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de Jong MJM, Schaftenaar FH, Depuydt MAC, Lozano Vigario F, Janssen GMC, Peeters JAHM, Goncalves L, Wezel A, Smeets HJ, Kuiper J, Bot I, van Veelen P, Slütter B. Virus-Associated CD8 + T-Cells Are Not Activated Through Antigen-Mediated Interaction Inside Atherosclerotic Lesions. Arterioscler Thromb Vasc Biol 2024; 44:1302-1314. [PMID: 38511327 DOI: 10.1161/atvbaha.123.320539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Viral infections have been associated with the progression of atherosclerosis and CD8+ T-cells directed against common viruses, such as influenza, Epstein-Barr virus, and cytomegalovirus, have been detected inside human atherosclerotic lesions. These virus-specific CD8+ T-cells have been hypothesized to contribute to the development of atherosclerosis; however, whether they affect disease progression directly remains unclear. In this study, we aimed to characterize the activation status of virus-specific CD8+ T-cells in the atherosclerotic lesion. METHODS The presence, clonality, tissue enrichment, and phenotype of virus-associated CD8+ T-cells in atherosclerotic lesions were assessed by exploiting bulk T-cell receptor-β sequencing and single-cell T-cell receptor (α and β) sequencing datasets on human endarterectomy samples and patient-matched blood samples. To investigate if virus-specific CD8+ T-cells can be activated through T-cell receptor stimulation in the atherosclerotic lesion, the immunopeptidome of human plaques was determined. RESULTS Virus-associated CD8+ T-cells accumulated more in the atherosclerotic lesion (mean=2.0%), compared with patient-matched blood samples (mean=1.4%; P=0.05), and were more clonally expanded and tissue enriched in the atherosclerotic lesion in comparison with nonassociated CD8+ T-cells from the lesion. Single-cell T-cell receptor sequencing and flow cytometry revealed that these virus-associated CD8+ T-cells were phenotypically highly similar to other CD8+ T-cells in the lesion and that both exhibited a more activated phenotype compared with circulating T-cells. Interestingly, virus-associated CD8+ T-cells are unlikely to be activated through antigen-specific interactions in the atherosclerotic lesion, as no virus-derived peptides were detected on HLA-I in the lesion. CONCLUSIONS This study suggests that virus-specific CD8+ T-cells are tissue enriched in atherosclerotic lesions; however, their potential contribution to inflammation may involve antigen-independent mechanisms.
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MESH Headings
- Humans
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/virology
- Plaque, Atherosclerotic
- Lymphocyte Activation
- Atherosclerosis/immunology
- Atherosclerosis/virology
- Atherosclerosis/pathology
- Male
- Phenotype
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Female
- Middle Aged
- Aged
- Carotid Artery Diseases/immunology
- Carotid Artery Diseases/virology
- Carotid Artery Diseases/pathology
- Host-Pathogen Interactions
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Affiliation(s)
- Maaike J M de Jong
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
| | - Frank H Schaftenaar
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
| | - Marie A C Depuydt
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
| | - Fernando Lozano Vigario
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
| | - George M C Janssen
- Department of Immunology, Leiden University Medical Centre, Center for Proteomics and Metabolomics, the Netherlands (G.M.C.J., P.v.V.)
| | - Judith A H M Peeters
- Department of Surgery, Haaglanden Medical Center - location Westeinde, Lijnbaan, The Hague, the Netherlands (J.A.H.M.P., L.G., A.W., H.J.S.)
| | - Lauren Goncalves
- Department of Surgery, Haaglanden Medical Center - location Westeinde, Lijnbaan, The Hague, the Netherlands (J.A.H.M.P., L.G., A.W., H.J.S.)
| | - Anouk Wezel
- Department of Surgery, Haaglanden Medical Center - location Westeinde, Lijnbaan, The Hague, the Netherlands (J.A.H.M.P., L.G., A.W., H.J.S.)
| | - Harm J Smeets
- Department of Surgery, Haaglanden Medical Center - location Westeinde, Lijnbaan, The Hague, the Netherlands (J.A.H.M.P., L.G., A.W., H.J.S.)
| | - Johan Kuiper
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
| | - Ilze Bot
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
| | - Peter van Veelen
- Department of Immunology, Leiden University Medical Centre, Center for Proteomics and Metabolomics, the Netherlands (G.M.C.J., P.v.V.)
| | - Bram Slütter
- Leiden Academic Centre for Drug Research, Division of BioTherapeutics, Leiden University, the Netherlands (M.J.M.J., F.H.S., M.A.C.D., F.L.V., J.K., I.B., B.S.)
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Park KA, Jeon H, Choi DG, Jung JH, Shin HJ, Lee BJ, Moon Y, Lee SY, Lee DC, Cho SY, Kim SJ, Oh SY, Moon S, Oh SY, Choi DD, Choi MY, Kim WJ, Kim US, Lee HJ, Kim Y. Ocular motility disorders following coronavirus disease-19 vaccination. Graefes Arch Clin Exp Ophthalmol 2023; 261:1127-1139. [PMID: 36383278 PMCID: PMC9667443 DOI: 10.1007/s00417-022-05888-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. METHODS Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. RESULTS Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22-81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0-28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. CONCLUSION This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.
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Affiliation(s)
- Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeshin Jeon
- Department of Ophthalmology, Pusan National University Collage of Medicine and Biomedical Research Institute, Busan, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine Hallym University, Seoul, Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jin Shin
- Department of Ophthalmology, Konkuk University Hospital, Seoul, Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se-Youp Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Soon Young Cho
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunghyuk Moon
- Department of Ophthalmology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Shin Yeop Oh
- Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Daye Diana Choi
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Chung-Ang University, Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chen CC, Lin CH, Chiu CC, Yang TY, Hsu MH, Wang YH, Lei MH, Yeh HT, Fang YA, Hao WR, Liu JC. Influenza Vaccination and Risk of Stroke in Women With Chronic Obstructive Pulmonary Disease: A Nationwide, Population-Based, Propensity-Matched Cohort Study. Front Med (Lausanne) 2022; 9:811021. [PMID: 35665329 PMCID: PMC9160371 DOI: 10.3389/fmed.2022.811021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundsThe risk of stroke is higher among patients with chronic obstructive pulmonary disease (COPD) than among the healthy population. Moreover, women generally have worse long-term stroke outcomes than men.MethodsThe data of 6681 women with COPD (aged ≥ 65 years) registered in Taiwan’s National Health Insurance Research Database were retrospectively analyzed from January 1, 2001 to December 31, 2011. After 1:1 propensity score matching, the patients were divided into vaccinated and unvaccinated groups.ResultsIn total, 5102 women were enrolled. The vaccinated group had a significantly lower risk of total, hemorrhagic, and ischemic stroke than the unvaccinated group (adjusted hazard ratio [aHR]: 0.60, 95% confidence interval [CI]: 0.54–0.67; aHR: 0.59, 95% CI: 0.43–0.83; and aHR: 0.59, 95% CI: 0.52–0.68, respectively). A lower risk of stroke was observed among the women aged 65–74 and ≥75 years, and the association was dose-dependent in all types of stroke (aHR: 1.08, 95% CI: 0.92–1.26; aHR: 0.70, 95% CI: 0.60–0.82; and aHR: 0.32, 95% CI: 0.26–0.38 for those vaccinated 1, 2 to 3, and ≥4 times, respectively, during the follow-up period). Women with a CHA2DS2-VASc score (conditions and characteristics included congestive heart failure, hypertension, diabetes, stroke, vascular disease, age, and sex) of 2–3 and ≥4 had a significantly lower risk of ischemic stroke while receiving more vaccinations. A smaller significant lower risk of hemorrhagic stroke after more than 4 times of vaccination was noted in the women with a CHA2DS2-VASc score of ≥4. Both interrupted and non-interrupted vaccination was associated with lower risk of stroke occurrence.ConclusionInfluenza vaccination is associated with a lower risk of total, hemorrhagic, and ischemic stroke among women with COPD, and the association is dose-dependent. However, the findings may be limited by unmeasurable confounders. Further investigations on this subject are warranted.
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Affiliation(s)
- Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Hsin Lin
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Tsung Yeh Yang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Min-Huei Hsu
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Hung Wang
- Department of Medical Research Executive Secretary, Center of Human Research Protection, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Meng-Huan Lei
- Cardiovascular Center, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Luodong, Taiwan
| | - Hsien Tang Yeh
- Department of Surgery, Lotung Poh-Ai Hospital, Luodong, Taiwan
| | - Yu-Ann Fang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Wen-Rui Hao
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Wen-Rui Hao,
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Ju-Chi Liu,
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Chowdhury RR, D’Addabbo J, Huang X, Veizades S, Sasagawa K, Louis DM, Cheng P, Sokol J, Jensen A, Tso A, Shankar V, Wendel BS, Bakerman I, Liang G, Koyano T, Fong R, Nau A, Ahmad H, Gopakumar JK, Wirka R, Lee A, Boyd J, Joseph Woo Y, Quertermous T, Gulati G, Jaiswal S, Chien YH, Chan C, Davis MM, Nguyen PK. Human Coronary Plaque T Cells Are Clonal and Cross-React to Virus and Self. Circ Res 2022; 130:1510-1530. [PMID: 35430876 PMCID: PMC9286288 DOI: 10.1161/circresaha.121.320090] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coronary artery disease is an incurable, life-threatening disease that was once considered primarily a disorder of lipid deposition. Coronary artery disease is now also characterized by chronic inflammation' notable for the buildup of atherosclerotic plaques containing immune cells in various states of activation and differentiation. Understanding how these immune cells contribute to disease progression may lead to the development of novel therapeutic strategies. METHODS We used single-cell technology and in vitro assays to interrogate the immune microenvironment of human coronary atherosclerotic plaque at different stages of maturity. RESULTS In addition to macrophages, we found a high proportion of αβ T cells in the coronary plaques. Most of these T cells lack high expression of CCR7 and L-selectin, indicating that they are primarily antigen-experienced memory cells. Notably, nearly one-third of these cells express the HLA-DRA surface marker, signifying activation through their TCRs (T-cell receptors). Consistent with this, TCR repertoire analysis confirmed the presence of activated αβ T cells (CD4<CD8), exhibiting clonal expansion of specific TCRs. Interestingly, we found that these plaque T cells had TCRs specific for influenza, coronavirus, and other viral epitopes, which share sequence homologies to proteins found on smooth muscle cells and endothelial cells, suggesting potential autoimmune-mediated T-cell activation in the absence of active infection. To better understand the potential function of these activated plaque T cells, we then interrogated their transcriptome at the single-cell level. Of the 3 T-cell phenotypic clusters with the highest expression of the activation marker HLA-DRA, 2 clusters expressed a proinflammatory and cytolytic signature characteristic of CD8 cells, while the other expressed AREG (amphiregulin), which promotes smooth muscle cell proliferation and fibrosis, and, thus, contributes to plaque progression. CONCLUSIONS Taken together, these findings demonstrate that plaque T cells are clonally expanded potentially by antigen engagement, are potentially reactive to self-epitopes, and may interact with smooth muscle cells and macrophages in the plaque microenvironment.
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Affiliation(s)
- Roshni Roy Chowdhury
- Department of Microbiology and Immunology, Stanford University
- Department of Medicine (Section of Genetic Medicine), University of Chicago
| | - Jessica D’Addabbo
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | - Xianxi Huang
- The First Affiliated Hospital of Shantou University Medical College
- Stanford Cardiovascular Institute, Stanford University
| | - Stefan Veizades
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Edinburgh Medical School, United Kingdom
| | - Koki Sasagawa
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | | | - Paul Cheng
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Jan Sokol
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Annie Jensen
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Alexandria Tso
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Vishnu Shankar
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Ben Shogo Wendel
- Institute for Immunity, Transplantation and Infection, Stanford University
| | - Isaac Bakerman
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Grace Liang
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University
| | - Allison Nau
- Department of Microbiology and Immunology, Stanford University
| | - Herra Ahmad
- Department of Pathology, Stanford University
| | | | - Robert Wirka
- Department of Medicine (Cardiovascular Medicine), Stanford University
| | - Andrew Lee
- Stanford Cardiovascular Institute, Stanford University
- Department of Pathology, Stanford University
- Institute for Cancer Research, Shenzhen Bay Laboratory, Shenzhen, 518055, China
| | - Jack Boyd
- Department of Surgery, Stanford University
| | | | - Thomas Quertermous
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
| | - Gunsagar Gulati
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University
| | | | - Yueh-Hsiu Chien
- Department of Microbiology and Immunology, Stanford University
| | - Charles Chan
- Stanford Cardiovascular Institute, Stanford University
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University
| | - Mark M. Davis
- Department of Microbiology and Immunology, Stanford University
- Edinburgh Medical School, United Kingdom
- Howard Hughes Medical Institute, Stanford University
| | - Patricia K. Nguyen
- Department of Medicine (Cardiovascular Medicine), Stanford University
- Stanford Cardiovascular Institute, Stanford University
- Institute for Immunity, Transplantation and Infection, Stanford University
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Veizades S, Tso A, Nguyen PK. Infection, inflammation and thrombosis: a review of potential mechanisms mediating arterial thrombosis associated with influenza and severe acute respiratory syndrome coronavirus 2. Biol Chem 2021; 403:231-241. [PMID: 34957734 DOI: 10.1515/hsz-2021-0348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
Abstract
Thrombosis has long been reported as a potentially deadly complication of respiratory viral infections and has recently received much attention during the global coronavirus disease 2019 pandemic. Increased risk of myocardial infarction has been reported during active infections with respiratory viruses, including influenza and severe acute respiratory syndrome coronavirus 2, which persists even after the virus has cleared. These clinical observations suggest an ongoing interaction between these respiratory viruses with the host's coagulation and immune systems that is initiated at the time of infection but may continue long after the virus has been cleared. In this review, we discuss the epidemiology of viral-associated myocardial infarction, highlight recent clinical studies supporting a causal connection, and detail how the virus' interaction with the host's coagulation and immune systems can potentially mediate arterial thrombosis.
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Affiliation(s)
- Stefan Veizades
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA 94305, USA.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA.,Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Alexandria Tso
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA 94305, USA.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
| | - Patricia K Nguyen
- Department of Medicine (Cardiovascular Medicine), Stanford University, Stanford, CA 94305, USA.,Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA
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Lippi G, Sanchis-Gomar F. Cardiac troponin elevation in patients with influenza virus infections. Biomed J 2021; 44:183-189. [PMID: 33097442 PMCID: PMC8178554 DOI: 10.1016/j.bj.2020.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 01/05/2023] Open
Abstract
The association between acute infections and cardiac injury, including myocarditis and acute myocardial infarction, is now well established. We have performed a systematic literature review for analyzing the results of epidemiological studies that measured cardiac troponins (cTn) in patients with Influenza virus infections. Overall, 14 articles were finally identified and analyzed. Taken together, the results of the scientific literature suggest that cTn elevation is a relatively rare phenomenon in patients with Influenza virus infection, with frequency generally comprised between 0 and 33%, more likely in elderly patients with significant comorbidities. In patients with modest cTn elevations, this phenomenon is apparently self-limited, transient and reversible, and especially involves patients with Influenza A (especially H1N1). In the minority of patients exhibiting an abrupt appearance of cardiovascular symptoms and concomitant elevation of cTn values, the relative increase of this biomarker reflects the presence of an underlying cardiac injury, that can be either myocarditis or an acute ischemic episode. Enhanced cTn values can also be more frequently observed in Influenza patients with complicated disease, in those developing acute respiratory distress syndrome and cardiac dysfunction, as well as in those at higher risk of death. cTn measurement shall be considered a valuable option in all patients developing acute cardiovascular symptoms during Influenza virus infections, as well as in those bearing cardiac or extra-cardiac comorbidities who bear a higher risk of complications.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
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7
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Adaptive Immune Responses in Human Atherosclerosis. Int J Mol Sci 2020; 21:ijms21239322. [PMID: 33297441 PMCID: PMC7731312 DOI: 10.3390/ijms21239322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease that is initiated by the deposition and accumulation of low-density lipoproteins in the artery wall. In this review, we will discuss the role of T- and B-cells in human plaques at different stages of atherosclerosis and the utility of profiling circulating immune cells to monitor atherosclerosis progression. Evidence supports a proatherogenic role for intraplaque T helper type 1 (Th1) cells, CD4+CD28null T-cells, and natural killer T-cells, whereas Th2 cells and regulatory T-cells (Treg) have an atheroprotective role. Several studies indicate that intraplaque T-cells are activated upon recognition of endogenous antigens including heat shock protein 60 and oxidized low-density lipoprotein, but antigens derived from pathogens can also trigger T-cell proliferation and cytokine production. Future studies are needed to assess whether circulating cellular biomarkers can improve identification of vulnerable lesions so that effective intervention can be implemented before clinical manifestations are apparent.
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8
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Mohammad MA, Tham J, Koul S, Rylance R, Bergh C, Erlinge D, Fröbert O. Association of acute myocardial infarction with influenza: A nationwide observational study. PLoS One 2020; 15:e0236866. [PMID: 32760080 PMCID: PMC7410234 DOI: 10.1371/journal.pone.0236866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Influenza may precipitate cardiovascular disease, but influenza typically peaks in winter, coinciding with other triggers of myocardial infarction (MI) such as low air temperature, high wind velocity, low atmospheric pressure, and short sunshine duration. Objective We aimed to determine the relationship of week-to-week variation in influenza cases and acute MI, controlling for meteorological factors in a nationwide population. Methods Weekly laboratory-confirmed influenza case reports were obtained from the Public Health Agency of Sweden from 2009 to 2016 and merged with the nationwide SWEDEHEART MI registry. Weekly incidence of MI was studied with regard to number of influenza cases stratified into tertiles of 0–16, 17–164, and >164 cases/week. Incidence rate ratios (IRR) were calculated using a count regression model for each category and compared to a non-influenza period as reference, controlling for air temperature, atmospheric pressure, wind velocity, and sunshine duration. Results A total of 133562 MI events was reported to the registry during the study period. Weeks with influenza cases were associated with higher incidence of MI than those without in unadjusted analysis for overall MI, ST-elevation MI and non ST-elevation MI independently. During the influenza season, weeks with 0–16 reported cases/week were not associated with MI incidence after adjusting for weather parameters, adjusted IRR for MI was 1.03 (95% CI 1.00–1.06, P = 0.09). However, weeks with more cases reported were associated with MI incidence: 17–163 reported cases/week, adjusted IRR = 1.05 (95% CI 1.02–1.08, P = 0.003); and for ≥164 cases/week, the IRR = 1.06 (95% CI 1.02–1.09, P = 0.002). Results were consistent across a large range of subgroups. Conclusions In this nationwide observational study, we found an association of incidence of MI with incidence of influenza cases beyond what could be explained by meteorological factors.
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Affiliation(s)
- Moman A. Mohammad
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
- * E-mail:
| | - Johan Tham
- Infectious Diseases Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
| | - Cecilia Bergh
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences Lund University, Lund, Sweden
| | - Ole Fröbert
- Department of Cardiology, Faculty of Medicine and Health; Örebro University, Örebro, Sweden
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9
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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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Fröbert O, Götberg M, Angerås O, Jonasson L, Erlinge D, Engstrøm T, Persson J, Jensen SE, Omerovic E, James SK, Lagerqvist B, Nilsson J, Kåregren A, Moer R, Yang C, Agus DB, Erglis A, Jensen LO, Jakobsen L, Christiansen EH, Pernow J. Design and rationale for the Influenza vaccination After Myocardial Infarction (IAMI) trial. A registry-based randomized clinical trial. Am Heart J 2017. [PMID: 28625387 DOI: 10.1016/j.ahj.2017.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Registry studies and case-control studies have demonstrated that the risk of acute myocardial infarction (AMI) is increased following influenza infection. Small randomized trials, underpowered for clinical end points, indicate that future cardiovascular events can be reduced following influenza vaccination in patients with established cardiovascular disease. Influenza vaccination is recommended by international guidelines for patients with cardiovascular disease, but uptake is varying and vaccination is rarely prioritized during hospitalization for AMI. METHODS/DESIGN The Influenza vaccination After Myocardial Infarction (IAMI) trial is a double-blind, multicenter, prospective, registry-based, randomized, placebo-controlled, clinical trial. A total of 4,400 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI undergoing coronary angiography will randomly be assigned either to in-hospital influenza vaccination or to placebo. Baseline information is collected from national heart disease registries, and follow-up will be performed using both registries and a structured telephone interview. The primary end point is a composite of time to all-cause death, a new AMI, or stent thrombosis at 1 year. IMPLICATIONS The IAMI trial is the largest randomized trial to date to evaluate the effect of in-hospital influenza vaccination on death and cardiovascular outcomes in patients with STEMI or non-STEMI. The trial is expected to provide highly relevant clinical data on the efficacy of influenza vaccine as secondary prevention after AMI.
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11
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Asghar Z, Coupland C, Siriwardena N. Influenza vaccination and risk of stroke: Self-controlled case-series study. Vaccine 2015; 33:5458-5463. [DOI: 10.1016/j.vaccine.2015.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/24/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
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12
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Famularo G, Minisola G, Gasbarrone L. Ischemic stroke after influenza vaccination. Ann Pharmacother 2015; 49:747. [PMID: 25975998 DOI: 10.1177/1060028015578452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Siriwardena AN, Asghar Z, Coupland CCA. Influenza and pneumococcal vaccination and risk of stroke or transient ischaemic attack-matched case control study. Vaccine 2014; 32:1354-61. [PMID: 24486370 DOI: 10.1016/j.vaccine.2014.01.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/17/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Evidence that respiratory infections trigger stroke suggests that influenza or pneumococcal vaccination might prevent stroke. We aimed to investigate whether influenza or pneumococcal vaccination or both together were associated with reduced risk of stroke or transient ischaemic attack (TIA). METHODS We used a matched 1:1 case-control design with data from the United Kingdom General Practice Research Database. Cases, aged 18 years or above with stroke (fatal or non-fatal) and TIA during September 2001 to August 2009, were compared with controls matched for age, sex, calendar time and practice, adjusting for cardiovascular risk factors, vaccine risk groups, comorbidity and indicators of functional ability. RESULTS We included 26,784 cases of stroke and 20,227 cases of TIA with equal numbers of matched controls. Influenza vaccination within-season was associated with 24% reduction in stroke risk (adjusted OR 0.76, 95% CI 0.72 to 0.80) but no reduction in TIA (1.03, 0.98 to 1.09). Stroke risk was significantly lower with early (September to mid-November: 0.74, 0.70 to 0.78) but not later influenza vaccination (mid-November onwards: 0.92, 0.83 to 1.01). Associations persisted after multiple imputation of missing data and sensitivity analysis for unmeasured confounders. Pneumococcal vaccination was not associated with a reduction in risk of stroke (0.98, 0.94 to 1.00) or TIA (1.15, 1.08 to 1.23). CONCLUSIONS Influenza vaccination was associated with a 24% reduction in risk of stroke but not TIA. Pneumococcal vaccination was not associated with reduced risk of stroke or TIA. This has important implications for potential benefits of influenza vaccine.
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Affiliation(s)
- A Niroshan Siriwardena
- Community and Health Research Unit, University of Lincoln & Lincolnshire Community Health Services NHS Trust, School of Health and Social Care, College of Social Science, Brayford Campus, Lincoln LN6 7TS, UK.
| | - Zahid Asghar
- Community and Health Research Unit, University of Lincoln, School of Health and Social Care, College of Social Science, Brayford Campus, Lincoln LN6 7TS, UK.
| | - Carol C A Coupland
- University of Nottingham, Division of Primary Care, School of Community Health Sciences, Floor 13, Tower Building, Nottingham NG7 2RD, UK.
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Bazaz R, Marriott HM, Francis SE, Dockrell DH. Mechanistic links between acute respiratory tract infections and acute coronary syndromes. J Infect 2013; 66:1-17. [DOI: 10.1016/j.jinf.2012.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 09/22/2012] [Accepted: 09/26/2012] [Indexed: 12/27/2022]
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Grivel JC, Ivanova O, Pinegina N, Blank PS, Shpektor A, Margolis LB, Vasilieva E. Activation of T lymphocytes in atherosclerotic plaques. Arterioscler Thromb Vasc Biol 2011; 31:2929-37. [PMID: 21960562 DOI: 10.1161/atvbaha.111.237081] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To decipher the immunologic mechanisms of plaque maturation and rupture, it is necessary to analyze the phenotypes and distribution of individual lymphocytes that migrate to the plaques, as well as their activation at different stages of plaque formation. METHODS AND RESULTS We developed a protocol to isolate plaque-residing immune cells and analyze their status using polychromatic flow cytometry. We found that the composition and phenotype of T lymphocytes in the plaques differs from that in blood. CD4 and, in particular, CD8(+) T cells in plaques are highly activated; the fraction of CD8 T cells coexpressing CD25 and human leukocyte antigen-D related in plaques was 6 times as large as in blood. CONCLUSIONS The first flow-cytoanalysis of individual T cells in atherosclerotic plaques indicates that plaques represent a separate immunologic compartment from blood with lymphocytes characterized by a high level of T-cell activation, which is compatible with the presence of antigen(s) that trigger infiltration activation of these cells. The ability to isolate and characterize these cells may lead to the identification of such antigens.
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Affiliation(s)
- Jean-Charles Grivel
- Eunice Kennedy-Shriver National Institute of Child Health and Human Development, Program on Physical Biology, Section on Intercellular Interactions, Bethesda, MD, USA
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Grau AJ. Tissue plasminogen activator for stroke and concomitant influenza infection: is this a dangerous combination? Stroke 2011; 42:585-6. [PMID: 21293013 DOI: 10.1161/strokeaha.110.609123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
The occurrence of stroke in populations is incompletely explained by traditional vascular risk factors. Data from several case-control studies and one large study using case series methodology indicate that recent infection is a temporarily acting, independent trigger factor for ischemic stroke. Both bacterial and viral infections, particularly respiratory tract infections, contribute to this association. A causal role for infection in stroke is supported by a graded temporal relationship between these conditions, and by multiple pathophysiological pathways linking infection and inflammation, thrombosis, and stroke. Furthermore, observational studies suggest that influenza vaccination confers a preventive effect against stroke. Case-control and prospective studies indicate that chronic infections, such as periodontitis, chronic bronchitis and infection with Helicobacter pylori, Chlamydia pneumoniae or Cytomegalovirus, might increase stroke risk, although considerable variation exists in the results of these studies, and methodological issues regarding serological results remain unresolved. Increasing evidence indicates that the aggregate burden of chronic and/or past infections rather than any one single infectious disease is associated with the risk of stroke. Furthermore, genetic predispositions relating to infection susceptibility and the strength of the inflammatory response seem to co-determine this risk. Here, we summarize and analyze the evidence for common acute and chronic infectious diseases as stroke risk factors.
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Posterior reversible encephalopathy syndrome and cerebral vasculopathy associated with influenza A infection: report of a case and review of the literature. J Comput Assist Tomogr 2010; 33:917-22. [PMID: 19940660 DOI: 10.1097/rct.0b013e3181993a43] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Influenza A infection can precipitate encephalopathy, encephalitis, or Reye syndrome with the development of cerebral edema in children and is associated with an increased incidence of stroke in adults. The mechanism of these events is poorly understood. Posterior reversible encephalopathy syndrome (PRES) is seen in association with infection/sepsis, and cerebral vasculopathy has been demonstrated in PRES. We describe a case of PRES that develops in association with influenza A. SUMMARY OF CASE A normotensive 65-year-old woman presented with altered mentation and nausea in the setting of a viral prodromal illness ultimately confirmed as influenza A. Posterior reversible encephalopathy syndrome developed on the second day after admission. Catheter cerebral angiogram documented vasculopathy in PRES-involved regions with areas of focal vessel dilatation and string-of-bead appearance. CONCLUSIONS The association between influenza A and PRES with documentation of cerebral vasculopathy suggests a common systemic vascular mechanism behind PRES and influenza-related encephalopathic edema and stroke.
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Businaro R, Profumo E, Tagliani A, Buttari B, Leone S, D’Amati G, Ippoliti F, Leopizzi M, D’Arcangelo D, Capoano R, Fumagalli L, Salvati B, Riganò R. Heat-shock protein 90: A novel autoantigen in human carotid atherosclerosis. Atherosclerosis 2009; 207:74-83. [DOI: 10.1016/j.atherosclerosis.2009.04.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 04/20/2009] [Accepted: 04/21/2009] [Indexed: 11/15/2022]
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Ward JR, Wilson HL, Francis SE, Crossman DC, Sabroe I. Translational mini-review series on immunology of vascular disease: inflammation, infections and Toll-like receptors in cardiovascular disease. Clin Exp Immunol 2009; 156:386-94. [PMID: 19309349 DOI: 10.1111/j.1365-2249.2009.03886.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease, in which atherosclerosis is the major underlying cause, is currently the largest cause of death in the world. Atherosclerosis is an inflammatory disease characterized by the formation of arterial lesions over a period of several decades at sites of endothelial cell dysfunction. These lesions are composed of endothelial cells, vascular smooth muscle cells, monocytes/macrophages and T lymphocytes (CD4(+)). As the lesions progress some can become unstable and prone to disruption, resulting in thrombus formation and possibly a myocardial infarction or stroke depending upon the location. Although the exact triggers for plaque disruption remain unknown, much recent evidence has shown a link between the incidence of myocardial infarction and stroke and a recent respiratory tract infection. Interestingly, many reports have also shown a link between a family of pattern recognition receptors, the Toll-like receptors, and the progression of atherosclerosis, suggesting that infections may play a role in both the progression of atherosclerosis and in inducing the more severe complications associated with the disease.
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Affiliation(s)
- J R Ward
- Cardiovascular Research Unit, The University of Sheffield, Sheffield, UK
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van der Meer JJ, van der Wal AC, Teeling P, Idu MM, van der Ende A, de Boer OJ. Multiple bacteria contribute to intraplaque T-cell activation in atherosclerosis. Eur J Clin Invest 2008; 38:857-62. [PMID: 19021704 DOI: 10.1111/j.1365-2362.2008.02031.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection with microorganisms is considered a pathogenic factor in atherogenesis. Several studies have shown the presence of a broad spectrum of bacterial species in atherosclerotic plaques, which could trigger local inflammation. Because T cells contribute to atherosclerotic plaque inflammation, we studied the responsiveness of human plaque derived T-cell cultures to bacteria of different species. MATERIALS AND METHODS Primary polyclonal T-cell cultures were generated from both carotid endarterectomy tissue and peripheral blood of nine patients, and the peripheral blood of eight matched controls. The in vitro proliferative responses of the T-cell cultures against H. pylori, N. meningitidis, N. lactamica, S. aureus, S. pneumoniae, S. epidermidis and E. coli were analysed. T-cell proliferation was measured by (3)H-thymidine incorporation and expressed as a stimulation index. Selective outgrowth of intraplaque microbial specific T cells was studied by calculating the ratio of plaque T-cell SI and peripheral blood T-cell SI in each patient. RESULTS All patients showed T-cell responsiveness to multiple bacteria in their plaque tissue. Stimulation indices were in the range of 0.3-30, and this degree of reactivity with the different species was heterogeneous among patients. Selective outgrowth (plaque/peripheral blood ratio) of T cells against multiple bacteria was observed in six out of nine patients. CONCLUSIONS T cells in atherosclerotic plaques have the capacity to selectively respond to antigens of a wide variety of microbial antigens. This supports the view that such mechanisms could contribute to the atherosclerotic inflammatory response.
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Affiliation(s)
- J J van der Meer
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Bibliography. Current world literature. Atherosclerosis: cell biology and lipoproteins. Curr Opin Lipidol 2008; 19:525-35. [PMID: 18769235 DOI: 10.1097/mol.0b013e328312bffc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Gewaltig J, Kummer M, Koella C, Cathomas G, Biedermann BC. Requirements for CD8 T-cell migration into the human arterial wall. Hum Pathol 2008; 39:1756-62. [PMID: 18706675 DOI: 10.1016/j.humpath.2008.04.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 04/12/2008] [Accepted: 04/23/2008] [Indexed: 01/11/2023]
Abstract
Atherosclerotic lesions develop in the arterial intima. Among the leukocytes that accumulate in advanced atherosclerotic plaques, CD8 T cells play a quantitatively important role. They may be involved in disease progression and plaque destabilization, leading to plaque rupture or erosion. These events finally precipitate cardiovascular events. Therefore, we wished to determine the accessibility of the human arterial wall, particularly the arterial intima, for CD8-positive, cytotoxic T lymphocytes. We quantified the number of CD8-positive T cells in the arterial wall using human arterial tissue microarrays. The conditions for efficient cytotoxic T-lymphocyte migration into the arterial wall were determined in an in vitro tissue invasion assay. The invasion pattern of resting or activated cytotoxic T-lymphocyte clones was morphometrically analyzed by confocal microscopy. CD8 T cells represented up to 50% of the lymphocytes in advanced atherosclerotic lesions. Resting CD8-positive cytotoxic T lymphocytes were able to migrate into the arterial intima when it was affected by advanced lesions but not at the earliest stages of the disease. After T-cell receptor and/or proinflammatory cytokine activation, cytotoxic T lymphocytes migrated efficiently into the arterial intima, even in the healthy or mildly affected sites. This in vitro tissue invasion assay mimics conditions under which effector cytotoxic T lymphocytes migrate into the arterial wall to reach similar cell densities as observed in arterial tissue sections from autopsies. Interference with T-cell activation may be important to inhibit cytotoxic T-lymphocyte invasion into the unaffected, healthy artery but may not prevent cytotoxic T-lymphocyte invasion into arteries that are severely affected by atherosclerotic lesions.
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Affiliation(s)
- Jan Gewaltig
- University Department of Medicine, Bruderholzspital, 4101 Bruderholz, Switzerland; Department of Biomedicine, University Hospital, 4031 Basel, Switzerland
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