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CHaPter 69 Inflammation and Atherothrombosis 945

Similarly, further efforts are warranted to identify a therapeutic 8. Bourantas CV, Garcia-Garcia HM, Farooq V, et al. Clinical and
target in Takotsubo syndrome. angiographic characteristics of patients likely to have vulnerable plaques:
analysis from the PROSPECT study. JACC Cardiovasc Imaging
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CONCLUSION 9. Casas JP, Shah T, Hingorani AD, et al. C-reactive protein and
coronary heart disease: a critical review. J Intern Med 2008;264:
As observed above, inflammation plays a detrimental role in the 295–314.
setting of ACS not only in determining plaque instability, but 10. Biasucci LM, Koenig W, Mair J, et al. How to use C-reactive protein in
also in cardiac remodeling after myocardial necrosis and in acute coronary care. Eur Heart J 2013;34:3687–90.
PCI-related myocardial injury. The different mechanisms con- 11. Buffon A, Biasucci LM, Liuzzo G, et al. Widespread coronary
tributing to the inflammatory outbursts observed in ACS might inflammation in unstable angina. N Engl J Med 2002;347:5–12.
need different forms of antiinflammatory treatment. 12. Narducci ML, Grasselli A, Biasucci LM, et al. High telomerase activity in
In addition to specific interventions targeting adaptive neutrophils from unstable coronary plaques. J Am Coll Cardiol
immunity in plaque fissure and systemic markers of inflammation 2007;50:2369–74.
as discussed above, IL-1 blockade might specifically address 13. Wyss CA, Neidhart M, Altwegg L, et al. Cellular actors, Toll-like receptors,
inflammation due to myocardial necrosis and prove to be useful and local cytokine profile in acute coronary syndromes. Eur Heart J
2010;31:1457–69.
in ventricular remodeling after myocardial necrosis, as suggested 14. Liuzzo G, Montone RA, Gabriele M, et al. Identification of unique
by the results of small pilot studies in STEMI patients. 31,32,34 adaptive immune system signature in acute coronary syndromes.
Finally, IL-6 blockade might prevent inflammation associated Int J Cardiol 2013;168:564–7.
with distal embolization in the setting of PCI in NSTEMI, resulting 15. Libby P, Nahrendorf M, Pittet MJ, et al. Diversity of denizens of the
in less myocardial injury. 34 atherosclerotic plaque: not all monocytes are created equal. Circulation
2008;117:3168–70.
16. Niessner A, Shin MS, Pryshchep O, et al. Synergistic proinflammatory
On tHe HOrIZOn effects of the antiviral cytokine interferon-alpha and Toll-like receptor
4 ligands in the atherosclerotic plaque. Circulation 2007;116:
Translational research is needed: 2043–52.
• To improve diagnostic criteria of vulnerable plaque 17. Liuzzo G, Biasucci LM, Trotta G, et al. Unusual CD4+CD28null T
• To find novel predictive markers of plaque instability lymphocytes and recurrence of acute coronary events. J Am Coll Cardiol
• To find specific triggers linked to different types of unstable plaque 2007;50:1450–8.
• To clarify the role of inflammation in plaque destabilization 18. Giubilato S, Liuzzo G, Brugaletta S, et al. Expansion of CD4+CD28null
• To evaluate alternative treatments and drug targets to prevent and T-lymphocytes in diabetic patients: exploring new pathogenetic
treat plaque instability mechanisms of increased cardiovascular risk in diabetes mellitus. Eur
Toll-like receptor (TLR) antagonists Heart J 2011;32:1214–26.
Repair T-cell signaling abnormalities and CD31 signaling potentiation 19. Mauri C, Bosma A. Immune regulatory function of B cells. Annu Rev
Restore Treg number and activity Immunol 2012;30:221–41.
Target myeloperoxidase (MPO) in plaque erosion 20. Liuzzo G, Vallejo AN, Kopecky SL, et al. Molecular fingerprint of
interferon-gamma signalling in unstable angina. Circulation
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21. Liuzzo G, Trotta F, Pedicino D. Interleukin-17 in atherosclerosis and
Please check your eBook at https://expertconsult.inkling.com/ cardiovascular disease: the good, the bad, and the unknown. Eur Heart J
for self-assessment questions. See inside cover for registration 2013;34:556–9.
details. 22. Klingenberg R, Brokopp CE, Grivès A, et al. Clonal restriction and
predominance of regulatory T cells in coronary thrombi of patients with
acute coronary syndromes. Eur Heart J 2015;36:1041–8.
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