title: Expression of tumour necrosis factor alpha and accumulation of fibronectin in coronary artery restenotic lesions retrieved by atherectomy.
abstract: BACKGROUND
  The formation of coronary artery neointima experimentally induced in piglets after cardiac transplantation is related to an immune-inflammatory reaction associated with increased expression of T cells and inflammatory mediators (tumour necrosis factor alpha and interleukin 1 beta) and upregulation of fibronectin. In vivo blockade of tumour necrosis factor alpha in rabbits after cardiac transplantation results in reduced neointimal formation. The objective of this study was to investigate the hypothesis that coronary restenosis after atherectomy or percutaneous balloon angioplasty is associated with a similar inflammatory cascade initiated by mechanical injury.
  
  
  METHODS
  Specimens taken at coronary atherectomy were analysed from 16 patients. Nine had had the procedure performed twice, firstly, to remove a primary lesion, and secondly, to remove a restenotic lesion. Seven had percutaneous balloon angioplasty after removal of restenotic tissue. Coronary atherectomy specimens were analysed by immunohistochemistry for the presence of T cells, macrophages, major histocompatibility complex II, interleukin 1 beta, tumour necrosis factor alpha, fibronectin, and the receptor for hyaluronan mediated motility.
  
  
  RESULTS
  The groups were clinically and angiographically similar with equivalent lumens before and after atherectomy. Restenotic lesions had increased expression of tumour necrosis factor alpha and fibronectin compared with the primary lesions (P < 0.05 for both). There was also a trend towards a greater number of T cells and increased expression of interleukin 1 beta.
  
  
  CONCLUSIONS
  Restenosis is associated with increased expression of tumour necrosis factor alpha and fibronectin, suggesting that an immune-inflammatory reaction probably contributes to neointimal formation and may represent a form of wound healing and repair secondary to mechanical injury.
authors.affiliation: Division of Cardiology, Toronto Hospital, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Clausell
authors.forename: V C
authors.initials: VC
authors.lastname: de Lima
authors.forename: S
authors.initials: S
authors.lastname: Molossi
authors.forename: P
authors.initials: P
authors.lastname: Liu
authors.forename: E
authors.initials: E
authors.lastname: Turley
authors.forename: A I
authors.initials: AI
authors.lastname: Gotlieb
authors.forename: A G
authors.initials: AG
authors.lastname: Adelman
authors.forename: M
authors.initials: M
authors.lastname: Rabinovitch
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017073:Atherectomy; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000601:surgery; D003327:Coronary Disease / Q000276:immunology; D005353:Fibronectins / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D007375:Interleukin-1 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D017539:Tunica Intima / Q000378:metabolism*
chemical_list: D005353:Fibronectins; D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha