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European Heart Journal Advance Access published online on June 25, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp248
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Delayed neutrophil apoptosis in patients with unstable angina: relation to C-reactive protein and recurrence of instability

Luigi M. Biasucci*, Giovanna Liuzzo, Simona Giubilato, Roberta Della Bona, Milena Leo, Michela Pinnelli, Anna Severino, Mario Gabriele, Salvatore Brugaletta, Maddalena Piro and Filippo Crea

Instituto di Cardiologia, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy

Received 23 January 2009; revised 6 May 2009; accepted 29 May 2009 * Corresponding author. Tel: +39 (0) 6 30154187, Fax: +39 (0) 6 3055535, Email: lmbiasucci{at}virgilio.it

Aims: To investigate spontaneous polymorphonuclear neutrophils (PMNs) apoptosis in unstable angina (UA) and its association with recurrence of instability.

Methods and results: We compared PMNs apoptotic rate at 4 and 24 h in patients with UA, stable angina (SA), and controls (H) with two different protocols by flow cytometry. We measured apoptotic rate of isolated PMNs (Protocol 1) in 30 UA patients, 13 SA patients, and 34 H; and apoptosis of PMNs in whole blood culture (Protocol 2) in further 10 UA patients, 7 SA patients, and 6 H. Serum high-sensitivity C-reactive protein was also measured. Polymorphonuclear neutrophils of UA patients showed a decreased apoptotic rate compared with SA patients and H at 4 h in Protocol 1 (both P < 0.01), and at 24 h in Protocol 2 (P < 0.05 and <0.01, respectively). In overall population, a negative correlation was found between apoptotic rate at 4 h and high-sensitivity C-reactive protein levels (P < 0.01). Six among 40 patients with UA had early recurrence of symptoms and their apoptotic rate was significantly reduced compared with UA patients without recurrence of symptoms (P = 0.024).

Conclusions: Our study demonstrates delayed PMN apoptosis in UA. This alteration might be involved in the persistence of inflammatory activation and affects recurrence of instability.

Key Words: Apoptosis • Polymorphonuclear neutrophils • Unstable angina • Inflammation


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