Skip to main content

Chlamydia pneumoniae and Atherosclerosis: Mechanisms of Vascular Damage

  • Chapter
Book cover Chlamydia pneumoniae
  • 55 Accesses

Abstract

In 1908 Sir William Osier first proposed a causative role of infection in the pathogenesis of atherosclerosis [1]. The view that infectious processes may contribute to cardiovascular diseases did not gain wide support, as autopsy and epidemiological studies shifted the attention towards other mechanisms, some of which have now become established risk factors. In recent years, however, it has become apparent that recognised risk factors for coronary heart disease (CHD) do not fully explain the diversity of this disease, or why risk factor modifications have not reduced its incidence as much as has been predicted. Recent observations have prompted research into other potential and hitherto unrecognised influences in the causation of atherogenesis. Amongst these, chronic infection by Gram-negative bacteria and herpesviridae have been shown to have a major role. Current evidence indicates that chronic Chlamydia pneumoniae infection may play a causal role in atherogenesis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Osler W (1908) Diseases of the arteries. In: Osler W (ed) Modern medicine: its practice and theory. Lea and Febiger, Philadelphia, pp 429–447

    Google Scholar 

  2. Saikku P (1992) The epidemiology and significance of Chlamydia pneumoniae. J Infect 39: 88–90

    Google Scholar 

  3. Grayston JT, Campbell LA, Kuo C-C et al (1990) A new respiratory pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis 161: 618–625

    Article  PubMed  CAS  Google Scholar 

  4. Saikku P, Mattila K, Nieminen S et al (1988) Serological evidence of an association of a novel Chlamydia TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet 2: 983–986

    Article  PubMed  CAS  Google Scholar 

  5. Saikku P, Leinonen M, Tenkanen L et al (1992) Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study. Ann Int Med 116: 273–278

    PubMed  CAS  Google Scholar 

  6. Thom DH, Grayston JT, Siscovick DS et al (1992) Association of prior infection with Chlamydia pneumoniae and angiographically demonstrated coronary artery disease. JAMA 268: 68–72

    Article  PubMed  CAS  Google Scholar 

  7. Melnick SL, Shahar E, Folsom AR et al (1993) Past infection by Chlamydia pneumoniae strain TWAR and asymptomatic carotid atherosclerosis. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Am J Med 95: 499–504

    Article  PubMed  CAS  Google Scholar 

  8. Thom DH, Wang SP, Grayston JT et al (1991) Chlamydia strain TWAR antibody and angiographically demonstrated coronary artery disease. Arterioscler Thromb 11: 547–551

    Article  PubMed  CAS  Google Scholar 

  9. Mendall MA, Carrington D, Strachan DP et al (1995) Chlamydia pneumoniae: risk factors for seropositivity and association with coronary heart disease. J Infect 30: 121–128

    Article  PubMed  CAS  Google Scholar 

  10. Haidl S, Juul-Moller S, Israelsson B et al (1992) Ischaemic heart disease and antibodies to Chlamydia pneumoniae (TWAR). Proc Eur Soc Chlam Res 2: 174 (abstract)

    Google Scholar 

  11. Cook PJ, Lip GY, Zarifis J et al (1996) Is Chlamydia pneumoniae infection associated with acute cardiac ischaemic syndromes? J Am Coll Cardiol 324[Suppl A]: 807–812

    Google Scholar 

  12. Patel P, Mendall MA, Carrington D et al (1995) Association of Helicobacter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ 311: 711–714

    Article  PubMed  CAS  Google Scholar 

  13. Danesh J, Collins R, Peto R (1997) Chronic infections and coronary heart disease: is there a link? Lancet 350: 430–436

    Article  PubMed  CAS  Google Scholar 

  14. Campbell LA, O’Brien ER, Cappuccio AL et al (1995) Detection of Chlamydia pneumoniae TWAR in human coronary atherectomy tissues. J Infect Dis 172: 585–588

    Article  PubMed  CAS  Google Scholar 

  15. Toss H, Gnarpe J, Siegbahn A et al (1998) Increased fibrinogen levels are associated with persistent Chlamydia pneumoniae infection in unstable coronary artery disease. Eur Heart J 19: 570–577

    Article  PubMed  CAS  Google Scholar 

  16. Cook PJ, Honeybourne D, Lip GY et al (1995) Chlamydia pneumoniae and acute arterial thrombotic disease. Circulation 95: 3148–3149

    Google Scholar 

  17. Aceti A, Mazzacurati G, Amendolea M et al (1996) Relation of C-reactive protein to cardiovascular risk factors: Helicobacter pylori and Chlamydia pneumoniae infections may account for most acute coronary syndromes. BMJ 313: 428–429

    Article  PubMed  CAS  Google Scholar 

  18. Davidson M, Kuo C-C, Middaugh JP et al (1998) Confirmed previous infection with Chlamydia pneumoniae (TWAR) and its presence in early coronary atherosclerosis. Circulation 98: 628–633

    PubMed  CAS  Google Scholar 

  19. Kuo C-C, Shor A, Campbell LA et al (1993) Demonstration of Chlamydia pneumoniae in atherosclerotic lesions of coronary arteries. J Infect Dis 167: 841–849

    Article  PubMed  CAS  Google Scholar 

  20. Kuo C-C, Gown AM, Benditt EP, Grayston JT (1993) Detection of Chlamydia pneumoniae in aortic lesions of atherosclerosis by immunocytochemical stain. Arterioscler Thromb 13: 1501–1504

    Article  PubMed  CAS  Google Scholar 

  21. Kuo C-C, Grayston JT, Campbell LA et al (1995) Chlamydia pneumoniae (TWAR) in coronary arteries of young adults (15–34 years old). Proc Natl Acad Sci USA 92: 6911–6914

    Article  PubMed  CAS  Google Scholar 

  22. Grayston JT, Kuo C-C, Coulson AS et al (1995) Chlamydia pneumoniae (TWAR) in atherosclerosis of the carotid artery. Circulation 92: 3397–3400

    PubMed  CAS  Google Scholar 

  23. Ong G, Thomas BJ, Mansfield AO et al (1996) Detection and widespread distribution of Chlamydia pneumoniae in the vascular system and its possible implications. J Clin Pathol 49: 102–106

    Article  PubMed  CAS  Google Scholar 

  24. Muhlestein JB, Hammond EH, Carlquist JF et al (1996) Increased incidence of Chlamydia species within the coronary arteries of patients with symptomatic atherosclerotic versus other forms of cardiovascular disease. J Am Coll Cardiol 27: 1555–1561

    Article  PubMed  CAS  Google Scholar 

  25. Yang Z, Kuo C-C, Grayston JT (1995) Systemic dissemination of Chlamydia pneumoniae following intranasal innoculation in mice. J Infect Dis 171: 736–738

    Article  PubMed  CAS  Google Scholar 

  26. Jackson LA, Campbell LA, Schmidt R et al (1997) Specificity of detection of Chlamydia pneumoniae in cardiovascular atheroma. Am J Pathol 150: 1785–1790

    PubMed  CAS  Google Scholar 

  27. Gaydos CA, Summersgill JT, Sahney NN et al (1996) Replication of Chlamydia pneumoniae in vitro in human macrophages, endothelial cells and aortic artery smooth muscle cells. Infect Immunol 64: 1614–1620

    CAS  Google Scholar 

  28. Ramirez JA (1996) Isolation of Chlamydia pneumoniae from the coronary artery of a patient with coronary atherosclerosis. The Chlamydia pneumoniae Atherosclerosis Study Group. Ann Int Med 125: 979–982

    PubMed  CAS  Google Scholar 

  29. Maass M, Bartels C, Engel PM et al (1998) Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease. J Am Coll Cardiol 31: 827–832

    Article  PubMed  CAS  Google Scholar 

  30. Jackson LA, Campbell LA, Kuo C-C et al (1998) Isolation of Chlamydia pneumoniae from a carotid endarterectomy specimen. J Infect Dis 176: 292–295

    Article  Google Scholar 

  31. Moazed TC, Kuo C-C, Grayston JT et al (1997) Murine models of Chlamydia pneumoniae infection and atherosclerosis. J Infect Dis 175: 883–890

    Article  PubMed  CAS  Google Scholar 

  32. Fong IW, Chiu B, Viira E et al (1997) Rabbit model for Chlamydia pneumoniae infection. J Clin Microbiol 35: 48–52

    PubMed  CAS  Google Scholar 

  33. Laitinen K, Laurila A, Pyhala L et al (1997) Chlamydia pneumoniae infection induces inflammatory changes in the aortas of rabbits. Infect Immun 65: 4825–4832

    Google Scholar 

  34. Muhlestein JB, Anderson JL, Hammond EH et al (1998) Infection with Chlamydia pneumoniae acelerates the development of atherosclerosis and treatment with azithromycin prevents it in a rabbit model. Circulation 97: 633–636

    PubMed  CAS  Google Scholar 

  35. Chen L, Chester MR, Redwood S, Huang J, Leatham E, Kaski JC (1995) Angiographic stenosis progression and cardiac events in patients with stabilised unstable angina. Circulation 91: 2319–2324

    PubMed  CAS  Google Scholar 

  36. Fuster V, Badimon L, Cohen M et al (1988) Insights into the pathogenesis of acute ischaemic syndromes. Circulation 77: 1213–1220

    Article  PubMed  CAS  Google Scholar 

  37. Falk E (1989) Morphological features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol 63: 114E–120E

    Article  PubMed  CAS  Google Scholar 

  38. Moreno P, Falk E, Palacios I et al (1994) Macrophage infiltration in acute coronary syndromes. Circulation 90: 775–780

    PubMed  CAS  Google Scholar 

  39. Annex B, Denning S, Channon K et al (1995) Differential expression of tissue factor protein in directional atherectomy specimens from patients with stable and unstable coronary syndromes. Circulation 91: 619–622

    PubMed  CAS  Google Scholar 

  40. Davies MJ (1996) Stability and instability: two faces of coronary atherosclerosis. Circulation 94: 2013–2020

    PubMed  CAS  Google Scholar 

  41. Davies MJ (1998) Reactive oxygen species, metalloproteinases and plaque stability. Circulation 97: 2382–2383

    PubMed  CAS  Google Scholar 

  42. Libby PJ (1995) The molecular bases of the acute coronary syndromes. Circulation 91: 2844–2850

    PubMed  CAS  Google Scholar 

  43. Liuzzo G, Biasucci LM, Gallimore JR et al (1994) The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. N Engl J Med 331: 417–424

    Article  PubMed  CAS  Google Scholar 

  44. Dollery CM, McEwan JR, Henney A (1995) Matrix metalloproteinases and cardiovascular disease. Circ Res 77: 863–868

    PubMed  CAS  Google Scholar 

  45. Henney A, Wakeley P, Davies M et al (1991) Localisation of stromelysin gene expression in atherosclerotic plaques by in-situ hybridization. Proc Natl Acad Sci USA 88(18): 8154–8158

    Article  PubMed  CAS  Google Scholar 

  46. Galis ZS, Sukhova GK, Lark MW et al (1994) Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaques. J Clin Invest 94: 2493–2503

    Article  PubMed  CAS  Google Scholar 

  47. Sernery GGN, Abbate R, Gori AM et al (1992) Transient intermittent lymphocyte activation is responsible for the instability of angina. Circulation 86: 790–797

    Google Scholar 

  48. Reidy MA, Bowyer DE (1978) Distortion of endothelial repair. The effect of hypercholesterolaemia on regulation of aortic endothelium following injury by endotoxin. A scanning microscopy study. Atherosclerosis 29: 459–466

    Article  PubMed  CAS  Google Scholar 

  49. Pesonen E, Kaprio K, Rapola J et al (1981) Endothelial cell damage in piglet coronary artery after administration of E. coli endotoxin. A scanning and transmission electron microscopic study. Atherosclerosis 40: 65–73

    Article  PubMed  CAS  Google Scholar 

  50. Hansson GK (1989) Immune mechanisms in atherosclerosis. Atherosclerosis 9: 567–588

    CAS  Google Scholar 

  51. Hajjar DP, Falcone DJ, Fabricant CG et al (1985) Altered cholesterol ester cycle is associated with lipid accumulation in herpes-infected arterial smooth muscle cells. J Biol Chem 260: 6124–6128

    PubMed  CAS  Google Scholar 

  52. Leatham EW, Bath PM, Tooze JA et al (1995) Increased monocyte tissue factor expression in coronary disease. Br Heart J 73: 10–13

    Article  PubMed  CAS  Google Scholar 

  53. Visser MR, Tracey PB, Vercellotti GM et al (1988) Enhancing thrombin generation and platelet binding on herpes simplex virus-infected endothelium. Proc Natl Acad Sci USA 85: 8227–8230

    Article  PubMed  CAS  Google Scholar 

  54. Gupta S, Camm AJ (1997) Chlamydia pneumoniae and coronary heart disease: coincidence, association, or causation? BMJ 314: 1778–1779

    Article  PubMed  CAS  Google Scholar 

  55. Holland MJ, Bailey RL, Hayes LJ et al (1998) Conjuctival scarring in trachoma is associated with depressed cell-mediated immune responses to Chlamydial antigens. J Infect Dis 168: 1528–1531

    Article  Google Scholar 

  56. Kaukoranta-Tolvanen SS, Teppo AM, Laitinen K et al (1996) Growth of Chlamydia pneumoniae in cultured human blood mononuclear cells and induction of a cytokine response. Microb Pathog 21: 215–221

    Article  PubMed  CAS  Google Scholar 

  57. Patel P, Carrington D, Strachan DP et al (1994) Fibrinogen: a link between chronic infection and coronary heart disease. Lancet 343: 1634–1635

    Article  PubMed  CAS  Google Scholar 

  58. Mendall MA, Patel P, Ballam L et al (1996) C-reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ 312: 1061–1065

    Article  PubMed  CAS  Google Scholar 

  59. Morrison RP, Belland RJ, Lyng K, Caldwell HD (1989) Chlamydial disease pathogenesis. The 57-kD chlamydial hypersensitivity antigen is a stress response protein. J Exp Med 170: 1271–1283

    Article  PubMed  CAS  Google Scholar 

  60. Birnie DH, Holme ER, McKay IC et al (1998) Association between antibodies to heat shock protein 65 and coronary atherosclerosis. Eur Heart J 19: 387–394

    Article  PubMed  CAS  Google Scholar 

  61. Kol A, Sukhova GK, Lichtman AH, Libby P (1998) Chlamydial heat shock protein 60 localises in human atheroma and regulates macrophage tumour necrosis factor-α and matrix metalloproteinase expression. Circulation 98: 300–307

    PubMed  CAS  Google Scholar 

  62. Xu Q, Dietrich H, Steiner HJ et al (1992) Induction of arteriosclerosis in normocholesterolaemic rabbits by immunisation with heat shock protein 65. Arterioscler Thromb 12: 789–799

    Article  PubMed  CAS  Google Scholar 

  63. Kaski JC, Cox I (1998) Chronic infection and atherogenesis. Eur Heart J 19: 366–367

    PubMed  CAS  Google Scholar 

  64. Fujita T, Fujimoto Y (1992) Formation and removal of active oxygen species and lipid peroxides in biological systems. Nippon Yakurigaku Zasshi 99: 381–389

    Article  PubMed  CAS  Google Scholar 

  65. Steinbrecher UP, Parathasarathy S, Leake DS et al (1984) Modification of low density lipoprotein by endothelial cells involves lipid peroxidation and degradation of low density lipoprotein phospholipids. Proc Natl Acad Sci USA 81: 3883–3887

    Article  PubMed  CAS  Google Scholar 

  66. Morel DW, DiCorleto PE, Chisholm GM (1984) Endothelial and smooth muscle cells alter low density lipoprotein in vitro by free radical oxidation. Arteriosclerosis 4: 357–364

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer-Verlag Italia, Milano

About this chapter

Cite this chapter

Kaski, J.C., Smith, D.A. (1999). Chlamydia pneumoniae and Atherosclerosis: Mechanisms of Vascular Damage. In: Allegra, L., Blasi, F. (eds) Chlamydia pneumoniae. Springer, Milano. https://doi.org/10.1007/978-88-470-2280-5_17

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2280-5_17

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0047-6

  • Online ISBN: 978-88-470-2280-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics