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Association between Bacterial Infection and Peripheral Vascular Disease: A Review
Jacek Budzyński1, Joanna Wiśniewska2, Marek Ciecierski2
1Chair of Vascular and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland; Department of Vascular and Internal Diseases, Jan Biziel Hospital No. 2, Bydgoszcz, Poland.
Abstract:
There are an increasing number of data showing a clinically important association between bacterial infection and peripheral artery disease (PAD). Bacteria suspected of being involved in PAD pathogenesis are: periodontal bacteria, gut microbiota, Helicobacter pylori, and Chlamydia pneumoniae. Infectious agents may be involved in the pathogenesis of atherosclerosis via activation of a systemic or local host immunological response to contamination of extravascular tissues or the vascular wall, respectively. A systemic immunological reaction may damage vascular walls in the course of autoimmunological cross-reactions between anti-pathogen antibodies and host vascular antigens (immunological mimicry), pathogen burden mechanisms (nonspecific activation of inflammatory processes in the vascular wall), and neuroendocrine-immune cross-talk. Besides activating the inflammatory pathway, bacterial infection may trigger PAD progression or exacerbation by enhancement of platelet reactivity, by a stimulatory effect on von Willebrand factor binding, factor VIII, fibrinogen, P-selectin activation, disturbances in plasma lipids, increase in oxidative stress, and resistance to insulin. Local inflammatory host reaction and induction of atherosclerotic plaque progression and/or instability result mainly from atherosclerotic plaque colonization by microorganisms. Despite these premises, the role of bacterial infection in PAD pathogenesis should still be recognized as controversial, and randomized, controlled trials are required to evaluate the outcome of periodontal or gut bacteria modification (through diet, prebiotics, and probiotics) or eradication (using antibiotics) in hard and surrogate cardiovascular endpoints.
Insights
Bacterial infections, including periodontal bacteria and gut microbiota, are increasingly linked to peripheral artery disease (PAD) development. Further research is needed to confirm the role of bacteria in PAD and test treatments like antibiotics or dietary changes.
Area of Science:
- Cardiovascular Science
- Infectious Disease
- Microbiology
Background:
- Growing evidence suggests a significant association between bacterial infections and peripheral artery disease (PAD).
- Specific bacteria implicated in PAD pathogenesis include periodontal pathogens, gut microbiota, Helicobacter pylori, and Chlamydia pneumoniae.
- Infectious agents may contribute to atherosclerosis through systemic or local immune responses.
Purpose of the Study:
- To explore the mechanisms by which bacterial infections may contribute to PAD pathogenesis.
- To review the potential roles of various bacteria in the development and progression of PAD.
- To highlight the controversial nature of bacterial infection's role in PAD and the need for further clinical trials.
Main Methods:
- Review of existing data and literature on bacterial infections and PAD.
- Discussion of proposed mechanisms involving immunological responses, pathogen burden, and neuroendocrine-immune interactions.
- Analysis of how bacterial infections can influence factors like platelet reactivity, lipid profiles, oxidative stress, and insulin resistance.
Main Results:
- Bacterial infections can trigger PAD progression through systemic immune activation (e.g., molecular mimicry) or local inflammation from plaque colonization.
- Infections can exacerbate PAD by increasing platelet reactivity, altering plasma lipids, raising oxidative stress, and promoting insulin resistance.
- The precise role of bacterial infection in PAD remains controversial, necessitating further investigation.
Conclusions:
- Bacterial infections are increasingly recognized as potential contributors to peripheral artery disease (PAD) pathogenesis.
- Mechanisms include immune system activation, direct plaque colonization, and metabolic disturbances.
- Randomized controlled trials are essential to validate the impact of modifying or eradicating specific bacteria on cardiovascular outcomes in PAD patients.
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