Role of oral bacterial flora in calcific aortic stenosis: an animal model.
BACKGROUND
Calcific aortic stenosis is a major public health problem in the United States. The mechanism of calcification remains unclear. The hypothesis that low grade chronic or recurrent bacterial endocarditis with specific calcifiable bacteria is a cause of calcification of the aortic valves was investigated using an animal model. Such bacteria are typically present as part of the normal human oral flora.


METHODS
Forty New Zealand white rabbits were divided into four groups: group 1, control (1 ml of normal saline); group 2, Corynebacterium matruchotti 100,000 colonies; group 3, Streptococcus sanguis II 10 colonies; and group 4, C matruchotti 100,000 colonies plus S sanguis II 10 colonies. Animals were inoculated with bacteria through a flexible catheter placed through the aortic valve through a right carotid cut down. Inoculations were repeated every 3 days the first 2 weeks and then twice a week thereafter. At postmortem examination the aortic valves were harvested, embedded in paraffin, and stained with von Kossa stain. They were also examined by scanning and transmission electron micrography.


RESULTS
Group 4 had 93.3% large calcifications (confluent calcium densities that are easily recognized with minimal magnification) and 6.6% small microcalcifications (dustlike microscopic particles requiring a compound microscope to appreciate) of the aortic valves. Group 3 exhibited large calcification in 20% and small in 40% of the aortic valves. Group 1 and group 2 had no evidence of calcification.


CONCLUSIONS
These results suggest that recurrent low-grade endocarditis from calcifying oral bacteria, particularly when occurring with synergistic strains, may be one cause of calcific aortic stenosis.
Cohen
David J
DJ
Cardiothoracic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA. david_j_cohen@hotmail.com
Malave
David
D
Ghidoni
John J
JJ
Iakovidis
Panagiotis
P
Everett
Mona M
MM
You
Shenghong
S
Liu
Youhong
Y
Boyan
Barbara D
BD
D000818:Animals; D001021:Aortic Valve / Q000382:microbiology / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000382:microbiology* / Q000473:pathology; D016470:Bacteremia / Q000382:microbiology / Q000473:pathology; D002114:Calcinosis / Q000382:microbiology* / Q000473:pathology; D002118:Calcium / Q000032:analysis; D002908:Chronic Disease; D015169:Colony Count, Microbial; D003352:Corynebacterium / Q000472:pathogenicity; D003354:Corynebacterium Infections / Q000382:microbiology* / Q000473:pathology; D003773:Dental Plaque / Q000382:microbiology; D004195:Disease Models, Animal; D004697:Endocarditis, Bacterial / Q000382:microbiology; D008297:Male; D008855:Microscopy, Electron, Scanning; D009061:Mouth Mucosa / Q000382:microbiology* / Q000473:pathology; D011817:Rabbits; D012307:Risk Factors; D013290:Streptococcal Infections / Q000382:microbiology* / Q000473:pathology; D013298:Streptococcus sanguis / Q000472:pathogenicity; D014774:Virulence
D002118:Calcium