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Boro N, Alexandrino Fernandes P, Mukherjee AK. Computational analysis to comprehend the structure-function properties of fibrinolytic enzymes from Bacillus spp for their efficient integration into industrial applications. Heliyon 2024; 10:e33895. [PMID: 39055840 PMCID: PMC11269858 DOI: 10.1016/j.heliyon.2024.e33895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 06/28/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Background The fibrinolytic enzymes from Bacillus sp. are proposed as therapeutics in preventing thrombosis. Computational-based analyses of these enzymes' amino acid composition, basic physiological properties, presence of functional domain and motifs, and secondary and tertiary structure analyses can lead to developing a specific enzyme with improved catalytic activity and other properties that may increase their therapeutic potential. Methods The nucleotide sequences of fibrinolytic enzymes produced by the genus Bacillus and its corresponding protein sequences were retrieved from the NCBI database and aligned using the PRALINE programme. The varied physiochemical parameters and structural and functional analysis of the enzyme sequences were carried out with the ExPASy-ProtParam tool, MEME server, SOPMA, PDBsum tool, CYS-REC tool, SWISS-MODEL, SAVES servers, TMHMM program, GlobPlot, and peptide cutter software. The assessed in-silico data were compared with the published experimental results for validation. Results The alignment of sixty fibrinolytic serine protease enzymes (molecular mass 12-86 kDa) sequences showed 49 enzymes possess a conserved domain with a catalytic triad of Asp196, His242, and Ser569. The predicted instability and aliphatic indexes were 1.94-37.77, and 68.9-93.41, respectively, indicating high thermostability. The random coil means value suggested the predominance of this secondary structure in these proteases. A set of 50 amino acid residues representing motif 3 signifies the Peptidase S8/S53 domain that was invariably observed in 56 sequences. Additionally, 28 sequences have transmembrane helices, with two having the most disordered areas, and they pose 25 enzyme cleavage sites. A comparative analysis of the experimental work with the results of in-silico study put forward the characteristics of the enzyme sequences JF739176.1 and MF677779.1 to be considered when creating a potential mutant enzyme as these sequences are stable at high pH with thermostability and to exhibit αβ-fibrinogenase activity in both experimental and in-silico studies.
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Affiliation(s)
- Nitisha Boro
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, 784028, Assam, India
| | - Pedro Alexandrino Fernandes
- LAQV@REQUIMTE, Departamento de Química e Bioquímica, Faculdade De Ciências, Universidade do Porto, Rua Do Campo Alegre S/N, 4169-007, Porto, Portugal
| | - Ashis K. Mukherjee
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, 784028, Assam, India
- Microbial Biotechnology and Protein Research Laboratory, Division of Life Sciences, Institute of Advanced Studies in Science and Technology, Vigyan Path, Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India
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2
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Hemostatic Biomarkers and Volumetry Help to Identify High-Risk Abdominal Aortic Aneurysms. Life (Basel) 2022; 12:life12060823. [PMID: 35743854 PMCID: PMC9225361 DOI: 10.3390/life12060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Predicting the progression of small aneurysms is a main challenge in abdominal aortic aneurysm (AAA) management. The combination of circulating biomarkers and image techniques might provide an alternative for risk stratification. We evaluated the association of plasma TAT complexes (TAT) and D-dimer with AAA severity in 3 groups of patients: group 1, without AAA (n = 52), group 2, AAA 40−50 mm (n = 51) and group 3, AAA > 50 mm (n = 50). TAT (p < 0.001) and D-dimer (p < 0.001) were increased in patients with AAA (groups 2 and 3) vs. group 1. To assess the association between baseline TAT and D-dimer concentrations, and AAA growth, aortic diameter and volume (volumetry) were measured by computed tomography angiography (CTA) in group 2 at recruitment (baseline) and 1-year after inclusion. Baseline D-dimer and TAT levels were associated with AAA diameter and volume variations at 1-year independently of confounding factors (p ≤ 0.044). Additionally, surgery incidence, recorded during a 4-year follow-up in group 2, was associated with larger aneurysms, assessed by aortic diameter and volumetry (p ≤ 0.036), and with elevated TAT levels (sub-hazard ratio 1.3, p ≤ 0.029), while no association was found for D-dimer. The combination of hemostatic parameters and image techniques might provide valuable tools to evaluate AAA growth and worse evolution.
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3
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Rastogi V, Stefens SJM, Houwaart J, Verhagen HJM, de Bruin JL, van der Pluijm I, Essers J. Molecular Imaging of Aortic Aneurysm and Its Translational Power for Clinical Risk Assessment. Front Med (Lausanne) 2022; 9:814123. [PMID: 35492343 PMCID: PMC9051391 DOI: 10.3389/fmed.2022.814123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/21/2022] [Indexed: 01/03/2023] Open
Abstract
Aortic aneurysms (AAs) are dilations of the aorta, that are often fatal upon rupture. Diagnostic radiological techniques such as ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT) are currently used in clinical practice for early diagnosis as well as clinical follow-up for preemptive surgery of AA and prevention of rupture. However, the contemporary imaging-based risk prediction of aneurysm enlargement or life-threatening aneurysm-rupture remains limited as these are restricted to visual parameters which fail to provide a personalized risk assessment. Therefore, new insights into early diagnostic approaches to detect AA and therefore to prevent aneurysm-rupture are crucial. Multiple new techniques are developed to obtain a more accurate understanding of the biological processes and pathological alterations at a (micro)structural and molecular level of aortic degeneration. Advanced anatomical imaging combined with molecular imaging, such as molecular MRI, or positron emission tomography (PET)/CT provides novel diagnostic approaches for in vivo visualization of targeted biomarkers. This will aid in the understanding of aortic aneurysm disease pathogenesis and insight into the pathways involved, and will thus facilitate early diagnostic analysis of aneurysmal disease. In this study, we reviewed these molecular imaging modalities and their association with aneurysm growth and/or rupture risk and their limitations. Furthermore, we outline recent pre-clinical and clinical developments in molecular imaging of AA and provide future perspectives based on the advancements made within the field. Within the vastness of pre-clinical markers that have been studied in mice, molecular imaging targets such as elastin/collagen, albumin, matrix metalloproteinases and immune cells demonstrate promising results regarding rupture risk assessment within the pre-clinical setting. Subsequently, these markers hold potential as a future diagnosticum of clinical AA assessment. However currently, clinical translation of molecular imaging is still at the onset. Future human trials are required to assess the effectivity of potentially viable molecular markers with various imaging modalities for clinical rupture risk assessment.
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Affiliation(s)
- Vinamr Rastogi
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sanne J. M. Stefens
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Judith Houwaart
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hence J. M. Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jorg L. de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ingrid van der Pluijm
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jeroen Essers
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, Netherlands
- *Correspondence: Jeroen Essers
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4
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Lagrange J, Lecompte T, Knopp T, Lacolley P, Regnault V. Alpha-2-macroglobulin in hemostasis and thrombosis: An underestimated old double-edged sword. J Thromb Haemost 2022; 20:806-815. [PMID: 35037393 DOI: 10.1111/jth.15647] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
Antiproteinases such as alpha-2-macroglobulin (A2M) play a role in hemostasis. A2M is highly conserved throughout evolution and is a high molecular weight homo-tetrameric glycoprotein. A2M proteinase inhibitor activity is possible via a unique cage structure leading to proteinase entrapment without direct enzymatic activity inhibition. Following this entrapment, proteinase clearance is possible through A2M binding to the low-density lipoprotein receptor-related protein 1. A2M synthesis is regulated by pro-inflammatory cytokines and increases during several chronic or acute inflammatory diseases and varies with age. For instance, A2M plasma levels are known to be increased in patients with diabetes mellitus, nephrotic syndrome, or sepsis. Concerning hemostasis, A2M can trap many proteinases involved in coagulation and fibrinolysis. Because of its pleiotropic effects A2M can be seen as both anti- and pro-hemostatic. A2M can inhibit thrombin, factor Xa, activated protein C, plasmin, tissue-plasminogen activator, and urokinase. Through its many different functions A2M is generally put apart in the balanced regulation of hemostasis. In addition, the fact that A2M plasma levels are differently regulated during inflammatory-related diseases and that A2M can neutralize cytokines that also modify hemostasis could explain why it is difficult to link common proteins and parameters of hemostasis with the mechanisms of thrombosis in such diseases. Thus, we propose in the present review to summarize known functions of A2M, give a brief overview about diseases, and then to focus on the roles of this antiproteinase in hemostasis and thrombosis.
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Affiliation(s)
- Jeremy Lagrange
- Faculté de Médecine, INSERM U1116, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Nancy, France
- CHRU Nancy, Médecine Vasculaire, Vandœuvre-lès-Nancy, France
| | - Thomas Lecompte
- Université de Lorraine, Nancy, France
- CHRU Nancy, Médecine Vasculaire, Vandœuvre-lès-Nancy, France
- Unité d'hémostase, Département de Médecine, Hôpitaux Universitaires de Genève, Faculté de Médecine - GpG, Université de Genève, Geneva, Switzerland
| | - Tanja Knopp
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Institute for Molecular Medicine, University Medical Center Mainz, Mainz, Germany
| | - Patrick Lacolley
- Faculté de Médecine, INSERM U1116, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Nancy, France
- CHRU Nancy, Médecine Vasculaire, Vandœuvre-lès-Nancy, France
| | - Véronique Regnault
- Faculté de Médecine, INSERM U1116, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Nancy, France
- CHRU Nancy, Médecine Vasculaire, Vandœuvre-lès-Nancy, France
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5
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Diwan D, Usmani Z, Sharma M, Nelson JW, Thakur VK, Christie G, Molina G, Gupta VK. Thrombolytic Enzymes of Microbial Origin: A Review. Int J Mol Sci 2021; 22:10468. [PMID: 34638809 PMCID: PMC8508633 DOI: 10.3390/ijms221910468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/10/2023] Open
Abstract
Enzyme therapies are attracting significant attention as thrombolytic drugs during the current scenario owing to their great affinity, specificity, catalytic activity, and stability. Among various sources, the application of microbial-derived thrombolytic and fibrinolytic enzymes to prevent and treat vascular occlusion is promising due to their advantageous cost-benefit ratio and large-scale production. Thrombotic complications such as stroke, myocardial infarction, pulmonary embolism, deep venous thrombosis, and peripheral occlusive diseases resulting from blood vessel blockage are the major cause of poor prognosis and mortality. Given the ability of microbial thrombolytic enzymes to dissolve blood clots and prevent any adverse effects, their use as a potential thrombolytic therapy has attracted great interest. A better understanding of the hemostasis and fibrinolytic system may aid in improving the efficacy and safety of this treatment approach over classical thrombolytic agents. Here, we concisely discuss the physiological mechanism of thrombus formation, thrombo-, and fibrinolysis, thrombolytic and fibrinolytic agents isolated from bacteria, fungi, and algae along with their mode of action and the potential application of microbial enzymes in thrombosis therapy.
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Affiliation(s)
- Deepti Diwan
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, MO 63110, USA; (D.D.); (J.W.N.)
| | - Zeba Usmani
- Department of Applied Biology, University of Science & Technology, Techno City, Killing Road, Baridua 9th Mile 793101, Meghalaya, India; (Z.U.); (M.S.)
| | - Minaxi Sharma
- Department of Applied Biology, University of Science & Technology, Techno City, Killing Road, Baridua 9th Mile 793101, Meghalaya, India; (Z.U.); (M.S.)
| | - James W. Nelson
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, MO 63110, USA; (D.D.); (J.W.N.)
| | - Vijay Kumar Thakur
- Biorefining and Advanced Materials Research Center, SRUC, Edinburgh EH9 3JG, UK;
- School of Engineering, University of Petroleum & Energy Studies (UPES), Dehradun 248007, Uttarakhand, India
| | - Graham Christie
- Department of Chemical Engineering & Biotechnology, University of Cambridge, Cambridge CB2 1TN, UK;
| | - Gustavo Molina
- Laboratory of Bioflavors and Bioactive Compounds, Department of Food Science, Faculty of Food Engineering, State University of Campinas, R. Monteiro Lobato, 80, Campinas, São Paulo 13083-862, Brazil;
| | - Vijai Kumar Gupta
- Biorefining and Advanced Materials Research Center, SRUC, Edinburgh EH9 3JG, UK;
- Centre for Safe and Improved Food, SRUC, Edinburgh EH9 3JG, UK
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Altaf F, Wu S, Kasim V. Role of Fibrinolytic Enzymes in Anti-Thrombosis Therapy. Front Mol Biosci 2021; 8:680397. [PMID: 34124160 PMCID: PMC8194080 DOI: 10.3389/fmolb.2021.680397] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Thrombosis, a major cause of deaths in this modern era responsible for 31% of all global deaths reported by WHO in 2017, is due to the aggregation of fibrin in blood vessels which leads to myocardial infarction or other cardiovascular diseases (CVDs). Classical agents such as anti-platelet, anti-coagulant drugs or other enzymes used for thrombosis treatment at present could leads to unwanted side effects including bleeding complication, hemorrhage and allergy. Furthermore, their high cost is a burden for patients, especially for those from low and middle-income countries. Hence, there is an urgent need to develop novel and low-cost drugs for thrombosis treatment. Fibrinolytic enzymes, including plasmin like proteins such as proteases, nattokinase, and lumbrokinase, as well as plasminogen activators such as urokinase plasminogen activator, and tissue-type plasminogen activator, could eliminate thrombi with high efficacy rate and do not have significant drawbacks by directly degrading the fibrin. Furthermore, they could be produced with high-yield and in a cost-effective manner from microorganisms as well as other sources. Hence, they have been considered as potential compounds for thrombosis therapy. Herein, we will discuss about natural mechanism of fibrinolysis and thrombus formation, the production of fibrinolytic enzymes from different sources and their application as drugs for thrombosis therapy.
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Affiliation(s)
- Farwa Altaf
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Shourong Wu
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing, China
| | - Vivi Kasim
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing, China
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7
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Memtsas VP, Arachchillage DRJ, Gorog DA. Role, Laboratory Assessment and Clinical Relevance of Fibrin, Factor XIII and Endogenous Fibrinolysis in Arterial and Venous Thrombosis. Int J Mol Sci 2021; 22:ijms22031472. [PMID: 33540604 PMCID: PMC7867291 DOI: 10.3390/ijms22031472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Diseases such as myocardial infarction, ischaemic stroke, peripheral vascular disease and venous thromboembolism are major contributors to morbidity and mortality. Procoagulant, anticoagulant and fibrinolytic pathways are finely regulated in healthy individuals and dysregulated procoagulant, anticoagulant and fibrinolytic pathways lead to arterial and venous thrombosis. In this review article, we discuss the (patho)physiological role and laboratory assessment of fibrin, factor XIII and endogenous fibrinolysis, which are key players in the terminal phase of the coagulation cascade and fibrinolysis. Finally, we present the most up-to-date evidence for their involvement in various disease states and assessment of cardiovascular risk.
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Affiliation(s)
- Vassilios P. Memtsas
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB, UK;
| | - Deepa R. J. Arachchillage
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London SW7 2AZ, UK;
- Department of Haematology, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Department of Haematology, Royal Brompton Hospital, London SW3 6NP, UK
| | - Diana A. Gorog
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB, UK;
- School of Life and Medical Sciences, Postgraduate Medical School, University of Hertfordshire, Hertfordshire AL10 9AB, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
- Correspondence: ; Tel.: +44-207-0348841
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8
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Paige E, Clément M, Lareyre F, Sweeting M, Raffort J, Grenier C, Finigan A, Harrison J, Peters JE, Sun BB, Butterworth AS, Harrison SC, Bown MJ, Lindholt JS, Badger SA, Kullo IJ, Powell J, Norman PE, Scott DJA, Bailey MA, Rose-John S, Danesh J, Freitag DF, Paul DS, Mallat Z. Interleukin-6 Receptor Signaling and Abdominal Aortic Aneurysm Growth Rates. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 12:e002413. [PMID: 30657332 PMCID: PMC6383754 DOI: 10.1161/circgen.118.002413] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The Asp358Ala variant (rs2228145; A>C) in the IL (interleukin)-6 receptor (IL6R) gene has been implicated in the development of abdominal aortic aneurysms (AAAs), but its effect on AAA growth over time is not known. We aimed to investigate the clinical association between the IL6R-Asp358Ala variant and AAA growth and to assess the effect of blocking the IL-6 signaling pathway in mouse models of aortic aneurysm rupture or dissection. Methods: Using data from 2863 participants with AAA from 9 prospective cohorts, age- and sex-adjusted mixed-effects linear regression models were used to estimate the association between the IL6R-Asp358Ala variant and annual change in AAA diameter (mm/y). In a series of complementary randomized trials in mice, the effect of blocking the IL-6 signaling pathways was assessed on plasma biomarkers, systolic blood pressure, aneurysm diameter, and time to aortic rupture and death. Results: After adjusting for age and sex, baseline aneurysm size was 0.55 mm (95% CI, 0.13–0.98 mm) smaller per copy of the minor allele [C] of the Asp358Ala variant. Change in AAA growth was −0.06 mm per year (−0.18 to 0.06) per copy of the minor allele; a result that was not statistically significant. Although all available worldwide data were used, the genetic analyses were not powered for an effect size as small as that observed. In 2 mouse models of AAA, selective blockage of the IL-6 trans-signaling pathway, but not combined blockage of both, the classical and trans-signaling pathways, was associated with improved survival (P<0.05). Conclusions: Our proof-of-principle data are compatible with the concept that IL-6 trans-signaling is relevant to AAA growth, encouraging larger-scale evaluation of this hypothesis.
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Affiliation(s)
- Ellie Paige
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia (E.P.).,BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom
| | - Marc Clément
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom
| | - Fabien Lareyre
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom.,Université Côte d'Azur, Institut National de la Sante et de la Recherche Medicale, Centre Mediterranéen de Recherche Moleculaire (F.L., J.R.).,University Hospital of Nice, France (F.L., J.R.)
| | - Michael Sweeting
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom.,Department of Health Sciences (M.S.), University of Leicester
| | - Juliette Raffort
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom.,Université Côte d'Azur, Institut National de la Sante et de la Recherche Medicale, Centre Mediterranéen de Recherche Moleculaire (F.L., J.R.).,University Hospital of Nice, France (F.L., J.R.)
| | - Céline Grenier
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom
| | - Alison Finigan
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom
| | - James Harrison
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom
| | - James E Peters
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.)
| | - Benjamin B Sun
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom
| | - Adam S Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.).,NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom (A.S.B., J.D.)
| | - Seamus C Harrison
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre (S.C.H., M.J.B.), University of Leicester.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.)
| | - Matthew J Bown
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre (S.C.H., M.J.B.), University of Leicester
| | - Jes S Lindholt
- Department of Cardiovascular and Thoracic Surgery, Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, Denmark (J.S.L.)
| | - Stephen A Badger
- Regional Vascular Surgery Unit, Belfast Health and Social Care Trust, United Kingdom (S.A.B.)
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Gonda Vascular Center, Mayo Clinic, Rochester, MN (I.J.K.)
| | - Janet Powell
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, United Kingdom (J.P.)
| | - Paul E Norman
- Medical School, University of Western Australia, Perth, Australia (P.E.N.)
| | - D Julian A Scott
- Leeds Vascular Institute, Leeds General Infirmary (D.J.A.S., M.A.B.).,Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom (D.J.A.S., M.A.B.)
| | - Marc A Bailey
- Leeds Vascular Institute, Leeds General Infirmary (D.J.A.S., M.A.B.).,Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, United Kingdom (D.J.A.S., M.A.B.)
| | - Stefan Rose-John
- Department of Biochemistry, Christian-Albrechts-University, Kiel, Germany (S.R.-J.)
| | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.).,NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom (A.S.B., J.D.).,Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom (J.D.)
| | - Daniel F Freitag
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.)
| | - Dirk S Paul
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (E.P., M.S., J.E.P., B.B.S., A.S.B., J.D., D.F.F., D.S.P.), University of Cambridge, United Kingdom.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.)
| | - Ziad Mallat
- Division of Cardiovascular Medicine (M.C., F.L., J.R., C.G., A.F., J.H., Z.M.), University of Cambridge, United Kingdom.,British Heart Foundation Centre of Excellence, Division of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK (J.E.P., A.S.B., S.C.H., J.D., D.F.F., D.S.P., Z.M.).,Institut National de la Santé et de la Recherche Médicale, Paris Cardiovascular Research Center, France (Z.M.)
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9
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Fan YN, Ke X, Yi ZL, Lin YQ, Deng BQ, Shu XR, Yang DH, Liao ZY, Nie RQ. Plasma D-dimer as a predictor of intraluminal thrombus burden and progression of abdominal aortic aneurysm. Life Sci 2020; 240:117069. [PMID: 31751582 DOI: 10.1016/j.lfs.2019.117069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.
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Affiliation(s)
- Ying-Nan Fan
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Xiao Ke
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Zhi-Long Yi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Yong-Qing Lin
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Bing-Qing Deng
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Xiao-Rong Shu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Da-Hao Yang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Zhi-Yong Liao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Ru-Qiong Nie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
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10
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Prognostic value of D-dimer and markers of coagulation for stratification of abdominal aortic aneurysm growth. Blood Adv 2019; 2:3088-3096. [PMID: 30442686 DOI: 10.1182/bloodadvances.2017013359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is associated with high morbidity and mortality and is an established cause of unbalanced hemostasis. A number of hemostatic biomarkers have been associated with AAA; however, the utility of hemostatic biomarkers in AAA diagnosis and prognosis is unclear. The aim of the present study was to characterize the potential prognostic value of D-dimer and markers of altered hemostasis in a large cohort of patients with AAAs characterized by either fast or slow aneurysm growth (frequency matched for baseline diameter) and subaneurysmal dilations. We measured plasma concentrations of thrombin-antithrombin (TAT) complex, platelet factor 4 (PF4), and D-dimer in 352 patients with either fast-growing AAAs (>2 mm/y), slow-growing AAAs (<2 mm/y), subaneurysmal aortic dilations, or nonaneurysmal aortas. Plasma D-dimer and TAT were significantly elevated in both AAA and subaneurysmal dilation patients compared with controls. Individuals with D-dimer levels ≥500 ng/mL had 3.09 times the odds of subaneurysms, 6.23 times the odds of slow-growing AAAs, and 7.19 times the odds of fast-growing AAAs than individuals with D-dimer level <500 ng/mL. However, no differences in D-dimer concentration were noted between fast- and slow-growing aneurysms. Plasma D-dimer and TAT were strong independent predictors of AAA growth rate with multivariate analysis revealing a 500-ng/mL increase in D-dimer or 1-µg/mL increase in TAT led to additional 0.21-mm and 0.24-mm changes in aortic diameter per year, respectively. Rising levels of plasma TAT, in addition to D-dimer, may predict disease progression and aneurysm growth in patients with AAA or subaneurysmal dilation.
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11
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Phospholipid membranes drive abdominal aortic aneurysm development through stimulating coagulation factor activity. Proc Natl Acad Sci U S A 2019; 116:8038-8047. [PMID: 30944221 PMCID: PMC6475397 DOI: 10.1073/pnas.1814409116] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a disease of the abdominal aorta where inflammation causes damage and can ultimately lead to rupture. When this happens, uncontrolled internal bleeding can lead to death within minutes. Many aneurysms are not detected until they rupture, and for those that are, treatments to stop them progressing are limited. Here we used biophysics and genetically modified mice to show that a new family of lipids (fats) made by circulating blood cells promote AAA formation in the vessel wall because they directly regulate blood clotting. An approach that prevents AAA development was identified, based on intravenous administration of lipids. The studies provide insights into how AAA develops and may lead to novel therapies for this disease. Abdominal aortic aneurysm (AAA) is an inflammatory vascular disease with high mortality and limited treatment options. How blood lipids regulate AAA development is unknown. Here lipidomics and genetic models demonstrate a central role for procoagulant enzymatically oxidized phospholipids (eoxPL) in regulating AAA. Specifically, through activating coagulation, eoxPL either promoted or inhibited AAA depending on tissue localization. Ang II administration to ApoE−/− mice increased intravascular coagulation during AAA development. Lipidomics revealed large numbers of eoxPL formed within mouse and human AAA lesions. Deletion of eoxPL-generating enzymes (Alox12 or Alox15) or administration of the factor Xa inhibitor rivaroxaban significantly reduced AAA. Alox-deficient mice displayed constitutively dysregulated hemostasis, including a consumptive coagulopathy, characterized by compensatory increase in prothrombotic aminophospholipids (aPL) in circulating cell membranes. Intravenously administered procoagulant PL caused clotting factor activation and depletion, induced a bleeding defect, and significantly reduced AAA development. These data suggest that Alox deletion reduces AAA through diverting coagulation away from the vessel wall due to eoxPL deficiency, instead activating clotting factor consumption and depletion in the circulation. In mouse whole blood, ∼44 eoxPL molecular species formed within minutes of clot initiation. These were significantly elevated with ApoE−/− deletion, and many were absent in Alox−/− mice, identifying specific eoxPL that modulate AAA. Correlation networks demonstrated eoxPL belonged to subfamilies defined by oxylipin composition. Thus, procoagulant PL regulate AAA development through complex interactions with clotting factors. Modulation of the delicate balance between bleeding and thrombosis within either the vessel wall or circulation was revealed that can either drive or prevent disease development.
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12
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Cameron SJ, Russell HM, Owens AP. Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental? Blood 2018; 132:2619-2628. [PMID: 30228233 PMCID: PMC6302498 DOI: 10.1182/blood-2017-08-743237] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/10/2018] [Indexed: 12/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative vascular pathology resulting in significant morbidity and mortality in older adults due to rupture and sudden death. Despite 150 000 new cases and nearly 15 000 deaths annually, the only approved treatment of AAA is surgical or endovascular intervention when the risk for aortic rupture is increased. The goal of the scientific community is to develop novel pharmaceutical treatment strategies to reduce the need for surgical intervention. Because most clinically relevant AAAs contain a complex structure of fibrin, inflammatory cells, platelets, and red blood cells in the aneurysmal sac known as an intraluminal thrombus (ILT), antithrombotic therapies have emerged as potential pharmaceutical agents for the treatment of AAA progression. However, the efficacy of these treatments has not been shown, and the effects of shrinking the ILT may be as detrimental as they are beneficial. This review discusses the prospect of anticoagulant and antiplatelet (termed collectively as antithrombotic) therapies in AAA. Herein, we discuss the role of the coagulation cascade and platelet activation in human and animal models of AAA, the composition of ILT in AAA, a possible role of the ILT in aneurysm stabilization, and the implications of antithrombotic drugs in AAA treatment.
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Affiliation(s)
- Scott J Cameron
- Department of Medicine (Cardiology) and
- Department of Surgery (Cardiac Surgery), University of Rochester School of Medicine, Rochester, NY; and
| | - Hannah M Russell
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
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13
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Bridge KI, Bollen L, Zhong J, Hesketh M, Macrae FL, Johnson A, Philippou H, Scott DJ, Gils A, Ariёns RAS. Thrombin-activatable fibrinolysis inhibitor in human abdominal aortic aneurysm disease. J Thromb Haemost 2017; 15:2218-2225. [PMID: 28834317 DOI: 10.1111/jth.13804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 12/01/2022]
Abstract
Essentials Patients with abdominal aortic aneurysms (AAA) develop dense clots that are resistant to lysis. This study explores the role of thrombin-activatable fibrinolysis inhibitor (TAFI) in human AAA. There is evidence of chronically increased TAFI activation in patients with AAA. TAFI may represent a pharmacological target for cardiovascular risk reduction in AAA. SUMMARY Background Intra-luminal thrombosis is a key factor in growth of abdominal aortic aneurysms (AAAs). Patients with AAA form dense clots that are resistant to fibrinolysis. Thrombin-activatable fibrinolysis inhibitor (TAFI) has been shown to influence AAA development in murine models. Objective The aim of this study is to characterize the role of TAFI in human AAA. Methods Plasma levels of TAFI, TAFI activation peptide (TAFI-AP), activated/inactivated TAFI (TAFIa/ai) and plasmin-α2-antiplasmin complex were measured by ELISAs in patients with AAA (n = 202) and controls (n = 188). Results TAFIa/ai and TAFI-AP levels were higher in patients than controls (median [IQR], 20.3 [14.6-32.8] ng mL-1 vs. 14.2 [11.2-19.3] ng mL-1 and 355.0 [232.4-528.1] ng mL-1 vs. 248.6 [197.1-328.1] ng mL-1 ). TAFIa/ai was positively correlated with TAFI-AP (r = 0.164). Intact TAFI levels were not different between patients and controls (13.4 [11.2-16.1] μg mL-1 vs. 12.8 [10.6-15.4] μg mL-1 ). Plasmin-α2-antiplasmin was higher in AAA patients than controls (690.0 [489.1-924.3] ng mL-1 vs. 480.7 [392.6-555.3] ng mL-1 ). Conclusions The increase in TAFIa/ai and TAFI-AP suggests an increased TAFI activation in patients with AAA. Prospective studies are required to further elucidate the role of TAFI and fibrinolysis in AAA pathogenesis.
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Affiliation(s)
- K I Bridge
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - L Bollen
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven-University of Leuven, Laboratory for Therapeutic and Diagnostic Antibodies, Leuven, Belgium
| | - J Zhong
- Department of Radiology, Leeds General Infirmary, Leeds, UK
| | - M Hesketh
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - F L Macrae
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - A Johnson
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - H Philippou
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - D J Scott
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - A Gils
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven-University of Leuven, Laboratory for Therapeutic and Diagnostic Antibodies, Leuven, Belgium
| | - R A S Ariёns
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
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14
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Bridge K, Revill C, Macrae F, Bailey M, Yuldasheva N, Wheatcroft S, Butlin R, Foster R, Scott DJ, Gils A, Ariёns R. Inhibition of plasmin-mediated TAFI activation may affect development but not progression of abdominal aortic aneurysms. PLoS One 2017; 12:e0177117. [PMID: 28472123 PMCID: PMC5417566 DOI: 10.1371/journal.pone.0177117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
Objective Thrombin-activatable fibrinolysis inhibitor (TAFI) reduces the breakdown of fibrin clots through its action as an indirect inhibitor of plasmin. Studies in TAFI-deficient mice have implicated a potential role for TAFI in Abdominal Aortic Aneurysm (AAA) disease. The role of TAFI inhibition on AAA formation in adult ApoE-/- mice is unknown. The aim of this paper was to investigate the effects of TAFI inhibition on AAA development and progression. Methods Using the Angiotensin II model of AAA, male ApoE-/- mice were infused with Angiotensin II 750ng/kg/min with or without a monoclonal antibody inhibitor of plasmin-mediated activation of TAFI, MA-TCK26D6, or a competitive small molecule inhibitor of TAFI, UK-396082. Results Inhibition of TAFI in the Angiotensin II model resulted in a decrease in the mortality associated with AAA rupture (from 40.0% to 16.6% with MA-TCK26D6 (log-rank Mantel Cox test p = 0.16), and 8.3% with UK-396082 (log-rank Mantel Cox test p = 0.05)). Inhibition of plasmin-mediated TAFI activation reduced the incidence of AAA from 52.4% to 30.0%. However, late treatment with MA-TCK26D6 once AAA were already established had no effect on the progression of AAA in this model. Conclusions The formation of intra-mural thrombus is responsible for the dissection and early rupture in the angiotensin II model of AAA, and this process can be prevented through inhibition of TAFI. Late treatment with a TAFI inhibitor does not prevent AAA progression. These data may indicate a role for inhibition of plasmin-mediated TAFI activation in the early stages of AAA development, but not in its progression.
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Affiliation(s)
- Katherine Bridge
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds, United Kingdom
| | | | - Fraser Macrae
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
| | - Marc Bailey
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds, United Kingdom
| | - Nadira Yuldasheva
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
| | - Stephen Wheatcroft
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
| | - Roger Butlin
- School of Chemistry, University of Leeds, Leeds, United Kingdom
| | - Richard Foster
- School of Chemistry, University of Leeds, Leeds, United Kingdom
| | - D. Julian Scott
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds, United Kingdom
| | - Ann Gils
- KU Leuven- University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, Laboratory for Therapeutic and Diagnostic Antibodies, Leuven, Belgium
| | - Robert Ariёns
- Thrombosis and Tissue Repair Group, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Research, University of Leeds, Leeds, United Kingdom
- * E-mail:
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15
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Robertson L, Atallah E, Stansby G. Pharmacological treatment of vascular risk factors for reducing mortality and cardiovascular events in patients with abdominal aortic aneurysm. Cochrane Database Syst Rev 2017; 1:CD010447. [PMID: 28079254 PMCID: PMC6464734 DOI: 10.1002/14651858.cd010447.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in individuals with atherosclerotic occlusive arterial disease. However, the role of prophylaxis in individuals with abdominal aortic aneurysm (AAA) remains unclear. Several studies have shown that despite successful repair, those people with AAA have a poorer rate of survival than healthy controls. People with AAA have an increased prevalence of coronary heart disease and risk of cardiovascular events. Despite this association, little is known about the effectiveness of pharmacological prophylaxis in reducing cardiovascular risk in people with AAA. This is an update of a Cochrane review first published in 2014. OBJECTIVES To determine the long-term effectiveness of antiplatelet, antihypertensive or lipid-lowering medication in reducing mortality and cardiovascular events in people with abdominal aortic aneurysm (AAA). SEARCH METHODS For this update the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (14 April 2016). In addition, the CIS searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 3) and trials registries (14 April 2016) and We also searched the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials in which people with AAA were randomly allocated to one prophylactic treatment versus another, a different regimen of the same treatment, a placebo, or no treatment were eligible for inclusion in this review. Primary outcomes included all-cause mortality and cardiovascular mortality. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, and completed quality assessment and data extraction. We resolved any disagreements by discussion. Only one study met the inclusion criteria of the review, therefore we were unable to perform meta-analysis. MAIN RESULTS No new studies met the inclusion criteria for this update. We included one randomised controlled trial in the review. A subgroup of 227 participants with AAA received either metoprolol (N = 111) or placebo (N = 116). There was no clear evidence that metoprolol reduced all-cause mortality (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.02 to 1.41), cardiovascular death (OR 0.20, 95% CI 0.02 to 1.76), AAA-related death (OR 1.05, 95% CI 0.06 to 16.92) or increased nonfatal cardiovascular events (OR 1.44, 95% CI 0.58 to 3.57) 30 days postoperatively. Furthermore, at six months postoperatively, estimated effects were compatible with benefit and harm for all-cause mortality (OR 0.71, 95% CI 0.26 to 1.95), cardiovascular death (OR 0.73, 95% CI 0.23 to 2.39) and nonfatal cardiovascular events (OR 1.41, 95% CI 0.59 to 3.35). Adverse drug effects were reported for the whole study population and were not available for the subgroup of participants with AAA. We considered the study to be at a generally low risk of bias. We downgraded the quality of the evidence for all outcomes to low. We downgraded the quality of evidence for imprecision as only one study with a small number of participants was available, the number of events was small and the result was consistent with benefit and harm. AUTHORS' CONCLUSIONS Due to the limited number of included trials, there is insufficient evidence to draw any conclusions about the effectiveness of cardiovascular prophylaxis in reducing mortality and cardiovascular events in people with AAA. Further good-quality randomised controlled trials that examine many types of prophylaxis with long-term follow-up are required before firm conclusions can be made.
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Affiliation(s)
- Lindsay Robertson
- Freeman HospitalDepartment of Vascular SurgeryNewcastle upon Tyne Hospitals NHS Foundation TrustHigh HeatonNewcastle upon TyneUKNE7 7DN
| | - Edmond Atallah
- United Lincolnshire Hospitals NHS TrustGastroenterologyGreetwell RoadLincolnEast MidlandsUKLN2 5QY
| | - Gerard Stansby
- Freeman HospitalNorthern Vascular CentreNewcastle upon TyneUKNE7 7DN
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16
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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17
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Owens AP, Edwards TL, Antoniak S, Geddings JE, Jahangir E, Wei WQ, Denny JC, Boulaftali Y, Bergmeier W, Daugherty A, Sampson UK, Mackman N. Platelet Inhibitors Reduce Rupture in a Mouse Model of Established Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2015; 35:2032-2041. [PMID: 26139462 PMCID: PMC4552620 DOI: 10.1161/atvbaha.115.305537] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/17/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Rupture of abdominal aortic aneurysms causes a high morbidity and mortality in the elderly population. Platelet-rich thrombi form on the surface of aneurysms and may contribute to disease progression. In this study, we used a pharmacological approach to examine a role of platelets in established aneurysms induced by angiotensin II infusion into hypercholesterolemic mice. APPROACH AND RESULTS Administration of the platelet inhibitors aspirin or clopidogrel bisulfate to established abdominal aortic aneurysms dramatically reduced rupture. These platelet inhibitors reduced abdominal aortic platelet and macrophage recruitment resulting in decreased active matrix metalloproteinase-2 and matrix metalloproteinase-9. Platelet inhibitors also resulted in reduced plasma concentrations of platelet factor 4, cytokines, and components of the plasminogen activation system in mice. To determine the validity of these findings in human subjects, a cohort of aneurysm patients were retrospectively analyzed using developed and validated algorithms in the electronic medical record database at Vanderbilt University. Similar to mice, administration of aspirin or P2Y12 inhibitors was associated with reduced death among patients with abdominal aortic aneurysm. CONCLUSIONS These results suggest that platelets contribute to abdominal aortic aneurysm progression and rupture.
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Affiliation(s)
- A. Phillip Owens
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Todd L Edwards
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
- Division of Epidemiology, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Silvio Antoniak
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Julia E. Geddings
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Eiman Jahangir
- Department of Cardiovascular Diseases John Ochsner Heart and Vascular Institute Ochsner Clinical School - The University of Queensland School of Medicine New Orleans, LA 70115 Phone: 504-392-3131
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Yacine Boulaftali
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Wolfgang Bergmeier
- Department of Biochemistry and Biophysics, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
| | - Alan Daugherty
- Saha Cardiovascular Research Center University of Kentucky Lexington, KY 40536 Phone: 859-323-3512
| | - Uchechukwu K.A. Sampson
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center Nashville, TN 37203 Phone: 615-322-3652
| | - Nigel Mackman
- Department of Medicine Division of Hematology and Oncology, UNC McAllister Heart Institute University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA Phone: 919-843-3961
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Bailey MA, Aggarwal R, Bridge KI, Griffin KJ, Iqbal F, Phoenix F, Purdell-Lewis J, Thomas T, Johnson AB, Ariëns RAS, Scott DJA, Ajjan RA. Aspirin therapy is associated with less compact fibrin networks and enhanced fibrinolysis in patients with abdominal aortic aneurysm. J Thromb Haemost 2015; 13:795-801. [PMID: 25660763 DOI: 10.1111/jth.12872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Thrombotic changes in fibrin networks contribute to increased cardiovascular risk in patients with abdominal aortic aneurysm (AAA). Given that aspirin modulates the fibrin network, we aimed to determine if aspirin therapy is associated with changes in ex-vivo fibrin clot characteristics in AAA patients and also conducted an exploratory analysis of 5-year mortality in these individuals. METHODS We recruited 145 male patients, divided into controls (aortic diameter < 3 cm, n = 49), AAA not taking aspirin (AAA-Asp, n = 50) and AAA on 75 mg day(-1) aspirin (AAA+Asp, n = 46), matched for aneurysm size. Characteristics of clots made from plasma and plasma-purified fibrinogen were investigated using turbidimetric analysis, permeation studies, and confocal and electron microscopy. Plasma fibrinogen, D-dimer and inflammatory marker levels were also measured. RESULTS Maximum absorbance (MA) of plasma clots from controls was lower than that of AAA patients not on aspirin (AAA-Asp) at 0.30 ± 0.01 and 0.38 ± 0.02 au, respectively (P = 0.002), whereas aspirin-treated subjects had MA similar to controls (0.31 ± 0.02 P = 0.9). Plasma clot lysis time displayed an identical pattern at 482 ± 15, 597 ± 24 and 517 ± 27 s for control, AAA-Asp and AAA+Asp (P = 0.001 and P = 0.8). The lysis time of clots made from purified fibrinogen of AAA-Asp was longer than that of AAA+Asp patients (756 ± 47 and 592 ± 52 s, respectively; P = 0.041). Permeation studies and confocal and electron microscopy showed increased clot density in AAA-Asp compared with the AAA+Asp group. Mortality in AAA-Asp and AAA+Asp was similar, despite increased cardiovascular risk in the latter group, and both exhibited higher mortality than controls. CONCLUSION Aspirin improves fibrin clot characteristics in patients with AAA, which may have important clinical implications.
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Affiliation(s)
- M A Bailey
- Division of Cardiovascular & Diabetes Research, School of Medicine, The Leeds Institute of Cardiovascular & Metabolic Medicine, The University of Leeds, Leeds, UK; The Leeds Vascular Institute, The Leeds General Infirmary, Leeds, UK
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Macrae FL, Evans HL, Bridge KI, Johnson A, Scott DJA, Ariëns RAS. Common FXIII and fibrinogen polymorphisms in abdominal aortic aneurysms. PLoS One 2014; 9:e112407. [PMID: 25384012 PMCID: PMC4226572 DOI: 10.1371/journal.pone.0112407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/05/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Abdominal aortic aneurysms (AAA) are characterized by a progressive dilatation of the abdominal aorta, and are associated with a high risk of rupture once the dilatation exceeds 55 mm in diameter. A large proportion of AAA develops an intraluminal thrombus, which contributes to hypoxia, inflammation and tissue degradation. We have previously shown that patients with AAA produce clots with altered structure which is more resistant to fibrinolysis. The aim of this study was to investigate genetic polymorphisms of FXIII and fibrinogen in AAA to identify how changes to these proteins may play a role in the development of AAA. Methods Subjects of Western/European descent, ≥55 years of age (520 AAA patients and 449 controls) were genotyped for five polymorphisms (FXIII-A Val34Leu, FXIII-B His95Arg, FXIII-B Splice Variant (intron K nt29576C-G), Fib-A Thr312Ala and Fib-B Arg448Lys) by RT-PCR. Data were analysed by χ2 test and CubeX. Results The FXIII-B Arg95 allele associated with AAA (Relative risk - 1.240, CI 1.093–1.407, P = 0.006). There was no association between FXIII-A Val34Leu, FXIII-B Splice Variant, Fib-A Thr312Ala or Fib-B Arg448Lys and AAA. FXIII-B His95Arg and FXIII-B Splice variant (intron K nt29576C-G) were in negative linkage disequilibrium (D’ = −0.609, p = 0.011). Discussion The FXIII-B Arg95 variant is associated with an increased risk of AAA. These data suggest a possible role for FXIII in AAA pathogenesis.
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Affiliation(s)
- Fraser L Macrae
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom
| | - Hannah Lee Evans
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom
| | - Katherine I Bridge
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom; Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Anne Johnson
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom; Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom
| | - D Julian A Scott
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom; Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Robert A S Ariëns
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds institute for Cardiovascular and Metabolic Medicine, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, United Kingdom
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Bridge KI, Philippou H, Ariëns RAS. Clot properties and cardiovascular disease. Thromb Haemost 2014; 112:901-8. [PMID: 24899357 DOI: 10.1160/th14-02-0184] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/29/2014] [Indexed: 12/19/2022]
Abstract
Fibrinogen is cleaved by thrombin to fibrin, which provides the blood clot with its essential structural backbone. As an acute phase protein, the plasma levels of fibrinogen are increased in response to inflammatory conditions. In addition to fibrinogen levels, fibrin clot structure is altered by a number of factors. These include thrombin levels, treatment with common cardiovascular medications, such as aspirin, anticoagulants, statins and fibrates, as well as metabolic disease states such as diabetes mellitus and hyperhomocysteinaemia. In vitro studies of fibrin clot structure can provide information regarding fibre density, clot porosity, the mechanical strength of fibres and fibrinolysis. A change in fibrin clot structure, to a denser clot with smaller pores which is more resistant to lysis, is strongly associated with cardiovascular disease. This pathological change is present in patients with arterial as well as venous diseases, and is also found in a moderate form in relatives of patients with cardiovascular disease. Pharmacological therapies, aimed at both the treatment and prophylaxis of cardiovascular disease, appear to result in positive changes to the fibrin clot structure. As such, therapies aimed at 'normalising' fibrin clot structure may be of benefit in the prevention and treatment of cardiovascular disease.
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Affiliation(s)
| | | | - Robert A S Ariëns
- Prof. R. A. S. Ariëns, LIGHT Laboratories, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK, Tel.: +44 113 343 7734, E-mail:
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Bridge KI, Macrae F, Bailey MA, Johnson A, Philippou H, Scott DJA, Ariёns RA. The alpha-2-antiplasmin Arg407Lys polymorphism is associated with Abdominal Aortic Aneurysm. Thromb Res 2014; 134:723-8. [DOI: 10.1016/j.thromres.2014.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/13/2014] [Accepted: 06/30/2014] [Indexed: 01/09/2023]
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Sidloff DA, Stather PW, Choke E, Bown MJ, Sayers RD. A systematic review and meta-analysis of the association between markers of hemostasis and abdominal aortic aneurysm presence and size. J Vasc Surg 2014; 59:528-535.e4. [DOI: 10.1016/j.jvs.2013.10.088] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/16/2013] [Accepted: 10/20/2013] [Indexed: 11/26/2022]
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Robertson L, Atallah E, Stansby G. Pharmacological treatment of vascular risk factors for reducing mortality and cardiovascular events in patients with abdominal aortic aneurysm. Cochrane Database Syst Rev 2014:CD010447. [PMID: 24449038 DOI: 10.1002/14651858.cd010447.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in patients with atherosclerotic occlusive arterial disease. However, the role of prophylaxis in patients with abdominal aortic aneurysm (AAA) remains unclear. Several studies have shown that despite successful repair, those with AAA have a poorer rate of survival than healthy controls. People with AAA have an increased prevalence of coronary heart disease and risk of cardiovascular events. Despite this association, little is known about the effectiveness of pharmacological prophylaxis in reducing cardiovascular risk in people with AAA. OBJECTIVES To determine the long-term effectiveness of antiplatelet, antihypertensive or lipid-lowering medication in reducing mortality and cardiovascular events in people with abdominal aortic aneurysm (AAA). SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2013) and CENTRAL (2013, Issue 3). Reference lists of relevant articles were also checked. SELECTION CRITERIA Randomised controlled trials in which people with AAA were randomly allocated to one prophylactic treatment versus another, a different regimen of the same treatment, a placebo, or no treatment were eligible for inclusion in this review. Primary outcomes included all-cause mortality and cardiovascular mortality. DATA COLLECTION AND ANALYSIS Selection of the studies, quality assessment and data extraction were completed independently by two review authors. Any disagreements were resolved by discussion. Only one study was included in the review, therefore meta-analysis could not be performed. MAIN RESULTS One randomised controlled study was included in the review. A subgroup of 227 patients with AAA received either metoprolol (N = 111) or placebo (N = 116). There was no clear evidence that metoprolol reduced all-cause mortality (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.02 to 1.41), cardiovascular death (OR 0.20, 95% CI 0.02 to 1.76), AAA-related death (OR 1.05, 95% CI 0.06 to 16.92) or increased nonfatal cardiovascular events (OR 1.44, 95% CI 0.58 to 3.57) 30 days postoperatively. Furthermore, at six months postoperatively, estimated effects were compatible with benefit and harm for all-cause mortality (OR 0.71, 95% CI 0.26 to 1.95), cardiovascular death (OR 0.73, 95% CI 0.23 to 2.39) and nonfatal cardiovascular events (OR 1.41, 95% CI 0.59 to 3.35). Adverse drug effects were reported for the whole study population and were not available for the subgroup of participants with AAA. The study was deemed to be at a generally low risk of bias. AUTHORS' CONCLUSIONS Due to the limited number of trials, there is insufficient evidence to draw any conclusions about the effectiveness of cardiovascular prophylaxis in reducing mortality and cardiovascular events in people with AAA. Further good-quality randomised controlled trials examining many types of prophylaxis with long-term follow-up are required before firm conclusions can be made.
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Affiliation(s)
- Lindsay Robertson
- Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, UK, NE7 7DN
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MATSUMOTO KENICHI, SATOH KAZUMI, MANIWA TOMOKO, TANAKA TETSUYA, OKUNISHI HIDEKI, ODA TEIJI. Proteomic comparison between abdominal and thoracic aortic aneurysms. Int J Mol Med 2014; 33:1035-47. [DOI: 10.3892/ijmm.2014.1627] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 01/14/2014] [Indexed: 11/06/2022] Open
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Bailey MA, Baxter PD, Jiang T, Charnell AM, Griffin KJ, Johnson AB, Bridge KI, Sohrabi S, Scott DJA. Modeling the Growth of Infrarenal Abdominal Aortic Aneurysms. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:268-73. [PMID: 26798704 DOI: 10.12945/j.aorta.2013.13-036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/11/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) growth is a complex process that is incompletely understood. Significant heterogeneity in growth trajectories between patients has led to difficulties in accurately modeling aneurysm growth across cohorts of patients. We set out to compare four models of aneurysm growth commonly used in the literature and confirm which best fits the patient data of our AAA cohort. METHODS Patients with AAA were included in the study if they had two or more abdominal ultrasound scans greater than 3 months apart. Patients were censored from analysis once their AAA exceeded 5.5 cm. Four models were applied using the R environment for statistical computing. Growth estimates and goodness of fit (using the Akaike Information Criterion, AIC) were compared, with p-values based on likelihood ratio testing. RESULTS Of 510 enrolled patients, 264 met the inclusion criteria, yielding a total of 1861 imaging studies during 932 cumulative years of surveillance. Overall, growth rates were: (1) 0.35 (0.31,0.39) cm/yr in the growth/time calculation, (2) 0.056 (0.042,0.068) cm/yr in the linear regression model, (3) 0.19 (0.17,0.21) cm/yr in the linear multilevel model, and (4) 0.21 (0.18,0.24) cm/yr in the quadratic multilevel model at time 0, slowing to 0.15 (0.12,0.17) cm/yr at 10 years. AIC was lowest in the quadratic multilevel model (1508) compared to other models (P < 0.0001). CONCLUSION AAA growth was heterogeneous between patients; the nested nature of the data is most appropriately modeled by multilevel modeling techniques.
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Affiliation(s)
- Marc A Bailey
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom; ; The Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom; and
| | - Paul D Baxter
- The Division of Epidemiology and Biostatistics, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom
| | - Tao Jiang
- The Division of Epidemiology and Biostatistics, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom
| | - Aimee M Charnell
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom; ; The Division of Epidemiology and Biostatistics, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom
| | - Kathryn J Griffin
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom; ; The Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom; and
| | - Anne B Johnson
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom
| | - Katherine I Bridge
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom; ; The Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom; and
| | - Soroush Sohrabi
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom
| | - D Julian A Scott
- Multidisciplinary Cardiovascular Research Centre, Division of Cardiovascular and Diabetes Research, The Leeds Institute of Genetics, Health and Therapeutics, The University of Leeds, Leeds, United Kingdom; ; The Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, United Kingdom; and
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Trellopoulos G, Georgiadis GS, Nikolopoulos ES, Kapoulas KC, Georgakarakos EI, Lazarides MK. Antiplatelet Treatment and Prothrombotic Diathesis Following Endovascular Abdominal Aortic Aneurysm Repair. Angiology 2013; 65:783-7. [DOI: 10.1177/0003319713505139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prothrombotic diathesis expressed by elevated levels of coagulation-specific biomarkers has been reported in patients with abdominal aortic aneurysm (AAA) and after AAA endovascular repair (EVAR). This study investigates the effect of antiplatelet agents (APLs) on the prothrombotic diathesis in the post-EVAR period. Forty elective EVAR patients had thrombin–antithrombin complex, d-dimer, fibrinopeptide A, and high-sensitivity C-reactive protein measured before, at 24 hours, 1 month, and 6 months after EVAR. Patients receiving APLs postoperatively were compared with those not receiving APLs. All biomarkers were above the normal limits preoperatively and increased significantly 24 hours postoperatively followed by a drop at 1 and 6 months. No statistically significant changes were noted among patients receiving APLs in comparison with those not receiving APLs. The preoperative and postoperative prothrombotic diathesis of AAA following EVAR was confirmed in line with other reports. There was however no significant alteration of the examined biomarkers in patients receiving APLs.
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Affiliation(s)
- G. Trellopoulos
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
| | - G. S. Georgiadis
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
| | - E. S. Nikolopoulos
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
| | - K. C. Kapoulas
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
| | - E. I. Georgakarakos
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
| | - M. K. Lazarides
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
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Categorization of aortic aneurysm thrombus morphology by magnetic resonance imaging. Eur J Radiol 2013; 82:e544-9. [DOI: 10.1016/j.ejrad.2013.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/29/2013] [Indexed: 11/17/2022]
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Plasma thrombin-antithrombin complex, prothrombin fragments 1 and 2, and D-dimer levels are elevated after endovascular but not open repair of infrarenal abdominal aortic aneurysm. J Vasc Surg 2013; 57:1512-8. [DOI: 10.1016/j.jvs.2012.12.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 11/22/2022]
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Ariëns RAS. Fibrin(ogen) and thrombotic disease. J Thromb Haemost 2013; 11 Suppl 1:294-305. [PMID: 23809133 DOI: 10.1111/jth.12229] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/08/2013] [Indexed: 01/21/2023]
Abstract
Fibrinogen is an abundant plasma protein that, when converted to fibrin by thrombin, provides the main building blocks for the clot. Dys-, a-, and hypo-fibrinogenemias have been variably linked to a normal phenotype, bleeding or even thrombosis. Meanwhile, increased fibrinogen concentrations in the blood have been associated with risk for thrombosis. More recently, studies have focussed on abnormal fibrin structure as a cause for thrombosis. Fibrin clots that have high fiber density and increased resistance to fibrinolysis have been consistently associated with risk for thrombosis. Fibrin structure measurements can (i) provide an overall assessment of hemostatic capacity of a sample, (ii) include effects of thrombin generation and fibrinogen concentrations, (iii) include effects of fibrinogen mutations, polymorphisms, and modifications, and (iv) give an indication of clot mechanical strength and resistance to fibrinolysis. A fibrinogen splice variation of the γ-chain (γ') is discussed as a model for changes in fibrin structure in relation to thrombosis. Results from prospective studies on fibrin structure are awaited. Studies of fibrin formation under flow, interactions of fibrin with blood cells, the mechanical properties of the fibrin clot, and nanoscale/molecular characterization of fibrin formation are likely to expose new causal mechanisms for the role of fibrin in thrombotic disease. Future studies into the causality and mechanisms may lead to new opportunities using fibrin structure in the diagnosis or treatment of thrombosis.
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Affiliation(s)
- R A S Ariëns
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Genetics, Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
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Scott DJA, Allen CJ, Honstvet CA, Hanby AM, Hammond C, Johnson AB, Perry SL, Jones PF. Lymphangiogenesis in abdominal aortic aneurysm. Br J Surg 2013; 100:895-903. [DOI: 10.1002/bjs.9128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Ongoing angiogenesis is implicated in the inflammatory environment that characterizes abdominal aortic aneurysm (AAA). Although lymphangiogenesis has been associated with chronic inflammatory conditions, it has yet to be demonstrated in AAA. The aim was to determine the presence of lymphangiogenesis and to delineate the relationship between inflammation and neovascularization in AAA tissue.
Methods
AAA samples and preoperative computed tomography images were obtained from patients undergoing elective AAA repair. Control samples were age-matched abdominal aortic tissue. Specific immunostains for blood vessels (CD31, CD105), lymphatic vessels (D2-40), vascular endothelial growth factor (VEGF) A and VEGF receptor (VEGFR) 3 allowed characterization and quantitation of vasculature.
Results
The AAA wall contained high levels of inflammatory infiltrate; microvascular densities of blood (P < 0·001) and lymphatic (P = 0·003) vessels were significantly increased in AAA samples compared with controls. Maximal AAA vascularity was observed in inflammatory areas, with vessels that stained positively for CD31 (ρ = 0·625, P = 0·017), CD105 (ρ = 0·692, P = 0·009) and D2-40 (ρ = 0·675, P = 0·008) correlating positively with the extent of inflammation. Increased VEGFR-3 and VEGF-A expression was also evident within inflammatory AAA areas.
Conclusion
These findings demonstrated lymphatic vessel involvement in end-stage AAA disease, which was associated with the degree of inflammation, and confirmed the involvement of neovascularization.
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Affiliation(s)
- D J A Scott
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - C J Allen
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - C A Honstvet
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - A M Hanby
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - C Hammond
- Department of Vascular Radiology, Leeds General Infirmary, Leeds, UK
| | - A B Johnson
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - S L Perry
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
| | - P F Jones
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, UK
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Abdelhamid MF, Davies RS, Vohra RK, Adam DJ, Bradbury AW. Effect of endovascular and open abdominal aortic aneurysm repair on thrombin generation and fibrinolysis. J Vasc Surg 2013; 57:103-7. [DOI: 10.1016/j.jvs.2012.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 10/27/2022]
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Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55:41-6. [DOI: 10.1016/j.jvs.2011.07.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 11/18/2022]
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Davies RS, Abdelhamid M, Wall ML, Vohra RK, Bradbury AW, Adam DJ. Coagulation, fibrinolysis, and platelet activation in patients undergoing open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2011; 54:865-78. [DOI: 10.1016/j.jvs.2011.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 03/29/2011] [Accepted: 04/03/2011] [Indexed: 10/18/2022]
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Pulinx B, Hellenthal FAMVI, Hamulyák K, van Dieijen-Visser MP, Schurink GWH, Wodzig WKWH. Differential protein expression in serum of abdominal aortic aneurysm patients - a proteomic approach. Eur J Vasc Endovasc Surg 2011; 42:563-70. [PMID: 21843957 DOI: 10.1016/j.ejvs.2011.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 07/16/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the differential expression of proteins in serum of abdominal aortic aneurysm (AAA) patients in relation to aneurysm size (D(max)) and progression. METHODS Two-dimensional differential in-gel electrophoresis (2D-DIGE) together with tandem mass spectrometry (MS/MS) was used to analyse the serum proteome from patients with small (D(max) 30-54 mm) AAA, either stable (increase D(max) <5 mm year⁻¹; n = 8) or progressive (increase D(max) ≥5 mm year⁻¹; n = 8), and large (D(max) ≥ 55 mm; n = 8) AAA. The identified proteins were quantitatively validated in a larger population (n = 80). RESULTS Several proteins were differentially expressed in serum of small stable, small progressive and large AAA. Three validated proteins (immunoglobulin G (IgG), α1-antitrypsin (α1-AT) and Factor XII activity) showed strong correlation with D(max). Size combined with either Factor XII activity or α1-antitrypsin had minimal effect on the prognostic value in predicting aneurysm progression compared with size alone (area under the curve (AUC), 0.85; 95% confidence interval (CI), 0.73-0.97; p < 0.001 and AUC, 0.85; 95% CI, 0.72-0.98; p < 0.001 vs. AUC, 0.83; 95% CI, 0.71-0.96; p < 0.001, respectively). CONCLUSION The present study indicates that both Factor XII and α1-antitrypsin are found in increased amounts in the serum of patients with expanding AAA. However, combination of either Factor XII or α1-antitrypsin with aneurysm diameter had little effect on prediction of aneurysm progression versus diameter alone.
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Affiliation(s)
- B Pulinx
- Department of Clinical Chemistry, Maastricht University Medical Centre, Maastricht, The Netherlands
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Michel JB, Martin-Ventura JL, Egido J, Sakalihasan N, Treska V, Lindholt J, Allaire E, Thorsteinsdottir U, Cockerill G, Swedenborg J. Novel aspects of the pathogenesis of aneurysms of the abdominal aorta in humans. Cardiovasc Res 2011; 90:18-27. [PMID: 21037321 PMCID: PMC3058728 DOI: 10.1093/cvr/cvq337] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/04/2010] [Accepted: 10/20/2010] [Indexed: 01/22/2023] Open
Abstract
Aneurysm of the abdominal aorta (AAA) is a particular, specifically localized form of atherothrombosis, providing a unique human model of this disease. The pathogenesis of AAA is characterized by a breakdown of the extracellular matrix due to an excessive proteolytic activity, leading to potential arterial wall rupture. The roles of matrix metalloproteinases and plasmin generation in progression of AAA have been demonstrated both in animal models and in clinical studies. In the present review, we highlight recent studies addressing the role of the haemoglobin-rich, intraluminal thrombus and the adventitial response in the development of human AAA. The intraluminal thrombus exerts its pathogenic effect through platelet activation, fibrin formation, binding of plasminogen and its activators, and trapping of erythrocytes and neutrophils, leading to oxidative and proteolytic injury of the arterial wall. These events occur mainly at the intraluminal thrombus-circulating blood interface, and pathological mediators are conveyed outwards, where they promote matrix degradation of the arterial wall. In response, neo-angiogenesis, phagocytosis by mononuclear cells, and a shift from innate to adaptive immunity in the adventitia are observed. Abdominal aortic aneurysm thus represents an accessible spatiotemporal model of human atherothrombotic progression towards clinical events, the study of which should allow further understanding of its pathogenesis and the translation of pathogenic biological activities into diagnostic and therapeutic applications.
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Affiliation(s)
- Jean-Baptiste Michel
- Inserm Unit 698, Cardiovascular Remodelling, Denis Diderot University, Hôpital X. Bichat, Paris, France.
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Parr A, McCann M, Bradshaw B, Shahzad A, Buttner P, Golledge J. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. J Vasc Surg 2011; 53:28-35. [PMID: 20934838 DOI: 10.1016/j.jvs.2010.08.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with abdominal aortic aneurysms (AAA) are predisposed to cardiovascular events and often experience continual expansion of their aneurysm. Cardiovascular events and expansion rates are positively correlated with aneurysm size. AAA is usually associated with intraluminal thrombus, which has previously been implicated in AAA pathogenesis. This study prospectively assessed the association of infrarenal abdominal aortic thrombus volume with cardiovascular events and AAA growth. METHODS Ninety-eight patients with AAAs underwent computed tomography angiography (CTA). The volume of infrarenal aorta thrombus was measured by a previously validated technique. Patients were monitored prospectively for a median of 3 years (interquartile range [IQR], 2.0-3.6 years), and cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, coronary revascularization, amputation, and cardiovascular death) were recorded. Of the original patients, 39 underwent repeat CTA a median of 1.5 years (IQR, 1.1-3.3 years) after entry to the study. Kaplan-Meier and Cox proportional analysis were used to examine the association of aortic thrombus with cardiovascular events and average weighted AAA growth. RESULTS There were 28 cardiovascular events during follow-up. The incidence of cardiovascular events was 23.4% and 49.2% for patients with small (smaller than the median) and large (median or larger) volumes of aortic thrombus, respectively, at 4 years (P = .040). AAA thrombus volume of median or larger was associated with increased cardiovascular events (relative risk [RR] 2.8, 95% confidence interval [CI], 1.01-5.24) independent of other risk factors, including initial AAA diameter, but was only of borderline significance when patients were censored at the time of AAA repair (RR, 2.35; 95% CI, 0.98-5.63). In the subset of patients with CTA follow-up, the median annual increase in AAA volume was 5.1 cm³ (IQR, 0.8-10.3 cm³). Annual AAA volume increase was positively correlated with initial AAA diameter (r = 0.44, P = .006) and thrombus volume (r = 0.50, P = .001). Median or larger aortic thrombus volume was associated with rapid AAA volume increase (≥ 5 cm/y), independent of initial aortic diameter (RR, 15.0; 95% CI, 1.9-115.7; P = .009). CONCLUSION In this small cohort, infrarenal aortic thrombus volume was associated with the incidence of cardiovascular events and AAA progression. These results need to be confirmed and mechanisms underlying the associations clarified in large further studies.
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Affiliation(s)
- Adam Parr
- Vascular Biology Unit, James Cook University, Townsville, Queensland, Australia
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Laughlin GA, Allison MA, Jensky NE, Aboyans V, Wong ND, Detrano R, Criqui MH. Abdominal aortic diameter and vascular atherosclerosis: the Multi-Ethnic Study of Atherosclerosis. Eur J Vasc Endovasc Surg 2011; 41:481-7. [PMID: 21236707 DOI: 10.1016/j.ejvs.2010.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/17/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To gain insight into early mechanisms of aortic widening, we examined associations between the diameter of the abdominal aorta (AD) and cardiovascular disease (CVD) risk factors and biomarkers, as well as measures of subclinical atherosclerosis, in a multi-ethnic population. DESIGN Cross-sectional cohort. METHODS A total of 1926 participants (mean age 62, 50% women) underwent chest and abdomen scanning by computed tomography, ultrasound of the carotid arteries, and CVD risk factor assessment. AD was measured 5 cm above and at the bifurcation. RESULTS In a model containing traditional CVD risk factors, biomarkers and ethnicity, only age (standardized β = 0.97), male sex (β = 1.88), body surface area (standardized β = 0.92), current smoking (β = 0.42), D-dimer levels (β = 0.19) and hypertension (β = 0.53) were independently and significantly associated with increasing AD (in mm) at the bifurcation; use of cholesterol-lowering medications predicted smaller AD (β = -0.70) (P < 0.01 for all). These findings were similar for AD 5 cm above the bifurcation with one exception: compared to Caucasian-Americans, Americans of Chinese, African and Hispanic descent had significantly smaller AD 5 cm above the bifurcation (β's = -0.59, -0.49, and -0.52, respectively, all P < 0.01), whereas AD at the bifurcation did not differ by ethnicity. Physical activity, alcohol consumption, diabetes and levels of IL-6, CRP and homocysteine were not independently associated with AD. Higher aortic and coronary artery calcium burden, but not common carotid artery intima-media thickness, were independently, but modestly (β = 0.11 to 0.19), associated with larger AD. CONCLUSIONS Incremental widening of the aortic diameter shared some, but not all, risk factors for occlusive vascular disease.
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Affiliation(s)
- G A Laughlin
- Department of Family and Preventive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, San Diego, CA 92093-0620, United States.
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Takagi H, Manabe H, Matsui M, Goto SN, Umemoto T. Plasma D-dimer and abdominal aortic aneurysm. Thromb Res 2010; 126:e451-2. [PMID: 20884046 DOI: 10.1016/j.thromres.2010.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/28/2010] [Accepted: 09/02/2010] [Indexed: 10/19/2022]
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Parry DJ, Al-Barjas HS, Chappell L, Rashid ST, Ariëns RAS, Scott DJA. Markers of inflammation in men with small abdominal aortic aneurysm. J Vasc Surg 2010; 52:145-51. [PMID: 20620767 DOI: 10.1016/j.jvs.2010.02.279] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/19/2010] [Accepted: 02/24/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Markers of inflammation and fibrin turnover are elevated in individuals with a large (>55 mm) abdominal aortic aneurysm (AAA). Fibrin degradation generates D-dimer, known to possess multiple proinflammatory effects, and levels are elevated during early AAA development. This study characterized the plasma inflammatory response during early AAA pathogenesis to determine the effect of D-dimer levels. METHODS The study compared 75 men with a small AAA (range, 30-54 mm) with 90 age-, sex-, and race-matched controls. Plasma interleukin-6 (IL-6), complement C3, high-sensitivity C-reactive protein (hsCRP), fibrinogen, and D-dimer levels were measured. RESULTS Mean levels of fibrinogen (2.92 vs 2.59 g/L; P = .003), hsCRP (2.07 vs 1.29 ng/mL; P = .005), and D-dimer (346.7 vs 120.2 ng/mL; P < .001) were higher in men with a small AAA. These markers correlated with maximum aortic diameter determined by ultrasound imaging. On multivariate analysis, D-dimer levels were elevated in AAA individuals independent of smoking, cardiovascular disease (CVD), atherosclerotic risk factors, and inflammatory parameters. Fibrinogen and hsCRP levels remained elevated after adjustment for these covariates but lost significance when D-dimer was added to the model. CONCLUSION C-reactive protein and D-dimer levels are elevated during early AAA development. D-dimer levels are most tightly associated with AAA status, however, and may mediate the observed elevation in acute-phase reactants.
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Affiliation(s)
- Duncan J Parry
- Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis, University of Leeds, Leeds, West Yorkshire, United Kingdom
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Diehm N, Baumgartner I. D-dimer measurement: a useful prognostic marker in surveillance of patients with abdominal aortic aneurysm? Eur Heart J 2010; 32:258-60. [PMID: 20605803 DOI: 10.1093/eurheartj/ehq219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Golledge J, Muller R, Clancy P, McCann M, Norman PE. Evaluation of the diagnostic and prognostic value of plasma D-dimer for abdominal aortic aneurysm. Eur Heart J 2010; 32:354-64. [DOI: 10.1093/eurheartj/ehq171] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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