title: The presence of biofilm structures in atherosclerotic plaques of arteries from legs amputated as a complication of diabetic foot ulcers.
abstract: OBJECTIVE
  Atherosclerosis, rather than microcirculatory impairment caused by endothelial cell dysfunction, is the main driver of circulatory compromise in patients with diabetic limbs. The presence of atherosclerotic plaque at the trifurcation is a significant contributor to amputation of diabetic legs. The presence of bacteria and other microorganisms in atherosclerotic plaque has long been known, however, the cause of chronic inflammation and the role of bacteria/viruses in atherosclerosis have not been studied in detail. The objective of this study was to clarify the cause of the chronic inflammation within atherosclerotic plaques, and determine if any bacteria and/or viruses are involved in the inflammatory pathway.
  
  
  METHODS
  This study uses fluorescence microscopy and fluorescence in-situ hybridisation (FISH) to identify components of biofilm in atherosclerotic arteries. These tools are also used to identify individual bacteria, and determine the architectural spatial location within the atherosclerotic plaque where the bacteria can be found.
  
  
  RESULTS
  The results indicate that the presence of biofilms in grossly involved arteries may be an important factor in chronic inflammatory pathways of atherosclerotic progression, in the amputated limbs of patients with diabetic foot ulcers and vascular disease.
  
  
  CONCLUSIONS
  While the presence of bacterial biofilm structures in atherosclerotic plaque does not prove that biofilm is the proximate cause of atherosclerosis, it could contribute to the persistent inflammation associated with it. Second, the synergistic relationship between the atherosclerotic infection and the diabetic foot ulcer may ultimately contribute to higher amputation rates in diabetics.
  
  
  BACKGROUND
  RAW and RDW have equity interest in PathoGenius, a clinical laboratory using DNA to identify microbes.
authors.affiliation: The Institute of Environmental and Human Health, Texas Tech University, Lubbock Texas.
authors.forename: D E
authors.initials: DE
authors.lastname: Snow
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock Texas.
authors.forename: J
authors.initials: J
authors.lastname: Everett
authors.affiliation: The Institute of Environmental and Human Health, Texas Tech University, Lubbock Texas.
authors.forename: G
authors.initials: G
authors.lastname: Mayer
authors.affiliation: Research and Testing Laboratory, Lubbock Texas.
authors.forename: S B
authors.initials: SB
authors.lastname: Cox
authors.affiliation: Eli Lilly and Company, Indianapolis.
authors.forename: B
authors.initials: B
authors.lastname: Miller
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Lubbock Texas.
authors.forename: K
authors.initials: K
authors.lastname: Rumbaugh
authors.affiliation: Research and Testing Laboratory, Lubbock Texas.
authors.forename: R A
authors.initials: RA
authors.lastname: Wolcott
authors.affiliation: Research and Testing Laboratory, Lubbock Texas.|Southwest Regional Wound Care Center, Lubbock Texas.
authors.forename: R D
authors.initials: RD
authors.lastname: Wolcott
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001158:Arteries / Q000648:ultrastructure; D050197:Atherosclerosis / Q000209:etiology* / Q000382:microbiology*; D018441:Biofilms; D017719:Diabetic Foot / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000382:microbiology*; D012307:Risk Factors
keywords: atherosclerosis; atherosclerotic plaque; biofilm; chronic inflammation; fluorescence in-situ hybridisation (FISH)