title: Presence of Chlamydophila pneumoniae DNA but not mRNA in stenotic aortic heart valves.
abstract: BACKGROUND
  The pathogenesis of aortic valve stenosis may involve inflammation and we have previously demonstrated Chlamydophila pneumoniae (C. pneumoniae) DNA in stenotic aortic heart valves. Dissemination of these bacteria is probably mediated by alveolar macrophages. Bacterial DNA alone does not indicate whether the bacteria are viable and replicating. This study aimed to investigate the presence of C. pneumoniae mRNA, a marker of replicating bacteria, and C. pneumoniae DNA in stenotic aortic valves and the prevalence of C. pneumoniae in peripheral blood mononuclear cells (PBMC).
  
  
  METHODS
  DNA was extracted from heart valves and PBMC and mRNA from heart valves from 76 patients undergoing aortic valve replacement surgery. C. pneumoniae DNA and mRNA were measured by real-time PCR targeting the ompA gene.
  
  
  RESULTS
  C. pneumoniae DNA was demonstrated in 22% of heart valves and in 5% of PBMC. C. pneumoniae mRNA was not detected in any valve. Patients positive for C. pneumoniae in the valve underwent coronary artery by-pass grafting more often (p=0.01) and suffered from angina pectoris (p=0.02) and arterial hypertension (p=0.03) more often than patients negative for C. pneumoniae in the valve.
  
  
  CONCLUSIONS
  These findings support a role for C. pneumoniae in the pathogenesis of aortic valve stenosis and indicate that the bacteria disseminate from the respiratory tract long before the patients were in need of surgery and that the valve infection thereafter entered into a persistent and non-replicative state. Moreover, patients positive for C. pneumoniae in the valve more often needed by-pass grafting because of more advanced coronary disease.
authors.affiliation: Department of Medical Sciences, Infectious Diseases, Uppsala University Hospital, S-75185 Uppsala, Sweden. marie.edvinsson@medsci.uu.se
authors.forename: Marie
authors.initials: M
authors.lastname: Edvinsson
authors.forename: Eva
authors.initials: E
authors.lastname: Hjelm
authors.forename: Stefan
authors.initials: S
authors.lastname: Thelin
authors.forename: Göran
authors.initials: G
authors.lastname: Friman
authors.forename: Christina
authors.initials: C
authors.lastname: Nyström-Rosander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000382:microbiology; D000907:Antibodies, Bacterial / Q000097:blood; D001021:Aortic Valve / Q000382:microbiology; D001024:Aortic Valve Stenosis / Q000382:microbiology* / Q000601:surgery; D023521:Chlamydophila Infections / Q000150:complications / Q000276:immunology / Q000382:microbiology*; D016993:Chlamydophila pneumoniae / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000032:analysis*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016676:Macrophages, Alveolar / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012329:RNA, Bacterial / Q000032:analysis*; D012333:RNA, Messenger / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D007074:Immunoglobulin G; D012329:RNA, Bacterial; D012333:RNA, Messenger