The Role of Chlamydia pneumoniae in the Atherosclerotic Process of Patients under 50 Years of Age Who Underwent Coronary Artery Bypass Graft Surgery

Selami Gurkan, Suat Canbaz, Ozcan Gur, Serhat Huseyin, Turan Ege, Enver Duran

Department of Cardiovascular Surgery, Namik Kemal University Hospital, Tekirda?, Turkey.
Department of Cardiovascular Surgery, Trakya University Hospital, Edirne, Turkey.

DOI: 10.4236/wjcs.2013.35030                

Abstract

Background: To evaluate the presence of C. pneumoniae DNA in the tissues and C. pneumoniae DNA antibodies in the blood samples of patients who underwent CABG surgery. Material and Methods: Fifty-one patients <50 years of age were included in the study, and analyzed in two groups according to the intimal thickness of aorta. C. pneumoniae DNA was evaluated in the tissues collected from the atrium, left internal thoracic artery and ascending aorta of patients. Results: Although, C. pneumoniae DNA was negative in the atrial and left internal thoracic artery tissues of all patients, it was positive in the tissues obtained from the ascending aortas of twelve patients. C. pneumoniae DNA positivity was significantly higher in patients with increased aortic intimal thickness compared to those without increased aortic thickness. Conclusion: The question whether C. pneumoniae is triggering atherosclerosis or is involved as a super-infection could not be clarified.

Keywords

Bypass Surgery; Chlamydia pneumoniae; Atherosclerosis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	V. Fuster, “Epidemic of Cardiovascular Disease and Stroke: The Three Main Challenges,” Circulation, Vol. 99, No. 9, 1999, pp. 1132-1137. doi:10.1161/01.CIR.99.9.1132
[2]	C. H. Hennekens, “Increasing Burden of Cardiovascular Disease: Current Knowledge and Future Directions for Research on Risk Factors,” Circulation, Vol. 97, No. 19, 1998, pp. 1095-1102. doi:10.1161/01.CIR.97.11.1095
[3]	G. Noll, “Pathogenesis of Atherosclerosis: A Possible Relation of Infection,” Atherosclerosis, Vol. 140, Supplement 1, 1998, pp. 3-9. doi:10.1016/S0021-9150(98)00113-0
[4]	S. Gupta and A. J. Camm, “Chlamydia pneumoniae and Coronary Heart Disease,” British Medical Journal, Vol. 314, No. 7097, 1997, pp. 1778-1779. doi:10.1136/bmj.314.7097.1778
[5]	C. Bartels, M. Maass, G. Bein, et al., “Detection of Chlamydia pneumoniae but Not Cytomegalovirus in Occluded Saphenous Vein Coronary Artery Bypass Grafts,” Circulation, Vol. 99, No. 7, 1999, pp. 879-882. doi:10.1161/01.CIR.99.7.879
[6]	Y. Wong, M. Thomas, V. Tsang, et al., “The Prevalence of Chlamydia pneumoniae in Atherosclerotic and Nonatherosclerotic Blood Vessels of Patients Attending for Redo and First Time Coronary Artery Bypass Graft Surgery,” Journal of the American College of Cardiology, Vol. 33, No. 1, 1999, pp. 152-156. doi:10.1016/S0735-1097(98)00547-6
[7]	P. Saikku, M. Leinonen, L. Tenkanen, et al., “Chronic Chlamydia pneumoniae Infection as a Risk Factor for Coronary Heart Disease in the Helsinki Heart Study,” Annals of Internal Medicine, Vol. 116, No. 4, 1992, pp. 273-278. doi:10.7326/0003-4819-116-4-273
[8]	C. C. Kuo, J. T. Grayston, L. A. Campbell, et al., “Chlamydia Pneumoniae (TWAR) in Coronary Arteries of Young Adults (15-34 Years Old),” Proceedings of the National Academy of Sciences of the United States of America, Vol. 92, No. 15, 1995, pp. 6911-6914. doi:10.1073/pnas.92.15.6911
[9]	J. T. Grayston, C. C. Kuo, A. S. Coulson, et al., “Chlamydia Pneumoniae (TWAR) in Atherosclerosis of the Carotid Artery,” Circulation, Vol. 92, No. 12, 1995, pp. 3397-3400. doi:10.1161/01.CIR.92.12.3397
[10]	C. C. Kuo, A. M. Gown, E. P. Benditt, et al., “Detection of Chlamydia pneumoniae in Aortic Lesions of Atherosclerosis by Immunocytochemical Stain,” Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 13, No. 10, 1993, pp. 1501-1504. doi:10.1161/01.ATV.13.10.1501
[11]	S. Gupta and E. W. Leatham, “The Relation between Chlamydia pneumoniae and Atherosclerosis,” Heart, Vol. 77, No. 1, 1997, pp. 7-8.
[12]	G. Ong, B. J. Thomas, A. O. Mansfield, et al., “Detection and Widespread Distribution of Chlamydia pneumoniae in the Vascular System and Its Possible Implications,” Journal of Clinical Pathology, Vol. 49, No. 2, 1996, pp. 102-106. doi:10.1136/jcp.49.2.102
[13]	S. M. Weiss, P. M. Roblin, C. A. Gaydos, et al., “Failure to Detect Chlamydia pneumoniae in Coronary Atheromas of Patients Undergoing Atherectomy,” The Journal of Infectious Diseases, Vol. 173, No. 4, 1996, pp. 957-962. doi:10.1093/infdis/173.4.957
[14]	K. Matsuyama, T. Goto, T. Baba, et al., “Echocardiographic and Pathological Evaluation of Atherosclerosis in the Ascending Aorta during Coronary Artery Bypass Grafting,” Anesthesia & Analgesia, Vol. 90, No. 6, 2000, pp. 1262-1268. doi:10.1097/00000539-200006000-00002
[15]	T. H. Wareing, V. G. Davila-Roman, B. Barzilai, et al., “Management of the Severely Atherosclerotic Ascending Aorta during Cardiac Operations. A Strategy for Detection and Treatment,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 103, No. 3, 1992, pp. 453-462.
[16]	M. L. Tondella, D. F. Talkington, B. P. Holloway, et al., “Development and Evaluation of Real-Time PCR-Based Fluorescence Assays for Detection of Chlamydia Pneumoniae,” Journal of Clinical Microbiology, Vol. 40, No. 2, 2002, pp. 575-583. doi:10.1128/JCM.40.2.575-583.2002
[17]	P. Saikku, M. Leinonen, K. Mattila, et al., “Serological Evidence of an Association of a Novel Chlamydia, TWAR, with Chronic Coronary Heart Disease and Acute Myocardial Infarction,” Lancet, Vol. 332, No. 8618, 1988, pp. 983-986. doi:10.1016/S0140-6736(88)90741-6
[18]	P. Pieniazek, E. Karczewska, E. Stepień, et al., “Incidence of Chlamydia pneumoniae Infection in Patients with Coronary Artery Disease Subjected to Angioplasty or Bypass Surgery,” Medical Science Monitor, Vol. 7, No. 5, 2001, pp. 995-1001.
[19]	D. S. Halvorsen, T. Borvik, I. Njolstad, et al., “Chlamydia Pneumoniae IgA-and IgG Antibodies in Young Survivors of Myocardial Infarction. A Comparison of Antibody Detection by a Microimmunofluorescence Test and an Enzyme Immunoassay,” Journal of Internal Medicine, Vol. 251, No. 2, 2002, pp. 142-147. doi:10.1046/j.1365-2796.2002.00942.x
[20]	L. A. Campbell, E. R. O’Brien, A. L. Cappuccio, et al., “Detection of Chlamydia pneumoniae TWAR in Human Coronary Atherectomy Tissues,” The Journal of Infectious Diseases, Vol. 172, No. 2, 1995, pp. 585-588. doi:10.1093/infdis/172.2.585
[21]	B. Farsak, A. Yildirir, Y. Aky?n, et al., “Detection of Chlamydia pneumoniae and Helicobacter pylori DNA in Human Atherosclerotic Plaques by PCR,” Journal of Clinical Microbiology, Vol. 38, No. 12, 2000, pp. 4408-4411.
[22]	D. Taylor-Robinson, B. J. Thomas, R. Goldin, et al., “Chlamydia pneumoniae in Infrequently Examined Blood Vessels,” Journal of Clinical Pathology, Vol. 55, No. 3, 2002, pp. 218-220. doi:10.1136/jcp.55.3.218
[23]	M. Davidson, C. C. Kuo, J. P. Middaugh, et al., “Confirmed Previous Infection with Chlamydia pneumoniae (TWAR) and Its Presence in Early Coronary Atherosclerosis,” Circulation, Vol. 98, No. 7, 1998, pp. 628-633. doi:10.1161/01.CIR.98.7.628
[24]	K. Ericson, T. G. Saldeen, O. Lindquist, et al., “Relationship of Chlamydia pneumoniae Infection to Severity of Human Coronary Atherosclerosis,” Circulation, Vol. 101, No. 22, 2000, pp. 2568-2571. doi:10.1161/01.CIR.98.7.628
[25]	F. Blasi, F. Denti, M. Erba, et al., “Detection of Chlamydia Pneumoniae but Not Helicobacter pylori in Atherosclerotic Plaques of Aortic Aneurysms,” Journal of Clinical Microbiology, Vol. 34, No. 11, 1996, pp. 2766-2769.
[26]	J. Sinisalo, K. Mattila, M. S. Nieminen, et al., “The Effect of Prolonged Doxycycline Therapy on Chlamydia Pneumoniae Serological Markers, Coronary Heart Disease Risk Factors and Forearm Basal Nitric Oxide Production,” Journal of Antimicrobial Chemotherapy, Vol. 41, No. 1, 1998, pp. 85-92. doi:10.1093/jac/41.1.85
[27]	J. B. Muhlestein, J. L. Anderson, J. F. Carlquist, et al., “Randomized Secondary Prevention Trial of Azithromycin in Patients with Coronary Artery Disease: Primary Clinical Results of the ACADEMIC Study,” Circulation, Vol. 102, No. 15, 2000, pp. 1755-1760. doi:10.1161/01.CIR.102.15.1755
[28]	L. A. Jackson, “Description and Status of the Azithromycin and Coronary Events Study (ACES) ,” The Journal of Infectious Diseases, Vol. 181, Supplement 3, 2000, pp. 579-581. doi:10.1086/315628