Acta Medica Iranica 2013. 51(12):864-870.

Chlamydia pneumoniae in the atherosclerotic plaques of coronary artery disease patients.
Morteza Izadi, Mozhgan Fazel, Mohsen Akrami, Seyed Hassan Saadat, Bahram Pishgoo, Mohammad Hassan Nasseri, Hossein Dabiri, Reza SafiAryan, Ali Akbar Esfahani, Ali Ahmadi, Davood Kazemi-Saleh, Mohammad Hassan Kalantar-Motamed, Saeed Taheri

Abstract


An association between Chlamydia pneumoniae (C. pneumoniae) and cardiovascular disease has been demonstrated. In this study, we aimed to study this potential relationship in 105 Iranian patients. Coronary artery specimens from 105 Iranian patients undergoing CABG were analyzed by PCR method for C. pneumoniae. Serological evaluation for C. pneumoniae IgG and IgM was performed using ELISA. 53 specimens from mamillary artery were also investigated. C. pneumoniae PCR test result was positive for 23 (21.9%) of patients with coronary artery atherosclerosis, but none of the specimens from the mamillary artery was positive for C. pneumoniae when it was evaluated by the PCR (P<0.001). Coronary artery disease patients with and without a history of unstable angina or myocardial infarction were comparable in C. pneumoniae PCR test positive rates (P=0.618). Relevance of IgG and IgM positivity were also studied by correlating it to the study parameters, but no difference was found. CRP was significantly higher in the IgM positive group (P<0.001). A significant proportion of coronary atherosclerotic plaques are infected with C. pneumoniae while no infection was found in the normal mamillary artery specimens. No association was found between acute coronary syndromes and serological and PCR positivity. Further prospective randomized controlled studies with large patient population are needed to confirm our findings.

Keywords


Atherosclerosis; Chlamydia pneumonia; Coronary heart disease; Infection

Full Text:

PDF

References


Gupta S, Camm AJ. Chlamydia pneumoniae and coronary heart disease. Br Med J 1997;314(7097):1778–9.

Grayston JT, Kuo CC, Wang SP, Altman J. A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections. N Engl J Med 1986;315(3):161–8.

Kuo CC, Chen HH, Wang SP, Grayston JT. Identification of a new group of Chlamydia psittaci strains called TWAR. J Clin Microbiol 1986;24(6):1034–7.

Falck G, Engstrand I, Gad A, Gnarpe J, Gnarpe H, Laurila A. Demonstration of Chlamydia pneumoniae in patients with chronic pharyngitis. Scand J Infect Dis 1997;29(6):585-9.

Nieto FJ, Adam E, Sorlie P, Farzadegan H, Melnick JL, Comstock GW, Szklo M: Cohort study of cytomegalovirus infection as a risk factor for carotid intimal-medial thickening, a measure of subclinical atherosclerosis. Circulation 1996;94(5):922–7.

Weinberger M. Respiratory infections and asthma: current treatment strategies. Drug Discov Today 2004;9(19):831–7.

Boelen E, Steinbusch HW, van der Ven AJ, Grauls G, Bruggeman CA, Stassen FR. Chlamydia pneumoniae infection of brain cells: an in vitro study. Neurobiol Aging 2007;28(4):524–32.

Villareal C, Whittum-Hudson JA, Hudson AP. PersistentChlamydiae and chronic arthritis. Arthritis Res 2002;4(1):5–9.

Campbell LA, Kuo CC. Chlamydia pneumoniae-an infectious risk factor for atherosclerosis? Nat Rev Microbiol 2004;2(1):23–32.

Melnick SL, Shahar E, Folsom AR, Grayston JT, Sorlie PD, Wang SP, Szklo M. Past infection by Chlamydia pneumoniae strain TWAR and asymptomatic carotid atherosclerosis. Am J Med 993;95(5):499–504.

Thom DH, Grayston JT, Siscovick DS, Wang SP, Weiss NS, Daling JR. Association of prior infection with Chlamydia pneumoniae and angiographically demonstrated coronary artery disease. J Am Med Assoc 1992;268(1):68–72.

Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Mäkelä PH, Huttunen JK, Valtonen V. Serological evidence of an association of a novel Chlamydia TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 1988;2(8618):983–6.

Blasi F, Cosentini R, Raccanelli R, Massari FM, Arosio C, Tarsia P, Allegra L. A possible association of Chlamydia pneumoniae infection and acute myocardial infarction in npatients younger than 65 years of age. Chest 1997;112(2):309–12.

Shor A, Kuo CC, Patton DL. Detection of Chlamydia pneumoniae in coronary arterial fatty streaks and atheromatous plaques. S Afr Med J 1992;82(3):158–61.

Kuo CC, Shor A, Campbell LA, Fukushi H, Patton DL, Grayston JT. Demonstration of Chlamydia pneumoniae in atherosclerotic lesions of coronary arteries. J Infect Dis 1993;157(4):841–9.

Campbell LA, O'Brien ER, Cappuccio AL, Kuo CC, Wang SP, Stewart D, Patton DL, Cummings PK, Grayston JT. Detection of Chlamydia pneumoniae TWAR in human coronary atherectomy tissues. J Infect Dis 1995;172(2):585–8.

Kuo CC, Grayston JT, Campbell LA, Goo YA, Wissler RW, Benditt EP. Chlamydia pneumoniae (TWAR) in coronary arteries of young adults (15–34 years). Proc Natl Acad Sci USA 1995;92(15):6911–4.

Linnanmaki E, Leinonen M, Mattila K, Nieminen MS, Valtonen V, Saikku P. Presence of Chlamydia pneumoniae-specific antibodies in circulating immune complexes in coronary heart disease. Circulation 1993;87(4):1130–4.

Verkooyen RP, Willemse D, Hiep-van Casteren SC, Joulandan SA, Snijder RJ, van den Bosch JM, van Helden HP, Peeters MF, Verbrugh HA. Evaluation of PCR, culture, and serology for diagnosis of Chlamydia pneumoniae respiratory infections. J Clin Microbiol 1998;36(8):2301-7.

Dymock IW, Lawson JM, MacLennan WJ, Ross CA. Myocarditis associated with psittacosis. Br J Clin Pract 1971;25(5):240-2.

Van der Bel-Kahn JM, Watanakunakorn C, Menefee MG, Long HD, Dieter R. Chlamydia trachomatis endocarditis. Am Heart J 1978;95(5):627-36.

Juvonen J, Laurila A, Juvonen T. Detection of chlamydia pneumoniae in human nonrheumatic stenotic aortic valves. J Am Coll Cardiol 1997;29(5):1054-9.

Grayston JT, Campbell LA, Kuo CC, Mordhorst CH, Saikku P, Thom DH, Wang SP. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis 1990;161(4):618-25.

Saikku P, Leinonen M, Mattila K, Ekman MR, Nieminen MS, Mäkelä PH, Huttunen JK, Valtonen V. Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 1988;2(8816):983-6.

Maia IL, Nicolau JC, Machado Mde N, Maia LN, Takakura IT, Rocha PR, Cordeiro JA, Ramires JA. Prevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae in different forms of coronary disease. Arq Bras Cardiol 2009;92(6):405-11, 422-8, 439-45.

Saikku P, Leinonen M, Tenkanen L, Linnanmäki E, Ekman MR, Manninen V, Mänttäri M, Frick MH, Huttunen JK. Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki heart study. Ann Intern Med 1992;116(4):273-8.

Pesonen E, Tiirola T, Andsberg E, Jauhiainen M, Paldanius M, Persson K, Saikku P, Sarna S, Ohlin H, Leinonen M. Serum chlamydial lipopolysaccharide as a prognostic factor for a new cardiovascular event. Heart Lung 2009;38(3):176-81.

Petyaev IM, Zigangirova NA, Petyaev AM, Pashko UP, Didenko LV, Morgunova EU, Bashmakov YK. Isolation of Chlamydia pneumoniae from serum samples of the patients with acute coronary syndrome. Int J Med Sci 2010;7(4):181-90.

West SK, Kohlhepp SJ, Jin R, Gleaves CA, Stamm W, Gilbert DN. Detection of circulating Chlamydophila pneumoniae in patients with coronary artery disease and healthy control subjects. Clin Infect Dis 2009;48(5):560-7.

Sawayama Y, Kikuchi K, Tatsukawa M, Hayashi S, Taira Y, Furusyo N, Hayashi J. Association of Chlamydophila pneumoniae DNA in peripheral blood mononuclear cells and IgA antibody with atherosclerotic diseases. Fukuoka Igaku Zasshi 2009;100(9):305-12.

Pesonen E, El-Segaier M, Persson K, Puolakkainen M, Sarna S, Ohlin H, Pussinen PJ. Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes. Ther Adv Cardiovasc Dis 2009;3(6):447-54.

Dabiri H, Rezadehbashi M, Badami N, Aghanouri R, Ahmadi H, Khoramizadeh MR, Emaneini M, Izadi M, Zali MR. Detection of Chlamydia pneumoniae in atherosclerotic plaques of patients in Tehran, Iran. Jpn J Infect Dis 2009;62(3):195-7.

Hoymans VY, Bosmans JM, Van Herck PL, Ieven MM, Vrints CJ. Implications of antibodies to heat-shock proteins in ischemic heart disease. Int J Cardiol 2008;123(3):277-82.

Campbell LA, Yaraei K, Van Lenten B, Chait A, Blessing E, Kuo CC, Nosaka T, Ricks J, Rosenfeld ME. The acute phase reactant response to respiratory infection with Chlamydia pneumoniae: implications for the pathogenesis of atherosclerosis. Microbes Infect 2010;12(8-9):598-606.

Sessa R, Di Pietro M, Schiavoni G, Macone A, Maras B, Fontana M, Zagaglia C, Nicoletti M, Del Piano M, Morrone S. Chlamydia pneumoniae induces T cell apoptosis through glutathione redox imbalance and secretion of TNF-alpha. Int J Immunopathol Pharmacol 2009;22(3):659-68.

Mousa A, Al-Zaki A, Taha S, Bakhiet M. Induction of interleukin-18 in atherosclerotic patients: a role for Chlamydia pneumoniae. Med Princ Pract 2009;18(2):105-10.

Liu W, He P, Cheng B, Mei CL, Wang YF, Wan JJ. Chlamydia pneumoniae disturbs cholesterol homeostasis in human THP-1 macrophages via JNK-PPARγ dependentsignal transduction pathways. Microbes Infect 2010;12(14-15):1226-35.

Chen S, Shimada K, Zhang W, Huang G, Crother TR, Arditi M. IL-17A is proatherogenic in high-fat dietinducedand Chlamydia pneumoniae infection-acceleratedatherosclerosis in mice. J Immunol 2010;185(9):5619-27.

Deniset JF, Cheung PK, Dibrov E, Lee K, Steigerwald S, Pierce GN.Chlamydophila pneumoniae infection leads to smooth muscle cell proliferation and thickening in the coronary artery without contributions from a host immune response. Am J Pathol 2010;176(2):1028-37.

Lin CY, Su SB, Chang CC, Lee TM, Shieh JM, Guo HR. The association between Chlamydia pneumoniae and metabolic syndrome in Taiwanese adults. South Med J 2009;102(12):1203-8.

Stone AF, Mendall MA, Kaski JC, Edger TM, Risley P, Poloniecki J, Camm AJ, Northfield TC. Effect of treatment for Chlamydia pneumoniae and Helicobacter pylori on markers of inflammation and cardiac events in patients with acute coronary syndromes: South Thames Trial of Antibiotics in Myocardial Infarction and Unstable Angina (STAMINA). Circulation 2002;106(10):1219-23.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.