Endovascular Presence of Chlamydia pneumoniae in Patients with Hemodynamically Effective Carotid Artery Stenosis

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Abstract
The bacterial pathogen Chlamydia pneumoniae has been associated with atherosclerosis. Recent studies have reported chlamydial antigen to be present in atherosclerotic coronary arteries, but this relation has not yet been widely accepted. In order to verify an endovas cular presence of potentially viable chlamydiae by detection of genomic DNA, the authors examined atherosclerotic carotid arteries by using a C. pneumoniae-specific nested poly merase chain reaction. Chlamydial DNA was detected in 9 of 61 (15%) arterial samples obtained from therapy of hemodynamically effective cervical vascular stenosis. Chlamydial presence was limited to advanced atherosclerotic lesions (P≤0.02) : tissues from the same arteries with early subendothelial lesions did not harbor the pathogen. Thus, an etiologic role of C. pneumoniae is more plausible for progression than for initi ation of atherosclerotic lesions. Histomorphologic discrimination of infected and nonin fected samples was not possible and serology was unrewarding in detecting the infected patients. Chlamydial occurrence in atheromatous plaques is apparently a general phenomenon of atherosclerosis not limited to coronary arteries. Endovascular presence of genomic DNA of a bacterial pathogen susceptible to antimicrobial agents encourages thought on a new approach to prevent progression of atherosclerosis in a substantial proportion of patients. However, an etiologic contribution of C. pneumoniae in the multi- factorial process of atherogenesis yet remains to be demonstrated.