Perinatal and infant early atherosclerotic coronary lesions.
OBJECTIVE
Because the fetal origin of coronary artery lesions is controversial, early atherosclerotic coronary artery lesions in late fetal stillborns and infants, as well as the possible atherogenic role of maternal cigarette smoking, were studied.


METHODS
Twenty-two fetal death and 36 sudden infant death syndrome victims were examined by autopsy. In 28 of 58 cases, the mothers were smokers. Serially cut sections of coronary arteries were stained for light microscopy and immunotypified for CD68, CD34, alpha-smooth muscle actin, proliferating cell nuclear antigen, c-fos and apoptosis.


RESULTS
Multifocal coronary lesions were detected in 10 of 12 fetuses and in 15 of 16 infants whose mothers smoked. Arterial lesions in infants with nonsmoking mothers were observed in only five cases (two of 10 fetuses and three of 20 infants) (P<0.001). Alterations ranged from focal areas with mild myointimal thickening in prenatal life to early soft plaques in infants. Smooth muscle cells infiltrated into the subendothelium. These early lesions demonstrated c-fos gene activation in the smooth muscle cells of the media, and in some of these, positivity for apoptosis was observed, suggesting that c-fos overexpression may promote proliferation, as evidenced by proliferating cell nuclear antigen-positive cells.


CONCLUSIONS
Early intimal alterations of the coronary arteries are detectable in the prenatal and infancy period, and may be significantly associated with maternal smoking.
Milei
José
J
Instituto de Investigaciones Cardiológicas, University of Buenos Aires--CONICET, Buenos Aires, Argentina. ininca@fmed.uba.ar
Ottaviani
Giulia
G
Lavezzi
Anna Maria
AM
Grana
Daniel R
DR
Stella
Inés
I
Matturri
Luigi
L
D000328:Adult; D017209:Apoptosis; D003324:Coronary Artery Disease / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D015870:Gene Expression; D006801:Humans; D007231:Infant, Newborn; D032389:Myocytes, Smooth Muscle / Q000378:metabolism / Q000473:pathology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D016760:Proto-Oncogene Proteins c-fos / Q000235:genetics / Q000378:metabolism; D012907:Smoking / Q000009:adverse effects*; D050497:Stillbirth; D013398:Sudden Infant Death / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology
D016760:Proto-Oncogene Proteins c-fos