Inflammation-related proteins in the superficial temporal arteries and Chlamydia trachomatis in the middle cerebral arteries in moyamoya disease.

OBJECTIVE: The role of Chlamydia trachomatis (CT) infection with inflammation of the superficial temporal artery (STA) and middle cerebral artery (MCA) in the development of moyamoya disease (MMD) is still under investigation. METHODS: We conducted a comparative analysis of the histopathological features and ultrastructures of STAs obtained from patients with MMD and control patients. Immunohistochemical staining for IL-1β, IL-10, CTLA-4, TNF-α, and CD15 was performed. A goat polyclonal antibody that targets a specific antigen associated with CT-related major outer membrane protein (MOMP) was used. The presence of CT was observed using laser scanning confocal microscopy (LSCM). Transmission electron microscopy (TEM) was used to detect CT-generated elementary bodies in the arterial wall tissues from four STA samples and three MCA samples using immunogold labeling. RESULTS: Immunostaining revealed higher expression of TNF-α and CTLA-4 in the STAs of MMD patients than in the STAs of control patients. Through LSCM, CT-related MOMP was observed in the intima and smooth muscle fibers under the elastic lamina of the STA. CT elementary bodies were detected in the arterial wall tissues of four STA samples and three MCA samples. CONCLUSION: The existing literature, together with our experimental findings, suggests that complex interactions among the immune system, inflammation, and angiogenesis occur during the pathogenesis of MMD. CT species appear to be present throughout the progression of MMD. Further investigation of these processes is crucial to understanding the cause of MMD.