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Aim: To study the role of lipoprotein(a) [Lp(a)] as a potential autoantigen causing the activation of immunocompetent cells in atherosclerosis., Subjects and Methods: A total of 104 men with stable coronary artery (CA) disease and different degrees of progressive coronary atherosclerosis were examined. Clinical blood analysis was carried out and lymphocyte subpopulations (CD4+, Th1, Th17, and Treg) were determined using immunofluorescence and flow cytometry. In addition, the indicators of blood lipid composition, Lp(a), autoantibody (autoAb) titer to Lp(a), and low-density lipoproteins (LDL), and the lymphocyte activation marker sCD25 were also measured., Results: The Lp(a) level was shown to predict the severity of CA lesions (β=0.28, p<0.05), regardless of age, the level of cholesterol, different T-lymphocyte subpopulations, sCD25, and autoAb. A combination of the concentration of Lp(a) above 11.8 mg/dl, that of Th17 over 11.4∙103 cells/ml and the reduced levels of regulatory T cells and IL-10-producing CD4+ T cells showed a manifold increase in the risk of severe and progressive CA atherosclerosis. There was a direct correlation of the blood level of Th1 with that of IgG autoAb specific to all atherogenic apoB-containing lipoproteins, including Lp(a). There was an inverse correlations of the lymphocyte activation marker sCD25 with IgM anti-Lp(a) autoAb titers (r=-0.36; p<0.005), but this was less significant with autoAbs to native and oxidized LDL (r=-0.21 and r=-0.24; p<0.05, respectively)., Conclusion: The slightly elevated Lp(a) concentration along with changes in the level of T lymphocyte subpopulations was first shown to significantly potentiate the risk of progressive and multiple CA lesion in the examinees. The correlation of IgM anti-Lp(a) autoAb with the lymphocyte activation marker sCD25 and that of IgG anti-Lp(a) autoAb with Th1 have demonstrated that Lp(a) is involved in the autoimmune inflammatory processes in atherosclerosis.

Aim: To investigate a balance between circulating regulatory T lymphocytes (Treg) exerting antiatherogenic activity and T helper type 1 (Th1) and T helper type 17 (Th1 7) cells having proatherogenic activity in patients with stable coronary artery disease (CAD) and different degrees of coronary atherosclerosis., Subjects and Methods: According to coronary angiography findings, 80 patients were allocated to 4 groups: 1) 18 patients with intact coronary arteries; 2) 21 with no progressive coronary atherosclerosis; 3) 16 with progressive coronary atherosclerosis (more than 50% stenosis) in the native coronary arteries; 4) 25 patients with three-vessel lesions. Groups 2 and 3 patients had undergone coronary stenting 23.8 ± 8.4 and 22.4 ± 8.7 months before their enrollment, respectively. Lymphocytes were typed by direct immunocytofluorometry: Treg was defined as CD4+CD25highCD127low and CD4+FoxP3+ lymphocytes. For CD4+IL-17a+ Th17 and CD4+INFgamma Th1 analysis, mononuclear cells were preactivated by culture. The serum levels of high-sensitivity C-reactive protein, IL-10, sCD25, and IL-17a were determined by nephelometry, chemiluminescence (Immulite) and ELISA, respectively., Results: Group 4 was found to have lower Treg levels and higher Th17 levels than Group 1. The ratio of Th17/Treg proved to be higher in Groups 3 and 4 than in Group 1 and that of (Th1+Th17)/Treg was higher in Group 3 than in Group 2. The female patients had higher Tregs levels than the male ones. The Th17/Treg index turned out to be increased in patients with a history of myocardial infarction., Conclusion: The imbalance of pro- and anti-atherogenic lymphocyte subpopulations plays a role in the pathogenesis of CAD and is associated with progressive atherosclerosis.

Aim: To study the effect of the anti-inflammatory peptide preparation ingramon on the peripheral blood levels of inflammatory markers in patients with exercise-induced stable angina after coronary stenting (CS)., Subjects and Methods: The investigation enrolled 64 patients with stable angina who had undergone coronary bypass surgery, of them 34 patients received ingramon in addition to standard therapy. The blood levels of high-sensitive C-reactive protein (hs-CRP), fibrinogen, the chemokines MCP-1, IL-8, IP-10, and MID were measured before and 1, 2, and 7 days and 1, 3, and 6 months after surgery. Twenty patients who had gone coronarography (CG) only were examined as a control group., Results: In the post CS patients receiving only standard therapy, the levels of hs-CRP and fibrinogen were much higher on days 1, 2, and 7 after surgery than in the CG patients. On day 1 following CS, the increment in hs-CRP correlated with the length of implanted stents. During ingramon therapy, the content of hs-CRP and fibrinogen was considerably lower on days 1, 2, and 7 after CS than in the control group; this trend persisted a month after surgery; there was also a reduction in MCP-1 levels within the first 24 hours after initiation of therapy. The levels of the chemokines IP-10, MIG, and IL-8 were significantly unchanged. CONCLUSION. When added to standard therapy, ingramon exerts a positive effect against risk factors for coronary heart disease (CHD) and its events. Further investigations are required to define the impact of ingramon therapy on prognosis in patients with CHD.

Aim: To investigate the effects of coronary stenting with rapamycin-eluting stents on parameters of cell immunity., Methods: 26 patients (group 1) with stable coronary heart disease and angiographically proved coronary stenosis underwent stenting with rapamycin-eluting stents. The control group (group 2) consisted of 6 patients: 4 patients underwent diagnostic coronaroangiography, I patient got a bare metal stent and in 1 patient angioplasty was unsuccessful. Blood samples were obtained before and 1 month after the intervention. The quantity of activated (CD4+CD25low+) and regulatory (CD4+CD25high+) T cells was measured by direct immunofluorescence and flow cytometry. Plasma concentration of IL-10 was determined by ELISA., Results: In group 1 the percentages of CD4+CD25high+ regulatory T-cells increased significantly one month after stenting, while in group 2 no difference in regulatory T-cell levels before and after the intervention was observed. No changes in total number of leukocytes, relative levels of lymphocytes, CD4+ T-cells, activated CD4+CD25+low T-cells and IL-10 plasma concentration before and after the procedure were detected in both groups., Conclusion: Rapamycin-eluting stent implantation is associated with a significant increase of circulating CD4+CD25high+ regulatory T-cell level.

Aim: To analyse contents of leukocytes and chemokines expression cytokines and transforming growth factor beta (TGFB) in atherosclerotic plaques (AP) of coronary arteries and aortic intima of patients with coronary artery disease (CAD)., Material and Methods: The samples of aortic intima and coronary artery tissues were obtained intraoperatively (coronary artery bypass grafting, endarterectomy). Leukocytes were typed immunohistochemically and cytometry in the flow. Gene expression was analysed using reverse transcription and polymerase chain reaction., Results: AP of the coronary arteries and macroscopically unaffected fragments of aortic imtima contained leukocytes. All the samples contained mRNA of chemokines SDF- 1 and MCP-3. Two groups of the plaques were identified by chemokines expression. Group I AP had marked expression of TGFB, chemokines SDF-1, MCP-3, MIG, I-309, MCP-1, MIP-1beta, I-TAC, RANTES and IL-13. Group II AP had mRNA of the proteins only in single samples. Intima samples free of morphological signs of atherosclerotic lesion contained mRNA of proinflammatory chemokines MIG, I-309, IL-13, had no expression of TGFB., Conclusion: In IHD patients arterial intima free of macroscopic visual affection may be a site of developing inflammation. AP differ by chemokines expression, cytokines, TGFB. The differences may indicate different stages or mechanisms of AP formation.

Aim: To estimate concentrations of C-reactive protein (CRP) and MCP-1 in blood plasma of patients with unstable angina (UA) and stable effort angina (SEA)., Material and Methods: Multiprojection coronaroangiography was performed in 12 patients with UA and 11 patients with SEA. Hemodynamically significant stenosis (50% and more) at least in one major coronary artery was confirmed in all the patients. CRP and MCP-1 were measured with latex agglutination and enzyme immunoassay (Biosource kits), respectively., Results: UA patients had significantly higher plasma levels of MCP-1 and CRP than those with SEA (107.25 +/- 16.19 vs. 63.0 +/- 16.16 pg/ml and 1.99 +/- 1.64 vs 0.44 +/- 0.28 mcg/ml, respectively)., Conclusion: Estimation of MCP-1, as a marker of vascular wall inflammation, can be used, in line with other indices, for verification of UA.

Aim: To study the condition of the sympathico-adrenal system (SAS), synthesis of cAMP dependent on beta2-adrenoreceptors and parameters of free radical oxidation in patients with primary pulmonary hypertension (PPH); to examine efficacy of non-selective beta- and alpha1-adrenoblocker carvedilol in PPH patients., Material and Methods: Twenty patients with PPH had 6-minute walk test, ECG monitoring with assessment of heart rhythm variability (HRV). Tests for noradrenalin and adrenalin concentration in blood plasma, cAMP synthesis by blood lymphocytes in basal conditions and under stimulation with isoproterenol and forskolin, free radical oxidation were made initially, 1 and 6 months later. Ten patients received carvedilol in addition to standard therapy, 10 patients served control., Results: PPH patients had higher NA in the blood, low cAMP synthesis, high malonic aldehyde, low activity of glutathionperoxidase, increased activity of superoxidedismutase and catalase of erythrocytes. The most pronounced changes in the above parameters were observed in patients with PPH FC III-IV. HRV declined in progression of cardiac failure. 6-months of combined treatment with carvedilol increased the distance of 6-min walk. Carvedilol had no effect on HRV, it reduced NA, stimulated cAMP synthesis, demonstrated no antioxidant activity., Conclusion: In PPH there is activation of SAS and desensitization of beta2-AR cells, oxidative stress develops. Addition of carvedilol to standard therapy with PPH improves clinical condition due to adrenoblocking properties of the drug.

Aim: To examine expression of superficial antigens by blood monocytes and granulocytes as well as the number of leukocyte-platelet complexes forming in in vitro activation in patients subjected to coronary angioplasty; to analyse changes in these parameters in coronary restenosis., Material and Methods: Membrane expression of leukocytic antigens and the number of leukocyte-platelet complexes after activation in the whole blood were measured by direct immunofluorescence and flow cytometry in 24 patients who have undergone stenting of coronary arteries. 14 of them had angiographically confirmed restenosis., Results: The tests discovered high expression of integrins Mac-1 and VLA-4 by monocytes and elevated relative number of monocyte-platelet complexes in patients with restenosis vs those free of stenosis (1425 +/- 76 and 1195 +/- 71 r.u. for Mac-1, 87 +/- 7 and 65 +/- 6 r.u. for VLA-4, 47 +/- 4 and 29 +/- 3%, respectively, for monocyte-platelet complexes; p < 0.05 for all the indices)., Conclusion: Coronary restenosis may result from elevated expression of adhesion molecules by monocytes manifest in activation of the cells in vitro.

Aim: To evaluate carvedilol effect on clinical state, norepinephrine (NE) and epinephrine (E) plasma concentration and lymphocyte beta 2-adrenoreceptor dependent cAMP synthesis in patients with primary pulmonary hypertension (PPH)., Material and Methods: 14 patients with PPH were included in the study; 9 patients were treated by carvedilol; 5 patients were in the control group. The primary efficiency parameters were submaximal exercise measured by 60 min walk test, systolic pulmonary artery pressure (SPAP) measured by Doppler echocardiography, heart rate (HR) measured by 24-hour ECG-monitoring., Results: One month carvedilol treatment of PPH patients resulted in a significant HR reduction. There was a tendency to SPAP decrease, the 6-minute walk test results improved in IIINYHA patients., Conclusion: Carvedilol therapy improves clinical state and evoked lymphocyte beta 2-adrenoceptor resensitization in PPH patients.

Aim: To evaluate norepinephrine (NE) and epinephrine (E) plasma concentration and lymphocyte beta-2-adrenoceptor dependent cAMP synthesis in primary pulmonary hypertension (PPH) patients in comparison with healthy controls., Material and Methods: Seven volunteers and fifteen patients with PPH were included in the study. NE and E plasma levels were measured by high performance liquid chromatography. Basal and stimulated (isoproterenol and forskolin) adenylyl cyclase activity in lymphocytes was measured by cAMP production using an enzyme immunoassay (Biotrak, Amersham UK)., Results: There was a 110% (p = 0.001) NE level increase in PPH patients. In systolic pulmonary artery pressure (SPAP) > 95 mm Hg lymphocyte cAMP production associated with adenylyl cyclase catalytic subunit was decreased by 170% and 70% vs PPH patients with SPAP < 95 mm Hg and healthy controls, respectively (p < 0.05). A significant negative correlation between forskolin cAMP production by lymphocytes and SPAP level was observed in PPH patients (k = -0.810, p = 0.011 by Kendell; k = -0.893, p = 0.007 by Spirman). Heart failure progressing from I-II to III NYHA functional classes was accompanied by plasma NE enhance and lymphocyte beta-2-adrenoreceptor-activated cAMP production decrease., Conclusion: The data demonstrate sympathoadrenal system activation and lymphocyte beta-2-adrenoceptor desensitization in PPH patients.

Obsidan (propranolol) monotherapy was investigated for the effect on the density of lymphocytic beta2-adrenoreceptors (B max), the activity of lymphocytic homogenates adenylate cyclase (AC), plasma renin activity (PRA), aldosterone concentration (A) and plasma catecholamines (CA). Obsidan treatment brought about a 40% increase in B max without a significant changes in AC activity. Contrary to a significant fall in PRA, A and norepinephrine in plasma reduced insignificantly. Changes in B max correlated with its baseline level (r = -0.56, p < 0.01), PRA (r = 0.57, p < 0.01) and A level in plasma (r = 0.62, p < 0.01). No significant correlations appeared between hypotensive effect of the drug and drug-related changes in B max and AC activity, while PRA and A concentrations showed such dependence. B max and before treatment mass of the left ventricular myocardium correlated significantly (r = = 0.595, p < 0.01). A small decrease in the myocardial mass followed obsidan administration, being related to B max (r = = 0.497, p < 0.05). It is concluded that obsidan-induced changes in lymphocytic beta 2-adrenoreceptors correlate with alterations in the activity of renin-angiotensin-aldosterone system and myocardial hypertrophy dynamics.