title: Evidence for a vascular microbiome and its role in vessel health and disease.
abstract: OBJECTIVE
  We have summarized available evidence for and against the presence of a vascular microbiome. Studies that have attempted to detect bacteria and viruses in blood vessels in both health and disease are critiqued in an attempt to explain contrary results that may be due to variations in methodology.
  
  
  RESULTS
  Many studies have demonstrated the presence of both bacteria and viruses within diseased blood vessels. Evidence is most compelling in atherosclerosis; however, recent reports have raised questions about the potential role of microbes in nonatherosclerotic aortic aneurysms and vasculitis. Preliminary evidence also suggests that apparently normal vessels may harbor microbes. With the exception of certain viral infections (e.g. hepatitis C virus, HIV, Epstein-Barr virus, and cytomegalovirus) and infectious endocarditis, systemic vasculitides have not been convincingly associated with infectious agents. However, emerging data suggest that different communities of microbes may be present in noninflammatory and inflammatory large-vessel diseases. Whether variations in vascular microbial communities are the cause or a secondary result (epiphenomena) of vessel injury remains to be determined.
  
  
  CONCLUSIONS
  Blood vessels may not be sterile. Future studies of microbes in vessel health and disease may provide important insights into disease pathogenesis and suggest new therapies for diseases now considered to be idiopathic and refractory.
authors.affiliation: aDivision of Rheumatology, University of Alberta, Edmonton, Alberta, Canada bDivision of Rheumatic and Immunologic Diseases, Center for Vasculitis Care and Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Clifford
authors.forename: Gary S
authors.initials: GS
authors.lastname: Hoffman
mesh_terms: D050197:Atherosclerosis / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D001808:Blood Vessels / Q000382:microbiology*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D064307:Microbiota; D014652:Vascular Diseases / Q000382:microbiology*; D014657:Vasculitis / Q000382:microbiology; D014780:Viruses / Q000302:isolation & purification