C-reaktivní protein a reakce akutní fáze. 1. část: CRP a bakteriální infekce

Cor Vasa 2002, 43(11):467-475

C-reactive protein and acute phase reaction. Part 1: CRP and bacterial reaction

Pavel Kuneš^1,*, Jan Krejsek²: ¹ Kardiochirurgická klinika; ² Ústav klinické imunologie a alergologie, Fakultní nemocnice a Lékařská fakulta Univerzity Karlovy, Hradec Králové, Česká republika

Acute phase reactions allow the survival of a body at risk of infection or injury. In man, the most important acute phase reactant is C-reactive protein (CRP). The binding partners of CRP are choline phosphate on the surface of prokaryotic cells, and lysophosphatidylcholine on the surface of eukaryotic cells. CRP binds to cells of the body's own tissue developing a change in the spatial orientation of membrane lipids. These cells have been affected by metabolic deficiency, which may be reversible possibly resulting in complete recovery of cellular functions. Under less favorable circumstances, this energy deficiency may become deeper and result in programmed cell death or apoptosis.
The action of CRP in acute phase reactions takes place at three levels:
1. The pro-inflammatory effects of CRP consist in bacterial opsonization, complement activation, and phagocytosis promotion. It is by this mechanism that pathogenic organisms are removed from the body.
2. The anti-inflammatory effects of CRP consist in the development of an immunosuppressive phenotype of phagocyting cells. It is by this mechanism that the body's own apoptotic cells are removed from the body and tissue regeneration is accelerated.
3. The modulatory effects of CRP on the inflammatory tissue consist in decreased activation of polymorphonuclear leukocytes and in increased activation of monocytes, macrophages, and endothelial cells. It is by this mechanism that the risk of damage to the body's own tissue structures is diminished in the presence of an inflammatory response while retaining the body's own defense potential.
Sustained inflammatory reactions result in progressive damage to the body. An example of this is atherosclerosis and its complications.
Part I of the review article discussed the role of CRP in protection of the body against bacterial infection and the possible role of CRP and seemingly non-pathogenic bacterial flora in the development of atherosclerosis.