title: Inflammation and Chlamydia pneumoniae infection correlate with the severity of peripheral arterial disease.
abstract: BACKGROUND
  Our aim was to investigate the association of inflammation and Chlamydia pneumoniae infection with the presence and severity of peripheral arterial disease.
  
  
  METHODS
  Twenty-eight patients whose initial claudication distance (ICD) in the traditional constant-load treadmill test was <200 m, underwent femoral endarterectomy as part of their interventional treatment (group A). Group B consisted of 23 patients whose ICD was >200 m and were put on medication and a daily exercise program. The control group consisted of 30 non-vascular patients of the Ophthalmology Department (group C). We measured the levels of C-reactive protein, fibrinogen, vascular cell adhesion molecule-1 and tumor necrosis factor-alpha, and the titers of IgA and IgG antibodies against C. pneumoniae in the serum of all the patients. Finally, the atheromas and vein segments of group A patients, were immunohistochemically (IHC) examined for the presence of C. pneumoniae.
  
  
  RESULTS
  Peripheral arterial disease (PAD) patients, had significantly higher CRP (p=0.026) and anti-Cp IgA levels (p=0.001) when compared to control subjects, after a multiple linear regression analysis. The odds ratio for the prevalence of femoral atherosclerosis was 3.16 for IgA seropositive patients (CI 1.15-8.67). When comparing group A and group B patients, CRP (p=0.003) and IgA (p=0.011), were significantly correlated with severe PAD. Group A patients with positive immunohistochemical examination of the plaque, had higher anti-Cp IgA levels (p=0.023) and TNF-alpha values (p=0.031), compared to the IHC negative patients. C. pneumoniae was detected in 50% of the femoral atheromas, but in only 3.6% of the veins.
  
  
  CONCLUSIONS
  This study supports the hypothesis that inflammation (CRP) and chronic C. pneumoniae infection (IgA seropositivity), have an important role in lower limb atherosclerosis and correlate with the severity of the disease.
authors.affiliation: 2nd Department of Propedeutic Surgery, Laikon Hospital, Athens University Medical School, Athens, Greece. pepperon7@hotmail.com
authors.forename: E A
authors.initials: EA
authors.lastname: Kaperonis
authors.forename: C D
authors.initials: CD
authors.lastname: Liapis
authors.forename: J D
authors.initials: JD
authors.lastname: Kakisis
authors.forename: D
authors.initials: D
authors.lastname: Dimitroulis
authors.forename: V G
authors.initials: VG
authors.lastname: Papavassiliou
authors.forename: D
authors.initials: D
authors.lastname: Perrea
authors.forename: A G
authors.initials: AG
authors.lastname: Kostakis
mesh_terms: D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D050197:Atherosclerosis / Q000097:blood* / Q000382:microbiology*; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D016993:Chlamydophila pneumoniae / Q000276:immunology / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000382:microbiology*; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D000907:Antibodies, Bacterial; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D019010:Vascular Cell Adhesion Molecule-1; D005340:Fibrinogen; D002097:C-Reactive Protein