Approximately fifteen years ago, when he began conducting autopsies in forensic medicine, Dr. Nemanja Radojević observed that it is not uncommon for young and middle-aged individuals, lacking traditional risk factors, to succumb to heart attacks amidst significant atherosclerosis.

At that time, he contemplated investigating a long-speculated notion of the last century and this one—that bacterial infection might be a contributor to obstructed blood vessels.

Dr. Radojević, a forensic medicine expert, successfully defended his doctoral thesis titled “Infectious Genesis of Atherosclerosis” at the Faculty of Medicine of the University of Montenegro (UCG) last month.

His research, carried out on autopsy materials from the Clinical Center of Montenegro, revealed the presence of the bacterium Chlamydophila pneumoniae (CP) in atherosclerotic plaques in nearly half of the cases, suggesting that this vascular condition may exhibit autoimmune disease traits.

What is atherosclerosis, and how does it influence the onset of cardiovascular diseases, which are the primary cause of illness and mortality in Montenegro?

Atherosclerosis, or arterial blockage, is a chronic degenerative condition of the blood vessels and an indirect leading cause of natural deaths, primarily due to heart attacks and strokes. Traditional risk factors for developing this condition include disorders in fat metabolism, diabetes, hypertension, smoking, and genetic predisposition. Nevertheless, early in the last century, scientists speculated that bacterial infection could be a cause of atherosclerosis, a concept that faded after World War II. Recent events, such as the COVID-19 pandemic, have rekindled interest in the potential infectious origin of atherosclerosis.

How and when did the idea to explore the impact of CP bacteria on the emergence of atherosclerosis arise?

My investigation into the infectious origins of atherosclerosis began about fifteen years ago, coinciding with my initial autopsy work in forensic medicine. I noticed that young and middle-aged individuals, often without classic risk factors, frequently died of heart attacks exacerbated by severe atherosclerosis. A significant observation in these autopsies was the common occurrence of prior pneumonia, which led me to question whether atherosclerosis is always the result of traditional risk factors or if it could sometimes stem from infections by low-pathogenic (“harmless”) bacteria found in the upper respiratory tract and gingiva.

What did the study entail, and how many deceased individuals were included?

The research focused on autopsy samples from 124 individuals, aiming to analyze the role of the bacterium Chlamydophila pneumoniae in the atherosclerotic process and to differentiate between plaques containing this bacterium and those that did not, in relation to the presence of traditional risk factors. The findings were indeed remarkable—nearly 50% of plaques tested positive for antigens (proteins) of this bacterium, suggesting that these atherosclerotic formations could either arise from a bacterial infection or be influenced in their progression by it. Additionally, the “bacterial” atherosclerotic plaques exhibited notable morphological differences compared to those formed by traditional risk factors.

What key conclusions did you draw from your study?

The research indicates that the presence of CP in atherosclerotic plaques is closely linked to the atherosclerotic process, offering new insights into the pathogenesis of this intricate disease. These findings suggest potential biomarkers or therapeutic targets for preventing and treating atherosclerosis. The study highlights that bacterial influence significantly shapes the body’s immune response, indicating that atherosclerosis might possess characteristics akin to autoimmune conditions. This opens avenues for developing targeted therapies aimed at reducing the risk of atherosclerotic disease and associated serious health issues such as heart disease and stroke.

How could your research and similar studies alter perspectives on the development and treatment of atherosclerosis?

While the role of antibiotics in preventing atherosclerosis remains a debated topic due to a lack of large-scale studies confirming their efficacy, it is anticipated that ongoing foundational research on various infectious agents’ influence on atherosclerosis will lead to new immunomodulatory drugs capable of mitigating the severe consequences of this condition.

News