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Collegium antropologicum, Vol.35 No.1 March 2011. -

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.

perforin; cardiovascular disease; atherosclerosis; myocardial infarction; percutaneous coronary intervention Introductio

Autor: Alen Ružić - Bojan Miletić - Sanja Balen - Viktor Peršić - Dijana Travica-Samsa - Marijana Rakić - Vesna Pehar-Pejčinović



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