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Immune Responses in Atherosclerosis and Microvascular Angina

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Chest Pain with Normal Coronary Arteries

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Abstract

Intense research into the mechanisms that trigger and drive atherosclerosis has dramatically challenged the view that this disease is merely caused by the accumulation of lipids (mainly low density lipoproteins, LDL) in the vessel wall and clearly demonstrated that chronic inflammation orchestrated by the immune system is crucial for atherogenesis. The innate as well as the adaptive arms of the immune system are actively involved in atherosclerosis. In support of this is the observation that immune cells like macrophages and T cells constitute a great part of the inflammatory infiltrate in atherosclerotic lesions. In addition, some patients with atherosclerosis develop T-cell-dependent and T-cell-independent antibodies that recognise modified lipids such as oxidised LDL (oxLDL). In this chapter, we provide a brief overview of the contribution of the immune system and in particular of T lymphocytes to atherosclerosis and discuss the importance of research in this area in patients with microvascular angina. A better understanding of the immune mechanisms that underlie atherogenesis both in patients with coronary artery disease and microvascular angina has important clinical implications as it may unravel novel targets for immunotherapy that may allow efficient control of these clinical entities.

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Abbreviations

ACS:

Acute coronary syndrome

APC:

Antigen presenting cell

CAD:

Coronary artery disease

DC:

Dendritic cell

HSP:

Heat shock protein

IFN-γ:

Interferon-γ

IL-12:

Interleukin-12

LDL:

Low density lipoprotein

MMP:

Matrix metallo-proteinases

oxLDL:

Oxidised low density lipoprotein

Th:

T helper

TGF-β:

Transforming growth factor-β

TNF-α:

Tumour necrosis factor-α

VSMC:

Vascular smooth muscle cell

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Acknowledgements

Supported by the British Heart Foundation (grant no. PG/10/50/28434, to IED and JCK) and St. George’s Hospital Charity, London, UK.

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Authors and Affiliations

  1. Division of Clinical Sciences, Cardiovascular Sciences Research Centre, St. George’s University of London, Cranmer Terrace, London, SW17 0RE, UK

    Ingrid E. Dumitriu MD, PhD & Juan Carlos Kaski MD, DM (Hons), DSc, FRCP, FESC, FACC, FAHA

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  1. Ingrid E. Dumitriu MD, PhD
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  2. Juan Carlos Kaski MD, DM (Hons), DSc, FRCP, FESC, FACC, FAHA
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Correspondence to Ingrid E. Dumitriu MD, PhD .

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Editors and Affiliations

  1. Medical School, Coronary Artery Disease, Research Group, St George's Hospital, Cranmer Terrace, London, SW17 0RE, United Kingdom

    Juan Carlos Kaski

  2. University of Sydney, Discipline of Surgery, The Whiteley-Martin Research Centre, Parker Street, Sydney, 2747, New South Wales, Australia

    Guy D. Eslick

  3. , Women's Heart Center, Cedars-Sinai Heart Institute, S. San Vicente Blvd 444, Los Angeles, 90048, USA

    C. Noel Bairey Merz

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Dumitriu, I.E., Kaski, J.C. (2013). Immune Responses in Atherosclerosis and Microvascular Angina. In: Kaski, J., Eslick, G., Bairey Merz, C. (eds) Chest Pain with Normal Coronary Arteries. Springer, London. https://doi.org/10.1007/978-1-4471-4838-8_15

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