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Piacentini L, Vavassori C, Werba PJ, Saccu C, Spirito R, Colombo GI. Deciphering Abdominal Aortic Diseases Through T-Cell Clonal Repertoire of Perivascular Adipose Tissue. J Am Heart Assoc 2024; 13:e034096. [PMID: 38888318 PMCID: PMC11255777 DOI: 10.1161/jaha.123.034096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/17/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Recent studies suggest that immune-mediated inflammation of perivascular adipose tissue of abdominal aortic aneurysms (AAAs) contributes to disease development and progression. Whether the perivascular adipose tissue of AAA is characterized by a specific adaptive immune signature remains unknown. METHODS AND RESULTS To investigate this hypothesis, we sequenced the T-cell receptor β-chain in the perivascular adipose tissue of patients with AAA and compared it with patients with aortic occlusive disease, who share the former anatomical site of the lesion and risk factors but differ in pathogenic mechanisms. Our results demonstrate that patients with AAA have a lower repertoire diversity than those with aortic occlusive disease and significant differences in variable/joining gene segment usage. Furthermore, we identified a set of 7 public T-cell receptor β-chain clonotypes that distinguished AAA and aortic occlusive disease with very high accuracy. We also found that the T-cell receptor β-chain repertoire differentially characterizes small and large AAAs (aortic diameter<55 mm and ≥55 mm, respectively). CONCLUSIONS This work supports the hypothesis that T cell-mediated immunity is fundamental in AAA pathogenesis and opens up new clinical perspectives.
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MESH Headings
- Humans
- Aortic Aneurysm, Abdominal/immunology
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Abdominal/pathology
- Male
- Aged
- Female
- T-Lymphocytes/immunology
- Adipose Tissue/pathology
- Adipose Tissue/immunology
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/immunology
- Middle Aged
- Aorta, Abdominal/pathology
- Aorta, Abdominal/immunology
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Affiliation(s)
- Luca Piacentini
- Bioinformatics and Artificial Intelligence Unit, Centro Cardiologico MonzinoIRCCSMilanItaly
- Immunology and Functional Genomics Unit, Centro Cardiologico MonzinoIRCCSMilanItaly
| | - Chiara Vavassori
- Immunology and Functional Genomics Unit, Centro Cardiologico MonzinoIRCCSMilanItaly
| | - Pablo J. Werba
- Atherosclerosis Prevention Unit, Centro Cardiologico MonzinoIRCCSMilanItaly
| | - Claudio Saccu
- Department of Cardiovascular Surgery of the University of Milan, Centro Cardiologico MonzinoIRCCSMilanItaly
| | - Rita Spirito
- Department of Cardiovascular Surgery of the University of Milan, Centro Cardiologico MonzinoIRCCSMilanItaly
| | - Gualtiero I. Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico MonzinoIRCCSMilanItaly
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Teng F, Tang Y, Lu Z, Chen Z, Guo Q. Adenosine 5'-Monophosphate-to-Threonine Ratio Promotes Abdominal Aortic Aneurysms via Up-Regulation of HLA-DR on Natural Killer Cells: A Bidirectional Mendelian Randomized Analysis. Biomedicines 2024; 12:1179. [PMID: 38927386 PMCID: PMC11200785 DOI: 10.3390/biomedicines12061179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: Immune-metabolic interactions may have causal and therapeutic impacts on abdominal aortic aneurysms (AAAs). However, due to the lack of research on the relationship between immune-metabolic interactions and AAAs, further exploration of the mechanism faces challenges. Methods: A two-sample, two-step mediation analysis with Mendelian randomization (MR) based on genome-wide association studies (GWASs) was performed to determine the causal associations among blood immune cell signatures, metabolites, and AAAs. The stability, heterogeneity, and pleiotropy of the results were verified using a multivariate sensitivity analysis. Results: After multiple two-sample MRs using the AAA data from two large-scale GWAS databases, we determined that the human leukocyte antigen-DR (HLA-DR) levels on HLA-DR + natural killer (NK) cells (HLA-DR/NK) were associated with the causal effect of an AAA, with consistent results in the two databases (FinnGen: odds ratio (OR) = 1.054, 95% confidence interval (CI): 1.003-1.067, p-value = 0.036; UK Biobank: OR = 1.149, 95% CI: 1.046-1.261, p-value = 0.004). The metabolites associated with the risk of developing an AAA were enriched to find a specific metabolic model. We also found that the ratio of adenosine 5'-monophosphate (AMP) to threonine could act as a potential mediator between the HLA/NK and an AAA, with a direct effect (beta effect = 0.0496) and an indirect effect (beta effect = 0.0029). The mediation proportion was 5.56%. Conclusions: Our study found that an up-regulation of HLA-DR on HLA-DR/NK cells can increase the risk of an AAA via improvements in the AMP-to-threonine ratio, thus providing a potential new biomarker for the prediction and treatment of AAAs.
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Affiliation(s)
- Fei Teng
- Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Alley, Chengdu 610041, China;
| | - Youyin Tang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Alley, Chengdu 610041, China;
| | - Zhangyu Lu
- West China School of Medicine, Sichuan University, No. 17 South Renming Road, Chengdu 610094, China;
| | - Zheyu Chen
- Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Alley, Chengdu 610041, China;
| | - Qiang Guo
- Division of Vascular Surgery, Department of General Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Alley, Chengdu 610041, China;
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Lu S, White JV, Nwaneshiudu I, Nwaneshiudu A, Monos DS, Solomides CC, Oleszak EL, Platsoucas CD. Human abdominal aortic aneurysm (AAA): Evidence for an autoimmune antigen-driven disease. Clin Exp Rheumatol 2022; 21:103164. [PMID: 35926768 DOI: 10.1016/j.autrev.2022.103164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/02/2022]
Abstract
Abdominal aortic aneurism (AAA) is a complex immunological disease with a strong genetic component, and one of the ten leading causes of death of individuals 55-74 years old worldwide. Strong evidence has been accumulated suggesting that AAA is an autoimmune specific antigen-driven disease. Mononuclear cells infiltrating AAA lesions comprised of T and B lymphocytes and other cells expressing early-, intermediate- and late-activation antigens, and the presence of antigen-presenting cells have been documented, demonstrating an ongoing immune response. The three components of the trimolecular complex, T-cell receptor (TCR)/peptide (antigen)/HLA have been identified in AAA, and specifically: (i) clonal expansions of T-cell clones in AAA lesions; (ii) the association of AAA with particular HLA Class I and Class II; and (iii) self or nonself putative AAA-associated antigens. IgG autoantibodies recognizing proteins present in normal aortic tissue have been reported in patients with AAA. Molecular mimicry, defined as the sharing of antigenic epitopes between microorganisms (bacteria, viruses) and self antigens, maybe is responsible for T-cell responses and antibody production in AAA. Also, the frequency and the suppressor activity of CD4 + CD25 + FOXP3+ Tregs and the expression of FOXP3 transcripts and protein have been reported to be significantly impaired in AAA patients vs normal donors.
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Affiliation(s)
- Song Lu
- Mon Health Medical Center, Department of Pathology, Morgantown, WV, USA
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital & University of Illinois School of Medicine, Park Ridge, IL, USA
| | - Ifeyinwa Nwaneshiudu
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adaobi Nwaneshiudu
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA, USA; Cutis Wellness Dermatology and Dermatopathology PLLC, Laredo, TX, USA
| | - Dimitri S Monos
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Charalambos C Solomides
- Department of Pathology & Laboratory Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Emilia L Oleszak
- Department of Biological Sciences and Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA
| | - Chris D Platsoucas
- Department of Biological Sciences and Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA.
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4
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Dubis J, Niepiekło-Miniewska W, Jędruchniewicz N, Sobczyński M, Witkiewicz W, Zapotoczny N, Kuśnierczyk P. Associations of Genes for Killer Cell Immunoglobulin-like Receptors and Their Human Leukocyte Antigen-A/B/C Ligands with Abdominal Aortic Aneurysm. Cells 2021; 10:cells10123357. [PMID: 34943866 PMCID: PMC8699266 DOI: 10.3390/cells10123357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is an immune-mediated disease with a genetic component. The multifactorial pathophysiology is not clear and there is still no pharmacotherapy to slow the growth of aneurysms. The signal integration of cell-surface KIRs (killer cell immunoglobulin-like receptors) with HLA (ligands, human leukocyte class I antigen molecules) modulates the activity of natural killer immune cells. The genetic diversity of the KIR/HLA system is associated with the risk of immune disorders. This study was a multivariate analysis of the association between genetic variants of KIRs, HLA ligands, clinical data and AAA formation. Genotyping was performed by single polymerase chain reaction with sequence-specific primers using commercial assays. Patients with HLA-A-Bw4 have a larger aneurysm by an average of 4 mm (p = 0.008). We observed a relationship between aneurysm diameter and BMI in patients with AAA and co-existing CAD; its shape was determined by the presence of HLA-A-Bw4. There was also a nearly 10% difference in KIR3DL1 allele frequency between the study and control groups. High expression of the cell surface receptor KIR3DL1 may protect, to some extent, against AAA. The presence of HLA-A-Bw4 may affect the rate of aneurysm growth and represents a potential regional pathogenetic risk of autoimmune injury to the aneurysmal aorta.
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Affiliation(s)
- Joanna Dubis
- Research and Development Centre, Regional Specialist Hospital, 51-124 Wroclaw, Poland;
- Correspondence: (J.D.); (P.K.)
| | - Wanda Niepiekło-Miniewska
- Laboratory of Immunogenetics and Tissue Immunology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland;
| | | | - Maciej Sobczyński
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 02-093 Warsaw, Poland;
| | - Wojciech Witkiewicz
- Department of Vascular Surgery, Regional Specialist Hospital in Wroclaw, 51-124 Wrocław, Poland; (W.W.); (N.Z.)
| | - Norbert Zapotoczny
- Department of Vascular Surgery, Regional Specialist Hospital in Wroclaw, 51-124 Wrocław, Poland; (W.W.); (N.Z.)
| | - Piotr Kuśnierczyk
- Laboratory of Immunogenetics and Tissue Immunology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland;
- Correspondence: (J.D.); (P.K.)
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5
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Anaya-Ayala JE, Escamilla-Tilch M, Granados J, Hernandez-Dono S, Hernandez-Sotelo K, Lozano-Corona R, Ruiz-Gomez D, Garcia-Toca M, Hinojosa CA. Investigation of an Immunogenetic Profile in Patients with Abdominal Aortic Aneurysms and Possible Applications in Screening and Surveillance. Ann Vasc Surg 2019; 62:57-62. [PMID: 31201975 DOI: 10.1016/j.avsg.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/20/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The pathogenesis of atherosclerotic abdominal aortic aneurysms (AAAs) remains not fully understood. Histological analyses confirm chronic adventitial and medial inflammatory cell infiltration, and its pathophysiology involves the upregulation of proteolytic pathways; added to this, genetic factors have been suggested to favor the susceptibility for AAA. The aim of the present study was to analyze the association between genetic polymorphism of the class II human leukocyte antigens (HLAs, HLA-DRB1) with the susceptibility to develop AAA in Mexican patients and to initiate a pilot study of single-nucleotide polymorphisms (SNPs) rs1024611 in the monocyte chemoattractant protein-1 (MCP-1/CCL2) gene to investigate a possible role in the AAA pathogenesis. METHODS In a cohort of patients with AAA, HLA molecular typing was completed for DRB1 loci with LABType SSO-One Lambda kit in 39 patients (69% men with a mean age of 72 years) and compared with 99 without the disease (60% men, mean age 65 years) (control group). Genotyping of rs1024611 in the MCP-1 gene was performed using TaqMan predesigned SNP genotyping assays in 27 patients with AAA (63% men, mean age of 71). Gene frequencies (gfs) and genotype frequencies (Gfs) were determined; categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), and odds ratios (ORs) were calculated using the STATA v14 software and StatCalc software Epi Info™ 7.2.2.2. RESULTS Seventy-eight HLA-DRB1 alleles of patients with AAA and 198 from the control group were studied. We observed that the gf of HLA-DRB1*01 was 0.128 in the AAA group compared with 0.05 in the control group (P = 0.03, OR: 2.6, 95% confidence interval [CI]: 1.04-6.5); the gf of HLA-DRB1*16 was 0.115 in the AAA and 0.025 in control group (P = 0.002, OR: 5, 95% CI: 1.6-16.9). The Gf for SNP rs1024611 were 0.51 in the GA genotype, 0.30 in AA, and 0.19 of GG. Four patients with the proinflammatory homozygous genotype GG (80%) were women and younger than patients with other genotypes, and only one had a history of dyslipidemia. CONCLUSIONS The dissection and interpretation of an immunogenetic profile in patients with AAA is an active and complex field of research that might assist in a more precise identification of those patients at genetic risk. Our study demonstrated increased frequencies of HLA-DRB1*01 and HLA-DRB1*16 alleles in Mexican patients with AAA compared with an ethnically matched control group.
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Affiliation(s)
- Javier E Anaya-Ayala
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico; Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico
| | | | - Julio Granados
- Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico; Division of Immunogenetics, Department of Transplant Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Susana Hernandez-Dono
- Division of Immunogenetics, Department of Transplant Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Kemberly Hernandez-Sotelo
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - Rodrigo Lozano-Corona
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico; Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico
| | - Daniela Ruiz-Gomez
- Division of Immunogenetics, Department of Transplant Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos A Hinojosa
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico; Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico.
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6
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Anaya-Ayala JE, Hernandez-Doño S, Escamilla-Tilch M, Marquez-Garcia J, Hernandez-Sotelo K, Lozano-Corona R, Ruiz-Gomez D, Granados J, Hinojosa CA. Genetic polymorphism of HLA-DRB1 alleles in Mexican mestizo patients with abdominal aortic aneurysms. BMC MEDICAL GENETICS 2019; 20:102. [PMID: 31174489 PMCID: PMC6555914 DOI: 10.1186/s12881-019-0833-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multiple factors are implicated in the etiology and pathogenesis of Abdominal Aortic Aneurysms (AAA). Available literature of genetic studies has previously suggested the possible roles of autoimmunity, genetic predisposition and ethnic susceptibility. Due to the association with autoimmune diseases and proven application in population genetics, we aimed to investigate alleles of the Class II Human Leukocyte Antigens (HLA-DRB1) in the Mexican Mestizo population with aortic aneurysms and determine possible associations with susceptibility. METHODS We performed a case Control Study; the HLA molecular typing was completed for DRB1 loci by LabType Sequence-Specific Oligonucleotide (SSO) SSO-OneLambda kit (Applied Biosystems; Thermo Fisher Scientific. Inc.) in the studied individuals. Allele frequencies (af) were determined, associations were assessed by chi square or fisher exact tests at significance level (< 0.05), and Odds Ratios (OR) were calculated using the STATA software version 14. RESULTS The genetic polymorphism of HLA-DRB1 of fifty one patients (70% males with a mean age of 71 years) with atherosclerotic or also known as degenerative AAA were compared with 99 unrelated patients (60% males, mean age 65 years) without the disease [Control group (CG)] from the same ethnic group. We examined a total of 102 Class II HLA-DRB1 alleles of AAA patients and 198 from CG. When comparing af, we observed the HLA-DRB1*01 af of 0.139 in the AAA compared to 0.05 in the CG [p = 0.015, OR 3, 95% confidence interval (CI) 1.29-7.08], the HLA-DRB1*16 af were 0.109 in the AAA and 0.025 in CG (p = 0.006, OR 4.7, 95% CI 1.59-13.98). CONCLUSIONS Our study confirmed increased frequencies of the alleles HLA-DRB1*01 and HLA-DRB1*16 and their association to the development of AAA in Mexican Mestizo patients. The utility of genetic testing may assist in identifying individuals at genetic risk for the development of this disease in different ethnic groups, who might benefit from earlier ultrasound screening and closer imaging surveillance.
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Affiliation(s)
- Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico
| | - Susana Hernandez-Doño
- Department of Transplant Surgery, Division of Immunogenetics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | | | - Jose Marquez-Garcia
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Biochemistry Unit, Mexico City, Mexico
| | - Kemberly Hernandez-Sotelo
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico
| | - Rodrigo Lozano-Corona
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico
| | - Daniela Ruiz-Gomez
- Department of Transplant Surgery, Division of Immunogenetics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Julio Granados
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico
- Department of Transplant Surgery, Division of Immunogenetics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico.
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico.
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Bradley DT, Badger SA, McFarland M, Hughes AE. Abdominal Aortic Aneurysm Genetic Associations: Mostly False? A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2015; 51:64-75. [PMID: 26460285 DOI: 10.1016/j.ejvs.2015.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/07/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE/BACKGROUND Many associations between abdominal aortic aneurysm (AAA) and genetic polymorphisms have been reported. It is unclear which are genuine and which may be caused by type 1 errors, biases, and flexible study design. The objectives of the study were to identify associations supported by current evidence and to investigate the effect of study design on reporting associations. METHODS Data sources were MEDLINE, Embase, and Web of Science. Reports were dual-reviewed for relevance and inclusion against predefined criteria (studies of genetic polymorphisms and AAA risk). Study characteristics and data were extracted using an agreed tool and reports assessed for quality. Heterogeneity was assessed using I(2) and fixed- and random-effects meta-analyses were conducted for variants that were reported at least twice, if any had reported an association. Strength of evidence was assessed using a standard guideline. RESULTS Searches identified 467 unique articles, of which 97 were included. Of 97 studies, 63 reported at least one association. Of 92 studies that conducted multiple tests, only 27% corrected their analyses. In total, 263 genes were investigated, and associations were reported in polymorphisms in 87 genes. Associations in CDKN2BAS, SORT1, LRP1, IL6R, MMP3, AGTR1, ACE, and APOA1 were supported by meta-analyses. CONCLUSION Uncorrected multiple testing and flexible study design (particularly testing many inheritance models and subgroups, and failure to check for Hardy-Weinberg equilibrium) contributed to apparently false associations being reported. Heterogeneity, possibly due to the case mix, geographical, temporal, and environmental variation between different studies, was evident. Polymorphisms in nine genes had strong or moderate support on the basis of the literature at this time. Suggestions are made for improving AAA genetics study design and conduct.
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Affiliation(s)
- D T Bradley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast BT12 6BA, UK.
| | - S A Badger
- Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
| | - M McFarland
- Department of Pathology, Institute of Pathology Building, Royal Victoria Hospital, Belfast Health and Social Care Trust, Grosvenor Road, Belfast BT12 6BL, UK
| | - A E Hughes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast BT12 6BA, UK
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8
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Radonic T, de Witte P, Groenink M, de Waard V, Lutter R, van Eijk M, Jansen M, Timmermans J, Kempers M, Scholte AJ, Hilhorst-Hofstee Y, van den Berg MP, van Tintelen JP, Pals G, Baars MJH, Mulder BJM, Zwinderman AH. Inflammation aggravates disease severity in Marfan syndrome patients. PLoS One 2012; 7:e32963. [PMID: 22479353 PMCID: PMC3316543 DOI: 10.1371/journal.pone.0032963] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 02/08/2012] [Indexed: 12/22/2022] Open
Abstract
Background Marfan syndrome (MFS) is a pleiotropic genetic disorder with major features in cardiovascular, ocular and skeletal systems, associated with large clinical variability. Numerous studies reveal an involvement of TGF-β signaling. However, the contribution of tissue inflammation is not addressed so far. Methodology/Principal Findings Here we showed that both TGF-β and inflammation are up-regulated in patients with MFS. We analyzed transcriptome-wide gene expression in 55 MFS patients using Affymetrix Human Exon 1.0 ST Array and levels of TGF-β and various cytokines in their plasma. Within our MFS population, increased plasma levels of TGF-β were found especially in MFS patients with aortic root dilatation (124 pg/ml), when compared to MFS patients with normal aorta (10 pg/ml; p = 8×10−6, 95% CI: 70–159 pg/ml). Interestingly, our microarray data show that increased expression of inflammatory genes was associated with major clinical features within the MFS patients group; namely severity of the aortic root dilatation (HLA-DRB1 and HLA-DRB5 genes; r = 0.56 for both; False Discovery Rate(FDR) = 0%), ocular lens dislocation (RAET1L, CCL19 and HLA-DQB2; Fold Change (FC) = 1.8; 1.4; 1.5, FDR = 0%) and specific skeletal features (HLA-DRB1, HLA-DRB5, GZMK; FC = 8.8, 7.1, 1.3; FDR = 0%). Patients with progressive aortic disease had higher levels of Macrophage Colony Stimulating Factor (M-CSF) in blood. When comparing MFS aortic root vessel wall with non-MFS aortic root, increased numbers of CD4+ T-cells were found in the media (p = 0.02) and increased number of CD8+ T-cells (p = 0.003) in the adventitia of the MFS patients. Conclusion/Significance In conclusion, our results imply a modifying role of inflammation in MFS. Inflammation might be a novel therapeutic target in these patients.
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Affiliation(s)
- Teodora Radonic
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the The Netherlands, Utrecht, The Netherlands
| | - Piet de Witte
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the The Netherlands, Utrecht, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the The Netherlands, Utrecht, The Netherlands
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rene Lutter
- Department of Pulmonology and Experimental Immunology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marco van Eijk
- Department of Medical Biochemistry, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marnix Jansen
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Janneke Timmermans
- Department of Cardiology, St. Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marlies Kempers
- Department of Clinical Genetics, St. Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Arthur J. Scholte
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Yvonne Hilhorst-Hofstee
- Department of Clinical and Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - J. Peter van Tintelen
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
- Durrer Cardiogenetic Research Center, Utrecht, The Netherlands
| | - Gerard Pals
- Department of Clinical Genetics and DNA Diagnostics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marieke J. H. Baars
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Barbara J. M. Mulder
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the The Netherlands, Utrecht, The Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
- Durrer Cardiogenetic Research Center, Utrecht, The Netherlands
- * E-mail:
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Abstract
Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since the first candidate gene studies were published 20 years ago, approximately 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. These studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, only when appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called contactin-3, which is located on chromosome 3p12.3. However, two follow-up studies could not replicate this association. Two other SNPs, which are located on chromosome 9p21 and 9q33, were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense ribonucleic acid that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute toward AAA pathogenesis.
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Saratzis A, Abbas AA, Kiskinis D, Melas N, Saratzis N, Kitas GD. Abdominal aortic aneurysm: a review of the genetic basis. Angiology 2010; 62:18-32. [PMID: 20566578 DOI: 10.1177/0003319710373092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a complex disease with a largely unknown pathophysiological background and a strong genetic component. Various studies have tried to link specific genetic variants with AAA. METHODS Systematic review of the literature (1947-2009). RESULTS A total of 249 studies were identified, 89 of which were eventually deemed relevant to this review. Genetic variants (polymorphisms) in a wide variety of genes, most of which encode proteolytic enzymes and inflammatory molecules, have been associated with AAA development and progression. CONCLUSION The genetic basis of AAA remains unknown, and most results from ''candidate-gene'' association studies are contradictory. Further analyses in appropriately powered studies in large, phenotypically well-characterized populations, including genome-wide association studies, are necessary to elucidate the exact genetic contribution to the pathophysiology of AAA.
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Affiliation(s)
- Athanasios Saratzis
- Russell's Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, West Midlands, UK.
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Badger SA, Soong CV, O'Donnell ME, Mercer C, Young IS, Hughes AE. C-reactive protein (CRP) elevation in patients with abdominal aortic aneurysm is independent of the most important CRP genetic polymorphism. J Vasc Surg 2008; 49:178-84. [PMID: 18829218 DOI: 10.1016/j.jvs.2008.07.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 07/17/2008] [Accepted: 07/26/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is a marker of cardiovascular disease. The objective was to determine if abdominal aortic aneurysm (AAA) and CRP serum concentration and its CRP gene are associated. METHODS AND RESULTS AAA patients and AAA negative controls were recruited. CRP concentration was measured and the single nucleotide polymorphism (SNP), rs3091244, assessed. AAA cases were divided into those measuring 30-55 mm and >55 mm in diameter, to assess correlation of CRP with AAA size. A total of 248 (227 male) cases and 400 (388 male) controls were included. CRP concentration was higher in cases (385.0 microl/dL [310.4-442.8] vs 180.3 microl/dL [168.1-196.9]; P < .0001). It was higher in large aneurysms (685.7 microl/dL [511.8-1083.0] vs 291.0 microl/dL [223.6-349.6]; P < .0001), with significant correlation observed to size (r = 0.37, P < .0001). CC was the most common SNP genotype with no difference in distribution (P = .43) between cases and controls. No difference existed in CRP for each genotype in the overall cohort (P = .17), cases (P = .18) and controls (P = .19). CONCLUSION The results demonstrate that CRP production may be related to the presence of AAA, especially in advanced disease. The serum concentration of CRP does not appear to be influenced by the functional SNP of the CRP gene, which also appears to have no association with AAA formation.
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Affiliation(s)
- Stephen A Badger
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom.
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Annambhotla S, Bourgeois S, Wang X, Lin PH, Yao Q, Chen C. Recent advances in molecular mechanisms of abdominal aortic aneurysm formation. World J Surg 2008; 32:976-86. [PMID: 18259804 DOI: 10.1007/s00268-007-9456-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abdominal aortic aneurysm (AAA) is an increasingly common clinical condition with fatal implications. It is associated with advanced age, male gender, cigarette smoking, atherosclerosis, hypertension, and genetic predisposition. Although significant evidence has emerged in the last decade, the molecular mechanisms of AAA formation remain poorly understood. Currently, the treatment for AAA remains primarily surgical with the lone innovation of endovascular therapy. With advances in the human genome, understanding precisely which molecules and genes mediate AAA development and blocking their activity at the molecular level could lead to important new discoveries and therapies. This review summarizes recent updates in molecular mechanisms of AAA formation, including animal models, autoimmune components, infection, key molecules and cytokines, mechanical forces, genetics, and pharmacotherapy. This review will be helpful to those who want to recognize the newest endeavors within the field and identify possible lines of investigation in AAA.
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Affiliation(s)
- Suman Annambhotla
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA
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Kuivaniemi H, Platsoucas CD, Tilson MD. Aortic aneurysms: an immune disease with a strong genetic component. Circulation 2008; 117:242-52. [PMID: 18195185 DOI: 10.1161/circulationaha.107.690982] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Helena Kuivaniemi
- Center for Molecular Medicine and Genetics and Department of Surgery, Wayne State University School of Medicine, 540 E Canfield Ave, Detroit, MI 48201, USA.
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Whole genome expression profiling reveals a significant role for immune function in human abdominal aortic aneurysms. BMC Genomics 2007; 8:237. [PMID: 17634102 PMCID: PMC1934369 DOI: 10.1186/1471-2164-8-237] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 07/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysms are a common disorder with an incompletely understood etiology. We used Illumina and Affymetrix microarray platforms to generate global gene expression profiles for both aneurysmal (AAA) and non-aneurysmal abdominal aorta, and identified genes that were significantly differentially expressed between cases and controls. RESULTS Affymetrix and Illumina arrays included 18,057 genes in common; 11,542 (64%) of these genes were considered to be expressed in either aneurysmal or normal abdominal aorta. There were 3,274 differentially expressed genes with a false discovery rate (FDR) </= 0.05. Many of these genes were not previously known to be involved in AAA, including SOST and RUNX3, which were confirmed using Q-RT-PCR (Pearson correlation coefficient for microarray and Q-RT-PCR data = 0.89; p-values for differences in expression between AAA and controls for SOST: 4.87 x 10-4 and for RUNX3: 4.33 x 10-5). Analysis of biological pathways, including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), indicated extreme overrepresentation of immune related categories. The enriched categories included the GO category Immune Response (GO:0006955; FDR = 2.1 x 10-14), and the KEGG pathways natural killer cell mediated cytotoxicity (hsa04650; FDR = 5.9 x 10-6) and leukocyte transendothelial migration (hsa04670; FDR = 1.1 x 10-5). CONCLUSION Previous studies have provided evidence for the involvement of the immune system in AAA. The current expression analysis extends these findings by demonstrating broad coordinate gene expression in immunological pathways. A large number of genes involved in immune function were differentially expressed in AAA, and the pathway analysis gave these results a biological context. The data provide valuable insight for future studies to dissect the pathogenesis of human AAA. These pathways might also be used as targets for the development of therapeutic agents for AAA.
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