Objective-Evidence linking Chlamydia pneumoniae to atherosclerotic cardiovascular disease is expanding. Platelets are considered to play an essential role in cardiovascular diseases; however, so far platelets have not been associated with an infectious cause of atherosclerosis. This study aims to clarify the interaction between C pneumoniae and platelets and possibly present a novel mechanism in the pathogenesis of atherosclerosis. Methods and Results-The effects of C pneumoniae on platelet aggregation and secretion were assessed with lumiaggregometry, and the ability of C pneumoniae to bind to platelets and stimulate expression of P-selectin was analyzed with flow cytometry. We found that C pneumoniae, at a chlamydia:platelet ratio of 1:15, adheres to platelets and triggers P-selectin expression after 1 minute and causes an extensive aggregation and ATP secretion after 20 minutes of incubation. Inhibition of glycoprotein IIb/IIIa with Arg-Gly-Asp-Ser or abciximab markedly reduced C pneumoniaeinduced platelet aggregation. Exposure of C pneumoniae to polymyxin B, but not elevated temperature, abolished the stimulatory effects on platelet activation, suggesting that chlamydial lipopolysaccharide has an active role. In contrast, other tested bacteria had no or only moderate effects on platelet functions. Key Words: atherosclerosis Ⅲ bacteria-cell interaction Ⅲ LPS Ⅲ thrombosis A therosclerosis and related diseases are a major cause of death in the industrialized world. Differences in the occurrence of typical cardiovascular risk factors, such as smoking, hypertension, and abnormalities of lipid and sugar metabolism, do not explain thoroughly temporal and geographical variations in the prevalence or severity of coronary artery disease. 1 Over the last decade, the potential role of infectious agents in the pathogenesis and progression of atherosclerosis has attracted much attention. 2,3 Among different microorganisms suspected, Chlamydia pneumoniae has arisen as the most plausible pathogen having a causal role. 4 Plaque rupture and thrombosis are the main mechanisms of acute arterial occlusion, leading to myocardial infarction. After taking into account conventional risk factors and genetic predisposition, at least one third of thrombotic incidents remain unclear. Several studies show an association between C pneumoniae and thrombosis in patients with carotid artery disease and venous thromboembolic disease. 5,6 C pneumoniae is an obligate intracellular bacterium responsible for a number of upper and lower respiratory tract diseases in humans, and Ϸ50% of adults worldwide have antibody evidence of previous infection by this bacterium. 7 An association between C pneumoniae infections and atherosclerosis has been demonstrated in a number of epidemiological, serological, immunohistochemical, and molecular biological investigations. 2,8,9 Furthermore, in vitro studies have revealed that C pneumoniae is able to infect and replicate in the major cell types found within the atherosclerotic lesion, such as macrophages, en...