Chlamydia Infection as a Risk Factor for Cerebrovascula*

描述(由申请人提供)： 感染肺炎衣原体与 普通人群患脑血管疾病的风险增加。儿童 患有镰状细胞性贫血(SCA)的人患上 脑血管疾病比正常儿童有一种已知的改变 对许多传染性病原体的免疫反应。肺炎衣原体是最主要的 急性胸腔综合征的感染原因，有趣的是，这是一种- SCA儿童卒中的既定危险因素。我们的初步数据 显示有MRI记录的脑梗塞的SCA患者有12人 患肺炎衣原体感染的可能性是患有SCA患者的三倍 正常的核磁共振扫描。我们假设SCA患者有一种异常免疫 对肺炎衣原体的反应，导致持续感染，进而， 触发脑血管疾病的发展。 经颅多普勒血流速度加快的镰状细胞性贫血患者 众所周知，超声(TCD)是中风和高血压的高危人群。 TCD升高可能反映了潜在的血管疾病。此外， 镰状细胞性贫血中的卒中预防试验(STOP)表明，几乎 40%的TCD升高的儿童有脑梗塞的证据 核磁共振检查。因此，患有异常TCDs的儿童是适当的人群 目的：探讨脑血管疾病与C. 肺炎感染。作为STOP II试验的辅助研究，我们建议 1)确定肺炎衣原体感染是否与脑部疾病有关 SCA儿童的脑梗塞；2)免疫反应的特征 SCA患者肺炎衣原体感染的关系。在两国之间建立联系 肺炎衣原体感染和脑梗塞将打开新奇的大门， SCA中治疗和预防中风的毒性较小的方法， 包括抗生素和疫苗。 本提案中获得的数据将提供必要的初步数据。 以证明进一步的临床试验是合理的。

DESCRIPTION (provided by applicant): Infection with Chlamydia pneumoniae (C. pneumoniae) is associated with an increased risk of cerebrovascular disease in the general population. Children with sickle cell anemia (SCA) are 200 times more likely to have cerebrovascular disease than normal children and are known to have an altered immune response to many infectious pathogens. C. pneumoniae is the leading infectious cause of acute chest syndrome which, interestingly, is a well- established risk factor for stroke in children with SCA. Our preliminary data indicates that SCA patients with MRI-documented cerebral infarction are 12 times more likely to have C. pneumoniae infection than SCA patients with normal MRI scans. We hypothesize that SCA patients have an abnormal immune response to C. pneumoniae that results in persistent infection which, in turn, triggers the development of cerebrovascular disease. Sickle cell anemia patients with an elevated velocity on transcranial doppler ultrasound (TCD) are known to be at high risk to develop stroke and an elevated TCD likely reflects underlying vascular disease. In addition, the Stroke Prevention in Sickle Cell Anemia Trial (STOP) demonstrated that almost 40% of children with an elevated TCD have evidence of cerebral infarction on MRI. Children with abnormal TCDs are, therefore, an appropriated population to investigate an association between cerebrovascular disease and C. pneumoniae infection. As an ancillary study of the STOP II trial we propose 1) To determine if C. pneumoniae infection is associated with cerebral infarction in children with SCA; 2) To characterize the immunological response to C. pneumoniae infection in patients with SCA. Establishing a link between C. pneumoniae infection and cerebral infarction will open the door to novel, less toxic approaches to the treatment and prevention of stroke in SCA, including antibiotics and vaccines. The data gained in this proposal would provide the preliminary data necessary to justify further clinical trials.