Original scientific paper
Perforin Expression after Acute Myocardial Infarction – A Pilot Study
Alen Ružić
Bojan Miletić
Sanja Balen
Viktor Peršić
Dijana Travica-Samsa
Marijana Rakić
Vesna Pehar-Pejčinović
Jelena Hajdin
Aleksandar Včev
Gordana Laškarin
Abstract
Perforin is an important mediator of inflammatory reactions. It is a quick-action cytotoxic mediator accumulated in
the cytoplasmic granules of effector immunity cells (T lymphocytes, NK and NKT cells) which provide death signal in infected
or transformed cells. Perforin-positive cells were previously detected in myocardial tissue during Trypanosoma
cruzi infection and viral myocarditis while its role in chronic and progressive cardiovascular inflammatory disease such
as atherosclerosis is almost completely unexplored. The perforin activity is also untested during acute coronary events
that represent unexpected atherosclerotic complications due to the inflammatory destabilisation and atherosclerotic plaque
rupture. The aim of this study was to investigate the presence of perforin, an important immunological inflammatory
molecule in peripheral blood lymphocytes during the early period after acute myocardial infarction. We analyzed three
subject groups: women with ST-segment elevation acute myocardial infarction (STEMI) treated with primary percutaneous
coronary intervention (PCI), conservatively treated women with acute myocardial infarction without ST-segment
elevation (NSTEMI) and a control group of healthy volunteers. The STEMI and NSTEMI groups did not basically differ
in medication neither in levels of routine laboratory tests, while troponin I were significantly higher in the STEMI
group. In the study, we detected an early decrease of perforin-positive lymphocytes in STEMI patients that were in contrast
with their persisting elevation among NSTEMI patients. Despite greater myocardial necrosis in the STEMI group,
results of this pilot-study indicated the prolonged perforin-mediated inflammatory response in patients with NSTEMI.
This perforin down-regulation that follows the coronary interventional reperfusion in STEMI emphasized the possible
anti-inflammatory role of primary PCI among patients with acute myocardial infarction. Given that the issue of routine
primary PCI in NSTEMI is nowadays highly topical, the results we expect in the wake of this pilot study could demonstrate
a significant impact on clinical practice. Further research is needed to confirm these results, compare the perforin-
mediated activity to other inflammatory mediators in acute coronary events and to examine their impact on the
long-term outcome.
Keywords
perforin; cardiovascular disease; atherosclerosis; myocardial infarction; percutaneous coronary intervention Introductio
Hrčak ID:
64771
URI
Publication date:
7.3.2011.
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