title: C-reactive protein is released in the coronary circulation and causes endothelial dysfunction in patients with acute coronary syndromes.
abstract: BACKGROUND
  C-reactive protein (CRP) plasma levels correlate with cardiovascular events. Although a direct role for CRP in atherothrombosis has been suggested, at the moment little is known about its involvement in the pathophysiology of acute coronary syndromes (ACS). Thus, the aim of this study was to determine whether CRP is produced in the culprit lesion and released within the coronary circulation of patients with ACS and whether it may affect coronary endothelial function.
  
  
  METHODS
  Blood samples were simultaneously obtained from the aorta (Ao) and the coronary sinus (CS) of patients with normal coronary artery (n=16), stable angina (n=30), and ACS (n=29) for later measurement of plasma CRP levels. Endothelium-dependent and -independent coronary vasodilation were evaluated by means of a Doppler Flow Wire in response to the increasing intracoronary doses of acetylcholine and adenosine, respectively.
  
  
  RESULTS
  CRP plasma levels were significantly higher across the coronary circulation only in ACS patients with the culprit lesion located in the left coronary artery, while no differences between CS and Ao CRP plasma levels were observed in all other groups. Transcardiac CRP levels were correlated with impairment in coronary endothelium-dependent vasodilation. In six additional patients (SA=3 and ACS=3), subjected to coronary atherectomy, real-time quantitative PCR revealed presence of CRP mRNA only in unstable plaques.
  
  
  CONCLUSIONS
  Thus, CRP is produced and released within the coronary circulation of patients with ACS; this is associated with impairment of endothelial function, suggesting a new pathophysiological link between CRP and ACS.
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Forte
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cimmino
authors.forename: Francesco
authors.initials: F
authors.lastname: Loffredo
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Palma
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Abbate
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.forename: Diego
authors.initials: D
authors.lastname: Ingrosso
authors.forename: Patrizia
authors.initials: P
authors.lastname: Galletti
authors.forename: Ciro
authors.initials: C
authors.lastname: Carangio
authors.forename: Beniamino
authors.initials: B
authors.lastname: Casillo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.forename: Paolo
authors.initials: P
authors.lastname: Golino
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D000368:Aged; D001011:Aorta / Q000502:physiology; D002097:C-Reactive Protein / Q000235:genetics* / Q000378:metabolism*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D054326:Coronary Sinus / Q000502:physiology; D003331:Coronary Vessels / Q000502:physiology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D014664:Vasodilation / Q000502:physiology
chemical_list: D002097:C-Reactive Protein