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Latent Epstein-Barr virus may trigger acute coronary events

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Reactivation of the Epstein-Barr virus may lead to acute MI, according to study data published in PLoS One.

Researchers at The Ohio State University College of Medicine examined the blood samples of 299 patients undergoing PCI for stable angina, unstable angina and acute MI. They found that patients with acute MI had higher blood levels of interleukin-6 and intercellular adhesion molecule-1 (ICAM-1) compared with patients with less acute coronary symptoms (analysis of variance P<.05; 4.6 ± 2.6 pg/mL in patients with acute MI vs. 3.2 ± 2.3 pg/mL in stable angina).

Researchers found a strong relationship between circulating ICAM-1 and the early viral protein deoxyuridine triphosphate nucleotidohydrolase (dUTPase) produced after the activation of Epstein-Barr virus. The highest concentrations of ICAM-1 were found in patients who tested positive for dUTPase and had acute MI (analysis of variance P=.008; 369 ± 183 pg/mL in acute MI and positive for dUTPase vs. 249 ± 70 pg/mL in stable angina negative for dUTPase antibody).

Identifying the link between a reactivated virus and CVD is important due to the prevalence of Epstein-Barr virus — 95% of Americans have been infected with the virus by adulthood. Once infected, the virus remains dormant and can be reactivated without symptoms of illness.

“It is possible that [Epstein-Barr virus]-encoded dUTPase induces a pro-inflammatory cascade even during incomplete viral replication when there is a low viral load that is difficult to detect using standard analytic methods,” the researchers wrote.

“This investigation provides essential clinical corroboration for a mechanism that accounts for the long-reported association between viral infections and CAD,” they wrote. “In part, variability in the capacity to detect viruses such as [Epstein-Barr virus] in atherosclerotic lesions has cast doubt on their role in atherogenesis despite epidemiologic and in vitro mechanistic evidence.”

For more information:

Binkley PF. PLoS One. 2013;8:e54008.

Disclosure: The researchers report no relevant financial disclosures.