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Chen J, Hu L, Liu Z. Medical treatments for abdominal aortic aneurysm: an overview of clinical trials. Expert Opin Investig Drugs 2024; 33:979-992. [PMID: 38978286 DOI: 10.1080/13543784.2024.2377747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/04/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Abdominal aortic aneurysm is a progressive, segmental, abdominal aortic dilation associated with a high mortality rate. Abdominal aortic aneurysms with diameters larger than 55 mm are associated with a high risk of rupture, and the most effective treatment options are surgical repair. Close observation and lifestyle adjustments are recommended for smaller abdominal aortic aneurysms with lower rupture risk. The development of medical therapies that limit or prevent the progression, expansion, and eventual rupture of abdominal aortic aneurysms remains an unmet clinical need. AREAS COVERED This review provides an overview of completed and ongoing clinical trials examining the efficacies of various drug classes, including antibiotics, antihypertensive drugs, hypolipidemic drugs, hypoglycemic drugs, and other potential therapies for abdominal aortic aneurysms. A search of PubMed, Web of Science, Clinical Trials, and another six clinical trial registries was conducted in January 2024. EXPERT OPINION None of the drugs have enough evidence to indicate that they can effectively inhibit the dilation of abdominal aortic aneurysm. More clinical trial data is required to support the efficacy of propranolol. Future research should also explore different drug delivery mechanisms, such as nanoparticles, to elevate drug concentration at the aneurysm wall.
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Affiliation(s)
- Jinyi Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lanting Hu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Patel R, Hall S, Lanford H, Ward N, Grespin RT, Figueroa M, Mattia V, Xiong Y, Mukherjee R, Jones J, Ruddy JM. Signaling through the IL-6-STAT3 Pathway Promotes Proteolytically-Active Macrophage Accumulation Necessary for Development of Small AAA. Vasc Endovascular Surg 2023; 57:433-444. [PMID: 36639147 PMCID: PMC10238619 DOI: 10.1177/15385744231152961] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Elevated interleukin-6 (IL-6) plasma levels have been associated with abdominal aortic aneurysm (AAA), but whether this cytokine plays a causative role in the degenerative remodeling or represents an effect from the inflammatory cascades initiated by infiltrating leukocytes remained unclear. This project aims to demonstrate that within the aortic wall, signaling from IL-6 through the STAT3 transcription factor is necessary for infiltration of proteolytically-active macrophages and development of small AAA. METHODS Following measurement of baseline infrarenal aortic diameter (AoD, digital microscopy), C57Bl/6 and IL-6 knockout (IL-6KO) mice underwent AAA induction by application of peri-adventitial CaCl2 (0.5 M) +/- implantation of an osmotic mini-pump delivering IL-6 (4.36 µg/kg/day over 21 days). At the terminal procedure, AoDs were measured by digital microscopy and aortas harvested for immunoblot (pSTAT3/STAT3), matrix metalloproteinase (MMP) quantification, or flow cytometric analysis of macrophage content. Plasma was collected for cytokine analysis. RESULTS IL-6 infusion significantly increased the plasma IL-6 levels in C57Bl/6 and IL-6KO animals. The C57Bl/6 + CaCl2 group developed AAA (AoD >50% above baseline) but IL-6KO + CaCl2 did not. In the IL-6KO + IL-6+CaCl2 group, AAA developed to match that of C57Bl/6 + CaCl2 mice. STAT3 activity was significantly increased in animals with advanced stages of dilation (>40% from baseline), compared to those with ectasia (≤25%). Although cytokine profiles did not support T-cells or neutrophils as being active contributors in this stage of aortic remodeling, changes in the profile of elaborated MMPs suggested macrophage activity with a trend toward alternatively activated pathways. Flow cytometry confirmed significantly increased macrophage abundance specifically in animals with upregulated STAT3 activity and advanced aortic dilation. CONCLUSION In this murine model of AAA, progressive dilation to development of true AAA was only accomplished when IL-6 signaling upregulated STAT3 activity to effect accumulation of proteolytically-active macrophages. This pathway warrants further investigation to identify potential therapeutic avenues to abrogate growth of small AAA.
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Affiliation(s)
- Raj Patel
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - SarahRose Hall
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Hayes Lanford
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Nicholas Ward
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - R. Tyler Grespin
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Mario Figueroa
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victoria Mattia
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ying Xiong
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rupak Mukherjee
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jeffrey Jones
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jean Marie Ruddy
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
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Arbănași EM, Mureșan AV, Coșarcă CM, Arbănași EM, Niculescu R, Voidăzan ST, Ivănescu AD, Hălmaciu I, Filep RC, Mărginean L, Suzuki S, Chirilă TV, Kaller R, Russu E. Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15961. [PMID: 36498041 PMCID: PMC9741090 DOI: 10.3390/ijerph192315961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Background: Abdominal aortic aneurysm (AAA) is a complex vascular disease characterized by progressive and irreversible local dilatation of the aortic wall. Currently, the indication for repair is linked to the transverse diameter of the abdominal aorta, using computed tomography angiography imagery, which is one of the most used markers for aneurysmal growth. This study aims to verify the predictive role of imaging markers and underlying risk factors in AAA rupture. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included 220 patients over 18 years of age with a diagnosis of AAA, confirmed by computed tomography angiography (CTA), admitted to Vascular Surgery Clinic of Mures County Emergency Hospital in Targu Mures, Romania, between January 2018 and September 2022. Results: Patients with a ruptured AAA had higher incidences of AH (p = 0.006), IHD (p = 0.001), AF (p < 0.0001), and MI (p < 0.0001), and higher incidences of all risk factors (tobacco (p = 0.001), obesity (p = 0.02), and dyslipidemia (p < 0.0001)). Multivariate analysis showed that a high baseline value of all imaging ratios markers was a strong independent predictor of AAA rupture (for all p < 0.0001). Moreover, a higher baseline value of DAmax (OR:3.91; p = 0.001), SAmax (OR:7.21; p < 0.001), and SLumenmax (OR:34.61; p < 0.001), as well as lower baseline values of DArenal (OR:7.09; p < 0.001), DACT (OR:12.71; p < 0.001), DAfemoral (OR:2.56; p = 0.005), SArenal (OR:4.56; p < 0.001), SACT (OR:3.81; p < 0.001), and SThrombusmax (OR:5.27; p < 0.001) were independent predictors of AAA rupture. In addition, AH (OR:3.33; p = 0.02), MI (OR:3.06; p = 0.002), and PAD (OR:2.71; p = 0.004) were all independent predictors of AAA rupture. In contrast, higher baseline values of SAmax/Lumenmax (OR:0.13; p < 0.001) and ezetimibe (OR:0.45; p = 0.03) were protective factors against AAA rupture. Conclusions: According to our findings, a higher baseline value of all imaging markers ratios at CTA strongly predicts AAA rupture and AH, MI, and PAD highly predicted the risk of rupture in AAA patients. Furthermore, the diameter of the abdominal aorta at different levels has better accuracy and a higher predictive role of rupture than the maximal diameter of AAA.
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Affiliation(s)
- Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Septimiu Toader Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Adrian Dumitru Ivănescu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ioana Hălmaciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Rareș Cristian Filep
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Lucian Mărginean
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Shuko Suzuki
- Queensland Eye Institute, South Brisbane, QLD 4101, Australia
| | - Traian V. Chirilă
- Queensland Eye Institute, South Brisbane, QLD 4101, Australia
- School of Chemistry & Physics, Queensland University of Technology, Brisbane, QLD 4001, Australia
- Australian Institute of Bioengineering & Nanotechnology (AIBN), University of Queensland, St. Lucia, QLD 4072, Australia
- Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia
- School of Molecular Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Duan L, Xin W, Li S, Zhao L, Xin S. The treatment choices of abdominal aortic aneurysm patients in China in the era of value-based healthcare. Front Cardiovasc Med 2022; 9:961830. [DOI: 10.3389/fcvm.2022.961830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundEndovascular aneurysm repair (EVAR) is often seen as the first choice treatment for patients with abdominal aortic aneurysm (AAA), particularly high-risk patients, yet the long-term survival rate and improvement in quality of life are still unclear. In order to seek the value of EVAR to the entire healthcare field, we conducted a retrospective study to evaluate whether the improvement EVAR can truly bring to the quality of medical care in the era of value-based healthcare.MethodsWe included AAA patients who underwent surgical treatment in the Department of Vascular Surgery, First Hospital of China Medical University, from January 1, 2004, to December 31, 2019 and evaluated surgery procedure data, short-term and long-term mortality, complications, prognoses, and medical costs.ResultsWe analyzed 507 patients with AAA who underwent open repair (n = 232) or EVAR (n = 275) over a 15-year period. The operative time, blood loss, blood transfusion rate, and postoperative length of hospital stay of the EVAR group is significantly lower than which of the open repair group. Meanwhile, neither short-term nor long-term mortality rates shows significant differences between the two groups. On the other hand, the complication rate of the EVAR group was significantly higher than that of the open repair group. Lastly, the total cost of EVAR was significantly higher than that of open repair.ConclusionExisting evidence suggests that EVAR improves neither short-term nor long-term survival rate compared with open surgery. In contrast, the complication rate and the reintervention rate in the EVAR group were higher than those in the open surgery group. Moreover, the cost of EVAR and that paid by medical insurance were higher than those for open surgery. For patients with a long-life expectancy, in order to ensure that patients receive appropriate and effective care, surgeons should choose a suitable method that considers both the quality of medical care as well as the expense accordingly.
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Griepke S, Grupe E, Lindholt JS, Fuglsang EH, Steffensen LB, Beck HC, Larsen MD, Bang-Møller SK, Overgaard M, Rasmussen LM, Lambertsen KL, Stubbe J. Selective inhibition of soluble tumor necrosis factor signaling reduces abdominal aortic aneurysm progression. Front Cardiovasc Med 2022; 9:942342. [PMID: 36186984 PMCID: PMC9523116 DOI: 10.3389/fcvm.2022.942342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Tumor necrosis factor (TNF) is pathologically elevated in human abdominal aortic aneurysms (AAA). Non-selective TNF inhibition-based therapeutics are approved for human use but have been linked to several side effects. Compounds that target the proinflammatory soluble form of TNF (solTNF) but preserve the immunomodulatory capabilities of the transmembrane form of TNF (tmTNF) may prevent these side effects. We hypothesize that inhibition of solTNF signaling prevents AAA expansion. Methods The effect of the selective solTNF inhibitor, XPro1595, and the non-selective TNF inhibitor, Etanercept (ETN) was examined in porcine pancreatic elastase (PPE) induced AAA mice, and findings with XPro1595 was confirmed in angiotensin II (ANGII) induced AAA in hyperlipidemic apolipoprotein E (Apoe) -/- mice. Results XPro1595 treatment significantly reduced AAA expansion in both models, and a similar trend (p = 0.06) was observed in PPE-induced AAA in ETN-treated mice. In the PPE aneurysm wall, XPro1595 improved elastin integrity scores. In aneurysms, mean TNFR1 levels reduced non-significantly (p = 0.07) by 50% after TNF inhibition, but the histological location in murine AAAs was unaffected and similar to that in human AAAs. Semi-quantification of infiltrating leucocytes, macrophages, T-cells, and neutrophils in the aneurysm wall were unaffected by TNF inhibition. XPro1595 increased systemic TNF levels, while ETN increased systemic IL-10 levels. In ANGII-induced AAA mice, XPro1595 increased systemic TNF and IL-5 levels. In early AAA development, proteomic analyses revealed that XPro1595 significantly upregulated ontology terms including "platelet aggregation" and "coagulation" related to the fibrinogen complex, from which several proteins were among the top regulated proteins. Downregulated ontology terms were associated with metabolic processes. Conclusion In conclusion, selective inhibition of solTNF signaling reduced aneurysm expansion in mice, supporting its potential as an attractive treatment option for AAA patients.
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Affiliation(s)
- Silke Griepke
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Emilie Grupe
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jes Sanddal Lindholt
- Elite Research Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Elizabeth Hvitfeldt Fuglsang
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lasse Bach Steffensen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Hans Christian Beck
- Elite Research Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Mia Dupont Larsen
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Sissel Karoline Bang-Møller
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martin Overgaard
- Elite Research Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Lars Melholt Rasmussen
- Elite Research Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Kate Lykke Lambertsen
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
- BRIDGE—Brain Research—Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jane Stubbe
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Elite Research Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
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Lu BH, Liu HB, Guo SX, Zhang J, Li DX, Chen ZG, Lin F, Zhao GA. Long non-coding RNAs: Modulators of phenotypic transformation in vascular smooth muscle cells. Front Cardiovasc Med 2022; 9:959955. [PMID: 36093159 PMCID: PMC9458932 DOI: 10.3389/fcvm.2022.959955] [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: 06/02/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
Long non-coding RNA (lncRNAs) are longer than 200 nucleotides and cannot encode proteins but can regulate the expression of genes through epigenetic, transcriptional, and post-transcriptional modifications. The pathophysiology of smooth muscle cells can lead to many vascular diseases, and studies have shown that lncRNAs can regulate the phenotypic conversion of smooth muscle cells so that smooth muscle cells proliferate, migrate, and undergo apoptosis, thereby affecting the development and prognosis of vascular diseases. This review discusses the molecular mechanisms of lncRNA as a signal, bait, stent, guide, and other functions to regulate the phenotypic conversion of vascular smooth muscle cells, and summarizes the role of lncRNAs in regulating vascular smooth muscle cells in atherosclerosis, hypertension, aortic dissection, vascular restenosis, and aneurysms, providing new ideas for the diagnosis and treatment of vascular diseases.
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Affiliation(s)
- Bing-Han Lu
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
| | - Hui-Bing Liu
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
- Henan Normal University, Xinxiang, China
| | - Shu-Xun Guo
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
| | - Jie Zhang
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
| | - Dong-Xu Li
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
| | - Zhi-Gang Chen
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
| | - Fei Lin
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
| | - Guo-An Zhao
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Key Laboratory of Cardiovascular Injury and Repair Medicine of Henan, Weihui, China
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Xiong T, Lv XS, Wu GJ, Guo YX, Liu C, Hou FX, Wang JK, Fu YF, Liu FQ. Single-Cell Sequencing Analysis and Multiple Machine Learning Methods Identified G0S2 and HPSE as Novel Biomarkers for Abdominal Aortic Aneurysm. Front Immunol 2022; 13:907309. [PMID: 35769488 PMCID: PMC9234288 DOI: 10.3389/fimmu.2022.907309] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Identifying biomarkers for abdominal aortic aneurysms (AAA) is key to understanding their pathogenesis, developing novel targeted therapeutics, and possibly improving patients outcomes and risk of rupture. Here, we identified AAA biomarkers from public databases using single-cell RNA-sequencing, weighted co-expression network (WGCNA), and differential expression analyses. Additionally, we used the multiple machine learning methods to identify biomarkers that differentiated large AAA from small AAA. Biomarkers were validated using GEO datasets. CIBERSORT was used to assess immune cell infiltration into AAA tissues and investigate the relationship between biomarkers and infiltrating immune cells. Therefore, 288 differentially expressed genes (DEGs) were screened for AAA and normal samples. The identified DEGs were mostly related to inflammatory responses, lipids, and atherosclerosis. For the large and small AAA samples, 17 DEGs, mostly related to necroptosis, were screened. As biomarkers for AAA, G0/G1 switch 2 (G0S2) (Area under the curve [AUC] = 0.861, 0.875, and 0.911, in GSE57691, GSE47472, and GSE7284, respectively) and for large AAA, heparinase (HPSE) (AUC = 0.669 and 0.754, in GSE57691 and GSE98278, respectively) were identified and further verified by qRT-PCR. Immune cell infiltration analysis revealed that the AAA process may be mediated by T follicular helper (Tfh) cells and the large AAA process may also be mediated by Tfh cells, M1, and M2 macrophages. Additionally, G0S2 expression was associated with neutrophils, activated and resting mast cells, M0 and M1 macrophages, regulatory T cells (Tregs), resting dendritic cells, and resting CD4 memory T cells. Moreover, HPSE expression was associated with M0 and M1 macrophages, activated and resting mast cells, Tregs, and resting CD4 memory T cells. Additional, G0S2 may be an effective diagnostic biomarker for AAA, whereas HPSE may be used to confer risk of rupture in large AAAs. Immune cells play a role in the onset and progression of AAA, which may improve its diagnosis and treatment.
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Affiliation(s)
- Tao Xiong
- Department of Cardiovascular, Shaanxi Provincial People’s Hospital, Xi’an, China
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiao-Shuo Lv
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Gu-Jie Wu
- Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Yao-Xing Guo
- Department of Pathology, College of Basic Medical Sciences China Medical University, Shenyang, China
| | - Chang Liu
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fang-Xia Hou
- Department of Cardiovascular, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Jun-Kui Wang
- Department of Cardiovascular, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Yi-Fan Fu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Fu-Qiang Liu
- Department of Cardiovascular, Shaanxi Provincial People’s Hospital, Xi’an, China
- *Correspondence: Fu-Qiang Liu,
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Hariri O, Al Laham O, Mohammad A. A distinguished case of a spontaneously dissecting Left Common Iliac Artery Aneurysm, associated with an Elastinopathy, in a healthy 36-year-old male, successfully treated with open surgical repair - A Case Report. Int J Surg Case Rep 2022; 95:107253. [PMID: 35661499 PMCID: PMC9163487 DOI: 10.1016/j.ijscr.2022.107253] [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: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Elastin is a major protein of the Extracellular Matrix (ECM), essential in providing elasticity to the vascular wall, which enables blood vessels to reversibly expand and contract. Several inherited or acquired etiologies, such as elastinopathies and fibrillinopathies negatively impact the objective of the Extracellular Matrix via compromising the Elastin fibers in the Cardiovascular System (CVS) and the skin. Such compromises will have devastating ramifications through the increase in vascular wall stiffness and the inability to properly dissipate energy. This impact on the vascular wall will contribute to the development of arterial aneurysms and dissections. CASE PRESENTATION Our case is of a 36-year-old previously healthy male patient who presented with an acute onset of left lower limb pain associated with cold sensation two days prior to admission. Radiology demonstrated a dissecting aneurysm in the left Common Iliac Artery. CLINICAL DISCUSSION The patient was surgically treated with an Aorto-bi-Femoral Bypass (ABFB). Histopathological analysis of the excised aortic and iliac specimens revealed no Elastin fibers in the vessel walls. CONCLUSION Isolated Iliac aneurysms are a rare entity and are challenging to diagnose preoperatively. In our case, there were no risk factors whatsoever and the patient's history - including family history - was negative. It is vital to establish preoperative diagnostic approaches in such cases and keep them in mind so that we can diminish the morbidity and mortality resultants from the complications.
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Affiliation(s)
- Omar Hariri
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Ammar Mohammad
- Department of Vascular Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
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Wang E, Xie X, Xu D, Shu X, Zhao YF, Zhang Y, Lin P, Guo D, Fu W, Wang L. Patients With Symptomatic AAAs Are More Likely to Develop Lumen Partial-Thrombus After Endovascular Aortic Repair Than Asymptomatic Patients. Front Cardiovasc Med 2022; 9:848848. [PMID: 35369335 PMCID: PMC8970593 DOI: 10.3389/fcvm.2022.848848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background According to their symptoms, abdominal aortic aneurysms (AAAs) can be divided into symptomatic and asymptomatic types. This study aimed to explore the differences and correlations between postoperative lumen thrombosis in these two groups after endovascular aortic repair (EVAR). Methods A retrospective study using clinical data of 169 patients with AAA treated with EVAR collected in our hospital between January 2018 and January 2021 was conducted based on the inclusion and exclusion criteria for patient selection. Based on whether the patient had clinical symptoms at admission and the presence of a complete lumen thrombus during follow-up, the patients were divided into two sets of groups: a complete-thrombus group (n = 44) and a partial-thrombus group (n = 125), and a group with clinical symptoms (n = 32) and a group without clinical symptoms (n = 137). The clinical data of these groups were compared, and a further stratified analysis was performed. Results A total of 169 patients were included in the analysis. An abdominal aorta stent graft was successfully implanted in all patients. The complete-thrombus rate of the patients in this study was 73.96%. Univariate analysis showed that the maximal aortic diameter and preoperative peripheral blood neutrophil levels affected the clinical symptoms of patients with AAA (p < 0.05). The complete thrombus rate of the lumen of the AAA was lower in patients with clinical symptoms than in those without symptoms during the follow-up period (p < 0.05). Female sex, preoperative hyperuricemia, and symptoms at admission were independent risk factors for a partial thrombus in the lumen during follow-up. Based on these independent risk factors, we constructed a scoring system to differentiate patients into low- (0 points), middle- (1 point), and high-risk (2 points) groups. The scoring system could distinguish the complete lumen thrombosis rate after EVAR to a certain extent. Conclusions Patients with symptomatic AAAs were more likely to develop incomplete lumen thrombosis than asymptomatic patients during follow-up after EVAR.
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Affiliation(s)
- Enci Wang
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinsheng Xie
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Dandan Xu
- Department of Neurology, Quanzhou First Hospital Affifiliated to Fujian Medical University, Quanzhou, China
| | - Xiaolong Shu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu fei Zhao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuchong Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Lin
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Weiguo Fu
| | - Lixin Wang
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Lixin Wang
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10
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Imene B, Nasser-Eddine B, Khaoula B, Slimane L. Fuzzy inference analysis of the arterial hypertension effect on aneurysm. VASCULAR INVESTIGATION AND THERAPY 2022. [DOI: 10.4103/2589-9686.348228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Arun D, Munir W, Schmitt LV, Vyas R, Ravindran JI, Bashir M, Williams IM, Velayudhan B, Idhrees M. Exploring the Correlation and Protective Role of Diabetes Mellitus in Aortic Aneurysm Disease. Front Cardiovasc Med 2021; 8:769343. [PMID: 34820431 PMCID: PMC8606667 DOI: 10.3389/fcvm.2021.769343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Diabetes mellitus is recognised as a significant risk factor for cardiovascular and peripheral vascular disease, as the abnormal metabolic state increases the risk for atherosclerosis, occlusive arterial disease and vascular dysfunction. There have been reports of potential association across the literature that illustrates a link between diabetes mellitus and aortic aneurysm, with the former having a protective role on the development of the latter. Methods: A thorough literature search was performed through electronic databases, to provide a comprehensive review of the study's reporting on the association of diabetes mellitus and aortic aneurysm, discussing the mechanisms that have been reported; furthemore, we reviewed the reports of the impact of oral hypoglycameic agents on aortic aneurysms. Results: Various proposed mechanisms are involved in this protective process including endothelial dysfunction, chronic hyperglycemia and insulin resistance. The evidence suggests a negative association between these disease process, with prevelance of diabetes mellitus resulting in lower rates of aortic aneurysm, via its protective mechanistic action. The increase in advanced glycation end products, increased arterial stiffness and vascular remodelling seen in diabetes, was found to have a profound impact on aneurysm development, its slow progression and lower rupture rate in these individuals. This review has also highlighted the role of oral hypoglycaemic agents having a protective effect against AA disease. Conclusion: A decrease in development, progression and mortality from aortic aneurysms as well as reduced rates of dissection, have been observed in those with diabetes. This review has provided a comprehensive insight on the effect of diabetes and its physiological processes, and elements of its con-committant treatment, having a protective role against these aortic diseases.
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Affiliation(s)
- Divyatha Arun
- Department of Endocrinology, Columbia Asia Referral Hospital, A Unit of Manipal Hospital, Yeshwanthpur, Bengaluru, India
| | - Wahaj Munir
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lara Victoria Schmitt
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Rohan Vyas
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jeuela Iris Ravindran
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mohamad Bashir
- Institue of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospitals), Chennai, India
| | | | - Bashi Velayudhan
- Institue of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospitals), Chennai, India
| | - Mohammed Idhrees
- Institue of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospitals), Chennai, India
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12
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Castro-Ferreira R, Vidoedo J, Peixoto J, Canedo A, Teixeira J, Leite-Moreira A, Sampaio S. Incidental abdominal aortic aneurysms are largely undocumented and unmonitored. Ann Vasc Surg 2021; 77:182-186. [PMID: 34411670 DOI: 10.1016/j.avsg.2021.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In countries without organized population screening, incidental detection remains the major form of abdominal aortic aneurysm (AAA) diagnosis. Despite the presumed homogeneity in AAA prevalence, its rate of repair is highly variable, with Portugal treating 2 to 6 times fewer AAA per habitant than other western countries. OBJECTIVES To evaluate the detection rate and monitoring of incidental AAA in a multicentre cohort from Portuguese hospitals. METHODS All abdominal CT scans performed in men ≥ 65 years old in three major Portuguese hospitals between January and June 2018 were selected for review. CT scans prescribed by the Vascular Surgery or Emergency Departments were excluded. Patients with previously known AAA were also excluded. Subjects with newly detected aneurysms were assessed for the two primary outcomes: the description of the finding by the radiologist in the written report; the effective follow-up recommendations by the prescriber of the CT or by the general practitioner (GP). Patients with newly found AAA that met criteria for monitoring or treatment and failed to be given guidance were contacted and included in surveillance programs. RESULTS Overall, 3292 abdominal CT scans were selected for review. A total of 133 newly found aneurysms were detected (4.2% prevalence in the cohort). Of those, 48 cases (36%) were not described by the radiologist in the written report. Further 42 patients (32%) were not successfully oriented by the ordering physician or GP, despite having had their AAA mentioned. Overall, only 32% (n = 42) of the newly diagnosed AAA were correctly identified and referred to monitoring. CONCLUSIONS Incidental AAA is a common occurrence in in-hospital abdominal CTs. A significant number is not documented by the radiologist and the vast majority is not referred to monitoring. This could be a major reason for the low elective treatment rate of AAA in Portugal.
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Affiliation(s)
- Ricardo Castro-Ferreira
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Gaia, Portugal.
| | - José Vidoedo
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - João Peixoto
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Gaia, Portugal
| | - Alexandra Canedo
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Gaia, Portugal
| | - José Teixeira
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Adelino Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sérgio Sampaio
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Centro de Investigação e Tecnologia de Informação em Sistemas de Saúde (CINTESIS) e Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Portugal
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13
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Miao T, Wang T, Feng T, Yuan D, Guo Q, Xiong F, Yang Y, Liu L, He Z, Huang B, Zhao J. Activated invariant natural killer T cells infiltrate aortic tissue as key participants in abdominal aortic aneurysm pathology. Immunology 2021; 164:792-802. [PMID: 34379797 DOI: 10.1111/imm.13401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023] Open
Abstract
Adaptive immunity and innate immunity have been implicated in the pathogenesis of abdominal aortic aneurysm (AAA), and damage and remodelling in the tunica media are a focus of the aneurysm development. Thus, identification of key immune cells or molecules that might be targets for the treatment of AAA is critical. We characterized the innate immune cells in human AAA tissue specimens by flow cytometry and found that apart from other lymphocytes, many invariant natural killer T (iNKT) cells marked as CD3 and Va24Ja18 had invaded the aortic tissues and were numerous, especially in the tunica media. These infiltrating iNKT cells have a high expression of CD69, indicating a highly active function. We were interested in whether iNKT cells could be the drivers of media damage in AAA. To answer this question, we used an AAA mouse model induced by angiotensin II (Ang II) infusion, which can reproduce the inflammatory response of AAA in mouse, which was confirmed by RNAseq. The results showed that the incidence of AAA was significantly higher after administration of α-galactosylceramide (α-GalCer), a synthetic glycolipid that activates iNKT cells via CD1d, compared with the Ang II-induced AAA alone (61·54% vs 31·82%) in mice. Histopathological and immunofluorescent staining results showed significantly more severe inflammatory infiltration and pathological lesions in the Ang II+α-GalCer treatment group. These results are highly suggestive that activated iNKT cells greatly contribute to AAA development and that the control of the activation state in iNKT cells may represent an important therapeutic strategy for AAA.
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Affiliation(s)
- Tianyu Miao
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Tiehao Wang
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Ting Feng
- Laboratory of infection and immunity, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Guo
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Fei Xiong
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Lihua Liu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Zhangyu He
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Bin Huang
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
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14
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Xie X, Wang EC, Xu D, Shu X, Zhao YF, Guo D, Fu W, Wang L. Bioinformatics Analysis Reveals the Potential Diagnostic Biomarkers for Abdominal Aortic Aneurysm. Front Cardiovasc Med 2021; 8:656263. [PMID: 34355024 PMCID: PMC8329524 DOI: 10.3389/fcvm.2021.656263] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/22/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives: Abdominal aortic aneurysms (AAAs) are associated with high mortality rates. The genes and pathways linked with AAA remain poorly understood. This study aimed to identify key differentially expressed genes (DEGs) linked to the progression of AAA using bioinformatics analysis. Methods: Gene expression profiles of the GSE47472 and GSE57691 datasets were acquired from the Gene Expression Omnibus (GEO) database. These datasets were merged and normalized using the “sva” R package, and DEGs were identified using the limma package in R. The functions of these DEGs were assessed using Cytoscape software. We analyzed the DEGs using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Protein–protein interaction networks were assembled using Cytoscape, and crucial genes were identified using the Cytoscape plugin, molecular complex detection. Data from GSE15729 and GSE24342 were also extracted to verify our findings. Results: We found that 120 genes were differentially expressed in AAA. Genes associated with inflammatory responses and nuclear-transcribed mRNA catabolic process were clustered in two gene modules in AAA. The hub genes of the two modules were IL6, RPL21, and RPL7A. The expression levels of IL6 correlated positively with RPL7A and negatively with RPL21. The expression of RPL21 and RPL7A was downregulated, whereas that of IL6 was upregulated in AAA. Conclusions: The expression of RPL21 or RPL7A combined with IL6 has a diagnostic value for AAA. The novel DEGs and pathways identified herein might provide new insights into the underlying molecular mechanisms of AAA.
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Affiliation(s)
- Xinsheng Xie
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - En Ci Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Vascular Surgery Institute of Fudan University, Fudan University, Shanghai, China
| | - Dandan Xu
- Department of Neurology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Xiaolong Shu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Vascular Surgery Institute of Fudan University, Fudan University, Shanghai, China
| | - Yu Fei Zhao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Vascular Surgery Institute of Fudan University, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Vascular Surgery Institute of Fudan University, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.,Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Vascular Surgery Institute of Fudan University, Fudan University, Shanghai, China
| | - Lixin Wang
- Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.,Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Vascular Surgery Institute of Fudan University, Fudan University, Shanghai, China
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15
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Steenberge SP, Clair DG, Eagleton MJ, Caputo FJ, Smolock CJ, Lyden SP. Visceral segment aortic thrombus is associated with proximal aortic degeneration after infrarenal abdominal aortic aneurysm repair. Vascular 2021; 30:607-615. [PMID: 34165017 DOI: 10.1177/17085381211021282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify predictors of aortic aneurysm formation at or above an infrarenal abdominal aortic aneurysm repair. METHODS A total of 881 infrarenal abdominal aortic aneurysm repairs were identified at a single institution from 2004 to 2008; 187 of the repairs were identified that had pre-operative and post-operative computed tomography imaging at least one year or greater to evaluate for aortic degeneration following repair. Aortic diameters at the celiac, superior mesenteric, and renal arteries were measured on all available computed tomographic scans. Aortic thrombus and calcification volumes in the visceral and infrarenal abdominal aortic segments were calculated. Multivariable modeling was used with log transformed variables to determine potential predictors of future aortic aneurysm development after infrarenal abdominal aortic aneurysm repair. RESULTS Of the 187 patients in the cohort, 100 had an open abdominal aortic aneurysm repair while 87 were treated with endovascular repair. Proximal aortic aneurysms developed in 26% (n = 49) of the cohort during an average of 72 ± 34.2 months of follow-up. After multivariable modeling, visceral segment aortic thrombus on pre-operative computed tomography imaging increased the risk of aortic aneurysm development above the infrarenal abdominal aortic aneurysm repair within both the open abdominal aortic aneurysm (hazard ratio 2.04, p = 0.033) and endovascular repair (hazard ratio 3.31, p = 0.004) cohorts. Endovascular repair was independently associated with a higher risk of future aortic aneurysm development after infrarenal abdominal aortic aneurysm repair when compared to open abdominal aortic aneurysm (hazard ratio 2.19, p = 0.025). CONCLUSIONS Visceral aortic thrombus present prior to abdominal aortic aneurysm repair and endovascular repair are both associated with an increased risk of future proximal aortic degeneration after infrarenal abdominal aortic aneurysm repair. These factors may predict patients at higher risk of developing proximal aortic aneurysms that may require complex aortic repairs.
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Affiliation(s)
- Sean P Steenberge
- Department of Vascular Surgery, Miller Family Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel G Clair
- Department of Surgery, Palmetto Health USC, Columbia, SC, USA
| | - Matthew J Eagleton
- Department of Vascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Francis J Caputo
- Department of Vascular Surgery, Miller Family Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher J Smolock
- Department of Vascular Surgery, Miller Family Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Miller Family Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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16
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Huguenard AL, Gupta VP, Braverman AC, Dacey RG. Genetic and heritable considerations in patients or families with both intracranial and extracranial aneurysms. J Neurosurg 2021; 134:1999-2006. [PMID: 33386011 DOI: 10.3171/2020.8.jns203234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna L Huguenard
- 1Department of Neurosurgery, Washington University in St. Louis; and
| | - Vivek P Gupta
- 1Department of Neurosurgery, Washington University in St. Louis; and
| | - Alan C Braverman
- 2Cardiovascular Division, Department of Medicine, Washington University in St. Louis, Missouri
| | - Ralph G Dacey
- 1Department of Neurosurgery, Washington University in St. Louis; and
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17
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Huang T, Liu S, Liu R, Pan B, Wang W. Inhibition of miR-188-5p Suppresses Progression of Experimental Abdominal Aortic Aneurysms. J Cardiovasc Pharmacol 2021; 77:107-114. [PMID: 33105327 DOI: 10.1097/fjc.0000000000000915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/29/2020] [Indexed: 12/27/2022]
Abstract
ABSTRACT Abdominal aortic aneurysm (AAA) is an aging-related degenerative disease. miR-188-5p was reported to induce cell senescence and play a key role in aging-related disease. Therefore, in this study, we investigated miR-188-5p expression during progression in experimental AAAs. Furthermore, we investigated whether inhibition of miR-188-5p could suppress AAA progression. Experimental AAAs were created in 9-12-week-old male C57BL/6J mice by transient intra-aortic infusion of porcine pancreatic elastase. Expression of miR-188-5p levels were assessed in aneurysmal and control aortae during the progression of aneurysm. For inhibition experiment, miR-188 inhibiting group mice were injected with AAV2-miR188-5p sponge through tail vein and control group mice were injected with AAV2-CMV-GFP. Influences on experimental AAA progression were assessed by measurements of aortic diameter and histopathologic analysis at sacrifice. Meanwhile, immunohistochemistry and fluorescence in situ hybridization were used to determine the inflammatory cells infiltration and colocalization of miR-188-5p in aortic sections. Expression of miR-188-5p is upregulated during progression of AAA. Importantly, miR-188-5p inhibition treatment prevented enlargement of experimental aneurysms. Meanwhile, miR-188-5p inhibition regimens attenuated medial elastin degradation, smooth muscle cell depletion, and mural angiogenesis and the accumulation of macrophages, T cells, and angiogenesis. Furthermore, colocalization of miR188-5p with CD68 and CD3 was observed, which suggest miR-188-5p was expressed mainly in infiltrated macrophages and T cells. Expression of miR-188-5p is increased in experimental AAAs. Treatment with miR-188-5p inhibition limits experimental AAA progression, with histologic evidence of reduced neovessels and attenuated mural leukocyte infiltration. These findings underscore the potential significance of miR-188-5p in aneurysm pathogenesis and as a target for suppression of AAA disease.
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MESH Headings
- Animals
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Aorta, Abdominal/metabolism
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/prevention & control
- CD3 Complex/metabolism
- Chemotaxis, Leukocyte
- Disease Models, Animal
- Disease Progression
- Down-Regulation
- Genetic Therapy
- Macrophages
- Male
- Mice, Inbred C57BL
- MicroRNAs/genetics
- MicroRNAs/metabolism
- T-Lymphocytes/metabolism
- Mice
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Affiliation(s)
- Tingting Huang
- Departments of Vascular Surgery; and
- Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuai Liu
- Departments of Vascular Surgery; and
| | - Rui Liu
- Departments of Vascular Surgery; and
| | | | - Wei Wang
- Departments of Vascular Surgery; and
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18
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Up-regulated MCPIP1 in abdominal aortic aneurysm is associated with vascular smooth muscle cell apoptosis and MMPs production. Biosci Rep 2020; 39:220754. [PMID: 31651935 PMCID: PMC6851509 DOI: 10.1042/bsr20191252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/24/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is often clinically silent before rupture characterized by extensive vascular inflammation and degenerative elasticity of aortic wall. Monocyte chemotactic protein-induced protein-1 (MCPIP1) exhibits anti-infllammatory and pro-apoptotic effects involved in atherogenesis. However, little is known about the expression and the contribution of MCPIP1 in AAA. In the present study, we collected clinical AAA specimens and constructed AAA mice model through Ang-II infusion, and found apparently increased MCPIP1 expression and severe inflammatory infiltration in AAA aortic membrane as evidenced by elevated levels of monocyte chemotactic protein 1 (MCP-1), interleukin 1 β (IL-1β) and NF-κB, as well as HE staining. The elasticity of aortic tunica media was impaired along with multiple apoptosis of vascular smooth muscle cells (VSMCs) in Ang-II-induced aneurysmal mouse. In vitro Ang-II administration of VSMCs induced MCPIP1 expression, accompanied by up-regulation of matrix metalloproteinase (MMP) 2 (MMP-2) and MMP-9, as well as enhancement of VSMCs proliferation and apoptosis, which may cause damage of intima–media elasticity. Silencing MCPIP1 reversed above effects to further restore the balance of proliferation and apoptosis in VSMCs. Overall, our data indicated that up-regulation of MCPIP1 may become a promising candidate for the diagnosis of AAA, and specific knockdown of MCPIP1 in VSMCs could inhibit VSMCs apoptosis and down-regulate MMPs to maintain vascular wall elasticity. Therefore, knockdown of MCPIP1 may serve as a potential target for gene therapy of AAA.
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19
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Lattanzi S. Abdominal aortic aneurysms: pathophysiology and clinical issues. J Intern Med 2020; 288:376-378. [PMID: 32301175 DOI: 10.1111/joim.13060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/03/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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20
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Kim HO, Yim NY, Kim JK, Kang YJ, Lee BC. Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Comprehensive Review. Korean J Radiol 2020; 20:1247-1265. [PMID: 31339013 PMCID: PMC6658877 DOI: 10.3348/kjr.2018.0927] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/02/2019] [Indexed: 12/19/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) can be defined as an abnormal, progressive dilatation of the abdominal aorta, carrying a substantial risk for fatal aneurysmal rupture. Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation. In contrast to open surgical repair, EVAR only requires a stab incision, shorter procedure time, and early recovery. Although EVAR seems to be an attractive solution with many advantages for AAA repair, there are detailed requirements and many important aspects should be understood before the procedure. In this comprehensive review, fundamental information regarding AAA and EVAR is presented.
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Affiliation(s)
- Hyoung Ook Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Yeol Yim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.
| | - Jae Kyu Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yang Jun Kang
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Ruptured Aortic Aneurysm and Dissection Related Death: an Autopsy Database Analysis. Pathol Oncol Res 2020; 26:2391-2399. [PMID: 32548697 PMCID: PMC7471188 DOI: 10.1007/s12253-020-00835-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 03/22/2020] [Accepted: 05/27/2020] [Indexed: 01/15/2023]
Abstract
Acute aortic catastrophes (AAC), mainly ruptured aneurysms and dissections, lead all other vascular conditions in morbidity and mortality, even if intervention occurs. The aim of our study was to give a descriptive overview of the demographic and pathological characteristics of AAC. Between 1994 and 2013, 80,469 autopsies were performed at Semmelweis University hospitals in Budapest. After collecting the autopsy reports we were able to create the AAC database upon which we conducted our analysis. We found 567 cases of AAC. The cause of death in 120 of them was classified as a non-ruptured aorta with malperfusion or distal embolization. Of the remaining 447 cases, in 305 the cause of death was a ruptured aortic aneurysm (rAA), and in 142 it was a ruptured aortic dissection (rAD). The distribution of rAA cases was 34.4% thoracal, 4.3% thoracoabdominal, and 61.3% abdominal. We found female dominance where the rAA was thoracal. In rAD cases, 84% were Stanford A and 16% Stanford B type. In both groups we found different pathological distributions. In the prehospital group, the number of thoracal ruptures was considerable. 88% of the patients with Stanford A dissection died in the prehospital or perioperative period. The most progressive AACs were ruptures of intrapericardial aneurysms and Stanford A dissections., however survival rate can be elevated by using rapid imaging examination and immediate surgical intervention. We want to highlight that our study contains such gender differences, which are worth to be taken into consideration.
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Aria H, Kalani M, Hodjati H, Doroudchi M. Different cytokine patterns induced by Helicobacter pylori and Lactobacillus acidophilus extracts in PBMCs of patients with abdominal aortic aneurysm. Comp Immunol Microbiol Infect Dis 2020; 70:101449. [PMID: 32126431 DOI: 10.1016/j.cimid.2020.101449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative inflammatory disease with unknown etiology. AAA is characterized by abdominal aortic dilatation more than 3 cm and is often asymptomatic, but the rupture of aneurysm can lead to death. Age, smoking and male sex are major predisposing factors of AAA. This study compares the effect of Helicobacter (H.) pylori and Lactobacillus (L.) acidophilus on the cytokine profile of PBMCs of 5 men with abdominal aortic aneurysm (AAA) and 5 men with normal/insignificant angiography, CT-Scan and ultrasonography results in the single-culture and in the co-culture with HUVECs. IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17 F, IL-21, IL-22, IFN-γ and TNF-α were measured in culture supernatants using a commercial fluorescent-labeled-bead assay. In general, CagA+ H. pylori-extract induced higher production of IFN-γ, IL-13 and IL-21 by PBMCs. Treatment of patients' PBMCs with CagA+H. pylori-extract induced Th2 cytokines while treatment of controls' PBMCs with CagA+H. pylori-extract increased Th1 cytokines. In the co-culture, however, patients' PBMCs produced Th1 cytokines irrespective of extract treatment, while controls' PBMCs produced Th2 cytokines and decreased IL-10. CagA+ H. pylori- as well as L. acidophilus-extract induced higher levels of IL-9 by controls' PBMCs in co-culture with HUVECs than patients (P = 0.05 and P = 0.01). The cytokine pattern of PBMCs induced by CagA+ H. pylori- and L. acidophilus-extracts in the co-culture with HUVECs shows differences in AAA patients and in comparison to controls. Decreased secretion of IL-9, IL-21 and IL-22 by PBMCs of patients treated with CagA+ H. pylori extract in co-culture, as opposed to non-AAA controls may indicate the active role ECs play in AAA. Simultaneous production of IL-10 and Th1 cytokines in patients and pronounced Th2 cytokines in controls in response to both bacteria may point to the inherent differences between patients and controls, which need further investigation.
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Affiliation(s)
- Hamid Aria
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Kalani
- Prof. Alborzi Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Hodjati
- Department of Vascular Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Doroudchi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ren J, Han Y, Ren T, Fang H, Xu X, Lun Y, Jiang H, Xin S, Zhang J. AEBP1 Promotes the Occurrence and Development of Abdominal Aortic Aneurysm by Modulating Inflammation via the NF-κB Pathway. J Atheroscler Thromb 2020; 27:255-270. [PMID: 31462616 PMCID: PMC7113137 DOI: 10.5551/jat.49106] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 06/13/2019] [Indexed: 01/03/2023] Open
Abstract
AIM Inflammation plays a significant role in the pathogenesis of human abdominal aortic aneurysm (AAA). AEBP1 can promote activation of the NF-κB pathway, subsequently affecting the expression of NF-κB target genes, including inflammatory cytokines and matrix metalloproteinases (MMPs). Our objective was to examine the role of AEBP1 in the development of AAA and characterize the underlying mechanism. METHODS ITRAQ, RT-PCR, western blot, immunohistochemistry, and ELISA were used to compare different experimental groups with the controls and to determine the differentially expressed genes. We generated an AAA model using porcine pancreatic elastase in Sprague-Dawley rats and silenced their AEBP1 in vivo by adenoviruses injected intra-adventitially. We also silenced or overexpressed AEBP1 in human vascular smooth muscle cells in vitro in the presence and in the absence of NF-κB inhibitor BAY 11-7082. RESULTS Proteome iTRAQ revealed a high expression of AEBP1 in AAA patients, which was verified by qRT-PCR, western blot, immunohistochemistry, and ELISA. The mean expression level of AEBP1 in AAA patients was higher than that in controls. Along with AEBP1 upregulation, we also verified mis-activation of NF-κB in human AAA samples. The in vivo studies indicated that AEBP1 knockdown suppressed AAA progression. Finally, the in vitro studies illustrated that AEBP1 promotes activation of the NF-κB pathway, subsequently upregulating pro-inflammatory factors and MMPs. CONCLUSIONS Our results indicate a role of AEBP1 in the pathogenesis of AAA and provide a novel insight into how AEBP1 causes the development of AAA by activating the NF-κB pathway.
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Affiliation(s)
- Jiancong Ren
- Department of Vascular & Thyroid Surgery, the First Hospital, China Medical University, Shenyang, China
| | - Yanshuo Han
- Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Tongming Ren
- Department of Anatomy Laboratory, Xinxiang Medical College, Xinxiang, China
| | - Hong Fang
- Department of Pancreatic Surgery, the First Hospital, China Medical University, Shenyang, China
| | - Xiaohan Xu
- Department of Anesthesiology, the First Hospital, China Medical University, Shenyang, China
| | - Yu Lun
- Department of Vascular & Thyroid Surgery, the First Hospital, China Medical University, Shenyang, China
| | - Han Jiang
- Department of Vascular & Thyroid Surgery, the First Hospital, China Medical University, Shenyang, China
| | - Shijie Xin
- Department of Vascular & Thyroid Surgery, the First Hospital, China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular & Thyroid Surgery, the First Hospital, China Medical University, Shenyang, China
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24
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Castro-Ferreira R, Barreira R, Mendes P, Couto P, Peixoto F, Aguiar M, Neto M, Rolim D, Pinto J, Freitas A, Dias PG, Mansilha A, Teixeira JF, Sampaio SM, Leite-Moreira A. First Population-Based Screening of Abdominal Aortic Aneurysm in Portugal. Ann Vasc Surg 2019; 59:48-53. [DOI: 10.1016/j.avsg.2018.12.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/03/2018] [Accepted: 12/15/2018] [Indexed: 01/08/2023]
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Castro-Ferreira R, Lachat M, Schneider PA, Freitas A, Leite-Moreira A, Sampaio SM. Disparities in Contemporary Treatment Rates of Abdominal Aortic Aneurysms Across Western Countries. Eur J Vasc Endovasc Surg 2019; 58:200-205. [PMID: 31201135 DOI: 10.1016/j.ejvs.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/BACKGROUND Several abdominal aortic aneurysm (AAA) screening programs have demonstrated a similar prevalence of this disease in Westerns countries, ranging from 1.2% to 2.8%. However, the annual rate of AAA repair is significantly less even, and its relationship to AAA prevalence is not clear. The objective was to perform a systematic review, describing an international overview in the yearly rate of AAA repairs. METHODS The number of elective and emergency AAA repairs was obtained via thorough review of publications indexed in PubMed and Scopus from 2010 to October 2018. Portuguese data were obtained from the national administrative database of health care. Data from the UK were extracted from the National Vascular Registry's 2015 annual report. Each country's population was assessed from published national censuses, thus allowing estimation of the number of AAAs treated per 100,000 habitants. RESULTS Data from 14 countries were obtained. The yearly number of elective operations per 100,000 habitants was 2.2 in Hungary, 3.8 in Portugal, 5.3 in Spain, 5.9 in Iceland, 6.5 in Finland, 7.0 in New Zealand, 7.8 in the UK, 10.0 in Denmark, 10.2 in Sweden, 13.3 in the USA, 14.8 in Norway, 15.3 in the Netherlands, 15.6 in Italy, and 17.3 in Germany. The yearly rate of ruptured repairs was 0.5 in Hungary, 1.5 in Portugal, 1.8 in Spain, 1.7 in Iceland, 1.7 in Finland, 1.3 in New Zealand, 1.8 in the UK, 3.3 in Denmark (2013), 2.7 in Sweden (2013), 1.7 in the USA, 2.1 in Norway, 3.1 in the Netherlands, 2.3 in Italy, and 2.7 in Germany. CONCLUSION The rate of AAA treatment is highly variable, with a nearly eightfold variance between the countries with the highest and lowest rates of elective repair. Correlation between elective and ruptured repairs was not clear. A deeper understanding of the reasons for the disparities in AAA treatment among Western countries is of the utmost importance.
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Affiliation(s)
- Ricardo Castro-Ferreira
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Mario Lachat
- Aortic and Vascular Centre, Clinic Hirslanden, Zürich, Switzerland
| | | | - Alberto Freitas
- Centro de Investigação e Tecnologia de Informação em Sistemas de Saúde (CINTESIS) e Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sérgio M Sampaio
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de São João, Porto, Portugal; Centro de Investigação e Tecnologia de Informação em Sistemas de Saúde (CINTESIS) e Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Wang LJ, Prabhakar AM, Kwolek CJ. Current status of the treatment of infrarenal abdominal aortic aneurysms. Cardiovasc Diagn Ther 2018; 8:S191-S199. [PMID: 29850431 DOI: 10.21037/cdt.2017.10.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aortic aneurysms are the 13th leading cause of death in the United States. While aneurysms can occur along the entire length of the aorta, the infrarenal location is the most common. Targeted ultrasound screening has been found to be an effective and economical means of preventing aortic aneurysm rupture. The indication for repair includes either symptomatic aneurysms or aneurysms with a diameter greater than 5.4 cm. Treatment options for the repair of infrarenal aortic aneurysms are open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Currently, EVAR is the primary treatment method for the repair of infrarenal aortic aneurysms due to improved short-term morbidity and mortality outcomes. This article is intended to review the current status of the management of infrarenal abdominal aortic aneurysms (AAA).
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Affiliation(s)
- Linda J Wang
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand M Prabhakar
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Kwolek
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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27
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Calderón M, Brito V, Alcaraz A, Rey-Ares L, Augustovski F, García-Martí S, Bardach A, Ciapponi A, López A, Pichón-Riviere A. Reparación Endovascular para Aneurisma de Aorta: Revisión Panorámica Sobre su Evidencia en el Mundo y su Aplicación en Latinoamérica. Value Health Reg Issues 2018; 17:94-101. [PMID: 29754017 DOI: 10.1016/j.vhri.2018.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/07/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Aortic aneurysm (AA) is a pathology with high morbidity and mortality. The management can be expectant, surgical, or through endovascular repair (EVAR). In Latin America the incidence of AA has increased and the analysis of therapeutic options, especially if they are expensive, is fundamental. OBJECTIVE To analyze available evidence on the effectiveness, safety and coverage policies of the EVAR. METHODOLOGY Panoramic review in the main bibliographical bases (MEDLINE, LILACS, EMBASE, Cochrane Library, DARE) and generic internet searchers, main health technology assessment (HTA) agencies and health insurance companies. Systematic reviews (SR), clinical practice guidelines (CPG), HTA and coverage policies, followed by the identification of primary studies published after the SR search date were included. A search of studies published until November 2015 in English and Spanish was carried out. RESULTS 311 references were recovered, from which seven SRs were selected, one clinical study and 15 CPGs, consensus or coverage policies and ETS. CONCLUSIONS For abdominal AA, high quality evidence showed no differences inlong-term survival with the use of EVAR compared to conventional surgery, but lower early mortality was observed (OR = 0.33, 95% CI 0.20 -0.55). EVAR was associated with a greater need for re-intervention. In the case of other types of AA, further evidence is still required to establish the benefit of EVAR. The CPGs, consensus, HTAs and coverage policies identified, mostly consider open surgery as the treatment of choice, reserving the EVAR for patients with high surgical risk for conventional surgery in the presence of favorable anatomy.
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Affiliation(s)
- María Calderón
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.
| | - Viviana Brito
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Andrea Alcaraz
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Lucila Rey-Ares
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Sebastián García-Martí
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Analía López
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Departamento de Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
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28
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Primary results of abdominal aortic aneurysm screening in the at-risk residents in middle China. BMC Cardiovasc Disord 2018; 18:60. [PMID: 29614976 PMCID: PMC5883536 DOI: 10.1186/s12872-018-0793-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 03/20/2018] [Indexed: 12/21/2022] Open
Abstract
Background There is a lack of information on the epidemiological data and risk factors associated with abdominal aortic aneurysm (AAA) in Chinese population. We reported the primary results from screening five-community population in Middle China for AAA. Methods From March 2014 to October 2015, an AAA screening program was performed in three urban and two rural communities. These communities were randomly selected. All at-risk residents (a total of 6925) aged 40 years or older were invited to attend an ultrasound scan for AAA. At-risk population was defined as having a family history of first-degree relative diagnosed with AAA; or smoking and aged 55 years or older; or having a history of CAD, cerebrovascular disease, hypercholesterolemia, obesity (BMI ≧ 26 kg/m2) or hypertension. Results The study investigated 5402 subjects and the mean age of them was 61.2 ± 10.4 years old. It included 2847 women aged 62.5 ± 10.4 years and 2555 men aged 59.7 ± 10.2 years. The mean maximum infrarenal aortic diameter (Max-IAD) was 15.0 ± 2.7 mm (from 4.1 to 51.5 mm). Eighteen people (aged 68.0 ± 10.4 years) with AAAs were detected (prevalence rate was 0.33%), and the prevalence rate in males was higher than in females (0.55% vs 0.14%, respectively, P = 0.009). Additionally, the screened subjects aged 55 to 75 years had a higher prevalence rate of AAA than other age groups (0.51% vs 0.11%, respectively, P = 0.016). Conclusion The mean Max-IAD of the screened population in Middle China was apparently small by comparison with other reports. The result of low prevalence rate of AAA didn’t support routine screening in Chinese population. The at-risk males aged 55 to 75 years should be targeted for further screening.
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Moushi A, Michailidou K, Soteriou M, Cariolou M, Bashiardes E. MicroRNAs as possible biomarkers for screening of aortic aneurysms: a systematic review and validation study. Biomarkers 2018; 23:253-264. [PMID: 29297231 DOI: 10.1080/1354750x.2018.1423704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT There is an urgent need to identify non-invasive biomarkers for the early detection of aortic aneurysms, preceding a fatal event. The potential role for MicroRNAs (miRNAs) as diagnostic markers for aortic aneurysms was investigated through the present systematic review. OBJECTIVE To perform a comprehensive review on published studies examining the association of miRNAs with aortic aneurysms and further validate these results with plasma samples collected from thoracic aortic aneurysm (TAA) patients. METHODS The literature search was performed via numerous databases and articles were only included if they fulfilled the predefined eligibility criteria. The miRNAs reported three times or more with expression consistency were validated using plasma samples from TAA patients collected before and following surgery. RESULTS Twenty-four articles were selected from the literature search and 11 miRNAs were chosen for validation using our samples. The miRNAs which were further validated were found to follow the trend in the regulation pattern as with the majority of the published data. MiRNA hsa-miR-193a-5p was found to be significantly down-regulated in the plasma samples collected before the aneurysmal removal when compared with postsurgical serum samples. CONCLUSIONS Numerous miRNAs have been associated with aortic aneurysms, and specifically hsa-miR-193a-5p and hsa-miR-30b-5p; therefore they warrant further investigation as potential biomarkers. Registration: The protocol of the review was registered in Prospero Databases (ID: CRD42016039953).
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Affiliation(s)
- Areti Moushi
- a Cyprus School of Molecular Medicine , The Cyprus Institute of Neurology and Genetics , Nicosia , Cyprus
| | - Kyriaki Michailidou
- b Department of Electron Microscopy/Molecular Pathology , The Cyprus Institute of Neurology and Genetics , Nicosia, Cyprus
| | | | - Marios Cariolou
- a Cyprus School of Molecular Medicine , The Cyprus Institute of Neurology and Genetics , Nicosia , Cyprus.,d Department of Cardiovascular Genetics and The Laboratory of Forensic Genetics , The Cyprus Institute of Neurology and Genetics , Nicosia , Cyprus
| | - Evy Bashiardes
- a Cyprus School of Molecular Medicine , The Cyprus Institute of Neurology and Genetics , Nicosia , Cyprus.,d Department of Cardiovascular Genetics and The Laboratory of Forensic Genetics , The Cyprus Institute of Neurology and Genetics , Nicosia , Cyprus
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Aria H, Kalani M, Hodjati H, Doroudchi M. Elevated levels of IL-6 and IL-9 in the sera of patients with AAA do not correspond to their production by peripheral blood mononuclear cells. Artery Res 2018. [DOI: 10.1016/j.artres.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cao X, Cai Z, Liu J, Zhao Y, Wang X, Li X, Xia H. miRNA‑504 inhibits p53‑dependent vascular smooth muscle cell apoptosis and may prevent aneurysm formation. Mol Med Rep 2017; 16:2570-2578. [PMID: 28677789 PMCID: PMC5548046 DOI: 10.3892/mmr.2017.6873] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 03/23/2017] [Indexed: 12/11/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a common disease that is associated with the proliferation and apoptosis of vascular smooth muscle cells (VSMCs). VSMCs are regulated by microRNAs (miRNA). The aim of the present study was to identify miRNA sequences that regulate aortic SMCs during AAA. miRNA-504 was identified using a miRNA PCR array and by reverse transcription-quantitative polymerase chain reaction analysis, and its expression levels were observed to be downregulated in the aortic cells derived from patients with AAA when compared with controls. Transfection of SMCs with pMSCV-miRNA-504 vector was performed, and cell proliferation and the expression levels of proliferating cell nuclear antigen (PCNA), replication factor C subunit 4 (RFC4), B-cell lymphoma-2 (Bcl-2) and caspase-3/9 were measured by western blotting. The mechanisms underlying the effects of miRNA-504 was then analyzed. The results demonstrated that overexpression of miRNA-504 significantly upregulated the expression levels of PCNA, RFC4 and Bcl-2, while caspase-3/9 expression was significantly inhibited when compared with non-targeting controls. In addition, miRNA-504 overexpression was observed to promote the proliferation of SMCs. The expression level of the tumor suppressor, p53, which is known to be a direct target of miRNA-504, was inhibited following transfection of SMCs with pMSCV-miRNA-504. In addition, the expression of the downstream targets of p53, p21 and Bcl-like protein-4, were significantly reduced following overexpression of miRNA-504. These results revealed the anti-apoptotic role of miRNA-504 in SMCs derived from patients with AAA via direct targeting of p53.
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Affiliation(s)
- Xue Cao
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Zhenguo Cai
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Junyan Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Yanru Zhao
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Xin Wang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Xueqi Li
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
| | - Hongyuan Xia
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150006, P.R. China
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Stackelberg O, Wolk A, Eliasson K, Hellberg A, Bersztel A, Larsson SC, Orsini N, Wanhainen A, Björck M. Lifestyle and Risk of Screening-Detected Abdominal Aortic Aneurysm in Men. J Am Heart Assoc 2017; 6:JAHA.116.004725. [PMID: 28490522 PMCID: PMC5524061 DOI: 10.1161/jaha.116.004725] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Modifiable lifestyle‐related factors associated with risk of abdominal aortic aneurysm (AAA) are rarely investigated with a prospective design. We aimed to study possible associations among such factors and comorbidities with mean abdominal aortic diameter (AAD) and with risk of AAA among men screened for the disease. Methods and Results Self‐reported lifestyle‐related exposures were assessed at baseline (January 1, 1998) among 14 249 men from the population‐based Cohort of Swedish Men, screened for AAA between 65 and 75 years of age (mean 13 years after baseline). Multivariable prediction of mean AAD was estimated with linear regression, and hazard ratios (HRs) of AAA (AAD ≥30 mm) with Cox proportional hazard regression. The AAA prevalence was 1.2% (n=168). Smoking, body mass index, and cardiovascular disease were associated with a larger mean AAD, whereas consumption of alcohol and diabetes mellitus were associated with a smaller mean AAD. The HR of AAA was increased among participants who were current smokers with ≥25 pack‐years smoked compared with never smokers (HR 15.59, 95% CI 8.96–27.15), those with a body mass index ≥25 versus <25 (HR 1.89, 95% CI, 1.22–2.93), and those with cardiovascular disease (HR 1.77, 95% CI, 1.13–2.77), and hypercholesterolemia (HR 1.59, 95% CI 1.08–2.34). Walking or bicycling for >40 minutes/day (versus almost never) was associated with lower AAA hazard (HR 0.59, 95% CI 0.36–0.97) compared with almost never walking or bicycling. Conclusions This prospective study confirms that modifiable lifestyle‐related factors are associated with AAD and with AAA disease.
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Affiliation(s)
- Otto Stackelberg
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden .,Department of Surgery, Södersjukhuset, Stockholm, Sweden.,Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ken Eliasson
- Section of Vascular Surgery, Department of Cardiovascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Anders Hellberg
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Section of Vascular Surgery, Centre for Clinical Research, Västmanlands County Hospital, Västerås, Sweden
| | - Adam Bersztel
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Section of Vascular Surgery, Centre for Clinical Research, Västmanlands County Hospital, Västerås, Sweden
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Björck
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Hagerty T, Geraghty P, Braverman AC. Abdominal Aortic Aneurysm in Marfan Syndrome. Ann Vasc Surg 2017; 40:294.e1-294.e6. [DOI: 10.1016/j.avsg.2016.07.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 12/22/2022]
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Gao P, Si J, Yang B, Yu J. Upregulation of MicroRNA-15a Contributes to Pathogenesis of Abdominal Aortic Aneurysm (AAA) by Modulating the Expression of Cyclin-Dependent Kinase Inhibitor 2B (CDKN2B). Med Sci Monit 2017; 23:881-888. [PMID: 28214350 PMCID: PMC5328202 DOI: 10.12659/msm.898233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The objective of the present study was to identify the association between miR-15a-5p and CDKN2B, and their roles in regulating the development of abdominal aortic aneurysm (AAA). Material/Methods We searched the miRNA database online (www.mirdb.org) and used a luciferase reporter assay system to study the regulatory relationship between miR-15a-5p and CDKN2B. We also conducted real-time PCR and Western blot analysis to study the mRNA and protein expression level of CDKN2B among different patient groups (participants with abdominal aortic aneurysm (AAA) and normal controls) or cells treated with scramble control, miR-15a-5p mimics, CDKN2B siRNA, and miR-15a-5p inhibitors. Results We found that CDKN2B was a virtual target of miR-15a-5p with potential binding sites in the 3′UTR of CDKN2B (77–83 bp). We also showed that miR-15a-5p could bind to the CDKN2B 3′UTR, resulting in a significant decrease in luciferase activity compared with the scramble control. Furthermore, we found that the cells isolated from AAA participants showed an over-expression of miR-15a-5p compared to the normal controls, while the CDKN2B mRNA and protein expression level of the AAA group were much lower than the normal control group. Additionally, the expression of CDKN2B mRNA and the protein of the cells transfected with miR-15a-5p mimics and CDKN2B siRNA was downregulated, while the cells showed upregulated expression subsequent to transfection with miR-15a-5p inhibitors compared to the scramble control. Conclusions The data revealed a negative regulatory role of miR-15a-5p in the apoptosis of smooth muscle cells via targeting CDKN2B, and showed that miR-15a-5p could be a novel therapeutic target of AAA.
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Affiliation(s)
- Peng Gao
- Department of Cardiac Surgery, No. 1 People's Hospital of Jining, Jining, Shandong, China (mainland)
| | - Jiyuan Si
- Department of Cardiac Surgery, No. 1 People's Hospital of Jining, Jining, Shandong, China (mainland)
| | - Bin Yang
- Department of Cardiac Surgery, No. 1 People's Hospital of Jining, Jining, Shandong, China (mainland)
| | - Jixiang Yu
- Department of Cardiac Surgery, No. 1 People's Hospital of Jining, Jining, Shandong, China (mainland)
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Teivelis MP, Malheiro DT, Hampe M, Dalio MB, Wolosker N. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil. Ann Vasc Surg 2016; 36:44-54. [DOI: 10.1016/j.avsg.2016.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/25/2022]
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The potential role of DNA methylation in the pathogenesis of abdominal aortic aneurysm. Atherosclerosis 2015; 241:121-9. [DOI: 10.1016/j.atherosclerosis.2015.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/20/2015] [Accepted: 05/03/2015] [Indexed: 12/18/2022]
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Gutierrez PS, Leite TNP, Mangione FM. Male gender and smoking are related to single, but not to multiple, human aortic aneurysms. Cardiovasc Pathol 2015; 24:290-3. [PMID: 26071928 DOI: 10.1016/j.carpath.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED There is scanty information concerning multiple aortic aneurysms. Thus, we verified if clinical or pathological characteristics are different in patients with multiple (two or more) aortic aneurysms in comparison with those with only one. MATERIAL AND METHODS We selected at the necropsy files of the Heart Institute, São Paulo University School of Medicine, the last 100 cases with aortic aneurysms, comparing between the two groups: sex, age, presence of systemic arterial hypertension, diabetes, dyslipedemia, history of smoking habit, cause of the aneurysm, cause of death, and if the diagnosis was reached during life. Age was analysed by Mann-Whitney test, and the other variables by chi-square or Fisher's exact test. RESULTS Multiple aneurysms corresponded to 14% of cases. The proportion of women among patients with multiple aneurysms was higher than among those with single aneurysm (64.3% versus 20.9%, P<.01), even if only cases with atherosclerosis were taken into consideration (women among multiple-6/10, 60.0%; among single-14/70, 20.0%; P=.01). Smoking was less reported in cases with multiple (4/14, 28.6%) than with single aneurysm (53/86, 61.6%; P=.04); considering cases with atherosclerosis, such difference decreases (40.0% of multiple versus 68.6% of single, P=.09). CONCLUSION although atherosclerosis is present in most cases of both single and multiple aortic aneurysms, male gender and smoking, considered highly influential in such lesions, are less frequent in patients with multiple than in patients with single aneurysms. Thus mechanisms underlying multiple aortic aneurysms are probably different from those related to single, more common aneurysms.
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Affiliation(s)
- Paulo S Gutierrez
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Thiago N P Leite
- Clinical Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda M Mangione
- Clinical Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Dai X, Shen J, Annam NP, Jiang H, Levi E, Schworer CM, Tromp G, Arora A, Higgins M, Wang XF, Yang M, Li HJ, Zhang K, Kuivaniemi H, Li L. SMAD3 deficiency promotes vessel wall remodeling, collagen fiber reorganization and leukocyte infiltration in an inflammatory abdominal aortic aneurysm mouse model. Sci Rep 2015; 5:10180. [PMID: 25985281 PMCID: PMC4434993 DOI: 10.1038/srep10180] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 04/01/2015] [Indexed: 01/30/2023] Open
Abstract
TGF-β signaling plays critical roles in the pathogenesis of aneurysms; however, it is still unclear whether its role is protective or destructive. In this study, we investigate the role of SMAD3 in the pathogenesis of calcium chloride (CaCl2)-induced abdominal aortic aneurysms (AAA) in Smad3−/−, Smad3+/− and Smad3+/+ mice. We find that loss of SMAD3 drastically increases wall thickening of the abdominal aorta. Histological analyses show significant vessel wall remodeling with elastic fiber fragmentation. Remarkably, under polarized light, collagen fibers in the hyperplastic adventitia of Smad3−/− mice show extensive reorganization accompanied by loosely packed thin and radial collagen fibers. The expressions of matrix metalloproteinases including MMP2, MMP9, and MMP12 and infiltration of macrophage/T cells are drastically enhanced in the vascular wall of Smad3−/− mice. We also observe marked increase of NF-κB and ERK1/2 signaling as well as the expression of nuclear Smad2, Smad4 and TGF-β1 in the vessel wall of Smad3−/− mice. In addition, we find that SMAD3 expression is reduced in the dedifferentiated medial smooth muscle-like cells of human AAA patients. These findings provide direct in vivo evidence to support the essential roles of SMAD3 in protecting vessel wall integrity and suppressing inflammation in the pathogenesis of AAAs.
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Affiliation(s)
- Xiaohua Dai
- 1] Department of Internal Medicine [2] Center for Molecular Medicine and Genetics
| | - Jianbin Shen
- 1] Department of Internal Medicine [2] Center for Molecular Medicine and Genetics [3] Cardiovascular Research Institute
| | | | | | - Edi Levi
- Department of Pathology, Veterans Affairs Medical Center, Detroit, MI 48201
| | - Charles M Schworer
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA 17822
| | - Gerard Tromp
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA 17822
| | | | | | - Xiao-Fan Wang
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710
| | - Maozhou Yang
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI 48202
| | - Hui J Li
- Department of Medicine, University of Massachusetts, Worcester, MA 01655
| | | | - Helena Kuivaniemi
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA 17822
| | - Li Li
- 1] Department of Internal Medicine [2] Center for Molecular Medicine and Genetics [3] Cardiovascular Research Institute
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Strauss E, Waliszewski K, Oszkinis G, Staniszewski R. Polymorphisms of genes involved in the hypoxia signaling pathway and the development of abdominal aortic aneurysms or large-artery atherosclerosis. J Vasc Surg 2015; 61:1105-13.e3. [DOI: 10.1016/j.jvs.2014.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 12/29/2022]
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Strauss E, Oszkinis G, Staniszewski R. SEPP1 gene variants and abdominal aortic aneurysm: gene association in relation to metabolic risk factors and peripheral arterial disease coexistence. Sci Rep 2014; 4:7061. [PMID: 25395084 PMCID: PMC4231327 DOI: 10.1038/srep07061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
An inadequate selenium level is supposed to be a risk factor for cardiovascular diseases. However little is known about variation of the genes encoding selenium-containing proteins that would confirm the causality in these diseases. The aim of this study was to analyze the relationships between two functional variants of selenoprotein P gene (SEPP1 rs3877899G>A, rs7579G>A) and the occurrence of abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD), as well as their metabolic risk factors. In AAA, the rs3877899A allele was associated with higher systolic blood (P < .003) and pulse pressure (P < .003) values (recessive model), and with coexistence of peripheral arterial disease (PAD; carriers: P = .033). The other SEPP1 variants were associated with BMI values and influenced the risk of aortic diseases, depending on body weight. The strongest associations in the case-control analysis was found between the presence of the rs3877899G-rs7579G haplotype and development of AAA in overweight and obese subjects (OR = 1.80, 95%CI = 1.16-2.79, P = .008). The higher BMI values were correlated with lower age of AAA patients and larger size of aneurysm. Our results suggests the potential role of the selenoprotein P in pathogenesis of AAA. Future studies should consider the role of the rs3877899G-rs7579G haplotype as a risk factor for aggressive-growing AAAs.
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Affiliation(s)
- Ewa Strauss
- 1] Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland [2] Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Ryszard Staniszewski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
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Kuivaniemi H, Ryer EJ, Elmore JR, Hinterseher I, Smelser DT, Tromp G. Update on abdominal aortic aneurysm research: from clinical to genetic studies. SCIENTIFICA 2014; 2014:564734. [PMID: 24834361 PMCID: PMC4009235 DOI: 10.1155/2014/564734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/02/2014] [Indexed: 06/03/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta with a diameter of at least 3.0 cm. AAAs are often asymptomatic and are discovered as incidental findings in imaging studies or when the AAA ruptures leading to a medical emergency. AAAs are more common in males than females, in individuals of European ancestry, and in those over 65 years of age. Smoking is the most important environmental risk factor. In addition, a positive family history of AAA increases the person's risk for AAA. Interestingly, diabetes has been shown to be a protective factor for AAA in many large studies. Hallmarks of AAA pathogenesis include inflammation, vascular smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. Autoimmunity may also play a role in AAA development and progression. In this Outlook paper, we summarize our recent studies on AAA including clinical studies related to surgical repair of AAA and genetic risk factor and large-scale gene expression studies. We conclude with a discussion on our research projects using large data sets available through electronic medical records and biobanks.
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Affiliation(s)
- Helena Kuivaniemi
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, USA
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Evan J. Ryer
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
- Department of Vascular and Endovascular Surgery, Geisinger Health System, Danville, PA, USA
| | - James R. Elmore
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
- Department of Vascular and Endovascular Surgery, Geisinger Health System, Danville, PA, USA
| | - Irene Hinterseher
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Diane T. Smelser
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, USA
| | - Gerard Tromp
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, USA
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Sensi L, Tedesco D, Mimmi S, Rucci P, Pisano E, Pedrini L, McDonald KM, Fantini MP. Hospitalization rates and post-operative mortality for abdominal aortic aneurysm in Italy over the period 2000-2011. PLoS One 2013; 8:e83855. [PMID: 24386294 PMCID: PMC3875532 DOI: 10.1371/journal.pone.0083855] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/10/2013] [Indexed: 12/21/2022] Open
Abstract
Background Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000–2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s. Methods This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs). Results Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001). The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001). No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs. Conclusions The incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008.
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Affiliation(s)
- Luigi Sensi
- Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Dario Tedesco
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Stefano Mimmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Emilio Pisano
- Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Luciano Pedrini
- Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Kathryn M. McDonald
- Stanford Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- * E-mail:
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Abstract
PURPOSE OF REVIEW Family history is a risk factor for abdominal aortic aneurysm (AAA), suggesting that genetic factors play an important role in AAA development, growth and rupture. Identification of these factors could improve understanding of the AAA pathogenesis and be useful to identify at risk individuals. RECENT FINDINGS Many approaches are used to examine genetic determinants of AAA, including genome-wide association studies (GWAS) and DNA linkage studies. Two recent GWAS have identified genetic markers associated with an increased risk of AAA located within the genes for DAB2 interacting protein (DAB2IP) and low density lipoprotein receptor-related protein 1 (LRP1). In addition, a marker on 9p21 associated with other vascular diseases is also strongly associated with AAA. The exact means by which these genes currently control AAA risk is not clear; however, in support of these findings, mice with vascular smooth muscle cell deficiency of Lrp1 are prone to aneurysm development. Further current work is concentrated on other molecular mechanisms relevant in AAA pathogenesis, including noncoding RNAs such as microRNAs. SUMMARY Current studies assessing genetic mechanisms for AAA have significant potential to identify novel mechanisms involved in AAA pathogenesis of high relevance to better clinical management of the disease.
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C-reactive protein polymorphism rs3091244 is associated with abdominal aortic aneurysm. J Vasc Surg 2013; 60:1332-1339. [PMID: 24135623 DOI: 10.1016/j.jvs.2013.07.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) formation involves an inflammatory process with a strong genetic background. C-reactive protein (CRP) regulates inflammation and is elevated in patients with AAA. The aim of this study was to investigate the association of the triallelic (C, A, and T alleles) rs3091244 functional CRP single nucleotide polymorphism (SNP) with AAA. METHODS This was a case-control study involving two independent populations: 351 AAA patients (mean aortic diameter, 6.25 ± 1.47 cm) and 391 controls (mean diameter, 2.4 ± 0.2 cm) were recruited from Greece (the main cohort); and 371 patients (mean diameter, 5.4 ± 1.0 cm) and 362 controls (mean diameter, 2.4 ± 0.6 cm) were recruited from the United Kingdom (replication cohort). The frequency of the functional triallelic (C, T, and A alleles) rs3091244 polymorphism was analyzed in univariate and adjusted (for cardiovascular risk factors) analyses, assuming that the rare T and A alleles have similar functional properties (pooled analysis for T and A). Three groups were constructed: group A included those with the rare T and A alleles (genotypes TT, AA, and TA), group B included heterozygotes for the C allele (CT, CA), and group C included C allele homozygotes (CC, reference genotype). Finally, meta-analysis of the two populations was performed together with previously reported results. RESULTS Genotype distributions differed significantly between cases and controls in both cohorts (P < .001 and P = .001). Adjusted analysis (for all aneurysm-related risk-factors) showed an estimated odds ratio of 4.88 (95% confidence interval [CI], 2.96-8.04) for SNP group A and 2.38 (95% CI, 1.69-3.36) for SNP group B (P < .001 in both cases) in the initial cohort and 2.07 (95% CI, 1.33-3.21) for SNP group A and 1.70 (95% CI, 1.21-2.39) for SNP group B (P = .001 and .002) in the replication cohort. The SNP group A patients among the main cohort also had higher CRP levels (median, 26; interquartile range, 17-52 mg/L vs median, 4; interquartile range, 4-12 mg/L; P < .001). Aneurysms >5.5 cm were significantly more frequent among the SNP groups A and B compared with C allele homozygotes both in the main and the replication cohorts (P < .001 and P = .001, respectively). Meta-analysis of the two populations with previously reported results showed a positive association between minor-allele and aneurysm presence with an odds ratio of 1.47 (95% CI, 1.01-2.14; I(2) = 83.1%; P = .04). CONCLUSIONS The rare T and A alleles were significantly related with AAA presence in both populations and correlated with higher CRP levels and AAA diameter.
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Rouer M, Meilhac O, Delbosc S, Louedec L, Pavon-Djavid G, Cross J, Legagneux J, Bouilliant-Linet M, Michel JB, Alsac JM. A new murine model of endovascular aortic aneurysm repair. J Vis Exp 2013:e50740. [PMID: 23851958 DOI: 10.3791/50740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 1990(1) in a rat, then described in mice(2). Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.
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Affiliation(s)
- Martin Rouer
- INSERM U698 Cardiovascular Remodelling, Hôpital X. Bichat, AP-HP, Paris.
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Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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