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Di Pietro M, Filardo S, Romano S, Sessa R. Chlamydia trachomatis and Chlamydia pneumoniae Interaction with the Host: Latest Advances and Future Prospective. Microorganisms 2019; 7:microorganisms7050140. [PMID: 31100923 PMCID: PMC6560445 DOI: 10.3390/microorganisms7050140] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 12/27/2022] Open
Abstract
Research in Chlamydia trachomatis and Chlamydia pneumoniae has gained new traction due to recent advances in molecular biology, namely the widespread use of the metagenomic analysis and the development of a stable genomic transformation system, resulting in a better understanding of Chlamydia pathogenesis. C. trachomatis, the leading cause of bacterial sexually transmitted diseases, is responsible of cervicitis and urethritis, and C. pneumoniae, a widespread respiratory pathogen, has long been associated with several chronic inflammatory diseases with great impact on public health. The present review summarizes the current evidence regarding the complex interplay between C. trachomatis and host defense factors in the genital micro-environment as well as the key findings in chronic inflammatory diseases associated to C. pneumoniae.
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Affiliation(s)
- Marisa Di Pietro
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome "Sapienza", 00185 Rome, Italy.
| | - Simone Filardo
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome "Sapienza", 00185 Rome, Italy.
| | - Silvio Romano
- Cardiology, Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Rosa Sessa
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome "Sapienza", 00185 Rome, Italy.
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Pesonen E, Liuba P, Aburawi EH. Review findings included diminished coronary flow reserve after surgery in children with congenital heart disease and inflammation. Acta Paediatr 2019; 108:218-223. [PMID: 30312493 DOI: 10.1111/apa.14613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/08/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Abstract
AIM The aim of this review was to develop a deeper knowledge of the physiology of coronary blood flow and coronary flow reserve in young patients with congenital heart disease and inflammatory diseases. METHODS We searched for papers published in English on coronary blood flow and coronary flow reserve using the PubMed and Google search databases. This identified 42 papers extending back to 1976 and a book from 2008 (Davis et al. Microcirculation. Boston, MA: Elsevier, 2008: 161-284). RESULTS Our review showed that the implications of coronary blood flow and coronary flow reserve in paediatric patients with congenital heart disease and inflammatory diseases are still not fully understood. However, a key finding was that coronary flow reserve was diminished in patients with congenital heart disease and inflammation after surgery, with or without a cardiopulmonary bypass. Other findings discussed by this review relate to volume and pressure overload in acyanotic congenital heart disease, reduced myocardial perfusion and cyanotic congenital heart disease. CONCLUSION We still have much to discover about paediatric patients with congenital heart disease and inflammatory diseases. Understanding the pathophysiology of coronary blood flow could help the postoperative treatment of such patients.
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Affiliation(s)
- Erkki Pesonen
- Children's Heart Center; Skåne University Hospital Lund; Lund University; Lund Sweden
| | - Petru Liuba
- Children's Heart Center; Skåne University Hospital Lund; Lund University; Lund Sweden
| | - Elhadi H. Aburawi
- Children's Heart Center; Skåne University Hospital Lund; Lund University; Lund Sweden
- Department of Paediatrics; College of Medicine and Health Sciences; United Arab Emirates University; Al-Ain United Arab Emirates
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Odermarsky M, Pesonen E, Sorsa T, Lernmark Å, Pussinen PJ, Liuba P. HLA, infections and inflammation in early stages of atherosclerosis in children with type 1 diabetes. Acta Diabetol 2018; 55:41-47. [PMID: 29064046 PMCID: PMC5794827 DOI: 10.1007/s00592-017-1063-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/26/2017] [Indexed: 01/30/2023]
Abstract
AIMS This prospective study focuses on risk factors for arterial damage in children with type 1 diabetes (T1D). METHODS Eighty children and adolescents with T1D were investigated twice, approximately 2 years apart, for carotid artery intima-media thickness (cIMT) and compliance (CAC), flow-mediated dilatation (FMD) of the brachial artery, and plasma levels of matrix metalloproteinase (MMP)-8. All subjects were genotyped for HLA. The number of respiratory tract infections (RTI) during the past year was obtained by a questionnaire in 56 patients. RESULTS cIMT progression, defined as percentage (%) change of cIMT from baseline, correlated inversely with the % changes of both CAC (p = 0.04, r = - 0.3; n = 62) and FMD (p = 0.03, r = - 0.3; n = 47). In multivariate analysis, RTI frequency correlated significantly with cIMT progression irrespective of age, diabetes duration, BMI, and HbA1c (p = 0.03, r = 0.3). When patients were divided in relation to RTI, the association of DQ2/8 with cIMT progression remained significant in patients with over three infections/year (p = 0.04, r = 0.3). During follow-up, the group of DQ2/8 patients with hsCRP > 1 mg/l showed significantly higher levels of plasma MMP-8 than the non-DQ2/8 group. CONCLUSIONS The diabetes-risk genotype DQ2/8 and systemic inflammation contribute to pro-atherosclerotic vascular changes in children and adolescents with T1D.
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Affiliation(s)
- Michal Odermarsky
- Department of Paediatric Cardiology, Paediatric Heart Center, Lund University and Skåne University Hospital, 22185, Lund, Sweden
| | - Erkki Pesonen
- Department of Paediatric Cardiology, Paediatric Heart Center, Lund University and Skåne University Hospital, 22185, Lund, Sweden
| | - Timo Sorsa
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Pirkko J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Petru Liuba
- Department of Paediatric Cardiology, Paediatric Heart Center, Lund University and Skåne University Hospital, 22185, Lund, Sweden.
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Pothineni NVK, Subramany S, Kuriakose K, Shirazi LF, Romeo F, Shah PK, Mehta JL. Infections, atherosclerosis, and coronary heart disease. Eur Heart J 2017; 38:3195-3201. [DOI: 10.1093/eurheartj/ehx362] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022] Open
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Campbell LA, Rosenfeld ME. Infection and Atherosclerosis Development. Arch Med Res 2015; 46:339-50. [PMID: 26004263 PMCID: PMC4524506 DOI: 10.1016/j.arcmed.2015.05.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/12/2015] [Indexed: 01/19/2023]
Abstract
Atherosclerosis is a chronic disease hallmarked by chronic inflammation, endothelial dysfunction and lipid accumulation in the vasculature. Although lipid modification and deposition are thought to be a major source of the continuous inflammatory stimulus, a large body of evidence suggests that infectious agents may contribute to atherosclerotic processes. This could occur by either direct effects through infection of vascular cells and/or through indirect effects by induction of cytokine and acute phase reactant proteins by infection at other sites. Multiple bacterial and viral pathogens have been associated with atherosclerosis by seroepidemiological studies, identification of the infectious agent in human atherosclerotic tissue, and experimental studies demonstrating an acceleration of atherosclerosis following infection in animal models of atherosclerosis. This review will focus on those infectious agents for which biological plausibility has been demonstrated in animal models and on the challenges of proving a role of infection in human atherosclerotic disease.
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Affiliation(s)
- Lee Ann Campbell
- Department of Epidemiology, School of Public Health, Seattle, Washington, USA.
| | - Michael E Rosenfeld
- Departments of Environmental, Health and Occupational Sciences and Pathology, University of Washington, Seattle, Washington, USA
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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: 2.2] [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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Birck MM, Saraste A, Hyttel P, Odermarsky M, Liuba P, Saukko P, Hansen AK, Pesonen E. Endothelial cell death and intimal foam cell accumulation in the coronary artery of infected hypercholesterolemic minipigs. J Cardiovasc Transl Res 2013; 6:579-87. [PMID: 23580230 DOI: 10.1007/s12265-013-9463-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/27/2013] [Indexed: 11/29/2022]
Abstract
Apoptosis of endothelial cells (ECs) has been suggested to play a role in atherosclerosis. We studied the synergism of hypercholesterolemia with Chlamydia pneumoniae and influenza virus infections on EC morphology and intimal changes in a minipig model. The coronary artery was excised at euthanasia (19 weeks of age) and serial sections were processed for the detection of EC apoptosis, histology, and transmission electron microscopy (TEM) studies. There was a significantly higher number of TUNEL-positive ECs in infected compared to noninfected groups [0.2942 % (interquartile ranges (IR), 0.2941; n = 26) versus 0 % (IR, 0; n = 12), p < 0.01]. Caspase-3 staining was negative. Cholesterol diet together with infections induced widening of the subendothelial space and appearance of increased numbers of foam cells. TEM revealed degenerative changes in cytoplasmic organelles and signs of EC necrosis. In conclusion, infection leads to an increase in coronary EC death and seems to exacerbate cholesterol-induced intimal thickening and foam cell accumulation.
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Affiliation(s)
- Malene M Birck
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 9, 1870, Frederiksberg C, Denmark.
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Aburawi EH, Malcus P, Thuring A, Fellman V, Pesonen E. Coronary Flow in Neonates with Impaired Intrauterine Growth. J Am Soc Echocardiogr 2012; 25:313-8. [DOI: 10.1016/j.echo.2011.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Indexed: 11/28/2022]
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Deniset JF, Hedley TE, Dibrov E, Pierce GN. Chlamydophila pneumoniae infection induces alterations in vascular contractile responses. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 180:1264-1272. [PMID: 22214836 DOI: 10.1016/j.ajpath.2011.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 10/11/2011] [Accepted: 11/11/2011] [Indexed: 11/29/2022]
Abstract
Chlamydophila pneumoniae infection has been associated in previous studies with coronary artery disease. The live bacterium has been detected within atherosclerotic plaques and can induce the structural remodeling of the vessel wall. However, the direct effects of infection on the contractile characteristics of the arteries remain unknown. Left anterior descending coronary arteries isolated from porcine hearts were dissected and placed in culture medium for 72 hours before infection with C. pneumoniae. Contractile responses to high molar KCl and u46619 levels and relaxation responses to bradykinin and sodium nitroprusside were assessed at days 5 and 10 postinfection. C. pneumoniae induced decreases in both KCl- and u46619-induced contractile responses at both time points. The altered contractile responses coincided with a down-regulation of L-type Ca(2+) channels at both time points and inositol 1,4,5-triphosphate receptor (IP3R) levels at day 10 postinfection. Infection also induced attenuation of the endothelial-dependent relaxation response to bradykinin at day 10 postinfection. A decrease in endothelial nitric oxide synthase expression levels was noted at day 10 postinfection. Furthermore, an increase in superoxide production combined with an increase in p22phox expression levels was also observed at this time point. These findings indicate that C. pneumoniae infection can directly alter the vascular contractile responses in porcine coronary arteries, providing additional evidence for the role of C. pneumoniae infection in cardiovascular disease.
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Affiliation(s)
- Justin F Deniset
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Department of Physiology, Faculties of Medicine and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas E Hedley
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Department of Physiology, Faculties of Medicine and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elena Dibrov
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Department of Physiology, Faculties of Medicine and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Grant N Pierce
- Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Department of Physiology, Faculties of Medicine and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Birck MM, Pesonen E, Odermarsky M, Hansen AK, Persson K, Frikke-Schmidt H, Heegaard PMH, Liuba P. Infection-induced coronary dysfunction and systemic inflammation in piglets are dampened in hypercholesterolemic milieu. Am J Physiol Heart Circ Physiol 2011; 300:H1595-601. [DOI: 10.1152/ajpheart.01253.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The synergism of infection with conventional cardiovascular risk factors in atherosclerosis is much debated. We hypothesized that coronary arterial injury correlates with infection recurrence and pathogen burden and is further aggravated by hypercholesterolemia. Forty-two Göttingen minipigs were assigned to repeated intratracheal inoculation of PBS, Chlamydia pneumoniae (Cpn), or both Cpn and influenza virus at 8, 11, and 14 wk of age. Animals were fed either standard or 2% cholesterol diet (chol-diet). At 19 wk of age coronary vasomotor responses to acetylcholine (ACh) and adenosine were assessed in vivo and blood and tissue samples were collected. Nonparametric tests were used to compare the groups. In cholesterol-fed animals, total cholesterol/HDL was significantly increased in infected animals compared with noninfected animals [3.13 (2.17–3.38) vs. 2.03 (1.53–2.41), respectively; P = 0.01]. C-reactive protein (CRP) rose in infected animals [10.60 (4.96–18.00) vs. 2.47 (1.44–3.01) μg/ml in noninfected; P < 0.01] without significant difference between the mono- and coinfected groups. Among coinfected animals, both CRP and haptoglobin were lower in those fed chol-diet than in those fed standard diet ( P < 0.05). The vasoconstricting response to ACh was most prominent in coinfected animals {769.3 (594–1,129) cm; P = 0.03 vs. noninfected [342 (309–455) cm] and P = 0.07 vs. monoinfected [415 (252.5–971.8) cm]}. Among monoinfected animals, similar to CRP, a trend for less vasoconstriction was observed in those fed chol-diet ( P = 0.08). Coinfection of piglets appears to be associated with more pronounced coronary muscarinic vasomotor dysfunction. In monoinfected animals, use of chol-diet seems to dampen both coronary dysfunction and systemic inflammation induced by infection.
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Affiliation(s)
- Malene M. Birck
- Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Erkki Pesonen
- Division of Pediatric Cardiology, Department of Pediatrics, Skåne University Hospital, Lund and
| | - Michal Odermarsky
- Division of Pediatric Cardiology, Department of Pediatrics, Skåne University Hospital, Lund and
| | - Axel K. Hansen
- Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Kenneth Persson
- Department of Microbiology, Skåne University Hospital, Malmö, Sweden; and
| | - Henriette Frikke-Schmidt
- Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Peter M. H. Heegaard
- Innate Immunology Group, National Veterinary Institute, Technical University of Denmark, Copenhagen, Denmark
| | - Petru Liuba
- Division of Pediatric Cardiology, Department of Pediatrics, Skåne University Hospital, Lund and
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11
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Tuomainen AM, Hyvärinen K, Ehlers PI, Mervaala E, Leinonen M, Saikku P, Kovanen PT, Jauhiainen M, Pussinen PJ. The effect of proatherogenic microbes on macrophage cholesterol homeostasis in apoE-deficient mice. Microb Pathog 2011; 51:217-24. [PMID: 21421042 DOI: 10.1016/j.micpath.2011.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 03/11/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathogens such as Aggregatibacter actinomycetemcomitans (Aa) and Chlamydia pneumoniae (Cpn) associate with an increased risk for cardiovascular diseases by inducing inflammation. We hypothesized that the pathogens affect the vascular wall by disturbing cholesterol homeostasis and endothelial function. METHODS Aa- and Cpn-infections were induced in apoE-deficient mice by intravenous and intranasal applications, respectively. Cholesterol efflux from mouse peritoneal macrophages to apo(lipoprotein)A-I was assessed. The efflux capacity of mouse sera as acceptors of cholesterol from RAW264.7-macrophages was determined. Additionally, endothelial function was studied by following the relaxation capacity of rat mesenteric arteries after incubation in the conditioned culture media of the peritoneal macrophages isolated from the mice. RESULTS Infection increased serum phospholipid transfer protein (PLTP) and lipopolysaccharide (LPS) activity, as well as serum amyloid A (SAA) and TNF-α concentrations. Peritoneal macrophages of mice with Aa-infection showed increased cholesterol uptake and reduced cholesterol efflux. Sera of Cpn and Cpn + Aa-infected mice had reduced cholesterol efflux capacity from RAW264.7-macrophages. Conditioned macrophage medium from mice with chronic C. pneumoniae infection induced endothelial dysfunction. Additionally, concentrations of serum adhesion molecules, intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) in Cpn-groups and E-selectin in Cpn + Aa-group, were elevated. The serum markers of endothelial function correlated positively with SAA. CONCLUSIONS Aa- and Cpn-infections may generate proatherogenic changes in the vascular wall by affecting the macrophage cholesterol homeostasis and endothelial function.
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Affiliation(s)
- Anita M Tuomainen
- Institute of Dentistry, University of Helsinki, FI-00014 Helsinki, Finland
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12
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Deniset JF, Pierce GN. Possibilities for therapeutic interventions in disrupting Chlamydophila pneumoniae involvement in atherosclerosis. Fundam Clin Pharmacol 2011; 24:607-17. [PMID: 20653790 DOI: 10.1111/j.1472-8206.2010.00863.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Strong sero-epidemiologic, pathologic, and experimental evidence suggests that Chlamydophila pneumoniae (Cpn) infection may play a causative role in the development of atherosclerosis. Cpn is an obligate intracellular gram-negative bacterium that is responsible for 10% of cases of community-acquired pneumonia. In addition to its presence in the respiratory tract, live Cpn has been found within atherosclerotic plaques. Experimental findings have established Cpn's ability to infect vascular cells and elicit important atherogenic responses. Furthermore, Cpn infection can promote atherosclerotic development in different animal models. To date however, large-scale antibiotic clinical trials have not been effective in preventing major cardiovascular events. It is becoming apparent that Cpn undergoes a persistent state of infection, which is refractory to current chlamydial antibiotics. New treatment strategies that are effective toward acute and persistent forms of Cpn infection are needed in order to effectively eradicate the bacterium within the vascular wall. Possible therapeutics targets include Cpn-specific proteins and machinery directly involved in their survival, replication and maintenance. Alternatively, selectively targeting host cell pathways and machinery required for Cpn's actions in vascular cells also represent potential treatment strategies for atherosclerosis.
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Affiliation(s)
- Justin F Deniset
- Department of Physiology, Faculties of Medicine and Pharmacy, Institute of Cardiovascular Sciences, St Boniface General Hospital Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Karinen L, Leinonen M, Bloigu A, Paldanius M, Koskela P, Saikku P, Hartikainen AL, Järvelin MR, Pouta A. Maternal SerumChlamydia PneumoniaeAntibodies and CRP Levels in Women with Preeclampsia and Gestational Hypertension. Hypertens Pregnancy 2009; 27:143-58. [DOI: 10.1080/10641950701885188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pesonen E, Andsberg E, Grubb A, Rautelin H, Meri S, Persson K, Puolakkainen M, Sarna S, Öhlin H. Elevated infection parameters and infection symptoms predict an acute coronary event. Ther Adv Cardiovasc Dis 2008; 2:419-24. [DOI: 10.1177/1753944708098695] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The etiology and significance of flu-like symptoms often appearing before myocardial infarction should be clarified. Methods: In a case-control study of 323 matched controls and a random sample of 110 out of 351 cases the presence of infection symptoms during the preceding four weeks before admission were asked and blood samples taken. Results: Enterovirus (EV), herpes simplex virus (HSV), and Chlamydia pneumoniae IgA titers were significantly higher in cases than in controls ( p<0.001, 0.008 and 0.046, respectively). Flu-like symptoms appeared significantly more often in patients than in controls the most common one being fatigue ( p<0.001). In controls with fatigue, EV and HSV titers showed a trend to be higher (1.50 vs 1.45 and 4.29 vs 3.73) than in controls without fatigue but only HSV titers were statistically significantly higher (3.47 vs 3.96, p = 0.02). Even CRP and amyloid A concentrations (3.49 vs 2.08, p<0.0001 and 5.70 vs 3.77 mg/l, p = 0.003, respectively) as well as C4 (0.40 vs 0.44, p = 0.02) were higher in controls with fatigue. Conclusions: Odds ratios for a coronary event in a logistic regression model were 4.79 for fatigue and 2.72 for EV antibody levels in their fourth quartile. A linear-by-linear association test showed increasing number of single symptoms with higher EV titer quartiles ( p = 0.004).
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Affiliation(s)
- Erkki Pesonen
- Department of Pediatric Cardiology, University Hospital, Lund, Sweden,
| | - Eva Andsberg
- Department of Pediatric Cardiology, University Hospital, Lund, Sweden
| | - Anders Grubb
- Department of Clinical Chemistry, University Hospital, Lund, Sweden
| | - Hilpi Rautelin
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital Laboratory, Helsinki, Finland
| | - Seppo Meri
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki and Helsinki University Central Hospital Laboratory, Helsinki, Finland
| | - Kenneth Persson
- Department of Microbiology, University Hospital, Lund, Sweden
| | - Mirja Puolakkainen
- Helsinki University Central Hospital Laboratory and Department of Virology, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Seppo Sarna
- Department of Public Health, Helsinki University, Helsinki, Finland
| | - Hans Öhlin
- Department of Cardiology, University Hospital, Lund, Sweden
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15
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Harskamp RE, van Ginkel MW. Acute respiratory tract infections: a potential trigger for the acute coronary syndrome. Ann Med 2008; 40:121-8. [PMID: 18293142 DOI: 10.1080/07853890701753672] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Clinical studies suggest that acute respiratory tract infection (ARTI) may be a risk factor for the acute coronary syndrome (ACS). ARTI is associated with an increased risk for ACS up to 2 weeks prior to a cardiac event. The mechanism that may underlie this association is unclear. Infections are thought to play a role in the progression and instability of atherosclerotic plaques, resulting in plaque rupture, sudden constriction, and/or blockage of coronary arteries. Inflammation, endothelial dysfunction and thrombotic activation seem to play an important role in this. Influenza vaccination may reduce the risk of ACS in patients with coronary artery disease. Future studies will provide more information about the underlying mechanisms of infection-related ACS.
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Affiliation(s)
- Ralf E Harskamp
- University of Texas Health Science Center at San Antonio, Division of Cardiothoracic Surgery, San Antonio, Texas 78229-3900, USA.
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Chen YW, Umeda M, Nagasawa T, Takeuchi Y, Huang Y, Inoue Y, Iwai T, Izumi Y, Ishikawa I. Periodontitis may increase the risk of peripheral arterial disease. Eur J Vasc Endovasc Surg 2007; 35:153-8. [PMID: 17964192 DOI: 10.1016/j.ejvs.2007.08.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Accepted: 08/26/2007] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this case control study was to evaluate whether periodontitis was associated with peripheral arterial disease (PAD). SUBJECTS AND METHODS Twenty-five patients diagnosed with aorto-iliac and/or femoro-popliteal occlusive disease and thirty-two generally healthy control subjects were enrolled in this study. Polymerase chain reaction (PCR) was used to identify Porphyromonas gingivalis, Treponema denticola, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Cytomegalovirus (CMV), Chlamydia pneumoniae, and Helicobacter pylori in tissue specimens taken from the anastomotic site of distal bypasses. Periodontal status was evaluated; serum IgG titres against the four listed bacteria were measured. RESULTS Periodontopathic bacteria were detected in 13/25 (52%) atherosclerotic specimens. CMV or C. pneumoniae was detected in 1/25 (4%) specimens; H. pylori was not detected from any of these specimens. Fontaine grade III or IV patients showed higher detection frequency of P. gingivalis than Fontaine grade II patients (57.1% vs 22.2%, P=0.09). After adjusting for age, gender, diabetes and smoking, periodontitis increased 5-fold the risk of having PAD (OR 5.45). There were preliminary indications that periodontitis was associated with increased serum IL-6 and TNF-alpha concentrations. CONCLUSIONS This study suggests that periodontitis may be associated with an increased risk of PAD. This association could result from the increased concentration of serum inflammatory cytokines in those with periodontitis.
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Affiliation(s)
- Y-W Chen
- Periodontology, Department of Hard Tissue Engineering, Graduate School, Tokyo Medical and Dental University, Yushima, Tokyo, Japan.
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Pesonen E, Andsberg E, Öhlin H, Puolakkainen M, Rautelin H, Sarna S, Persson K. Dual role of infections as risk factors for coronary heart disease. Atherosclerosis 2007; 192:370-5. [DOI: 10.1016/j.atherosclerosis.2006.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Revised: 04/10/2006] [Accepted: 05/03/2006] [Indexed: 12/21/2022]
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Mussa FF, Chai H, Wang X, Yao Q, Lumsden AB, Chen C. Chlamydia pneumoniae and vascular disease: an update. J Vasc Surg 2006; 43:1301-7. [PMID: 16765261 DOI: 10.1016/j.jvs.2006.02.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 02/26/2006] [Indexed: 11/16/2022]
Abstract
Exposure to Chlamydia pneumoniae is extremely common, and its incidence increases with age. C pneumoniae infection is strongly associated with coronary artery disease, as well as with atherosclerosis of the carotid artery, aorta, and peripheral arteries. This association has been shown in seroepidemiologic studies and by direct detection of the organism in atherosclerotic lesions by immunohistochemistry, polymerase chain reaction, electron microscopy, and tissue culture. Animal models of atherosclerosis have been used to study the role of C pneumoniae in the initiation and progression of atherosclerotic disease. The association of this organism with cardiovascular complications has inspired many human trials of antibiotics for the secondary prevention of atherosclerosis. C pneumoniae can infect several types of cells, including circulating macrophages, arterial smooth muscle cells, and vascular endothelial cells, causing the secretion of proinflammatory cytokines and procoagulants by endothelial cells and foam cell formation by infected macrophages. This report reviews the role of C pneumoniae in atherogenesis in light of recent, large antibiotic treatment trials, animal studies, and in vitro studies. The role of Chlamydia heat shock protein as a potential mediator of this harmful effect is also reviewed.
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Affiliation(s)
- Firas F Mussa
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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Liuba P, Pesonen E, Forslid A, Paakkari I, Kornerup-Hansen A, Kovanen P, Pentikäinen M, Persson K, Østergård G. Protective effects of simvastatin on coronary artery function in swine with acute infection. Atherosclerosis 2005; 186:331-6. [PMID: 16223501 DOI: 10.1016/j.atherosclerosis.2005.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 08/11/2005] [Accepted: 08/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The risk for coronary events may rise during acute infection. Perturbation in coronary endothelial function emerges as one important link. We investigated whether simvastatin could protect the coronary arterial function from the adverse effects of acute infection in swine. METHODS Coronary endothelium-dependent and -independent vasomotor responses were assessed by Doppler velocimetry in 12 Chlamydia pneumoniae-infected and 6 sham-infected swine 2 weeks after intratracheal inoculation. Half of animals from the infection group were pre-treated with simvastatin (80 mg daily), while the remaining animals received placebo. The treatment was started 2 weeks prior to inoculation and continued until the end of the study. ANOVA was used for statistical calculations. Data are mean+/-S.D. RESULTS All animals inoculated with C. pneumoniae developed IgM antibodies against this organism. As compared to noninfected animals, peak-to-baseline coronary flow velocity (CFV) ratio after bradykinin was significantly decreased in infected animals regardless of statin treatment (p=0.01). Intracoronary 10(-6) M acetylcholine caused slight dilatory responses in both noninfected and infected-treated animals (CFV ratio: 1.6+/-0.2 and 1.4+/-0.2, respectively; p>0.1), while a velocity drop (CFV ratio: 0.7+/-0.1; p<0.01 versus noninfected-infected and treated), indicating constriction, was observed in infected-nontreated animals; 10(-5) M acetylcholine caused vasoconstriction in all animals, with a significantly more prolonged response in the infected-nontreated group (p<0.01). Intracoronary adenosine and SNP induced similar dilatory responses in all groups (p>0.5). There were no differences in markers of systemic inflammation (fibrinogen, amyloid, and CRP) and lipid profile (HDL, LDL and total cholesterol) between the groups (p>0.2). CONCLUSION Acute infection is associated with impairment of the muscarinic and kinin-related reactivity of coronary circulation. These functional abnormalities are in part prevented by simvastatin through mechanisms unrelated to lipid lowering.
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Affiliation(s)
- Petru Liuba
- Department of Pediatric Cardiology, Lund University Hospital, 22185 Lund, Sweden.
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Abstract
UNLABELLED Although clinical manifestations of atherosclerotic coronary heart disease occur in adult life, the initial stages of its development commence in childhood. Therefore, elucidating the pathogenesis of early atherosclerosis and identifying the network of risk factors have become fundamental priorities for both cardiovascular healthcare providers and scientists. There is mounting evidence from both human studies and animal experiments that infectious pathogens could be implicated in atherosclerosis development. The vulnerability of the arterial wall to the adverse effects of infection is probably augmented when additional risk factors and/or certain proatherogenic genetic profiles are also present. The precise mechanisms whereby infection, alone or in synergy with conventional cardiovascular risk factors, could contribute to atherosclerosis are not fully understood. CONCLUSION Injury to the vascular endothelium, which could be elicited by infection through inflammatory, metabolic, autoimmune, and pathogen-related mechanisms, might be a central link between infection and early atherosclerosis.
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Affiliation(s)
- Petru Liuba
- Division of Paediatric Cardiology, Children's Hospital, University Hospital Lund, Lund, Sweden.
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Abstract
Children already have intimal thickenings occupying over half of the vascular lumen. Intimal thickening is one of the first steps in atherogenesis. Classical risk factors such as hypercholesterolaemia, genetic background and acute noxious factors play a role in its development. Genetic origin of the children from high-risk groups for coronary heart disease seems to be a determinant of the magnitude of thickenings. Extrinsic factors such as infections also seem to play a role. The magnitude of the thickening is related to viral and bacterial infections. Infections may lead to endothelial injury and secondary intimal thickening. The process may advance stepwise with acute exacerbations of endothelial dysfunction and intimal thickening followed by incomplete healing. In particular, repeated acute infections might lead to permanent damage. Morphological evidence for early atherogenesis in children is presented.
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Affiliation(s)
- E Pesonen
- Department of Paediatric Cardiology, Lund University Hospital, Lund, Sweden.
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Liuba P. Arterial endothelial injury due to infection in childhood: ticking bomb or innocent bystander? Acta Paediatr 2004; 93:55-62. [PMID: 15702671 DOI: 10.1111/j.1651-2227.2004.tb00240.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atherosclerosis is regarded as a chronic disease that begins in early life. While the main underlying mechanism of atherosclerosis is nowadays unequivocally attributed to a low-grade inflammatory reaction, the spectrum of aetiological conditions is far from being fully elucidated. Both viruses and bacteria have been suggested to intervene at various stages of atherosclerosis development, although a clear pathogenic link between infection and atherosclerosis remains debatable. As one key event in atherogenesis involves a perturbation of the protective mechanisms normally posed by the arterial endothelium, a number of studies have enquired into the possible detrimental effects of microbes and their components on the endothelial cells. This review aims to scrutinize the current literature in this regard, and to suggest several possible directions for future studies.
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Affiliation(s)
- P Liuba
- Division of Paediatric Cardiology, University Hospital Lund, Lund, Sweden.
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Haubitz M, Votsch K, Woywodt A, Nashan B, Groh A, Haller H, Brunkhorst R. SEROLOGIC EVIDENCE OF CHLAMYDIA PNEUMONIAE INFECTION AS A LONG-TERM PREDICTOR OF CARDIOVASCULAR DEATH IN RENAL TRANSPLANT RECIPIENTS. Transplantation 2004; 77:1517-21. [PMID: 15239614 DOI: 10.1097/01.tp.0000121194.20339.0a] [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: 02/05/2023]
Abstract
BACKGROUND Cardiovascular disease is the main cause of death with a functioning graft in renal transplant recipients. Elevated levels of C-reactive protein (CRP) and evidence of chronic Chlamydia pneumoniae infection have been linked to cardiovascular disease and survival in patients with normal renal function and patients with end-stage renal disease on dialysis. So far, no such data have been available in renal transplant recipients. METHODS CRP, immunoglobulin (Ig)G and IgA antibodies to C. pneumoniae, and classic risk factors were compiled in 143 patients who underwent renal transplantation between January 1989 and April 1991. Samples were collected at transplantation, 1 year later, and at study end. Cardiovascular disease, death, and graft loss were documented during follow-up. RESULTS A total of 44 patients died during a mean follow-up of 10 years. Cardiac events were responsible for 37% of deaths. Age, gender, number of antihypertensive drugs, and seropositivity for IgG and IgA antibodies to C. pneumoniae, but not CRP levels, were significantly associated with cardiac death. C. pneumoniae serology and CRP levels, however, did not influence graft survival. Age, presence of diabetes, calcium phosphorus ion product, number of antihypertensive drugs, serum creatinine at 1 year, and presence of chronic rejection were all negatively correlated with graft survival. CONCLUSIONS Serologic evidence of chronic C. pneumoniae infection is associated with mortality as the result of cardiovascular disease in renal transplant recipients. CRP serum levels do not predict cardiac death in renal transplant recipients, in contrast with patients with normal renal function and patients on dialysis.
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Affiliation(s)
- Marion Haubitz
- Department of Nephrology, Hannover Medical School, Carl-Neuberg-Strasse-1, 30625 Hannover, Germany.
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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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