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Background  We previously showed that the burden of  Chlamydia pneumoniae  in carotid plaques was significantly associated with plaque interleukin (IL)-6, and serum IL-6 and C-reactive protein (CRP), suggesting that infected plaques contribute to systemic inflammatory markers in patients with stroke risk. Since lipoprotein-associated phospholipase A2 (Lp-PLA 2 ) mediates inflammation in atherosclerosis, we hypothesized that serum Lp-PLA 2  mass and activity levels and plaque Lp-PLA 2  may be influenced by plaque  C. pneumoniae  infection.    Methodology/Principal Findings  Forty-two patients underwent elective carotid endarterectomy. Tissue obtained at surgery was stained by immunohistochemistry for Lp-PLA 2  grade, macrophages, IL-6,  C. pneumoniae  and CD4+ and CD8+ cells. Serum Lp-PLA 2  activity and mass were measured using the colorimetric activity method (CAM™) and ELISA, respectively. Serum homocysteine levels were measured by HPLC. Eleven (26.2%) patients were symptomatic with transient ischemic attacks. There was no correlation between patient risk factors (smoking, coronary artery disease, elevated cholesterol, diabetes, obesity, hypertension and family history of genetic disorders) for atherosclerosis and serum levels or plaque grade for Lp-PLA 2 . Plaque Lp-PLA 2  correlated with serum homocysteine levels (p = 0.013), plaque macrophages (p<0.01), and plaque  C. pneumoniae  (p<0.001), which predominantly infected macrophages, co-localizing with Lp-PLA 2 .    Conclusions  The significant association of plaque Lp-PLA 2  with plaque macrophages and  C. pneumoniae  suggests an interactive role in accelerating inflammation in atherosclerosis. A possible mechanism for  C. pneumoniae  in the atherogenic process may involve infection of macrophages that induce Lp-PLA 2  production leading to upregulation of inflammatory mediators in plaque tissue. Additional  in vitro  and  in vivo  research will be needed to advance our understanding of specific  C. pneumoniae  and Lp-PLA 2  interactions in atherosclerosis.

Association of Carotid Plaque Lp-PLA2 with Macrophages and Chlamydia pneumoniae Infection among Patients at Risk for Stroke