Abstract
Tuberculosis has been associated with increased risk of atherosclerotic cardiovascular disease. To examine whether mycobacterial infection exacerbates atherosclerosis development in experimental conditions, we infected low-density lipoprotein receptor knockout (Ldlr -/-) mice with Mycobacterium bovis Bacille-Calmette-Guérin (BCG), an attenuated strain of the Mycobacterium tuberculosis complex. Twelve-week old male Ldlr -/- mice were infected with BCG (0.3–3.0x106 colony-forming units) via the intranasal route. Mice were subsequently fed a western-type diet containing 21% fat and 0.2% cholesterol for up to 16 weeks. Age-matched uninfected Ldlr -/- mice fed with an identical diet served as controls. Atherosclerotic lesions in aorta were examined using Oil Red O staining. Changes induced by BCG infection on the immunophenotyping profile of circulating T lymphocytes and monocytes were assessed using flow cytometry. BCG infection increased atherosclerotic lesions in en face aorta after 8 weeks (plaque ratio; 0.021±0.01 vs. 0.013±0.01; p = 0.011) and 16 weeks (plaque ratio, 0.15±0.13 vs. 0.06±0.02; p = 0.003). No significant differences in plasma cholesterol or triglyceride levels were observed between infected and uninfected mice. Compared to uninfected mice, BCG infection increased systemic CD4/CD8 T cell ratio and the proportion of Ly6Clow non-classical monocytes at weeks 8 and 16. Aortic plaque ratios correlated with CD4/CD8 T cell ratios (Spearman’s rho = 0.498; p = 0.001) and the proportion of Ly6Clow non-classical monocytes (Spearman’s rho = 0.629; p < 0.001) at week 16. In conclusion, BCG infection expanded the proportion of CD4+ T cell and Ly6Clow monocytes, and aggravated atherosclerosis formation in the aortas of hyperlipidemic Ldlr -/- mice. Our results indicate that mycobacterial infection is capable of enhancing atherosclerosis development.
Highlights
It is estimated that a quarter of the world population has latent tuberculosis infection, and about 10 million people develop active tuberculosis each year globally [1, 2]
M. bovis BCG infection increased the extent of atherosclerosis formation in the aortas of western-type diet (WD)-fed hyperlipidemic Ldlr-/- mice
Our results indicate that mycobacterial infection is capable of enhancing atherosclerosis development
Summary
It is estimated that a quarter of the world population has latent tuberculosis infection, and about 10 million people develop active tuberculosis each year globally [1, 2]. Patients with a history of active tuberculosis have an increased risk of myocardial infarction, ischemic stroke, and peripheral arterial disease, suggesting that mycobacterial infection has a role in atherosclerotic cardiovascular disease [3,4,5,6]. These studies accounted for common traditional cardiovascular risk factors, there is a possibility of residual confounding effects from measured and unmeasured characteristics that may not be fully controlled for in human population-based studies [7]. These immune cells play an important role in atherosclerosis development [10], but their correlation with atherosclerotic plaque in the setting of mycobacterial infection is not well characterized
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