title: Perforin expression after acute myocardial infarction--a pilot study.
abstract: Perforin is an important mediator of inflammatory reactions. It is a quick-action cytotoxic mediator accumulated in the cytoplasmic granules of effector immunity cells (T lymphocytes, NK and NKT cells) which provide death signal in infected or transformed cells. Perforin-positive cells were previously detected in myocardial tissue during Trypanosoma cruzi infection and viral myocarditis while its role in chronic and progressive cardiovascular inflammatory disease such as atherosclerosis is almost completely unexplored. The perforin activity is also untested during acute coronary events that represent unexpected atherosclerotic complications due to the inflammatory destabilisation and atherosclerotic plaque rupture. The aim of this study was to investigate the presence of perforin, an important immunological inflammatory molecule in peripheral blood lymphocytes during the early period after acute myocardial infarction. We analyzed three subject groups: women with ST-segment elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), conservatively treated women with acute myocardial infarction without ST-segment elevation (NSTEMI) and a control group of healthy volunteers. The STEMI and NSTEMI groups did not basically differ in medication neither in levels of routine laboratory tests, while troponin I were significantly higher in the STEMI group. In the study, we detected an early decrease of perforin-positive lymphocytes in STEMI patients that were in contrast with their persisting elevation among NSTEMI patients. Despite greater myocardial necrosis in the STEMI group, results of this pilot-study indicated the prolonged perforin-mediated inflammatory response in patients with NSTEMI. This perforin down-regulation that follows the coronary interventional reperfusion in STEMI emphasized the possible anti-inflammatory role of primary PCI among patients with acute myocardial infarction. Given that the issue of routine primary PCI in NSTEMI is nowadays highly topical, the results we expect in the wake of this pilot study could demonstrate a significant impact on clinical practice. Further research is needed to confirm these results, compare the perforin-mediated activity to other inflammatory mediators in acute coronary events and to examine their impact on the long-term outcome.
authors.affiliation: Thalassotherapia Hospital, Clinic for Cardiovascular Diseases Treatment, Rehabilitation and Prevention, Opatija, Croatia. alen.ruzic1@ri.t-com.hr
authors.forename: Alen
authors.initials: A
authors.lastname: Ruzić
authors.forename: Bojan
authors.initials: B
authors.lastname: Miletić
authors.forename: Sanja
authors.initials: S
authors.lastname: Balen
authors.forename: Viktor
authors.initials: V
authors.lastname: Persić
authors.forename: Dijana
authors.initials: D
authors.lastname: Travica-Samsa
authors.forename: Marijana
authors.initials: M
authors.lastname: Rakić
authors.forename: Vesna
authors.initials: V
authors.lastname: Pehar-Pejcinović
authors.forename: Jelena
authors.initials: J
authors.lastname: Hajdin
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Vcev
authors.forename: Gordana
authors.initials: G
authors.lastname: Laskarin
mesh_terms: D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000378:metabolism* / Q000628:therapy*; D054353:Perforin / Q000096:biosynthesis*; D010865:Pilot Projects
chemical_list: D054353:Perforin