Association of Chlamydia pneumoniae with atherosclerosis: Potential pathogenetic mechanisms

Part of the Developments in Cardiovascular Medicine book series (DICM, volume 218)


How Chlamydia pneumoniae enters atheromatous plaques and whether or not it can cause or contribute to, atherogenesis are not entirely clear. Also, the mounting clinical data suggesting C. pneumoniae may have a direct role in atherosclerosis remain largely indirect and do not indicate a particular process by which the organism might exert its effects. This chapter aims to discuss some plausible pathogenetic mechanisms.


Coronary Heart Disease Chlamydia Trachomatis Major Outer Membrane Protein Atherogenic Lipid Profile Chronic Coronary Heart Disease 
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  1. 1.
    Gupta S, Leatham EW. The relation between Chlamydia pneumoniae and atherosclerosis. Heart 1997; 77: 7–8.PubMedGoogle Scholar
  2. 2.
    Black CM, Perez R. Chlamydia pneumoniae multiplies within human pulmonary macrophages. 90th Annual Meeting of the American Society for Microbiology, Washington DC, American Society for Microbiology, 1990, No. D-1, p. 80 [abstract].Google Scholar
  3. 3.
    Kuo CC, Shor A, Campbell LA et al. Demonstration of Chlamydia pneumoniae in atherosclerotic lesions of coronary arteries. J Infect Dis 1993; 167: 841–9.PubMedGoogle Scholar
  4. 4.
    Grayston JT, Kuo CC, Coulson AS et al. Chlamydia pneumoniae (TWAR) in atherosclerosis of the carotid artery. Circulation 1995; 92: 3397–400.PubMedGoogle Scholar
  5. 5.
    Muhlestein JB, Hammond EH, Carlquist JF et al. Increased incidence of Chlamydia species within the coronary arteries of patients with symptomatic atherosclerotic versus other forms of cardiovascular disease. J Am Coll Cardiol 1996; 27: 1555–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Yang ZP, Kuo CC, Grayston JT. A mouse model of Chlamydia pneumoniae strain pneumonitis. Infect Immun 1993; 61: 2037–40.PubMedGoogle Scholar
  7. 7.
    Yang ZP, Kuo CC, Grayston JT. Systemic dissemination of Chlamydia pneumoniae following intranasal inoculation in mice. J Infect Dis 1995; 171: 736–8.PubMedGoogle Scholar
  8. 8.
    Haidl S, Ivarsson S, Bjerre I, Persson K. Guillain-Barré syndrome after Chlamydia pneumoniae infection. N Engl J Med 1992; 326: 576–7 [letter].PubMedGoogle Scholar
  9. 9.
    Braun J, Laitko S, Treharne J et al. Chlamydia pneumoniae — a new causative agent of reactive arthritis and undifferentiated oligoarthritis. Ann Rheum Dis 1994; 53: 100–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Gaydos CA, Summersgill JT, Sahney NN, Ramirez JA, Quinn TC. Replication of Chlamydia pneumoniae in vitro in human macrophages, endothelial cells, and aortic artery smooth muscle cells. Infect Immun 1996; 64: 1614–20.PubMedGoogle Scholar
  11. 11.
    Gabriel AS, Gnarpe H, Gnarpe J et al. The prevalence of chronic Chlamydia pneumoniae infection as detected by polymerase chain reaction in pharyngeal samples from patients with ischaemic heart disease. Eur Heart J 1998; 19: 1321–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Kalayoglu MV, Byrne GI. Induction of macrophage foam cell formation by Chlamydia pneumoniae. J Infect Dis 1998; 177: 725–9.Google Scholar
  13. 13.
    Lopes-Virella MF, Klein RL, Stevenson HC. Low density lipoprotein metabolism in human macrophages stimulated with microbial or microbial-related products. Arteriosclerosis 1987; 7: 176–84.PubMedGoogle Scholar
  14. 14.
    Bozovich GE, Gurfinkel EP. Chlamydia pneumoniae: More than a bystander in acute coronary syndromes. Br J Cardiol1998; 5: 84–91.Google Scholar
  15. 15.
    Kaukoranta-Tolvanen SS, Teppo AM, Laitinen K et al. Growth of Chlamydia pneumoniae in cultured human peripheral blood mononuclear cells and induction of a cytokine response. Microb Pathog 1996; 21: 215–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Patel P, Carrington D, Strachan DP et al. Fibrinogen: a link between chronic infection and coronary heart disease. Lancet 1994; 343: 1634–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Mendall MA, Patel P, Ballam L, Strachan DP, Northfield TC. C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ 1996; 312: 1061–5.PubMedGoogle Scholar
  18. 18.
    Holland MJ, Bailey RL, Ward ME et al. Cell mediated immune responses to Chlamydia trachomatis in scarring trachoma. Proceedings of the European Society of Chlamydial Research 1992; 2: 134 [abstract].Google Scholar
  19. 19.
    Campbell LA, O’Brien E, Cappuccio A et al. Detection of Chlamydia pneumoniae TWAR in human coronary atherectomy tissues. J Infect Dis 1995; 172: 585–8.PubMedGoogle Scholar
  20. 20.
    Chiu B, Viira E, Tucker W, Fong IW. Chlamydia pneumoniae, cytomegalovirus and herpes simplex virus in atherosclerosis of the carotid artery. Circulation 1997; 96: 2144–8.PubMedGoogle Scholar
  21. 21.
    Young RA and Elliot TJ. Stress proteins, infection and immune surveillance. Cell 1989; 59: 5–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Kleindienst R, Xu Q, Willeit J et al. Immunology of atherosclerosis: Demonstration of heat shock protein 60 expression and T lymphocytes bearing alpha/beta or gamma/delta receptor in human atherosclerotic lesions. Am J Pathol 1993; 142: 1927–37.PubMedGoogle Scholar
  23. 23.
    Schett G, Xu Q, Amberger A et al. Autoantibodies against heat shock protein 60 mediate endothelial cytotoxicity. J Clin Invest 1995; 96: 2569–77.PubMedGoogle Scholar
  24. 24.
    Morrison RP. Chlamydial hsp60 and the immunopathogenesis of chlamydial disease. Sem Immunol 1989; 3: 25–33.Google Scholar
  25. 25.
    Xu Q, Willit J, Marosi M et al. Association of serum antibodies to heat shock protein 65 with carotid atherosclerosis. Lancet 1993; 341: 255–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Beatty WL, Byrne GI, Morrison RP. Repeated and persistent infection with Chlamydia and the development of chronic inflammation and disease. Trends Microbiol 1994; 2: 94–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Kol A, Sukhova GK, Lichtman AH, Libby P. Chlamydial heat shock protein 60 localizes in human atheroma and regulates macrophage tumor necrosis factor-α and matrix metalloproteinase expression. Circulation 1998; 98: 300–7.PubMedGoogle Scholar
  28. 28.
    Patel P, Mendall MA, Carrington D et al. Association of Helicobacter pylori and Chlamydia pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ 1995; 311: 711–4.PubMedGoogle Scholar
  29. 29.
    Leatham EW, Bath PM, Tooze JA, Camm AJ. Increased monocyte tissue factor expression in coronary disease. Br Heart J 1995; 73: 10–3.PubMedCrossRefGoogle Scholar
  30. 30.
    Grayston JT, Wang SP, Campbell LA, Kuo C-C. Current knowledge on Chlamydia pneumoniae strain TWAR, an important cause of pneumonia and other acute respiratory diseases. Eur J Clin Microbiol Infect Dis 1989; 8: 191–202.PubMedCrossRefGoogle Scholar
  31. 31.
    Cook PJ, Lip GY, Davies P et al. Chlamydia pneumoniae antibodies in severe essential hypertension. Hypertension 1998; 31: 589–94.PubMedGoogle Scholar
  32. 32.
    Laurila A, Bloigu A, Näyhä S et al. Chronic Chlamydia pneumoniae infection is associated with a serum lipid profile known to be a risk factor for atherosclerosis. Arterioscler Thromb Vasc Biol 1997; 17: 2910–3.PubMedGoogle Scholar
  33. 33.
    Hahn DL, Golubjatnikov R. Smoking is a potential confounder of the Chlamydia pneumoniae-coronary artery disease association. Arterioscler Thromb 1992; 12: 255–60.Google Scholar
  34. 34.
    Libby P, Egan D, Skarlatos S. Roles of infectious agents in atherosclerosis and restenosis: An assessment of the evidence and need for future research. Circulation 1997; 96: 4095–103.PubMedGoogle Scholar
  35. 35.
    Dahlén GH, Boman J, Birgander LS, Lindholm B. Lipoprotein(a), IgG, IgA and IgM antibodies to Chlamydia pneumoniae and HLA class II genotype in early coronary artery disease. Atherosclerosis 1995; 114: 165–74.PubMedCrossRefGoogle Scholar
  36. 36.
    Toss H, Gnarpe J, Gnarpe A et al. Increased fibrinogen levels are associated with persistent Chlamydia pneumoniae infection in unstable coronary artery disease. Eur Heart J 1998; 19: 570–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Gallin JI, Kaye D, O’Leary WM. Serum lipids in infection. N Engl J Med 1969; 281: 1081–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Farshtchi D, Lewis VJ. Effects of three bacterial infections on serum lipids of rabbits. J Bacteriol 1968; 95: 1615–21.PubMedGoogle Scholar
  39. 39.
    Laurila A, Bloigu A, Näyhä S et al. Chlamydia pneumoniae antibodies and serum lipids in Finnish males. BMJ 1997; 314: 1456–7.PubMedGoogle Scholar
  40. 40.
    Feingold KR, Pollock AS, Moser AH, Shigenaga JK, Grunfield C. Discordant regulation of proteins of cholesterol metabolism during the acute phase response. J Lipid Res 1995; 36: 1474–82.PubMedGoogle Scholar
  41. 41.
    Feingold KR, Grunfeld C. Tumor necrosis factor-α stimulates hepatic lipogenesis in the rat in vivo. J Clin Invest 1987; 80: 184–90.PubMedGoogle Scholar
  42. 42.
    Ingalls RR, Rice PA, Qureshi N et al. The inflammatory cytokine response to Chlamydia trachomatis infection is endotoxin mediated. Infect Immun 1995; 63: 3125–30.PubMedGoogle Scholar
  43. 43.
    Juveonen J, Juvonen T, Laurila A et al. Demonstration of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms. J Vasc Surg 1997; 25: 499–505.CrossRefGoogle Scholar
  44. 44.
    Meade T, Chakrabati R, Haines A et al. Haemostatic function and cardiovascular death: Early results of a prospective study. Lancet 1980; 17: 1050–3.CrossRefGoogle Scholar
  45. 45.
    Becker R, Cannon C, Bovill E et al. Prognostic value of plasma fibrinogen concentration in patients with unstable angina and non-Q-wave myocardial infarction (TIMI IIIB trial). Am J Cardiol 1996; 78: 142–7.PubMedGoogle Scholar

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© Kluwer Academic Publishers 1999

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