PERSISTENCE OF CHLAMYDIA-PNEUMONIAE IN HU MAN ATHEROSCLEROTIC PLAQUESMATERIAL - EVIDENCE AND CONSEQUENCES

The obligat intracellular bacterium Chlamydia pneumoniae has recently been implicated in the pathogenesis of atherosclerosis. Serological re sponse to Chlamydia pneumoniae statistically indicates an increased ri sk of coronary artery disease and myocardial infarction. This surprisi ng relation is corroborated by the presence of chlamydial structures a nd even viable Chlamydia pneumoniae in atherosclerotic plaques. These findings have already resulted in initial studies on the potential ben efit of antimicrobial therapy in coronary heart. disease. However, exp erimental proof of an etiological role of Chlamydia pneumoniae in arte riosclerosis has not yet been accomplished since a well established an imal model and a system of genetic recombination are not vet available . In addition, clinical evaluation of patients is complicated by the l ack of a useful parameter to indicate the risk of endovascular infecti on. Whether chlamydiae initiate atherosclerotic injury, facilitate pro gression of existing plaques. or merely colonize the lesions is theref ore not known. Chlamydial contribution to the development of atheroscl erosis is a fascinating hypothesis that may initiate a radical change of clinical practice for one of the leading causes of death. At the cu rrent slate of scientific knowledge, however, an experimental antichla mydial treatment in coronary heart disease may only be justified in we ll controlled clinical trials.