens and atherosclerosis: update on the potential contribution of multiple infectious organisms to the pathogenesis of atherosclerosis. Thromb Haemost 2011; 106:858-67. [PMID: 22012133 DOI: 10.1160/th11-06-0392] [Citation(s) in RCA: 240] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/03/2011] [Indexed: 12/15/2022]
Abstract
It is currently unclear what causes the chronic inflammation within atherosclerotic plaques. One emerging paradigm suggests that infection with bacteria and/or viruses can contribute to the pathogenesis of atherosclerosis either via direct infection of vascular cells or via the indirect effects of cytokines or acute phase proteins induced by infection at non-vascular sites. This paradigm has been supported by multiple epidemiological studies that have established positive associations between the risk of cardiovascular disease morbidity and mortality and markers of infection. It has also been supported by experimental studies showing an acceleration of the development of atherosclerosis following infection of hyperlipidaemic animal models. There are now a large number of different infectious agents that have been linked with an increased risk of cardiovascular disease. These include: Chlamydia pneumoniae, Porphyromonas gingivalis, Helicobacter pylori , influenza A virus, hepatitis C virus, cytomegalovirus, and human immunodeficiency virus. However, there are significant differences in the strength of the data supporting their association with cardiovascular disease pathogenesis. In some cases, the infectious agents are found within the plaques and viable organisms can be isolated suggesting a direct effect. In other cases, the association is entirely based on biomarkers. In the following review, we evaluate the strength of the data for individual or groups of pathogens with regard to atherosclerosis pathogenesis and their potential contribution by direct or indirect mechanisms and discuss whether the established associations are supportive of the infectious disease paradigm. We also discuss the failure of antibiotic trials and the question of persistent infection.
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Affiliation(s)
- M E Rosenfeld
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98109-4714, USA.
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Jegier B, Jaszewski R, Kurnatowski P, Kuba K, Lelonek M. Mycotic DNA in non-atherosclerotic aortic wall of coronary patients is associated with sICAM-1 expression. Circ J 2010; 74:749-53. [PMID: 20173302 DOI: 10.1253/circj.cj-09-0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atherosclerosis is currently being investigated as a chronic inflammatory process and the role of infectious agents is unclear. The presence of mycotic DNA in the wall of the non-atherosclerotic aorta of patients with coronary artery disease (CAD) and its association with levels of soluble intercellular adhesion molecule (sICAM)-1 expression was examined in the present study. METHODS AND RESULTS In 40 patients with CAD and a comparative group of 20 patients with aortic valve stenosis (AS) without CAD, specimens of the aortic wall were obtained during cardiac surgery. Mycotic DNA was analyzed by polymerase chain reaction (PCR) using a fungus-specific universal primer pair, ITS3 and ITS4, to amplify a portion of the 5.8S rDNA region, the entire ITS2 region and a portion of the 28S rDNA region, and using a species-specific primer pair, CALB1 and CALB2, to specifically amplify Candida (C.) albicans. The nested PCR method was performed to amplify the intergenic transcribed spacer regions of the rRNAs of Candida species. Before surgery the serum level of sICAM-1 was estimated. Mycotic DNA was detected in 48% of the CAD patients and in 40% of the AS patients, with C. albicans DNA in 58% and 100%, respectively (P>0.05). In CAD patients with a high level of sICAM-1, C. albicans DNA was found more frequently than in patients without elevated levels of sICAM-1 (P<0.05). CONCLUSIONS Mycotic DNA was found in the non-atherosclerotic aortic wall of CAD patients as well as in patients with AS. In the CAD patients C. albicans DNA was related to sICAM-1 expression.
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Affiliation(s)
- Bogdan Jegier
- Department of Cardiac Surgery, Medical University of Lodz, Lodz, Poland.
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Rupp J, Pfleiderer L, Jugert C, Moeller S, Klinger M, Dalhoff K, Solbach W, Stenger S, Laskay T, van Zandbergen G. Chlamydia pneumoniae hides inside apoptotic neutrophils to silently infect and propagate in macrophages. PLoS One 2009; 4:e6020. [PMID: 19547701 PMCID: PMC2695784 DOI: 10.1371/journal.pone.0006020] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 05/19/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intracellular pathogens have developed elaborate strategies for silent infection of preferred host cells. Chlamydia pneumoniae is a common pathogen in acute infections of the respiratory tract (e.g. pneumonia) and associated with chronic lung sequelae in adults and children. Within the lung, alveolar macrophages and polymorph nuclear neutrophils (PMN) are the first line of defense against bacteria, but also preferred host phagocytes of chlamydiae. METHODOLOGY/PRINCIPAL FINDINGS We could show that C. pneumoniae easily infect and hide inside neutrophil granulocytes until these cells become apoptotic and are subsequently taken up by macrophages. C. pneumoniae infection of macrophages via apoptotic PMN results in enhanced replicative activity of chlamydiae when compared to direct infection of macrophages, which results in persistence of the pathogen. Inhibition of the apoptotic recognition of C. pneumoniae infected PMN using PS- masking Annexin A5 significantly lowered the transmission of chlamydial infection to macrophages. Transfer of apoptotic C. pneumoniae infected PMN to macrophages resulted in an increased TGF-ss production, whereas direct infection of macrophages with chlamydiae was characterized by an enhanced TNF-alpha response. CONCLUSIONS/SIGNIFICANCE Taken together, our data suggest that C. pneumoniae uses neutrophil granulocytes to be silently taken up by long-lived macrophages, which allows for efficient propagation and immune protection within the human host.
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Affiliation(s)
- Jan Rupp
- Institute of Medical Microbiology and Hygiene, University of Luebeck, Luebeck, Germany
- Medical Clinic III, University hospital Schleswig-Holstein, Luebeck, Germany
- * E-mail: (JR); (GvZ)
| | - Lisa Pfleiderer
- Institute of Medical Microbiology and Hygiene, University Clinic of Ulm, Ulm, Germany
| | - Christiane Jugert
- Institute of Medical Microbiology and Hygiene, University of Luebeck, Luebeck, Germany
| | - Sonja Moeller
- Institute of Medical Microbiology and Hygiene, University of Luebeck, Luebeck, Germany
| | | | - Klaus Dalhoff
- Medical Clinic III, University hospital Schleswig-Holstein, Luebeck, Germany
| | - Werner Solbach
- Institute of Medical Microbiology and Hygiene, University of Luebeck, Luebeck, Germany
| | - Steffen Stenger
- Institute of Medical Microbiology and Hygiene, University Clinic of Ulm, Ulm, Germany
| | - Tamas Laskay
- Institute of Medical Microbiology and Hygiene, University of Luebeck, Luebeck, Germany
| | - Ger van Zandbergen
- Institute of Medical Microbiology and Hygiene, University Clinic of Ulm, Ulm, Germany
- * E-mail: (JR); (GvZ)
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Villegas E, Camacho A, Carrillo JA, Sorlózano A, Rojas J, Gutiérrez J. Emerging strategies in the diagnosis, prevention and treatment ofChlamydophila pneumoniaeinfections. Expert Opin Ther Pat 2008. [DOI: 10.1517/13543776.18.10.1175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hassantash SA, Bikdeli B, Kalantarian S, Sadeghian M, Afshar H. Pathophysiology of aortocoronary saphenous vein bypass graft disease. Asian Cardiovasc Thorac Ann 2008; 16:331-6. [PMID: 18670032 DOI: 10.1177/021849230801600418] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortocoronary saphenous vein bypass grafting relieves anginal pain in patients with coronary artery disease. However, its effectiveness is limited due to graft failure; the 10-year patency rate is 50%-60%. Early, 1-year and late graft failure may be due to thrombosis, fibrointimal hyperplasia and atherosclerosis, respectively. There is general agreement that vein graft atherosclerosis differs from arterial lesions in terms of temporal and histological changes. Vein graft atherosclerosis is more rapid, with diffuse concentric changes and a less noticeable fibrous cap, making venous plaques more vulnerable to rupture and subsequent thrombus formation. Despite progress in understanding the pathophysiology, some aspects of vein graft atherosclerosis need to be clarified. This review focuses on the pathophysiologic aspects of this widespread, costly and disabling disease, with emphasis on late graft occlusion and distinctions between arterial and venous atherosclerosis in terms of histology, pathophysiology and risk factors.
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Affiliation(s)
- Seyed-Ahmad Hassantash
- Department of Cardiovascular Surgery, Modarres Medical Center, Shaheed Beheshti University of Medical Sciences, Saadat-Abad, Tehran, Iran.
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Reszka E, Jegier B, Wasowicz W, Lelonek M, Banach M, Jaszewski R. Detection of infectious agents by polymerase chain reaction in human aortic wall. Cardiovasc Pathol 2008; 17:297-302. [DOI: 10.1016/j.carpath.2007.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/08/2007] [Accepted: 11/05/2007] [Indexed: 01/24/2023] Open
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Kloppenburg GTL, de Graaf R, Grauls GELM, Bruggeman CA, Stassen FR. Chlamydia pneumoniae aggravates vein graft intimal hyperplasia in a rat model. BMC Microbiol 2007; 7:111. [PMID: 18062811 PMCID: PMC2222630 DOI: 10.1186/1471-2180-7-111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 12/06/2007] [Indexed: 11/29/2022] Open
Abstract
Background Along with angioplasty, autologus vein grafts are commonly used for artery bypass grafting in patients with advanced arterial stenosis and drug-resistant angina pectoris. Although initially a successful procedure, long-term functionality is limited due to proliferation and migration of smooth muscle cells. Like in atherosclerosis, common chronic infections caused by viruses and bacteria may contribute to this process of vein graft failure. Here we investigated the possible role of Chlamydia pneumoniae (Cpn) in the pathogenesis of venous graft failure in an experimental animal model. In 2 groups (n = 10 rats/group), an epigastric vein-to-common femoral artery interposition graft was placed. Immediately thereafter, rats were infected with Cpn (5*108 IFU) or injected with control solutions. Rats were sacrificed three weeks after surgery and the grafts were harvested for morphometrical and immunohistochemical analysis. Results Cpn administration immediately after vein grafting resulted in a significant increase in medial cross-sectional area, wall thickness and total wall area. There were no significant differences in T-cell or macrophage influx. Likewise, although positive immunostaining for both HSP60 and CRP could be detected, no differences were found between groups. Based on the observation that the number of cells/μm2 was also not altered, we conclude that Cpn infection stimulates smooth muscle cell proliferation by hereunto unknown molecular mechanisms, resulting in a significant increase in intimal hyperplasia. Conclusion In conclusion, in a well defined animal model we present here for the first time evidence for a role of Chlamydia pneumoniae in the process of venous graft failure.
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Affiliation(s)
- Geoffrey T L Kloppenburg
- Cardiovascular Research Institute Maastricht, Department of Medical Microbiology, Academic Hospital Maastricht/Maastricht University, Maastricht, MD Maastricht, The Netherlands.
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Yoshida T, Koide N, Mori I, Ito H, Yokochi T. Chlamydia pneumoniae infection enhances lectin-like oxidized low-density lipoprotein receptor (LOX-1) expression on human endothelial cells. FEMS Microbiol Lett 2006; 260:17-22. [PMID: 16790013 DOI: 10.1111/j.1574-6968.2006.00286.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Many studies indicate that Chlamydia pneumoniae infection is a crucial risk factor in atherogenesis. The most relevant cell type for the pathogenesis is the macrophage, which possesses classical scavenger receptors that uptake oxidized low-density lipoprotein (LDL). Here, a direct involvement of vascular endothelial cells in atherogenesis was examined employing in vitro infection of human umbilical vein endothelial cells (HUVEC) with C. pneumoniae. Chlamydia pneumoniae infection greatly enhanced the uptake of oxidized LDL, but not of acetylated LDL, by HUVEC. Among the scavenger receptors analyzed, LOX-1 transcription, which prefers oxidized LDL to acetylated LDL, was significantly amplified.
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Affiliation(s)
- Tomoaki Yoshida
- Department of Microbiology and Immunology, Aichi Medical University, School of Medicine, Nagakute, Aichi, Japan.
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Tang RB, Dong JZ, Liu XP, Ma CS. Inflammation and atrial fibrillation: Is Chlamydia pneumoniae a candidate pathogen of atrial fibrillation? Med Hypotheses 2006; 67:462-6. [PMID: 16793213 DOI: 10.1016/j.mehy.2006.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Accepted: 03/14/2006] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation is the most common arrhythmia, however, the mechanism of atrial fibrillation is not well explained. It has been considered that inflammation plays a role in atrial fibrillation, recently. Patients undergoing coronary artery bypass graft are at high risk for developing postoperative atrial fibrillation. The peak levels of C-reactive protein (CRP) were paralleled to the incidence of postoperative atrial fibrillation. In general population, CRP was also higher in patients with atrial fibrillation than in control people. Persistent atrial fibrillation patients had a higher CRP level than paroxysmal atrial fibrillation patients. CRP was not only associated with the presence of atrial fibrillation but may also predict patients at increased risk for future development of atrial fibrillation. Why inflammation markers in atrial fibrillation are high is a puzzling problem. We hypothesized that Chlamydia pneumoniae infection is a possible cause of atrial fibrillation by initiating inflammation response. It was demonstrated that infection of endothelial cells with C. pneumoniae elicited the production of Monocyte Chemoattractant Protein-1, interleukin-1, interleukin-8, interleukin-18, tumor necrosis factor, interferon and soluble intercellular adhesion molecule. Most of these cytokines play a crucial role in inflammation response that associate with the initiating and maintenance of atrial fibrillation. There are so many pathogens that can trigger inflammation. Some evidences showed that C. pneumoniae was the most likely pathogen of atrial fibrillation. In epidemic study, the incidence of atrial fibrillation increased from younger to elder and atrial fibrillation was more common in men than in women. C. pneumoniae has the same epidemic trend as the incidence of atrial fibrillation. Hypertension, myocardial infarction and reduced lung function are predictors of atrial fibrillation. C. pneumoniae infection is high in the patients with the above diseases. C. pneumoniae was found in endomyocardial biopsy samples, which supported C. pneumoniae was the candidate pathogen, too. Chlamydia infection can cause myocardial interstitial fibrosis and inflammation cells infiltration. The pathology characters of C. pneumoniae infection are similar to that found in atrial fibrillation. Seroepidemic study should be carried out to evaluate if there is relationship between C. pneumoniae and atrial fibrillation. If the hypothesis is confirmed, macrocyclic lactone antibiotics may be used to eliminate the pathogen. It will be a new target point to treat atrial fibrillation.
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Affiliation(s)
- Ri Bo Tang
- Ward 2nd, Department of Cardiology, Beijing AnZhen Hospital affliated with Capital University of Medical Sciences, Chaoyang District, Beijing 100029, PR China.
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Ibrahim AI, Obeid MT, Jouma MJ, Moasis GA, Al-Richane WL, Kindermann I, Boehm M, Roemer K, Mueller-Lantzsch N, Gärtner BC. Detection of herpes simplex virus, cytomegalovirus and Epstein-Barr virus DNA in atherosclerotic plaques and in unaffected bypass grafts. J Clin Virol 2005; 32:29-32. [PMID: 15572003 DOI: 10.1016/j.jcv.2004.06.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/28/2004] [Accepted: 06/28/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Herpes virus infections are suspected to be involved in the pathogenesis of atherosclerosis. OBJECTIVE AND METHOD Viral DNA of herpes simplex virus (HSV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) was analyzed by real-time PCR on 48 biopsies from atherosclerotic plaques extracted by end-arterectomy (46 coronary arteries, 2 carotid arteries), and in tissue from non-atherosclerosis vessels from the same patient as controls (23 internal mammary arteries, 43 saphenous veins). RESULTS HSV-1 DNA was detected significantly more frequently in plaques (35%) than in control veins (9%, P = 0.006). However, the frequency of HSV-1 DNA detection in the internal mammary artery grafts was as high as in plaques (22%, P = 0.28). CMV and EBV DNA were exclusively found in plaques but not in controls, with 10% for CMV (P = 0.06 versus veins, P = 0.17 versus graft arteries) and 2% for EBV (P = 1.0), respectively. HSV-2 was neither detected in plaques nor in controls. Herpes viral DNA was significantly associated only with arterial hypertension but not with other classical risk factors (P = 0.02), in accordance with the hypothesis that herpes viral infection may alter the vessel wall. CONCLUSION We conclude that herpes viral infections may have a role in atherosclerosis and that the presence of herpes viral DNA in the grafts used for bypass surgery might constitute a potential risk for atherosclerosis or restenosis.
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Affiliation(s)
- Ali I Ibrahim
- Department of Clinical Chemistry and Microbiology, University of Damascus, Syria
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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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Maraha B, Berg H, Kerver M, Kranendonk S, Hamming J, Kluytmans J, Peeters M, van der Zee A. Is the perceived association between Chlamydia pneumoniae and vascular diseases biased by methodology? J Clin Microbiol 2004; 42:3937-41. [PMID: 15364972 PMCID: PMC516358 DOI: 10.1128/jcm.42.9.3937-3941.2004] [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: 01/18/2023] Open
Abstract
Inter- and intralaboratory inconsistencies in detection rates of Chlamydia pneumoniae in vascular specimens have been demonstrated. In this study, 66 vascular tissue specimens from 66 patients with vascular disease were tested by three PCR assays: a 16S PCR-based reverse line blot (RLB) assay, a single-step PCR, and a nested PCR. Also, we explored the impacts of different DNA polymerase enzymes on the results based on gel electrophoresis and hybridization. The PCR results by gel electrophoresis in the single-step PCR depended on which DNA polymerase was used. All samples were negative with AmpliTaq Gold DNA polymerase, and 54.5% (36 of 66) were positive with the conventional Taq DNA polymerase. All samples were negative after hybridization with a C. pneumoniae-specific probe. In the nested PCR, all specimens were negative by gel electrophoresis and after hybridization. The RLB assay failed to detect C. pneumoniae in any specimen; however, 20 specimens were Chlamydia sp. positive. The sequence analysis of six of these samples demonstrated Chlamydia-like organisms. RLB detected Chlamydia sp. DNA in water and in the elution buffer after passage of the Qiagen columns (11 of 40). This study identified factors that may influence the detection of C. pneumoniae DNA in vascular tissues and consequently bias the perception of a link between C. pneumoniae and vascular diseases. The following are strongly recommended: to use DNA polymerases that have to be activated, to decontaminate with dUTP-uracil-DNA glycosylase, to hybridize with specific probes, to include sufficient controls, and to use molecular grade water.
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Affiliation(s)
- Boulos Maraha
- Regional Laboratory Medical Microbiology, P.O. Box 899, 3300 AW, Dordrecht, The Netherlands.
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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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Brassard P, Bourgault C, Brophy J, Kezouh A, Rainville B, Xhignesse M, Suissa S. Antibiotics in primary prevention of myocardial infarction among elderly patients with hypertension. Am Heart J 2003; 145:E20. [PMID: 12766754 DOI: 10.1016/s0002-8703(03)00087-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Given the premise that certain bacteria (such as Chlamydia pneumoniae) may play a role in the etiology of atherosclerosis, subjects treated with antibiotics that have antibacterial activity against C pneumoniae may be at lower risk for the development of an acute myocardial infarction (MI) than untreated subjects. METHODS A case-control design, nested within a cohort of 29,937 elderly subjects in whom antihypertensive therapy was initiated (1982-1995) was used, in which each subject who was hospitalized with a primary discharge diagnosis of MI between 1987 and 1995 (n = 1047) was matched on calendar time to 5 randomly selected control subjects for exposure contrasts. Conditional logistic regression analyses were conducted to adjust for predisposing factors for MI. RESULTS Although no clear consistent effect of antibiotics use was found in relation to MI, a trend was observed for a decreased risk of acute MI in patients receiving a prescription for antichlamydial antibiotics in the preceding 3 months (odds ratio 0.68, 95% CI 0.46-1.00). Antibiotics without antichlamydial activity showed no benefit in MI risk. CONCLUSION The beneficial effect of certain antichlamydial antibiotics in reducing the risk of MI cannot be excluded on the basis of this representative cohort of elderly patients in a routine clinical care setting. Larger prospective studies are required to confirm the usefulness of antibiotics in the primary prevention of MI.
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Affiliation(s)
- Paul Brassard
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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Boman J, Hammerschlag MR. Chlamydia pneumoniae and atherosclerosis: critical assessment of diagnostic methods and relevance to treatment studies. Clin Microbiol Rev 2002; 15:1-20. [PMID: 11781264 PMCID: PMC118057 DOI: 10.1128/cmr.15.1.1-20.2002] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A number of studies have found that inflammation of the vessel wall plays an essential role in both the initiation and progression of atherosclerosis and erosion and fissure and the eventual rupture of plaques. Chlamydia pneumoniae is one of the infectious agents that have been investigated as possible causes of this inflammation. Initial studies of the association of C. pneumoniae and cardiovascular disease (CVD) were seroepidemiologic, and these were followed by studies in which the organism was identified in vascular tissue from patients with CVD by electron microscopy, PCR and immunocytochemical staining (ICC). C. pneumoniae has also been isolated by culture from vascular tissue in a small number patients. However, no single serologic, PCR, or ICC assay has been used consistently across all studies. The assays used are also not standardized. Recent studies of serologic and PCR assays for diagnosis of C. pneumoniae infection have suggested that there may be substantial interlaboratory variation in the performance of these tests. It now appears that some of the inconsistency of results from study to study may be due, in part, to lack of standardized methods. Although initial seroepidemiologic studies demonstrated a significantly increased risk of adverse cardiac outcome in patients who were seropositive, subsequent prospective studies found either small or no increased risk. In addition to the lack of consistent serologic criteria, recent evaluations have demonstrated inherent problems with performance of the most widely used serologic methods. Most importantly, we do not have a reliable serologic marker for chronic or persistent C. pneumoniae infection.
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Affiliation(s)
- Jens Boman
- Department of Virology, Umeå University, Umeå, Sweden
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18
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Johnson WD, Moses J, Kipshidze N. Absence of Chlamydia pneumoniae in surgical specimens of coronary and carotid arteries by polymerase chain reaction. CARDIOVASCULAR RADIATION MEDICINE 2001; 2:221-4. [PMID: 12160763 DOI: 10.1016/s1522-1865(02)00130-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Several recent articles indicate the renewed interest that Chlamydia pneumoniae is associated with and contributes to arterial diseases. Associations have been established for coronary arteries, carotid arteries and abdominal aortic aneurysms by serological studies, immunofluorescence and DNA-specific testing. The purpose of this study was to determine the presence of C. pneumoniae in coronary artery plaques, carotid artery plaques and old vein grafts that were harvested at the time of surgery. METHODS AND MATERIALS Interventions were carried out on patients with carotid artery disease and coronary disease based upon their anatomic findings and symptomatology. Plaques were removed from the carotid arteries with standard endarterectomy techniques. The coronary plaques were removed utilizing blunt dissection to peel the plaque from the coronary artery. Old vein grafts were harvested during repeat surgery by excising the vein grafts. The tissue specimens were analyzed by polymerase chain reaction (PCR). RESULTS Ninety-nine specimens from 68 consecutive patients with advanced coronary atherosclerosis with or without cerebrovascular disease were analyzed. We failed to find C. pneumoniae in any of the vascular tissue. CONCLUSIONS A large cooperative study involving surgical specimen analysis is needed to assess the role of C. pneumoniae in the etiology of atherosclerosis.
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Affiliation(s)
- W D Johnson
- W. Dudley Johnson Heart Care Center, Milwaukee, WI, USA
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19
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Frohlich J, Dobiasova M, Lear S, Lee KW. The role of risk factors in the development of atherosclerosis. Crit Rev Clin Lab Sci 2001; 38:401-40. [PMID: 11720280 DOI: 10.1080/20014091084245] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Our understanding of risk factors for atherogenesis has changed significantly over the last decade. In addition to better grasp of the mechanism of action of the "classic" (causal) risk factors, a number of potentially important new factors has emerged. In this review we briefly summarize the evidence of the relation between atherosclerosis and the currently recognized causal risk factors, namely, age, smoking, LDL cholesterol, HDL cholesterol, hypertension, and diabetes. More emphasis has been put on description of the emerging entities such as atherogenic profile of plasma lipoproteins with discussion of LDL and HDL subclasses, Lp(a), homocysteine, and, last but not least, on the role of infection and inflammation in atherogenesis. Whenever possible, we tried to summarize the relevant lines of evidence such as epidemiological, pathological, genetic, and clinical trial data linking the specific factor with atherosclerosis.
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Affiliation(s)
- J Frohlich
- Healthy Heart Program and The University of British Columbia, Vancouver, Canada
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20
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Rassu M, Cazzavillan S, Scagnelli M, Peron A, Bevilacqua PA, Facco M, Bertoloni G, Lauro FM, Zambello R, Bonoldi E. Demonstration of Chlamydia pneumoniae in atherosclerotic arteries from various vascular regions. Atherosclerosis 2001; 158:73-9. [PMID: 11500176 DOI: 10.1016/s0021-9150(01)00411-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chlamydia pneumoniae (CP) has been reported to be a pathogenic agent in the mechanism leading to atherosclerosis. The majority of available data is focused mainly on coronary artery disease whereas the distribution of CP in different areas, associated with atherosclerotic disorders, has not been completely clarified. In this study we investigated the presence of CP in atheromasic plaques from five different vascular areas (basilary artery, coronary artery, thoracic aorta, abdominal aorta, renal arteries) using nested polymerase chain reaction (PCR) and immunohistochemical staining (IHC), in order to establish the putative association of CP with atherosclerotic disease. The same atheromasic plaques were also tested for the presence of Helicobacter pylori (HP) and cytomegalovirus (CMV), other putative agents of atherosclerosis, using a nested PCR technique. Our data indicate that the presence of CP can be demonstrated in 100% of patients tested, considering globally the five areas of analysis. On the other hand the presence of HP has been demonstrated in four out of 18 patients (22.2%), and CMV only in three out of 18 (16.6%). Our results strongly suggest an association between CP and atherosclerosis and highlight the need for the detection of CP in multiple vascular areas of the same patient.
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Affiliation(s)
- M Rassu
- Department of Microbiology, S. Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy.
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21
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Weber T, Berent R, Kirchgatterer A, Auer J, Mayr H, Schwarz C, Maurer E, Punzengruber C, Hartl P, Eber B. [Coronary artery bypass graft dysfunction--clinical presentation, laboratory and electrocardiographic parameters]. ACTA MEDICA AUSTRIACA 2001; 28:5-10. [PMID: 11253630 DOI: 10.1046/j.1563-2571.2001.01002.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The recurrence of symptoms after coronary artery bypass surgery is often caused by bypass-dysfunction. In this study we tried to determine factors related to the long-term patency of arterial and venous bypass grafts. We evaluated all patients with bypass grafts undergoing coronary angiography in the year 1998 at our hospital (163 patients, mean age 67 years, mean interval since the operation 79 months, a total of 341 venous bypasses (VBP), 386 peripheral venous anastomoses and 85 arterial (LIMA = left internal mammarial artery) bypasses. The data were collected by a retrospective analysis of the hospital records. Statistics were performed using the Wilcoxon-Mann-Whitney-U test. After an interval of 53 months LIMA-bypasses were patent without stenosis in 92%. Symptoms were caused in only 2% by a dysfunction of the LIMA-graft. The patency of venous bypass grafts decreased with time (5 years after the operation 74% were patent without stenosis, 5-10 years 56%, more than 10 years 35%, p < 0.01). We found clear relations between the function of the venous grafts and the clinical presentation (patent grafts without stenosis in 43% with acute coronary syndromes, in 57% with stable angina [p = 0.08] and in 86% with atypical angina [p < 0.0001 for the difference between each of the first two and the last syndrome]), the resting-ECG (65% patent VBP without stenosis with normal ST-segments and 49% with abnormal ST-segments, p < 0.01), the body-mass-index (70% patent VBP without stenosis with a BMI < 25 and 56% with a BMI > 30, p = 0.05) and the erythrocyte sedimentation rate after 2 hours (79% patent VBP with an ESR < or = 20 mm vs. 64% with an ESR > 49 mm, p = 0.02). The function of VBP after coronary artery bypass graft (CABG)-procedure depends primarily upon the interval since the operation. In addition, we found correlations with clinical presentation, resting-ECG, body-mass-index and erythrocyte-sedimentation rate as a possible marker of inflammation in bypass-atherosclerosis. Therefore, inflammatory processes seem to play an important role in the development of venous graft dysfunction.
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Affiliation(s)
- T Weber
- II. Internen Abteilung mit Kardiologie, I. Chirurgischen Abteilung für Herz- und Thoraxchirurgie des A. ö. Krankenhauses der Barmherzigen Schwestern vom Heiligen Kreuz, Grieskirchnerstrasse 42, A-4600 Wels.
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22
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Ngeh J, Gupta S. Inflammation, infection and antimicrobial therapy in coronary heart disease--where do we currently stand? Fundam Clin Pharmacol 2001; 15:85-93. [PMID: 11468018 DOI: 10.1046/j.1472-8206.2001.00021.x] [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] [Indexed: 11/20/2022]
Abstract
Traditional atherosclerotic risk factors such as hypertension, smoking, hyperlipidaemia and diabetes mellitus, account for only about 50% of the clinical occurrence of coronary heart disease (CHD). The infectious hypothesis proposes that various microorganisms, in particular, Chlamydia pneumoniae, may serve as potential etiological factors, linking inflammation and atherosclerosis (or its clinical manifestations). Evidence from seroepidemiology, pathology, animal models, molecular biology and immunology, and human antibiotic intervention studies, collectively have suggested a largely positive association between C. pneumoniae infection and CHD. As CHD is a multifactorial disease, it is possible that C. pneumoniae may interact with conventional cardiovascular risk factors and predispose certain genetically susceptible people to atherosclerotic disease. However, the precise nature of a causal or coincidental link between C. pneumoniae and CHD remains to be determined. The results of ongoing antibiotic intervention studies may help to further clarify the role of infection and inflammation in CHD, but until such a role is proven beyond reasonable doubt, antimicrobial therapy cannot yet be justified in the treatment or prevention of CHD. A current perspective is presented in this review.
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Affiliation(s)
- J Ngeh
- Department of Medicine in Care of the Elderly, Newham General Hospital, Plaistow, London E13 8SL, United Kingdom
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23
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Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000; 71:1554-60. [PMID: 11063387 DOI: 10.1902/jop.2000.71.10.1554] [Citation(s) in RCA: 697] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies suggest that chronic infections including those associated with periodontitis increase the risk for coronary vascular disease (CVD) and stroke. We hypothesize that oral microorganisms including periodontal bacterial pathogens enter the blood stream during transient bacteremias where they may play a role in the development and progression of atherosclerosis leading to CVD. METHODS To test this hypothesis, 50 human specimens obtained during carotid endarterectomy were examined for the presence of Chlamydia pneumoniae, human cytomegalovirus, and bacterial 16S ribosomal RNA using specific oligonucleotide primers in polymerase chain reaction (PCR) assays. Approximately 100 ng of chromosomal DNA was extracted from each specimen and then amplified using standard conditions (30 cycles of 30 seconds at 95 degrees C, 30 seconds at 55 degrees C, and 30 seconds at 72 degrees C). Bacterial 16S rDNA was amplified using 2 synthetic oligonucleotide primers specific for eubacteria. The PCR product generated with the eubacterial primers was transferred to a charged nylon membrane and probed with digoxigenin-labeled synthetic oligonucleotides specific for Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis, and Prevotella intermedia. RESULTS Eighty percent of the 50 endarterectomy specimens were positive in 1 or more of the PCR assays. Thirty-eight percent were positive for HCMV and 18% percent were positive for C. pneumoniae. PCR assays for bacterial 16S rDNA also indicated the presence of bacteria in 72% of the surgical specimens. Subsequent hybridization of the bacterial 16S rDNA positive specimens with species-specific oligonucleotide probes revealed that 44% of the 50 atheromas were positive for at least one of the target periodontal pathogens. Thirty percent of the surgical specimens were positive for B. forsythus, 26% were positive for P. gingivalis, 18% were positive for A. actinomycetemcomitans, and 14% were positive for P. intermedia. In the surgical specimens positive for periodontal pathogens, more than 1 species was most often detected. Thirteen (59%) of the 22 periodontal pathogen-positive surgical specimens were positive for 2 or more of the target species. CONCLUSIONS Periodontal pathogens are present in atherosclerotic plaques where, like other infectious microorganisms such as C. pneumoniae, they may play a role in the development and progression of atherosclerosis leading to coronary vascular disease and other clinical sequelae.
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Affiliation(s)
- V I Haraszthy
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, USA
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24
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Kaski JC. [Inflammation, infection and coronary artery disease: myths and realities. Special XXXV Conference of the National Congress of the Spanish Society of Cardiology]. Rev Esp Cardiol 2000; 53:1311-7. [PMID: 11060248 DOI: 10.1016/s0300-8932(00)75234-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the past decades it has become apparent that inflammation plays a role in atherogenesis and rapid coronary artery disease progression. Active, or vulnerable, atheromatous plaques are responsible for acute coronary events and contain high concentrations of inflammatory cells as well as molecules involved in the inflammatory process, such as cytokines, adhesion molecules and growth factors. From a clinical perspective, early detection of these plaques may prevent the occurrence of serious coronary events. Unfortunately, current diagnostic techniques -i.e. angiography- do not allow the characterization of events taking place in the arterial wall. Therefore, these diagnostic tools cannot identify vulnerable plaques. Recent studies have suggested that markers of systemic inflammation may help in the detection of high risk patients. Although the role of inflammation in the pathogenesis of atherosclerosis is established, it is not known what triggers inflammation in this context. Infectious agents such as viruses and Gram negative bacteria -i.e. Chlamydia pneumoniae- have been postulated to play a role. Several mechanisms, involving inflammation and immunological processes, have been suggested to explain how chronic infections may cause atherosclerosis. Small pilot studies have also been carried out which suggest a causal role of infection in coronary artery disease. These results, however, await confirmation by other large, currently ongoing, studies. The infectious hypothesis of atherosclerosis is still a matter of debate; however, this theory has contributed to the rapid advance of our knowledge regarding the pathogenesis of coronary artery disease in the past few years. Moreover, the notion that coronary artery disease can be considered to be an inflammatory condition in its own right has opened new and challenging avenues for research.
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25
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Morré SA, Stooker W, Lagrand WK, van den Brule AJ, Niessen HW. Microorganisms in the aetiology of atherosclerosis. J Clin Pathol 2000; 53:647-54. [PMID: 11041053 PMCID: PMC1731245 DOI: 10.1136/jcp.53.9.647] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recent publications have suggested that infective pathogens might play an important role in the pathogenesis of atherosclerosis. This review focuses on these microorganisms in the process of atherosclerosis. The results of in vitro studies, animal studies, tissue studies, and serological studies will be summarised, followed by an overall conclusion concerning the strength of the association of the microorganism with the pathogenesis of atherosclerosis. The role of the bacteria Chlamydia pneumoniae and Helicobacter pylori, and the viruses human immunodeficiency virus, coxsackie B virus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, and measles virus will be discussed.
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Affiliation(s)
- S A Morré
- Department of Pathology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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26
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Abstract
More than a century ago, inflammation and infection were considered to have atherogenic effects. During last century, however, this hypothesis was completely abandoned, and the old idea that coronary heart disease (CHD) possibly has an infectious etiology has only re-emerged in recent years. Both viral and bacterial pathogens have been proposed to be associated with the inflammatory changes found in atherosclerosis. Herpes group viruses, especially cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV1), have been associated with both atherosclerosis and restenosis. Helicobacter pylori and dental infections have also been linked to CHD, but the evidence is strongest for a respiratory tract bacterium, Chlamydia pneumoniae. The association was originally found in seroepidemiological studies, but the presence of organisms in atherosclerotic lesions, the first animal studies and preliminary successful intervention trials with antibiotics suggest that C. pneumoniae may have a pathogenetic role in the disease. The causal relationship has not yet been proven, but ongoing large intervention trials and research on pathogenetic mechanisms may lead to the use of antimicrobial agents in the treatment of CHD in the future.
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Affiliation(s)
- M Leinonen
- Department in Oulu, KTL, National Public Health Institute, Finland.
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27
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Maass M, Jahn J, Gieffers J, Dalhoff K, Katus HA, Solbach W. Detection of Chlamydia pneumoniae within peripheral blood monocytes of patients with unstable angina or myocardial infarction. J Infect Dis 2000; 181 Suppl 3:S449-51. [PMID: 10839736 DOI: 10.1086/315610] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Because individual diagnoses of vascular infection with Chlamydia pneumoniae depend entirely on surgically removed tissues, a better assay to predict vascular infection is needed. Polymerase chain reaction detection of chlamydial DNA was applied to CD14-positive cells collected from 238 patients with angiographically identified unstable angina or acute myocardial infarction. C. pneumoniae was detected in 52 (28%) of 188 persons with unstable angina and in 13 (26%) of 50 persons with myocardial infarction. Differences between groups were not significant. C. pneumoniae is present in monocytes/macrophages of a significant proportion of persons with progressive coronary artery disease. Infarction is not accompanied by a rise in chlamydial detection rates. The potential role of chlamydiae in coronary atherosclerosis may therefore be more related to acceleration of disease or systemic effects by persistent infection than to sudden initiation of infarction by acute infection.
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Affiliation(s)
- M Maass
- Institute of Medical Microbiology and Hygiene, Medical University of Lübeck, 23538 Lübeck, Germany.
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28
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Meier CR. Antibiotics in the prevention and treatment of coronary heart disease. J Infect Dis 2000; 181 Suppl 3:S558-62. [PMID: 10839758 DOI: 10.1086/315632] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Seroepidemiology, pathology, and animal studies provide evidence for a possible association between Chlamydia pneumoniae infections and atherosclerosis, coronary heart disease, and myocardial infarction. If this association exists, then exposure to certain antibiotics may positively affect the clinical course after an acute ischemic cardiac event (secondary prevention) and affect the risk of developing a first-time myocardial infarction (primary prevention). Preliminary evidence from clinical trials suggests that treatment with new macrolide antibiotics may improve outcome after ischemic events, and evidence from a large case-control analysis indicates that exposure to tetracyclines or quinolones may reduce the risk of developing a first-time myocardial infarction. However, antibiotics for the treatment or prevention of ischemic heart disease must not be recommended yet. This review of published studies briefly summarizes the currently available literature on the effects of antibiotics on the risk of developing coronary heart disease and myocardial infarction.
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Affiliation(s)
- C R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology, Dept. of Internal Medicine, University Hospital, 4031 Basel, Switzerland.
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29
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Abstract
In literature in which detection of Chlamydia pneumoniae in the artery is described, the methods used were immunocytochemistry (ICC), polymerase chain reaction (PCR), electron microscopy, and isolation. These studies demonstrated the presence of the organism in atheromatous lesions. The organism was detected frequently by ICC and PCR in atheromatous tissues (approximately 50% of subjects) but rarely in normal arteries (approximately 1% of subjects). There has been poor correlation between detection and serology. Detection studies have been used to assess the etiologic role of C. pneumoniae in atherosclerosis and to determine whether C. pneumoniae infection contributes to acute cardiovascular events. Although these studies produced suggestive evidence of an etiologic role, the use of observational studies to obtain a definitive answer is difficult. Therefore, investigators are increasingly concentrating their efforts on studies that use animal models, in vitro cultured arterial cells, and therapeutic trials in humans to determine the pathogenic role of the organism in atherosclerosis.
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Affiliation(s)
- C Kuo
- Department of Pathobiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, USA. cckuo@u. washington.edu
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30
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Dengler TJ, Raftery MJ, Werle M, Zimmermann R, Schönrich G. Cytomegalovirus infection of vascular cells induces expression of pro-inflammatory adhesion molecules by paracrine action of secreted interleukin-1beta. Transplantation 2000; 69:1160-8. [PMID: 10762222 DOI: 10.1097/00007890-200003270-00022] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infection with human cytomegalovirus (HCMV) has been associated with vascular disease processes such as vascular allograft rejection, transplantation vasculopathy, restenosis after angioplasty, and native atherosclerosis. To elucidate underlying pathomechanisms, the effect of acute HCMV infection on the expression of pro-inflammatory adhesion molecules on human umbilical vein endothelial cells (HUVEC) and human vascular smooth muscle cells (hvSMC) was examined. METHODS AND RESULTS Cells were infected in vitro with clinical strains of HCMV and the resulting changes in adhesion molecule expression were quantified by histology and flow cytometric analysis. On HUVEC, surface expression of vascular cell adhesion molecule-1 and E-selectin was induced de novo on HCMV infection and intercellular adhesion molecule-1 expression was increased by >200%. On hvSMC, intercellular adhesion molecule-1 surface expression induced de novo, although vascular cell adhesion molecule-1 and E-selectin were not changed. Expression of major histocompatibility complex (MHC) class II, lymphocyte-function associated antigen 3 (LFA-3; CD58), and CD40 was not altered by HCMV infection in either cell type. In partially infected cultures, up-regulation of surface molecules also occurred on noninfected cells, suggesting a paracrine mechanism via a soluble factor. Expression of surface molecules could be enhanced in noninfected HUVEC and hvSMC by incubation with virus-free conditioned supernatant from HCMV-infected cells or by coincubation in transwells with infected cells. The responsible agent could be identified as IL- interleukin- (IL) 1beta by detection of de novo secretion of IL-1beta by HCMV-infected cells and by prevention of adhesion molecule up-regulation after addition of an IL-1-converting enzyme inhibitor or IL-1 receptor antagonist. Surface molecule up-regulation could be suppressed by UV inactivation of virus, but not by treatment of cell cultures with inhibitors of viral replication (ganciclovir). CONCLUSION We propose that HCMV infection induces IL-1beta release and subsequent up-regulation of pro-inflammatory adhesion molecules on noninfected neighboring cells through a paracrine mechanism. This may lead to local potentiation of the inflammatory effects of HCMV infection, not amenable to current therapeutic antiviral strategies.
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MESH Headings
- Cell Adhesion Molecules/biosynthesis
- Cell Adhesion Molecules/physiology
- Cells, Cultured
- Chemokines/biosynthesis
- Culture Media, Conditioned/chemistry
- Cytomegalovirus Infections/physiopathology
- Endothelium, Vascular/cytology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/virology
- Enzyme-Linked Immunosorbent Assay
- Humans
- Interleukin-1/analysis
- Interleukin-1/antagonists & inhibitors
- Interleukin-1/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/virology
- Tumor Necrosis Factor-alpha/analysis
- Umbilical Veins/cytology
- Up-Regulation
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Affiliation(s)
- T J Dengler
- Department of Cardiology, University of Heidelberg, Germany
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31
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Abstract
Cardiovascular diseases, particularly coronary heart disease (CHD) and myocardial infarction (MI), are among the leading causes for morbidity and mortality in industrialized countries [2, 77]. During the past decades, various clinical or lifestyle risk factors for myocardial infarction such as hyperlipidemia, hypertension, obesity, lack of physical exercise and smoking have been identified. However, it is also recognized that these well-documented risk factors do not sufficiently account for all new cases of myocardial infarction [77]. Many patients with myocardial infarction have only a borderline risk profile or even lack known risk factors. The question arises: What additional risk factors may play a role in the etiology of atherosclerosis and ischemic heart disease?
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Affiliation(s)
- C R Meier
- Basel Pharmacoepidemiology Unit, Department of Internal Medicine, University Hospital, Switzerland
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