1
|
Chen J, Hu L, Liu Z. Medical treatments for abdominal aortic aneurysm: an overview of clinical trials. Expert Opin Investig Drugs 2024:1-14. [PMID: 38978286 DOI: 10.1080/13543784.2024.2377747] [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: 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.
Collapse
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
| |
Collapse
|
2
|
Atkinson G, Bianco R, Di Gregoli K, Johnson JL. The contribution of matrix metalloproteinases and their inhibitors to the development, progression, and rupture of abdominal aortic aneurysms. Front Cardiovasc Med 2023; 10:1248561. [PMID: 37799778 PMCID: PMC10549934 DOI: 10.3389/fcvm.2023.1248561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) account for up to 8% of deaths in men aged 65 years and over and 2.2% of women. Patients with AAAs often have atherosclerosis, and intimal atherosclerosis is generally present in AAAs. Accordingly, AAAs are considered a form of atherosclerosis and are frequently referred to as atherosclerotic aneurysms. Pathological observations advocate inflammatory cell infiltration alongside adverse extracellular matrix degradation as key contributing factors to the formation of human atherosclerotic AAAs. Therefore, macrophage production of proteolytic enzymes is deemed responsible for the damaging loss of ECM proteins, especially elastin and fibrillar collagens, which characterise AAA progression and rupture. Matrix metalloproteinases (MMPs) and their regulation by tissue inhibitors metalloproteinases (TIMPs) can orchestrate not only ECM remodelling, but also moderate the proliferation, migration, and apoptosis of resident aortic cells, alongside the recruitment and subsequent behaviour of inflammatory cells. Accordingly, MMPs are thought to play a central regulatory role in the development, progression, and eventual rupture of abdominal aortic aneurysms (AAAs). Together, clinical and animal studies have shed light on the complex and often diverse effects MMPs and TIMPs impart during the development of AAAs. This dichotomy is underlined from evidence utilising broad-spectrum MMP inhibition in animal models and clinical trials which have failed to provide consistent protection from AAA progression, although more encouraging results have been observed through deployment of selective inhibitors. This review provides a summary of the supporting evidence connecting the contribution of individual MMPs to AAA development, progression, and eventual rupture. Topics discussed include structural, functional, and cell-specific diversity of MMP members; evidence from animal models of AAA and comparisons with findings in humans; the dual role of MMPs and the requirement to selectively target individual MMPs; and the advances in identifying aberrant MMP activity. As evidenced, our developing understanding of the multifaceted roles individual MMPs perform during the progression and rupture of AAAs, should motivate clinical trials assessing the therapeutic potential of selective MMP inhibitors, which could restrict AAA-related morbidity and mortality worldwide.
Collapse
Affiliation(s)
| | | | | | - Jason L. Johnson
- Laboratory of Cardiovascular Pathology, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
3
|
Bouazizi K, Zarai M, Noufaily A, Prigent M, Dietenbeck T, Bollache E, Nguyen T, Della Valle V, Blondiaux E, Clément K, Aron-Wisnewsky J, Andreelli F, Redheuil A, Kachenoura N. Associations of aortic stiffness and intra-aortic flow parameters with epicardial adipose tissue in patients with type-2 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1106342. [PMID: 37304050 PMCID: PMC10250660 DOI: 10.3389/fcdhc.2023.1106342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
Background It has been shown that increased aortic stiffness is related to type-2 diabetes (T2D) which is considered as a risk factor for cardiovascular disease. Among other risk factors is epicardial adipose tissue (EAT) which is increased in T2D and is a relevant biomarker of metabolic severity and adverse outcome. Purpose To assess aortic flow parameters in T2D patients as compared to healthy individuals and to evaluate their associations with EAT accumulation as an index of cardiometabolic severity in T2D patients. Materials and methods Thirty-six T2D patients as well as 29 healthy controls matched by age and sex were included in this study. Participants had cardiac and aortic MRI exams at 1.5 T. Imaging sequences included cine SSFP for left ventricle (LV) function and EAT assessment and aortic cine and phase-contrast imaging for strain and flow parameters quantification. Results In this study, we found LV phenotype to be characterized by concentric remodeling with decreased stroke volume index despite global LV mass within a normal range. EAT was increased in T2D patients compared to controls (p<0.0001). Moreover, EAT, a biomarker of metabolic severity, was negatively correlated to ascending aortic (AA) distensibility (p=0.048) and positively to the normalized backward flow volume (p=0.001). These relationships remained significant after further adjustment for age, sex and central mean blood pressure. In a multivariate model, presence/absence of T2D and AA normalized backward flow (BF) to forward flow (FF) volumes ratio are both significant and independent correlates of EAT. Conclusion In our study, aortic stiffness as depicted by an increased backward flow volume and decreased distensibility seems to be related to EAT volume in T2D patients. This observation should be confirmed in the future on a larger population while considering additional biomarkers specific to inflammation and using a longitudinal prospective study design.
Collapse
Affiliation(s)
- Khaoula Bouazizi
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Mohamed Zarai
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Abdallah Noufaily
- Unité d’Imagerie Cardiovasculaire et Thoracique (ICT), Pitié-Salpêtrière Hospital, Paris, France
| | - Mikaël Prigent
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Thomas Dietenbeck
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Emilie Bollache
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Toan Nguyen
- Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Valéria Della Valle
- Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Eléonore Blondiaux
- Assistance Publique Hôpitaux de Paris, Radiology Department, Armand-Trousseau Hospital, Paris, France
| | - Karine Clément
- Sorbonne Université, INSERM, Nutrition and Obesities; approches systémiques (NutriOmique), Pitié-Salpêtrière Hospital, Nutrition Department, Paris, France
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Centre de Recherche en Nutrition Humaine (CRNH) Ile-de-France, Pitié-Salpêtrière Hospital, Paris, France
| | - Judith Aron-Wisnewsky
- Sorbonne Université, INSERM, Nutrition and Obesities; approches systémiques (NutriOmique), Pitié-Salpêtrière Hospital, Nutrition Department, Paris, France
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Centre de Recherche en Nutrition Humaine (CRNH) Ile-de-France, Pitié-Salpêtrière Hospital, Paris, France
| | - Fabrizio Andreelli
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Assistance Publique Hôpitaux de Paris, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Alban Redheuil
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Unité d’Imagerie Cardiovasculaire et Thoracique (ICT), Pitié-Salpêtrière Hospital, Paris, France
| | - Nadjia Kachenoura
- Laboratoire d’Imagerie Biomédicale (LIB), Sorbonne Université, Institut National de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Paris, France
- ICAN Imaging, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| |
Collapse
|
4
|
Huanggu H, Yang D, Zheng Y. Blood immunological profile of abdominal aortic aneurysm based on autoimmune injury. Autoimmun Rev 2023; 22:103258. [PMID: 36563768 DOI: 10.1016/j.autrev.2022.103258] [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: 11/12/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Abdominal aortic aneurysm (AAA) occupies a large part of aorta aneurysm, and if there's no timely intervention or treatment, the risks of rupture and death would rise sharply. With the depth of research in AAA, more and more evidence showed correlations between AAA and autoimmune injury. Currently, a variety of bioactive peptides and cells have been confirmed to be related with AAA progression. Despite the tremendous progress, more than half researches were sampling from lesion tissues, which would be difficult to obtain. Given that the intrusiveness and convenience, serological test take advantages in initial diagnosis. Here we review blood biomarkers associated with autoimmune injury work in AAA evolution, aiming to make a profile on blood immune substances of AAA and provide a thought for potential clinical practice.
Collapse
Affiliation(s)
- Haotian Huanggu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China
| | - Dan Yang
- Department of Computational Biology and Bioinformatics, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| |
Collapse
|
5
|
Plasma complement component C2: a potential biomarker for predicting abdominal aortic aneurysm related complications. Sci Rep 2022; 12:21252. [PMID: 36482198 PMCID: PMC9732295 DOI: 10.1038/s41598-022-24698-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Blood-based adjunctive measures that can reliably predict abdominal aortic aneurysm (AAA)-related complications hold promise for mitigating the AAA disease burden. In this pilot study, we sought to evaluate the prognostic performance of complement factors in predicting AAA-related clinical outcomes. We recruited consecutive AAA patients (n = 75) and non-AAA patients (n = 75) presenting to St. Michael's Hospital. Plasma levels of complement proteins were assessed at baseline, as well as prospectively measured regularly over a period of 2 years. The primary outcome was the incidence of rapidly progressing AAA (i.e. aortic expansion), defined as change in AAA diameter by either 0.5 cm in 6 months, or 1 cm in 12 months. Secondary outcomes included incidence of major adverse aortic events (MAAE) and major adverse cardiovascular events (MACE). All study outcomes (AAA diameter, MACE and MAAE) were obtained during follow-up. Multivariable adjusted Cox regression analyses were performed to assess the prognostic value of plasma C2 levels in patients with AAA regarding rapid aortic expansion and MAAE and MACE. Event-free survival rates of both groups were also compared. Compared to non-AAA patients, patients with AAA demonstrated significantly higher plasma concentrations of C1q, C4, Factor B, Factor H and Factor D, and significantly lower plasma concentrations of C2, C3, and C4b (p = 0.001). After a median of 24 months from initial baseline measurements, C2 was determined as the strongest predictor of rapid aortic expansion (HR 0.10, p = 0.040), MAAE (HR 0.09, p = 0.001) and MACE (HR 0.14, p = 0.011). Based on the data from the survival analysis, higher levels of C2 at admission in patients with AAA predicted greater risk for rapid aortic expansion and MAAE (not MACE). Plasma C2 has the potential to be a biomarker for predicting rapid aortic expansion, MAAE, and the eventual need for an aortic intervention in AAA patients.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Knappich C, Spin JM, Eckstein HH, Tsao PS, Maegdefessel L. Involvement of Myeloid Cells and Noncoding RNA in Abdominal Aortic Aneurysm Disease. Antioxid Redox Signal 2020; 33:602-620. [PMID: 31989839 PMCID: PMC7455479 DOI: 10.1089/ars.2020.8035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Significance: Abdominal aortic aneurysm (AAA) is a potentially fatal condition, featuring the possibility of high-mortality rupture. To date, prophylactic surgery by means of open surgical repair or endovascular aortic repair at specific thresholds is considered standard therapy. Both surgical options hold different risk profiles of short- and long-term morbidity and mortality. Targeting early stages of AAA development to decelerate disease progression is desirable. Recent Advances: Understanding the pathomechanisms that initiate formation, maintain growth, and promote rupture of AAA is crucial to developing new medical therapeutic options. Inflammatory cells, in particular macrophages, have been investigated for their contribution to AAA disease for decades, whereas evidence on lymphocytes, mast cells, and neutrophils is sparse. Recently, there has been increasing interest in noncoding RNAs (ncRNAs) and their involvement in disease development, including AAA. Critical Issues: The current evidence on myeloid cells and ncRNAs in AAA largely originates from small animal models, making clinical extrapolation difficult. Although it is feasible to collect surgical human AAA samples, these tissues reflect end-stage disease, preventing examination of critical mechanisms behind early AAA formation. Future Directions: Gaining more insight into how myeloid cells and ncRNAs contribute to AAA disease, particularly in early stages, might suggest nonsurgical AAA treatment options. The utilization of large animal models might be helpful in this context to help bridge translational results to humans.
Collapse
Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joshua M Spin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philip S Tsao
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
8
|
Harris J, VanPatten S, Deen NS, Al-Abed Y, Morand EF. Rediscovering MIF: New Tricks for an Old Cytokine. Trends Immunol 2019; 40:447-462. [DOI: 10.1016/j.it.2019.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
|
9
|
Groeneveld ME, Meekel JP, Rubinstein SM, Merkestein LR, Tangelder GJ, Wisselink W, Truijers M, Yeung KK. Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture. J Am Heart Assoc 2018; 7:JAHA.117.007791. [PMID: 29960996 PMCID: PMC6064909 DOI: 10.1161/jaha.117.007791] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture. METHODS AND RESULTS Potential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty-two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S-elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta-analysis was conducted because of clinical and methodological heterogeneity. CONCLUSIONS We identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.
Collapse
Affiliation(s)
- Menno E Groeneveld
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Jorn P Meekel
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Sidney M Rubinstein
- Department of Health Sciences and Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
| | - Lisanne R Merkestein
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Geert Jan Tangelder
- Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Maarten Truijers
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands .,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| |
Collapse
|
10
|
Decano JL, Mattson PC, Aikawa M. Macrophages in Vascular Inflammation: Origins and Functions. Curr Atheroscler Rep 2016; 18:34. [DOI: 10.1007/s11883-016-0585-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
11
|
Novel biomarkers of abdominal aortic aneurysm disease: identifying gaps and dispelling misperceptions. BIOMED RESEARCH INTERNATIONAL 2014; 2014:925840. [PMID: 24967416 PMCID: PMC4055358 DOI: 10.1155/2014/925840] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/29/2014] [Accepted: 05/04/2014] [Indexed: 11/17/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a prevalent and potentially life-threatening disease. Early detection by screening programs and subsequent surveillance has been shown to be effective at reducing the risk of mortality due to aneurysm rupture. The aim of this review is to summarize the developments in the literature concerning the latest biomarkers (from 2008 to date) and their potential screening and therapeutic values. Our search included human studies in English and found numerous novel biomarkers under research, which were categorized in 6 groups. Most of these studies are either experimental or hampered by their low numbers of patients. We concluded that currently no specific laboratory markers allow screeing for the disease and monitoring its progression or the results of treatment. Further studies and studies in larger patient groups are required in order to validate biomarkers as cost-effective tools in the AAA disease.
Collapse
|
12
|
Sanchez-Niño MD, Sanz AB, Ruiz-Andres O, Poveda J, Izquierdo MC, Selgas R, Egido J, Ortiz A. MIF, CD74 and other partners in kidney disease: tales of a promiscuous couple. Cytokine Growth Factor Rev 2012; 24:23-40. [PMID: 22959722 DOI: 10.1016/j.cytogfr.2012.08.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 08/20/2012] [Indexed: 12/27/2022]
Abstract
Macrophage migration inhibitory factor (MIF) is increased in kidney and urine during kidney disease. MIF binds to and activates CD74 and chemokine receptors CXCR2 and CXCR4. CD74 is a protein trafficking regulator and a cell membrane receptor for MIF, D-dopachrome tautomerase (D-DT/MIF-2) and bacterial proteins. MIF signaling through CD74 requires CD44. CD74, CD44 and CXCR4 are upregulated in renal cells in diseased kidneys and MIF activation of CD74 in kidney cells promotes an inflammatory response. MIF or CXCR2 targeting protects from experimental kidney injury, CD44 deficiency modulates kidney injury and CXCR4 activation promotes glomerular injury. However, the contribution of MIF or MIF-2 to these actions of MIF receptors has not been explored. The safety and efficacy of strategies targeting MIF, CD74, CD44 and CXCR4 are under study in humans.
Collapse
|
13
|
Silaghi H, Branchereau A, Malikov S, Andercou A. Management of small asymptomatic abdominal aortic aneurysms - a review. Int J Angiol 2012; 16:121-7. [PMID: 22477326 DOI: 10.1055/s-0031-1278264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The approach for abdominal aortic aneurysms (AAAs) larger than 55 mm is well defined due to the risk of rupture being higher than 10% per year, and a 30-day perioperative mortality rate between 2.5% and 5%. However, the approach for small asymptomatic AAAs is less well defined.There are different definitions given to describe a small AAA. The one the authors accepted and applied is "a localized, permanent and irreversible dilation of the aorta of at least 50% in relation to the normal adjacent infrarenal or suprarenal aorta, with a maximum diameter between 30-55 mm".The investigators of the largest study on small AAAs (United Kingdom Small Aneurysm Trial [UK-SAT]) concluded, in brief, that ultrasound monitoring is the most appropriate solution because the results do not support a policy of surgical restoration for AAAs with a diameter of between 40 mm and 55 mm.The aim of the present review article is to highlight several challenges that could change the limits or create a more flexible deciding factor in the management of AAAs. There are multiple factors that influence surgical decision-making, and the limit on aneurysm diameter that indicates surgery should depend on the patient's age, life expectancy, general status, associated diseases, diameter in relation to body mass, risk factors, sex, anxiety and compliance during the follow-up period. Monitoring is an acceptable alternative for AAAs between 40 mm and 55 mm, and is probably the best solution for high-risk patients. Surgery is the most reasonable solution for patients who are at moderate risk, have a significant life expectancy, are less than 70 to 75 years of age, and/or have aortic aneurysms larger than 50 mm.
Collapse
Affiliation(s)
- H Silaghi
- Surgical Clinic II, UMPh Cluj-Napoca, Cluj-Napoca, Romania
| | | | | | | |
Collapse
|
14
|
De Haro J, Acin F, Bleda S, Varela C, Medina FJ, Esparza L. Prediction of asymptomatic abdominal aortic aneurysm expansion by means of rate of variation of C-reactive protein plasma levels. J Vasc Surg 2012; 56:45-52. [PMID: 22551908 DOI: 10.1016/j.jvs.2012.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/29/2011] [Accepted: 01/03/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is an independent risk factor for arteriosclerosis, but its role in abdominal aortic aneurysm (AAA) expansion remains not completely verified. There are no data about the prognostic significance of rates of variation of the CRP levels in asymptomatic AAAs. This study investigated the association between plasma CRP levels and AAA diameter and assessed the relationship between the gradient of CRP levels and rates of expansion in asymptomatic AAAs. METHODS Plasma levels of high-sensitive CRP (hs-CRP) were measured using a high-sensitivity technique and AAA size was determined by computed tomography in 435 patients with asymptomatic AAAs followed up in our outpatient department. RESULTS The median hs-CRP level was 4.23 mg/L. The aorta diameter increased in the four groups of patients determined according to hs-CRP quartiles (35 ± 2, 40 ± 3, 49 ± 4, and 58 ± 5 mm; P = .01). The median rate of CRP level variation per year was 1.4 mg/L. Patients with an elevation >1.4 mg/L had an expansion rate of 4.8 mm vs 3.9 mm in those <1.4 mg/L (P < .01). The multivariate age-adjusted logistic model confirmed initial diameter and variation of CRP level were the only factors associated with expansion, with odds ratios (95% confidence intervals) of 6.3 (3.1-7.5) and 3.4 (2.1-5.6). CONCLUSIONS These results confirm a statistical association between AAA diameter and hs-CRP plasma levels. This cohort study corroborates this potential causal association and contributes information about the value of the hs-CRP plasma level gradient as a marker of disease progression and rate of expansion.
Collapse
Affiliation(s)
- Joaquin De Haro
- Angiology and Vascular Surgery Department of Hospital Universitario Getafe, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
15
|
Xie X, Wang Y, Zhang S, Zhang G, Xu Y, Bi H, Daugherty A, Wang JA. Chinese red yeast rice attenuates the development of angiotensin II-induced abdominal aortic aneurysm and atherosclerosis. J Nutr Biochem 2011; 23:549-56. [PMID: 21764282 DOI: 10.1016/j.jnutbio.2011.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 02/11/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is a chronic vascular disease characterized by medial degradation and inflammation. No medical approaches have been validated for treating AAA, and therapeutic options are limited to regular surveillance leading to surgical intervention. This study aimed to investigate whether administration of Chinese red yeast rice (Monascus purpureus; RYR) suppressed angiotensin II (AngII)-induced AAA and atherosclerosis. METHODS AND RESULTS Apolipoprotein E-deficient male mice fed a normal diet were administered either RYR extract (200 mg/kg/day) or vehicle by gavage for 1 week before initiating AngII infusion (1000 ng/kg/min) via subcutaneous osmotic pumps for 28 days. Red yeast rice extract administration significantly suppressed AngII-induced expansion of suprarenal diameter and area (P<.05). Furthermore, RYR extract significantly reduced atherosclerotic lesion areas in both the intima of aortic arches and cross sections of aortic roots (P<.05). These effects were associated with reductions of serum total cholesterol, intercellular adhesion molecule 1, vascular cell adhesion molecule 1, matrix metalloproteinase (MMP) 2 and increases of serum macrophage migration inhibitory factor, but no changes in serum interleukin (IL) 1α, IL-6, monocyte chemoattractant protein 1, MMP-9 and expression of MMP-2 and MMP-9 in aortic walls. CONCLUSIONS This study demonstrated that RYR extract administration suppressed AngII-induced AAA and atherosclerosis associated with regulating inflammation responses independent of lipid-lowering effects. Red yeast rice may have preventive potential for patients with AAA.
Collapse
Affiliation(s)
- Xiaojie Xie
- State Laboratory of Traditional Chinese Medicine in Cardiovascular Pharmacology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, PR China
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Martinez-Pinna R, Ramos-Mozo P, Madrigal-Matute J, Blanco-Colio LM, Lopez JA, Calvo E, Camafeita E, Lindholt JS, Meilhac O, Delbosc S, Michel JB, de Ceniga MV, Egido J, Martin-Ventura JL. Identification of Peroxiredoxin-1 as a Novel Biomarker of Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2011; 31:935-43. [DOI: 10.1161/atvbaha.110.214429] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Roxana Martinez-Pinna
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Priscila Ramos-Mozo
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Julio Madrigal-Matute
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Luis M. Blanco-Colio
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Juan A. Lopez
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Enrique Calvo
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Emilio Camafeita
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Jes S. Lindholt
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Olivier Meilhac
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Sandrine Delbosc
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Jean-Baptiste Michel
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Melina Vega de Ceniga
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Jesus Egido
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| | - Jose L. Martin-Ventura
- From the Vascular Research Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Diaz-Autonoma University, Madrid, Spain (R.M.-P., P.R.-M., J.M.-M., L.M.B.-C., J.E., J.L.M.-V.); Unidad de Proteómica, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (J.A.L., E. Calvo, E. Camafeita); Vascular Research Unit, Viborg Hospital, Viborg, Denmark (J.S.L.); Institut National de la Santé et de la Recherche Médicale U698, Paris, France (O.M., S.D., J.-B.M.); Université Denis
| |
Collapse
|
17
|
Abstract
Abdominal aortic aneurysms (AAA) affect 5% of the population in developed countries and are characterized by progressive aortic dilatation with an unpredictable time course. This condition is more common in men than in women, and in smokers than in nonsmokers. If left untreated, AAA can result in aortic rupture and death. Pathologically, aortic extracellular matrix degradation, inflammation, and neovascularization are hallmarks of AAA. Diagnosis of AAA and subsequent surveillance utilize established aortic imaging methods, such as ultrasound, CT, and MRI. More-speculative diagnostic approaches include molecular and cellular imaging methods that interrogate the underlying pathological processes at work within the aneurysm. In this Review, we explore the current diagnostic and therapeutic strategies for the management of AAA. We also describe the diagnostic potential of new imaging techniques and therapeutic potential of new treatments for the management of small AAA.
Collapse
|
18
|
Biomechanics and Pathobiology of Aortic Aneurysms. STUDIES IN MECHANOBIOLOGY, TISSUE ENGINEERING AND BIOMATERIALS 2011. [DOI: 10.1007/8415_2011_84] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
19
|
Conroy H, Mawhinney L, Donnelly SC. Inflammation and cancer: macrophage migration inhibitory factor (MIF)--the potential missing link. QJM 2010; 103:831-6. [PMID: 20805118 PMCID: PMC2955282 DOI: 10.1093/qjmed/hcq148] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Macrophage migration inhibitory factor (MIF) was the original cytokine, described almost 50 years ago and has since been revealed to be an important player in pro-inflammatory diseases. Recent work using MIF mouse models has revealed new roles for MIF. In this review, we present an increasing body of evidence implicating the key pro-inflammatory cytokine MIF in specific biological activities related directly to cancer growth or contributing towards a microenvironment favouring cancer progression.
Collapse
Affiliation(s)
- H Conroy
- Conway Institute for Biomolecular and Biomedical Research, School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland
| | | | | |
Collapse
|
20
|
Martinez-Pinna R, Lindholt JS, Blanco-Colio LM, Dejouvencel T, Madrigal-Matute J, Ramos-Mozo P, Vega de Ceniga M, Michel JB, Egido J, Meilhac O, Martin-Ventura JL. Increased levels of thioredoxin in patients with abdominal aortic aneurysms (AAAs). A potential link of oxidative stress with AAA evolution. Atherosclerosis 2010; 212:333-8. [PMID: 20609439 DOI: 10.1016/j.atherosclerosis.2010.05.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 05/11/2010] [Accepted: 05/19/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Oxidative stress is a main mechanism involved in vascular pathologies. Increased thioredoxin (TRX) levels have been observed in several oxidative stress-associated cardiovascular diseases. We aim to test the potential role of TRX as a biomarker of oxidative stress in abdominal aortic aneurysm (AAA). METHODS TRX levels were analysed in both AAA intraluminal thrombus (ILT) tissue and in tissue-conditioned media by immunohistochemistry, Western blot and ELISA. Moreover, serum TRX levels were assessed in AAA Caucasian patients by ELISA. RESULTS TRX was mainly localized in the luminal part of ILT in AAA. Compared with the abluminal layer, TRX release was increased in the luminal layer of the ILT of AAA (31+/-9 ng/ml vs. 9+/-3 ng/ml, p<0.05). The interest of this approach is that we can identify proteins potentially released into the blood compartment, which could serve as biomarkers of the pathology. In a training population, serum TRX levels were significantly increased in patients with AAA relative to healthy subjects (50+/-6 ng/ml vs. 26+/-3 ng/ml, p<0.05). These results were validated in a second independent group of patients. Moreover, a positive correlation between TRX and AAA size (rho=0.5, p<0.001) was observed. Finally, in AAA samples with follow-up, TRX was positively associated to aneurismal growth rate (rho=0.25, p=0.027). CONCLUSIONS TRX release is increased in the luminal part of AAA and TRX serum levels are increased in AAA patients compared with healthy subjects. TRX levels correlates with AAA size and expansion, suggesting its potential role as a biomarker of AAA evolution.
Collapse
Affiliation(s)
- R Martinez-Pinna
- IIS-Vascular Research Lab, Fundación Jiménez Diaz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Kovacevic M, Jonjic N, Stalekar H, Zaputovic L, Stifter S, Vitezic D. Apoptotic cell death and rupture of abdominal aortic aneurysm. Med Hypotheses 2009; 74:908-10. [PMID: 19896778 DOI: 10.1016/j.mehy.2009.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 10/11/2009] [Indexed: 11/16/2022]
Abstract
The abdominal aortic aneurysm (AAA) development and expansion is characterized by an extracellular matrix degradation and widespread inflammation. In contrast, the processes that characterize the AAA rupture are not completely understood. The results obtained in animal and clinical studies have shown the importance of inflammation, proteolysis, and antioxidant mechanisms in the aortic degeneration and formation of AAA. We hypothesize that the rupture of the AAA could have a similar pathway like an atherosclerotic plaque rupture, and in both the cases the apoptotic cell death of smooth muscle cells could play a significant role. If the apoptotic cell death significantly contributes to the expansion and rupture of aneurysm, the hypothesis is that aggressive medical antiapoptotic treatment with high doses of appropriate drugs could decrease the apoptotic index of smooth muscle cells, reduce the aneurysm expansion and prevent rupture.
Collapse
Affiliation(s)
- M Kovacevic
- Department of Cardiovascular Surgery, University Hospital Rijeka, School of Medicine, Tome Strizica 3, Rijeka, Croatia.
| | | | | | | | | | | |
Collapse
|
22
|
Sun J, Zhang J, Lindholt JS, Sukhova GK, Liu J, He A, Abrink M, Pejler G, Stevens RL, Thompson RW, Ennis TL, Gurish MF, Libby P, Shi GP. Critical role of mast cell chymase in mouse abdominal aortic aneurysm formation. Circulation 2009; 120:973-82. [PMID: 19720934 DOI: 10.1161/circulationaha.109.849679] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mast cell chymase may participate in the pathogenesis of human abdominal aortic aneurysm (AAA), yet a direct contribution of this serine protease to AAA formation remains unknown. METHODS AND RESULTS Human AAA lesions had high numbers of chymase-immunoreactive mast cells. Serum chymase level correlated with AAA growth rate (P=0.009) in a prospective clinical study. In experimental AAA produced by aortic elastase perfusion in wild-type (WT) mice or those deficient in the chymase ortholog mouse mast cell protease-4 (mMCP-4) or deficient in mMCP-5 (Mcpt4(-/-), Mcpt5(-/-)), Mcpt4(-/-) but not Mcpt5(-/-) had reduced AAA formation 14 days after elastase perfusion. Even 8 weeks after perfusion, aortic expansion in Mcpt4(-/-) mice fell by 50% compared with that of the WT mice (P=0.0003). AAA lesions in Mcpt4(-/-) mice had fewer inflammatory cells and less apoptosis, angiogenesis, and elastin fragmentation than those of WT mice. Although Kit(W-sh/W-sh) mice had protection from AAA formation, reconstitution with mast cells from WT mice, but not those from Mcpt4(-/-) mice, partially restored the AAA phenotype. Mechanistic studies suggested that mMCP-4 regulates expression and activation of cysteine protease cathepsins, elastin degradation, angiogenesis, and vascular cell apoptosis. CONCLUSIONS High chymase-positive mast cell content in human AAA lesions, greatly reduced AAA formation in Mcpt4(-/-) mice, and significant correlation of serum chymase levels with human AAA expansion rate suggests participation of mast cell chymase in the progression of human and mouse AAA.
Collapse
Affiliation(s)
- Jiusong Sun
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Cho BS, Woodrum DT, Roelofs KJ, Stanley JC, Henke PK, Upchurch GR. Differential regulation of aortic growth in male and female rodents is associated with AAA development. J Surg Res 2009; 155:330-8. [PMID: 19111327 PMCID: PMC3205088 DOI: 10.1016/j.jss.2008.07.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/25/2008] [Accepted: 07/24/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective was to examine effects of gonadal hormone manipulation on aortic diameter and macrophage infiltration in rodents during abdominal aortic aneurysm (AAA) formation. METHODS Experiment 1: 17-beta estradiol and testosterone pellets were implanted in male (ME) and female (FT) rats. No pellet was implanted in shams (MES, FTS). Experiment 2: Testes and ovaries were removed from males (MO) and females (FO), respectively. No organs were removed from shams (MOS, FOS). Experiment 3: Male and female rats were orchiectomized and oophorectomized, respectively. Four weeks post-castration, testosterone (MOT) and 17-beta estradiol (FOE) pellets were implanted. Shams underwent castration, but no pellet was implanted (MOTS, FOES). All rats underwent infrarenal aortic infusion with elastase postimplantation/postcastration. Diameters were measured on postoperative d 14. Tissue was stained for macrophages by immunohistochemistry. RESULTS Diameter (P = 0.046) and macrophage counts (P = 0.014) decreased in ME compared with shams, but not in females treated with testosterone (FT). Diameter (P = 0.019) and macrophage infiltration (P = 0.024) decreased in MO compared with shams, but not in FO. Diameter increased in MOT compared with MOTS (P = 0.033), but decreased in FOE compared with FOES (P = 0.002). Macrophages decreased in FOE compared with FOES (P = 0.002). CONCLUSION This study documents a decrease in AAA diameter in males treated with estrogen or undergoing orchiectomy, but no changes in females treated with testosterone or undergoing oophorectomy; and an increase in diameter in MOT and a decrease in FOE. These data suggest that gonadal hormones differentially regulate AAA growth in association with changes in macrophages.
Collapse
Affiliation(s)
- Brenda S. Cho
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| | - Derek T. Woodrum
- Department of Surgery, Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| | - Karen J. Roelofs
- Department of Surgery, Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| | - James C. Stanley
- Department of Surgery, Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| | - Peter K. Henke
- Department of Surgery, Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gilbert R. Upchurch
- Department of Surgery, Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
24
|
Hellenthal FAMVI, Buurman WA, Wodzig WKWH, Schurink GWH. Biomarkers of abdominal aortic aneurysm progression. Part 2: inflammation. Nat Rev Cardiol 2009; 6:543-52. [PMID: 19546866 DOI: 10.1038/nrcardio.2009.102] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
25
|
Nordon I, Brar R, Hinchliffe R, Cockerill G, Loftus I, Thompson M. The role of proteomic research in vascular disease. J Vasc Surg 2009; 49:1602-12. [DOI: 10.1016/j.jvs.2009.02.242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 02/20/2009] [Accepted: 02/28/2009] [Indexed: 12/23/2022]
|
26
|
Jian Z, Li JB, Ma RY, Chen L, Zhong QJ, Wang XF, Wang W, Hong Y, Xiao YB. Increase of macrophage migration inhibitory factor (MIF) expression in cardiomyocytes during chronic hypoxia. Clin Chim Acta 2009; 405:132-8. [PMID: 19394321 DOI: 10.1016/j.cca.2009.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 04/21/2009] [Accepted: 04/21/2009] [Indexed: 01/12/2023]
Abstract
BACKGROUND Macrophage migration inhibitory factor (MIF) might play an important role in the myocardium during chronic hypoxia because MIF protects the heart during myocardial ischemia by activating 5'-adenosine monophosphate activated protein kinase (AMPK). METHODS We investigated 35 infants with cyanotic or acyanotic cardiac defects and H9c2 embryonic rat cardiomyocytes to examine the effect of chronic hypoxia on the expression of MIF in vivo and in vitro, respectively. RESULTS We found out an increase of endogenous cardiac MIF expression positively correlated with degree of hypoxia. Also, AMPK activation was elevated while MIF expression was increased in cells exposed to long periods of hypoxia in vitro. There was no significant difference in the growth ratio of cells cultivated in long periods of hypoxia and normoxia. CONCLUSIONS The expression of MIF is significantly increased in cardiomyocytes exposed to chronic hypoxia, and the activation of AMPK was increased accordingly.
Collapse
Affiliation(s)
- Zhao Jian
- Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao Street, Chongqing 400037, PR China
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Golledge J, Tsao PS, Dalman RL, Norman PE. Circulating markers of abdominal aortic aneurysm presence and progression. Circulation 2008; 118:2382-92. [PMID: 19047592 DOI: 10.1161/circulationaha.108.802074] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jonathan Golledge
- Vascular Biology Unit, Department of Surgery, School of Medicine, James Cook University, Townsville, Queensland, Australia.
| | | | | | | |
Collapse
|
29
|
Active cytomegalovirus infection in aortic smooth muscle cells from patients with abdominal aortic aneurysm. J Mol Med (Berl) 2008; 87:347-56. [DOI: 10.1007/s00109-008-0413-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 10/09/2008] [Accepted: 10/14/2008] [Indexed: 11/26/2022]
|
30
|
Abstract
The highly conserved and archetypical yet atypical cytokine macrophage migration inhibitory factor (MIF) fulfills pleiotropic immune functions in many acute and chronic inflammatory diseases. Recent evidence has emerged from both expression and functional studies to implicate MIF in various aspects of cardiovascular disease. The present review is aimed at providing a synopsis of the involvement of MIF in the inflammatory pathogenesis of atherosclerosis and its consequences, namely unstable plaque formation, remodeling after arterial injury, aneurysm formation, myocardial infarction, or ischemia-reperfusion injury. In addition, other forms of myocardial dysfunction and inflammation and the role of MIF in angiogenesis are reviewed. The functional data are reconciled with recent progress in the identification of heptahelical (CXC chemokine) receptors for MIF, its prototypic role as their noncanonical ligand, and its signal transduction profile operative in atherogenic and inflammatory recruitment of mononuclear cells and in the oxidative damage and apoptosis of cardiomyocytes. Its unique features and functions clearly distinguish MIF from other cytokines implicated in atherogenesis and make it a prime target for achieving therapeutic regression of atherosclerosis. The potential of targeting or exploiting MIF for therapeutic strategies or as a diagnostic marker in the management of cardiovascular diseases or disorders is scrutinized.
Collapse
Affiliation(s)
- Alma Zernecke
- Institute for Molecular Cardiovascular Research, Molekulare Herz-Kreislaufforschung, RWTH Aachen University, Aachen, Germany
| | | | | |
Collapse
|
31
|
Urbonavicius S, Urbonaviciene G, Honoré B, Henneberg EW, Vorum H, Lindholt JS. Potential circulating biomarkers for abdominal aortic aneurysm expansion and rupture--a systematic review. Eur J Vasc Endovasc Surg 2008; 36:273-80; discussion 281-2. [PMID: 18639476 DOI: 10.1016/j.ejvs.2008.05.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 05/14/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND The maximal diameter of abdominal aortic aneurysms (AAAs) is the dominating indication for repair. However half of the AAAs repaired would never have ruptured if left unrepaired, although small AAAs occasionally rupture. Earlier surgery may be associated with a lower mortality. More precise indicators for surgery are warranted. This systematic review identifies potential systemic biomarkers for AAA rupture or expansion. METHODS MEDLINE/PubMed and EMBASE (from 1985 trough May 2007) were searched with the medical subject heading abdominal aortic aneurysm and keywords "size", "progression" or "growth" or "expansion rate" or "rupture" on the basis of MESH tree and as a text search restricted to English, German, French and Italian. In addition, reference lists were studied and manual searches performed. Observational studies investigating the association of circulating biomarkers with AAA rupture, expansion or size were selected. DATA EXTRACTION Two reviewers (SU and GU) independently extracted the following data: year of publication, study characteristics, duration of follow-up, circulating biomarker, AAA expansion rate or size or rupture. RESULTS 699 papers were identified. After exclusion of thoracic aneurysms and cardiac studies (n=118), surgical or medical treatment studies (n=179), case reports and animal studies (n=87), as well as reviews or letters (n=66), 249 articles were selected. Also excluded were 230 papers that did not report AAA size, expansion rate or rupture. 39 papers were included. Several potential biomarkers were identified. The strongest association with AAA was obtained with serum elastin peptides (SEP) and plasmin-antiplasmin (PAP) complexes. Matrix-degrading metalloproteinase 9 (MMP9) and interferon-gamma (IFN-gamma) could have clinical potential while many putative biomarkers showed poor association. CONCLUSIONS Several circulating agents in peripheral blood may predict AAA size, expansion rate or rupture. Few of them have clinical potential for future use. Confirmative studies and development of multivariate models are needed, together with continuing search for new biomarkers using the discovery based sciences within proteomics and/or genomics.
Collapse
Affiliation(s)
- S Urbonavicius
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark.
| | | | | | | | | | | |
Collapse
|
32
|
Schober A, Bernhagen J, Weber C. Chemokine-like functions of MIF in atherosclerosis. J Mol Med (Berl) 2008; 86:761-70. [PMID: 18385967 DOI: 10.1007/s00109-008-0334-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 02/18/2008] [Accepted: 02/22/2008] [Indexed: 12/22/2022]
Abstract
The cytokine macrophage migration inhibitory factor (MIF) is a unique pro-inflammatory regulator of many acute and chronic inflammatory diseases. In the pathogenesis of atherosclerosis, chronic inflammation of the arterial wall characterized by chemokine-mediated influx of leukocytes plays a central role. The contribution of MIF to atherosclerotic vascular disease has come into focus of many studies in recent years. MIF is highly expressed in macrophages and endothelial cells of different types of atherosclerotic plaques, and functional studies established the contribution of MIF to lesion progression and plaque inflammation. This proatherogenic effect may partly be explained by the finding that MIF regulates inflammatory cell recruitment to lesion areas. Similar to chemokines, MIF induces integrin-dependent arrest and transmigration of monocytes and T cells. These chemokine-like functions are mediated through interaction of MIF with the chemokine receptors CXCR2 and CXCR4 as a non-canonical ligand. In atherogenic monocyte recruitment, MIF-induced monocyte adhesion involves CD74 and CXCR2, which form a signaling receptor complex. In addition to lesion progression, MIF has been implicated in plaque destabilization, since MIF is predominantly expressed in vulnerable plaques and can induce collagen-degrading matrix metalloproteinases. The latter could be a relevant mechanism in atherosclerotic abdominal aneurysm formation, where MIF expression is correlated with aneurysmal expansion. In summary, MIF has been identified as an important regulator of atherosclerotic vascular disease with exceptional chemokine-like functions. Detailed analysis of the interaction of MIF with its receptors could provide valuable information for drug development for the anti-inflammatory treatment of established and unstable atherosclerosis.
Collapse
Affiliation(s)
- Andreas Schober
- Cardiology Unit, Medical Policlinic-City Center Campus, University of Munich, Munich, Germany
| | | | | |
Collapse
|
33
|
Gene expression signature in peripheral blood detects thoracic aortic aneurysm. PLoS One 2007; 2:e1050. [PMID: 17940614 PMCID: PMC2002514 DOI: 10.1371/journal.pone.0001050] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 09/05/2007] [Indexed: 12/16/2022] Open
Abstract
Background Thoracic aortic aneurysm (TAA) is usually asymptomatic and associated with high mortality. Adverse clinical outcome of TAA is preventable by elective surgical repair; however, identifying at-risk individuals is difficult. We hypothesized that gene expression patterns in peripheral blood cells may correlate with TAA disease status. Our goal was to identify a distinct gene expression signature in peripheral blood that may identify individuals at risk for TAA. Methods and Findings Whole genome gene expression profiles from 94 peripheral blood samples (collected from 58 individuals with TAA and 36 controls) were analyzed. Significance Analysis of Microarray (SAM) identified potential signature genes characterizing TAA vs. normal, ascending vs. descending TAA, and sporadic vs. familial TAA. Using a training set containing 36 TAA patients and 25 controls, a 41-gene classification model was constructed for detecting TAA status and an overall accuracy of 78±6% was achieved. Testing this classifier on an independent validation set containing 22 TAA samples and 11 controls yielded an overall classification accuracy of 78%. These 41 classifier genes were further validated by TaqMan® real-time PCR assays. Classification based on the TaqMan® data replicated the microarray results and achieved 80% classification accuracy on the testing set. Conclusions This study identified informative gene expression signatures in peripheral blood cells that can characterize TAA status and subtypes of TAA. Moreover, a 41-gene classifier based on expression signature can identify TAA patients with high accuracy. The transcriptional programs in peripheral blood leading to the identification of these markers also provide insights into the mechanism of development of aortic aneurysms and highlight potential targets for therapeutic intervention. The classifier genes identified in this study, and validated by TaqMan® real-time PCR, define a set of promising potential diagnostic markers, setting the stage for a blood-based gene expression test to facilitate early detection of TAA.
Collapse
|
34
|
Papalambros E, Sigala F, Georgopoulos S, Paraskevas KI, Andreadou I, Menenakos X, Sigalas P, Papalambros AL, Vourliotakis G, Giannopoulos A, Bakoyiannis C, Bastounis E. Malondialdehyde as an indicator of oxidative stress during abdominal aortic aneurysm repair. Angiology 2007; 58:477-82. [PMID: 17875961 DOI: 10.1177/0003319707305246] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ischemia-reperfusion injury significantly contributes to abdominal aortic aneurysm (AAA)- related mortality and morbidity; therefore, we measured oxidative stress during open AAA repair and investigated any potential associations with intraoperative or perioperative events (aortic clamping time, blood loss, and the need to transfer to the intensive care unit). Blood samples were collected at specific time points from 53 patients undergoing open AAA repair: (1) before induction of anesthesia; (2) 15, 30, 60, and 120 minutes after aortic clamping; (3) 15 and 60 minutes after clamp removal; and (4) 24 hours postoperatively. Malondialdehyde (MDA) levels were measured by a spectrophotometric method. Baseline MDA values in patients with AAA were significantly higher than in controls (P < .0001). A positive correlation was found between preoperative MDA levels and the size of AAAs (Pearson correlation = 0.578, P < .001). No difference was observed in MDA levels between ruptured and nonruptured AAAs; however, when all symptomatic patients (ruptured and elective symptomatic AAAs, n = 18) were considered, there was a significant elevation in MDA levels (P < .001). There was also a significant increase in MDA values in patients transferred postoperatively to the intensive care unit (P < .001). Finally, a positive association was found between the duration of aortic clamping with MDA values at 15 and 60 minutes after declamping, but not after 24 hours (Pearson correlation = 0.467, P < .001). MDA levels may predict the postoperative course of elective and ruptured AAAs.
Collapse
Affiliation(s)
- Efstathios Papalambros
- Division of Vascular Surgery, First Department of Surgery, University of Athens, Medical School, Greece.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Lindholt JS. Activators of Plasminogen and the Progression of Small Abdominal Aortic Aneurysms. Ann N Y Acad Sci 2006; 1085:139-50. [PMID: 17182930 DOI: 10.1196/annals.1383.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to examine the role of activating pathways of plasminogen in the natural history of abdominal aortic aneurysms (AAA). To fulfill this objective 70 male patients with small AAA (> 3 cm) were interviewed and examined. Their blood samples were taken at diagnosis. The patients were scanned annually for a minimum period of 1 year and a maximum of 5 years (mean 2.5 years), and referred for surgery if the AAA exceeded 5 cm in diameter. Plasma levels of urokinase-like plasminogen activator (uPA), tissue-type plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage-inhibiting factor (MIF), transforming-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and cotinine (a nicotine metabolite) were measured. The annual expansion rate correlated positively with tPA, IgA-CP, and S-cotinine; rho = 0.37 (P = 0.004), 0.28 (P = 0.01), and 0.24 (P = 0.04), while PAI-1, uPA, TGF-beta1, homocysteine, and MIF did not. S-cotinine and PAI-1 also correlated positively with tPA, rho = 0.24 (P = 0.04), and 0.33 (P = 0.005). IgA-CP did not correlate with tPA. By receiver operating characteristics (ROC) curve analysis, tPA showed to be predictive of cases expanding to above 5 cm within the first 5 years with an optimal sensitivity and specificity of 0.73 and 0.71, respectively (P = 0.015). The aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but not by uPA, which usually dominates matrix degradation. Smoking seems to be an important factor for this pathway, while the pathway of IgA-CP seems different.
Collapse
Affiliation(s)
- Jes S Lindholt
- Department of Vascular Surgery, Viborg Hospital, Denmark.
| |
Collapse
|
36
|
Golledge J, Muller J, Daugherty A, Norman P. Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol 2006; 26:2605-13. [PMID: 16973970 DOI: 10.1161/01.atv.0000245819.32762.cb] [Citation(s) in RCA: 442] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abdominal aortic aneurysm (AAA) affects approximately 5% of elderly men and is responsible for a significant number of deaths in Western Countries. At present surgery by open or endovascular means is the only widely used therapy for this condition. In this review we examine the risk factors, serum, and genetic associations of AAA. Epidemiology studies suggest that smoking cessation and control of cholesterol and blood pressure should reduce the number of patients developing AAA. Natural history studies suggest that smoking cessation should reduce the rate of progression of AAA. Clear level 1 evidence for drug treatments of AAA are presently lacking; however, animal and human in vitro studies suggest that medication targeted at reducing inflammation and proteolysis are most likely to be beneficial, with limited data to support the use of statins, Angiotensin II inhibitors, and macrolides. Work has commenced in understanding which patients, identified by clinical, serum, and genotype, are more at risk of AAA progression and thus should be selected out for aggressive treatment. Well designed large multicenter randomized controlled trials are required to examine the medical treatment of AAA.
Collapse
Affiliation(s)
- Jonathan Golledge
- The Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Queensland 4811, Australia.
| | | | | | | |
Collapse
|
37
|
Bergoeing MP, Thompson RW, Curci JA. Pharmacological targets in the treatment of abdominal aortic aneurysms. Expert Opin Ther Targets 2006; 10:547-59. [PMID: 16848691 DOI: 10.1517/14728222.10.4.547] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The natural history of an abdominal aortic aneurysm (AAA) is of progressive aortic wall degeneration occurring over the course of many years, ultimately, culminating in loss of structural integrity and fatal aortic rupture. Although surgical exclusion of an aneurysm can effectively prevent aortic rupture in large aneurysms, small aneurysms are generally completely asymptomatic and are very unlikely to rupture. Further, AAA can be easily diagnosed with noninvasive testing; thus, small aneurysms present an excellent opportunity for disease-modifying pharmacological intervention. Research over the past two decades has defined many of the mechanisms which result in aortic matrix degeneration in both human tissue and particularly within animal models. This has resulted in the identification of several potential targets for pharmacological intervention. Drugs directed at inhibition of the inflammatory process and matrix degrading enzymes have been successful in multiple animal models, and early evidence now suggests that disease modification with some of these agents may be successful in slowing AAA growth in humans as well. The future of AAA therapy, however, may belong to agents which can induce aneurysm regression and to delivery methods which specifically target affected arterial tissue.
Collapse
Affiliation(s)
- Michel P Bergoeing
- Washington University in Saint Louis, Department of Surgery, Section of Vascular Surgery, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO 63110, USA
| | | | | |
Collapse
|
38
|
Morand EF, Leech M, Bernhagen J. MIF: a new cytokine link between rheumatoid arthritis and atherosclerosis. Nat Rev Drug Discov 2006; 5:399-410. [PMID: 16628200 DOI: 10.1038/nrd2029] [Citation(s) in RCA: 276] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Macrophage migration inhibitory factor (MIF) is well established as a key cytokine in immuno-inflammatory diseases such as rheumatoid arthritis. Inflammation is now also recognized as having a crucial role in atherosclerosis, and recent evidence indicates that MIF could also be important in this disease. Here, we review the role of MIF in rheumatoid arthritis and atherosclerosis, discuss the ways in which MIF and its relationship with glucocorticoids could link these diseases, and consider the potential of MIF as a new therapeutic target for small-molecule and antibody-based anti-cytokine drugs.
Collapse
Affiliation(s)
- Eric F Morand
- Centre for Inflammatory Diseases, Monash Institute for Medical Research, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | | | | |
Collapse
|
39
|
Lindblad B, Börner G, Gottsäter A. Factors Associated with Development of Large Abdominal Aortic Aneurysm in Middle-aged Men. Eur J Vasc Endovasc Surg 2005; 30:346-52. [PMID: 15936229 DOI: 10.1016/j.ejvs.2005.04.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 04/04/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate whether any variables in a health-screened population study were associated with later development of large abdominal aortic aneurysms (AAA). SETTING Malmö, Southern Sweden. MATERIAL AND METHODS Within the Malmö Preventive Study 22,444 men and 10,982 women were investigated between 1974 and 1991. The mean age at the health screening was 43.7 years. RESULTS After a median follow-up of 21 years, 126 men and six women (p<0.001) had large AAA that were symptomatic or evaluated for operation (5 cm diameter or more) or had autopsy-verified ruptured AAA. The male group (mean age 47 years) was, because of difference in age (p<0.001) also compared with an age-matched control group. The male patients with AAA showed increased diastolic blood pressure (p<0.007) at the health screening. Smoking predicted the development of AAA (p<0.0001). No difference in forced vital capacity or BMI was seen. Those who were physically inactive (e.g. not walking or cycling to work) had an increased risk of developing AAA (p<0.001). Among the laboratory markers measured, the erythrocyte sedimentation rate did not differ (7.1+/-5.9 vs. 6.4+/-5.7), but cholesterol (6.3+/-1.12 vs. 5.8+/-1.0) (p<0.0001) and triglycerides (1.9+/-0.12 vs. 1.5+/-0.07) (p<0.001) were significantly elevated in these individuals who subsequently developing AAA. The inflammatory proteins alfa-1-antitrypsin, ceruloplasmin, orosmucoid, fibrinogen, and haptoglobulin were increased (p<0.001). CONCLUSION Male gender, smoking, physical inactivity and cholesterol are significant factors associated with the development of AAA.
Collapse
Affiliation(s)
- B Lindblad
- Department of Vascular Diseases Malmö-Lund, Malmö University Hospital, Lund University, Malmö, Sweden.
| | | | | |
Collapse
|
40
|
Verschuren L, Lindeman JHN, van Bockel JH, Abdul-Hussien H, Kooistra T, Kleemann R. Up-regulation and coexpression of MIF and matrix metalloproteinases in human abdominal aortic aneurysms. Antioxid Redox Signal 2005; 7:1195-202. [PMID: 16115023 DOI: 10.1089/ars.2005.7.1195] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a localized dilatation of the arterial wall as a result of extensive breakdown of its structural proteins by matrix metalloproteinases (MMPs). AAA continuously expand and may eventually rupture, causing high mortality rates. The molecular processes underlying expansion and rupture of AAA are only poorly understood. In this study, evidence was sought for a direct involvement of macrophage migration inhibitory factor (MIF) in the pathogenesis of AAA through up-regulating MMPs, with particular reference to macrophages. To this end, expression and cellular localization of MIF were analyzed in human aortic wall samples of stable AAA and ruptured AAA, and compared with control aorta and atherosclerotic aorta (AS). MIF expression was up-regulated in stable AAA and further intensified in ruptured AAA. The increased aneurysmal MIF expression was paralleled by an enhanced expression of specific MMPs, viz. MMP-1, MMP-9, and MMP-12, and by a decrease of their inhibitors. Immunohistochemical analysis of AAA and AS showed MIF protein in endothelial cells, smooth muscle cells (SMCs), macrophages, and T cells. MMP-1 (in SMCs and macrophages) and MMP-9 (in macrophages) were colocalized with MIF at the cellular level in ruptured AAA. The up-regulation of aneurysmal MIF/MMP expression was associated with an increased content of cytotoxic T cells.
Collapse
Affiliation(s)
- Lars Verschuren
- Gaubius Laboratory, TNO-Prevention and Health, Leiden, The Netherlands
| | | | | | | | | | | |
Collapse
|
41
|
Gleason TG. Heritable Disorders Predisposing to Aortic Dissection. Semin Thorac Cardiovasc Surg 2005; 17:274-81. [PMID: 16253833 DOI: 10.1053/j.semtcvs.2005.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2005] [Indexed: 11/11/2022]
Abstract
Heritable disorders of connective tissue often predispose patients to aortic pathology and in particular aortic dissection. The Marfan syndrome, vascular Ehlers-Danlos syndrome, familial forms of thoracic aortic aneurysms or aortic dissection, and bicuspid aortic valve are all examples of heritable disorders that have associated defects affecting the integrity of the aortic wall, posing a risk of both aneurysmal dilation and dissection. The purpose of this review was to outline the phenotypes of the heritable syndromes that predispose to aortic dissection, present a guideline to their management and surveillance, and to offer insight into some of the surgical pitfalls that occur when repairing ascending aortic dissections in these types of patients.
Collapse
Affiliation(s)
- Thomas G Gleason
- Thoracic Aortic Surgery Program, Division of Cardiothoracic Surgery, Northwestern University School of Medicine, Chicago, IL 60611-3056, USA.
| |
Collapse
|
42
|
Schlittenhardt D, Schmiedt W, Bonaterra GA, Metz J, Kinscherf R. Colocalization of oxidized low-density lipoprotein, caspase-3, cyclooxygenase-2, and macrophage migration inhibitory factor in arteriosclerotic human carotid arteries. Cell Tissue Res 2005; 322:425-35. [PMID: 16133150 DOI: 10.1007/s00441-005-0024-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
Apoptotic and inflammatory processes occur in human arteriosclerotic lesions. We examined the hypothesis whether both processes are possibly associated by studying the colocalization of corresponding markers. In 11 human arteriosclerotic carotid arteries, proapoptotic markers (CPP32 (caspase-3), poly(ADP-ribose) polymerase, apoptosis-inducing factor, c-Jun/AP-1, and p53) and proinflammatory markers (macrophage migration inhibitory factor (MIF) and cyclooxygenase-2) were found in macrophages (MPhi) evaluated by computer-assisted immunohistomorphometry. Double-labeling studies demonstrated a colocalization of, both, proapoptotic and proinflammatory markers in these MPhi. Moreover, these MPhi also contained oxidized low-density lipoproteins (oxLDL). Exposure of cultured human MPhi to oxLDL, C6-ceramide, and tumor necrosis factor-alpha or H2O2 resulted in a significant increase of the apoptosis rate as well as of the MIF protein expression. Our study of MPhi in arteriosclerotic carotid arteries and in vitro experiments provide evidence that markers of apoptosis and inflammation are not only significantly increased but are also coexpressed. We conclude there are reciprocal modulatory interactions between apoptotic and inflammatory pathways in human plaque MPhi, which might importantly modify plaque progression or stability.
Collapse
Affiliation(s)
- Daniel Schlittenhardt
- Department of Anatomy & Cell Biology III and Interdisciplinary Center of Neurosciences, University of Heidelberg, Im Neuenheimer Feld 307, 69120, Heidelberg, Germany
| | | | | | | | | |
Collapse
|
43
|
Tashimo A, Mitamura Y, Nagai S, Nakamura Y, Ohtsuka K, Mizue Y, Nishihira J. Aqueous levels of macrophage migration inhibitory factor and monocyte chemotactic protein-1 in patients with diabetic retinopathy. Diabet Med 2004; 21:1292-7. [PMID: 15569131 DOI: 10.1111/j.1464-5491.2004.01334.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the relationship of aqueous macrophage migration inhibitory factor (MIF) and monocyte chemotactic protein-1 (MCP-1) levels with the clinical stage of diabetic retinopathy. METHODS We assayed MIF and MCP-1 levels in aqueous humour samples obtained from 40 diabetic patients (49 eyes) and 24 non-diabetic patients (31 eyes) using enzyme-linked immunosorbent assay. According to the clinical stage of diabetic retinopathy, the diabetic patients were classified into non-diabetic retinopathy (11 eyes), non-proliferative diabetic retinopathy (14 eyes) and proliferative diabetic retinopathy (24 eyes). RESULTS The aqueous levels of MIF (mean +/- sd) were 6.34 +/- 4.53 ng/ml in proliferative diabetic retinopathy, 3.22 +/- 1.71 ng/ml in non proliferative diabetic retinopathy, 1.25 +/- 0.96 ng/ml in non-diabetic retinopathy and 1.07 +/- 0.94 ng/ml in non-diabetic patients. Significant differences were found among these four groups (P < 0.0001). Aqueous MCP-1 levels were 1668.6 +/- 1442.3 pg/ml in proliferative diabetic retinopathy, 1528.6 +/- 1994.6 pg/ml in non-proliferative diabetic retinopathy, 690.2 +/- 402.1 pg/ml in non-diabetic retinopathy and 622.7 +/- 245.3 pg/ml in non-diabetic patients. Significant differences were also found among these four groups (P < 0.0001). After correcting for total aqueous protein, the ratios of MIF and MCP-1 to total protein remained significantly correlated with the clinical stage of diabetic retinopathy (P < 0.0001, P = 0.0004, respectively). The ratios of MIF to total protein significantly correlated with the ratios of MCP-1 to total protein in diabetic patients (r = 0.680, P < 0.0001). CONCLUSIONS Aqueous MIF levels significantly correlated with aqueous MCP-1 levels and the clinical stage of diabetic retinopathy. The results suggest that MIF has a co-operative role with MCP-1 in the progression of diabetic retinopathy.
Collapse
Affiliation(s)
- A Tashimo
- Department of Ophthalmology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | | | | | | | | | | | | |
Collapse
|
44
|
Creager MA, Jones DW, Easton JD, Halperin JL, Hirsch AT, Matsumoto AH, O'Gara PT, Safian RD, Schwartz GL, Spittell JA. Atherosclerotic Vascular Disease Conference. Circulation 2004; 109:2634-42. [PMID: 15173046 DOI: 10.1161/01.cir.0000128522.98016.19] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
45
|
Sho E, Sho M, Hoshina K, Kimura H, Nakahashi TK, Dalman RL. Hemodynamic forces regulate mural macrophage infiltration in experimental aortic aneurysms. Exp Mol Pathol 2004; 76:108-16. [PMID: 15010288 DOI: 10.1016/j.yexmp.2003.11.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Indexed: 11/23/2022]
Abstract
Blood flow (BF) and wall shear stress (WSS) influence reactive oxygen species production and oxidative stress in abdominal aortic aneurysm (AAA) disease. To gain further insight into the mechanisms of hemodynamic influences on AAA inflammation, we examined aneurysm macrophage density, chemotaxis and survival under varying aortic flow conditions. Rat AAAs were created via porcine pancreatic elastase (PPE) infusion. In selected cohorts, AAA flow was increased via left common femoral arteriovenous fistula (AVF) creation (HF-AAA) or decreased by left common iliac ligation (LF-AAA). WSS was highest in HF-AAA (10.4 +/- 2.3 dyn/cm(2) vs. 2.4 +/- 0.4 and 0.5 +/- 0.2 for NF- and LF-AAA, respectively, P < 0.001) 7 days after PPE infusion, with reduced medial macrophage density and increased apoptosis. Adventitial macrophage density was not significantly influenced by flow. Monocyte chemoattractant protein-1 (MCP-1) and granulocyte-macrophage colony-stimulating factor (GM-CSF) gene expression correlated with observed macrophage densities in the media and adventitia. Luminal flow conditions regulate AAA inflammation in part via influences on medial macrophage density. Hemodynamic forces may modulate AAA inflammation and diameter enlargement via direct regulation of intimal macrophage adhesion, transmural migration or survival.
Collapse
Affiliation(s)
- Eiketsu Sho
- Division of Vascular Surgery, Stanford University, Palo Alto, CA 94304, USA
| | | | | | | | | | | |
Collapse
|
46
|
Chen Z, Sakuma M, Zago AC, Zhang X, Shi C, Leng L, Mizue Y, Bucala R, Simon D. Evidence for a role of macrophage migration inhibitory factor in vascular disease. Arterioscler Thromb Vasc Biol 2004; 24:709-14. [PMID: 14751814 DOI: 10.1161/01.atv.0000119356.35748.9e] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Inflammation plays an essential role in atherosclerosis and restenosis. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that is widely expressed in vascular cells. However, there is no in vivo evidence that MIF participates directly in vascular injury and repair. Therefore, we investigated the effect of MIF blockade on the response to experimental angioplasty in atherosclerosis-susceptible mice. METHODS AND RESULTS Carotid artery dilation (2.5 atm) and complete endothelial denudation were performed in male C57BL/6J LDL receptor-deficient mice treated with a neutralizing anti-MIF or isotype control monoclonal antibody. After 7 days and 28 days, intimal and medial sizes were measured and intima/media area ratio (I/M) was calculated. Intimal thickening and I/M were reduced significantly by anti-MIF compared with control antibody. Vascular injury was accompanied by progressive vessel enlargement or "positive remodeling" that was comparable in both treatment groups. MIF blockade was associated with reduced inflammation and cellular proliferation and increased apoptosis after injury. CONCLUSIONS Neutralizing MIF bioactivity after experimental angioplasty in atherosclerosis-susceptible mice reduces vascular inflammation, cellular proliferation, and neointimal thickening. Although the molecular mechanisms responsible for these effects are not yet established, these data prompt further research directed at understanding the role of MIF in vascular disease and suggest novel therapeutic interventions for preventing atherosclerosis and restenosis.
Collapse
MESH Headings
- Angioplasty, Balloon/adverse effects
- Animals
- Antibodies, Monoclonal/pharmacology
- Apoptosis/physiology
- Arteriosclerosis/genetics
- Carotid Artery Injuries/metabolism
- Carotid Artery Injuries/pathology
- Cell Division/drug effects
- Chemotaxis, Leukocyte/drug effects
- Culture Media, Serum-Free/pharmacology
- Diet, Atherogenic
- Endothelium, Vascular/injuries
- Endothelium, Vascular/physiopathology
- Genetic Predisposition to Disease
- Intramolecular Oxidoreductases
- Macrophage Migration-Inhibitory Factors
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/drug effects
- Proteins/antagonists & inhibitors
- Proteins/immunology
- Proteins/physiology
- Rats
- Receptors, LDL/deficiency
- Receptors, LDL/genetics
- Tunica Intima/pathology
- Tunica Media/pathology
- Vasculitis/physiopathology
- Vasculitis/prevention & control
Collapse
Affiliation(s)
- Zhiping Chen
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA
| | | | | | | | | | | | | | | | | |
Collapse
|