Markers of Chlamydia pneumoniae and human cytomegalovirus infection in patients with chronic peripheral vascular disease and their relation to inflammation, endothelial dysfunction and changes in lipid metabolism.

Our aim was to detect markers of Chlamydia pneumoniae (CPN) and human cytomegalovirus (HCMV) infection in patients with peripheral vascular occlusive disease and to follow markers of inflammation, endothelial dysfunction and lipid metabolism alteration in patients with active infection. CPN genome was detected in 9 (47.4 %) patients by at least one PCR method. Serological markers of acute CPN infection were found in 5 (26.3 %) subjects; each of them showed also positivity in at least one of the PCR methods. HCMV DNA were detected in 2 (10.5 %) patients; HCMV-specific antibodies were detected in 14 (73.7 %) subjects, however only in IgG subclass. Subjects with HCMV PCR positivity thus showed no serological markers of active HCMV infection. Laboratory findings of acute CPN infection were associated with increased plasma levels of Lp(a), triacylglycerols, atherogenic index of plasma and E-selectin (p < 0.05). No significant differences were found in the other markers, including plasma levels of total cholesterol, ferritin, homocysteine, oxidized LDL, IL-6, IL-8, IL-18, TNF-alpha, soluble forms of VCAM-1 and ICAM-1, von Willebrand factor, C-reactive protein, and plasma nitrites & nitrates. Frequent presence of chlamydial DNA in atheromatous plaques from patients with peripheral vascular disease was confirmed. HCMV DNA was detected only sporadically and with positivity in anamnestic anti-HCMV antibodies (IgG) only, indicating a rare presence of latent virus rather than active replication. Patients with laboratory markers of acute CPN infection exhibited more pronounced alterations in lipid metabolism and endothelial dysfunction.

Homocysteinemia and endothelial damage after methionine load.

Homocysteinemia increased significantly after a methionine load of 50 mg/kg in patients with peripheral artery occlusive disease but this load was insufficient to increase circulating endothelial cell count as a marker of endothelial damage. Only after an increased load of 100 mg/kg methionine circulating endothelial cells also increased markedly confirming the results of a previous experimental study. These data indicate a threshold concentration of homocysteine in blood necessary to induce endothelial lesions.

[The effect of heparan sulfate on percutaneous transluminal angioplasty in the vessels supplying the lower extremities]. / Vliv heparansulfátu na efekt perkutánní transluminální angioplastiky v oblasti tepen zásobujících dolní koncetiny.

BACKGROUND: The condition of patients after percutaneous transluminal angioplasty is influenced among others by the subsequent development of restenoses and reocclusions. The objective of the submitted work was to assess whether oral administration of heparan sulphate can influence the development of restenoses after percutaneous transluminal angioplasty in the pelvic and femoropopliteal region. METHODS AND RESULTS: 102 patients (78 men and 24 women, age 42-86 years) were divided into four groups. Percutaneous transluminal angioplasty was performed either on account stenosis in the aortoiliac or femoropopliteal area. (The original number was 115 patients, 13 patients were eliminated: the reasons were technical failure of the intervention procedure, reocclusion, the patient was lost from records.) As antiaggregant the patients were given acetylsalicylic acid, 250 mg/day: patients included in the heparan group were given heparan sulphate (Hemovasal, Manetti and Roberts) 100 mg/day for a period of 3 - 4 months. As compared with controls, the patients treated with heparan sulphate had within the 3 - 4 month period a significantly longer claudication distance (p < 0.05), a higher Doppler index (p < 0.05) and maximal blood flow in the feet. CONCLUSIONS: Heparan sulphate administration to patients after percutaneous transluminal angioplasty on account of stenosis of the aortoiliac or femoropopliteal area improves some angiological parameters which can suggest a slighter tendency of early restenosis.

[Lipoperoxides and their clinical importance]. / Lipoperoxidy a jejich klinický význam.

BACKGROUND: Research and investigations in the sphere of lipid peroxides has been pursued so far for a relatively short time. Therefore every new finding is a great asset for this branch of medicine. An elevated lipid peroxide level signalizes pathological changes in the organism. Malondialdehyde is an indicator of lipid peroxidation. The authors focused their experimental work on assessment of malondialdehyde in human serum. They tested the effect of increased radical peroxidation caused by diabetes and investigated whether it raises the lipid peroxide level in a group of patients suffering from ischaemic heart disease. METHODS AND RESULTS: Two groups were formed--one comprising 10 patients with ischaemic heart disease and another one of 8 patients with ischaemic heart disease and type II diabetes. The malondialdehyde concentrations were moreover compared with a control group of healthy subjects. The mean age of the first group was 72 years, of the second group 69 years. The mean age of the control group was 64 years. Lipid peroxidation was assessed from the concentration of malondialdehyde using an analytical method--spectrophotometry with fluorescence detection. CONCLUSIONS: Statistical evaluation of lipid peroxide levels in the two groups of patients with ischaemic heart disease led to the conclusion that the differences were not significant. Type II diabetes did not cause a greater increase of lipid peroxides in patients with IHD.