1
|
Virmani R, Sato Y, Sakamoto A, Romero ME, Butany J. Aneurysms of the aorta: ascending, thoracic, and abdominal and their management. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
2
|
Jiang YF, Guo LL, Zhang LW, Chu YX, Zhu GL, Lu Y, Zhang L, Lu QS, Jing ZP. Local upregulation of interleukin-1 beta in aortic dissecting aneurysm: correlation with matrix metalloproteinase-2, 9 expression and biomechanical decrease. Interact Cardiovasc Thorac Surg 2019; 28:344-352. [PMID: 30169834 DOI: 10.1093/icvts/ivy256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to examine whether interleukin-1 beta (IL-1β) originates locally and its possible relationship with matrix metalloproteinases (MMPs), apoptosis, elastin fibres and biomechanics in aortic dissecting aneurysms (DAs). METHODS Aortic DAs were induced in 24 rats with β-aminopropionitrile (BAPN); another 12 rats without BAPN were designated as controls. Then IL-1β levels were measured both in the circulation and in local aortic specimens. The expression of MMP-2 and MMP-9 and Victoria blue and TUNEL staining were also detected. Biomechanical parameters such as the elasticity modulus were used to detect the biomechanical changes in the aortic wall. The correlation of IL-1β, MMP-2, MMP-9, apoptosis and biomechanical properties was analysed. RESULTS Seventeen rats (17/24, 71%) in the BAPN-treated group died of DA rupture. IL-1β levels were dramatically increased in the DA specimens but not in the circulation. Victoria blue staining confirmed the formation of the DA and the reduction of elastin content after induction by BAPN. The extent of apoptosis in the aortic media was dramatically higher in rats with BAPN-induced DA than that in the control group and that in rats treated with BAPN but without DA. MMP-2 and MMP-9 levels were significantly increased in BAPN-treated rats compared to the controls, but no statistical significance was found between rats with and without DA. There were significant differences in biomechanical parameters, such as the elasticity modulus. Among the 3 groups, IL-1β was positively correlated with MMP-2 and MMP-9 levels and with the elasticity modulus but not with apoptosis. CONCLUSIONS Local IL-1β might participate in the formation of aortic DA through the upregulation of MMP-2 and MMP-9 and the breakage of elastin fibres, which finally weakens the biomechanical properties of the aortic wall.
Collapse
Affiliation(s)
- Yun-Fei Jiang
- Department of Vascular Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Ling-Ling Guo
- Department of Biological Therapies for Cancer, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Li-Wei Zhang
- Department of Cardio-Thoracic Surgery, The People's Hospital of China Three Gorges University, Yichang, Hubei, China
| | - Yong-Xin Chu
- Department of Vascular Surgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - Guang-Lang Zhu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ye Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zai-Ping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
3
|
Kauhanen SP, Hedman M, Kariniemi E, Jaakkola P, Vanninen R, Saari P, Liimatainen T. Aortic dilatation associates with flow displacement and increased circumferential wall shear stress in patients without aortic stenosis: A prospective clinical study. J Magn Reson Imaging 2019; 50:136-145. [PMID: 30659686 DOI: 10.1002/jmri.26655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The relationship between blood flow characteristics and ascending aortic (AA) dilatation has not been studied in patients with a tricuspid aortic valve (TAV) without aortic stenosis. PURPOSE To evaluate whether 4D flow characteristics determined in MRI are related to AA dilatation by comparing dilated AA and nondilated AA subjects with TAV. STUDY TYPE Prospective. POPULATION Twenty patients with dilated AA and 20 age-matched patients with nondilated AA. FIELD STRENGTH/SEQUENCE 1.5T/4D flow, 2D flow, and anatomic images. ASSESSMENT Altogether, 16 different 4D flow parameters were assessed in 10 planes in the thoracic aorta. Intra- and interobserver reproducibility were analyzed. STATISTICAL TESTS Independent t-test for normally distributed and the Mann-Whitney test for skewed distributed parameters were used. A paired-samples t-test was used to compare 2D and 4D flow parameters. Intraclass correlation coefficient (ICC) was used in intra- and interobserver reproducibility analysis. RESULTS Aortic flow was displaced from the centerline of the aorta in the proximal and tubular planes. Flow displacement (FD) was greatest in the proximal plane of AA and was higher in dilated AA (4.5%, range 3.0-5.8%) than in nondilated AA (2.0%, 1.0-3.0%, P < 0.001). Total wall shear stress (WSS) values were 1.3 ± 0.4 times higher on the displaced side than on the opposite side of the aorta (P < 0.01). The circumferential WSS (WSSC ) ratio to total WSS was greater in dilated AA, being 0.48 ± 0.11 vs. 0.32 ± 0.09 in the inner curvature of the proximal AA (P < 0.001) and 0.37 ± 0.11 vs. 0.26 ± 0.07 in the whole aortic ring in the distal AA (P < 0.001). Depending on 4D flow parameters, reproducibility varied from excellent (ICC = 0.923) to very low (ICC = 0.204). DATA CONCLUSION The present study demonstrates that 4D flow measurements help to visualize the pathological flow patterns related to aortic dilatation. Flow displacement and an increased WSSc/WSS ratio are significantly associated with AA dilatation. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:136-145.
Collapse
Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Elina Kariniemi
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Pekka Jaakkola
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland
| | - Timo Liimatainen
- Department of Clinical Radiology, Kuopio University Hospital, Imaging Center, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
4
|
Liu R, Lo L, Lay AJ, Zhao Y, Ting KK, Robertson EN, Sherrah AG, Jarrah S, Li H, Zhou Z, Hambly BD, Richmond DR, Jeremy RW, Bannon PG, Vadas MA, Gamble JR. ARHGAP18 Protects Against Thoracic Aortic Aneurysm Formation by Mitigating the Synthetic and Proinflammatory Smooth Muscle Cell Phenotype. Circ Res 2017; 121:512-524. [DOI: 10.1161/circresaha.117.310692] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
Rationale:
Thoracic aortic aneurysm (TAA) is a potentially lethal condition, which can affect individuals of all ages. TAA may be complicated by the sudden onset of life-threatening dissection or rupture. The underlying mechanisms leading to TAA formation, particularly in the nonsyndromal idiopathic group of patients, are not well understood. Thus, identification of new genes and targets that are involved in TAA pathogenesis are required to help prevent and reverse the disease phenotype.
Objective:
Here we explore the role of ARHGAP18, a novel Rho GAP expressed by smooth muscle cells (SMCs), in the pathogenesis of TAA.
Methods and Results:
Using human and mouse aortic samples, we report that ARHGAP18 levels were significantly reduced in the SMC layer of aortic aneurysms.
Arhgap18
global knockout (
Arhgap18
−/
−
) mice exhibited a highly synthetic, proteolytic, and proinflammatory smooth muscle phenotype under basal conditions and when challenged with angiotensin II, developed TAA with increased frequency and severity compared with littermate controls. Chromatin immunoprecipitation studies revealed this phenotype is partly associated with strong enrichment of H3K4me3 and depletion of H3K27me3 at the
MMP2
and
TNF-α
promoters in
Arhgap18
-deficient SMC. We further show that TAA formation in the
Arhgap18
−/−
mice is associated with loss of Akt activation. The abnormal SMC phenotype observed in the
Arhgap18
−/−
mice can be partially rescued by pharmacological treatment with the mTORC1 inhibitor rapamycin, which reduces the synthetic and proinflammatory phenotype of
Arhgap18
-deficient SMC.
Conclusion:
We have identified
ARHGAP18
as a novel protective gene against TAA formation and define an additional target for the future development of treatments to limit TAA pathogenesis.
Collapse
Affiliation(s)
- Renjing Liu
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Lisa Lo
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Angelina J. Lay
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Yang Zhao
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Ka Ka Ting
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Elizabeth N. Robertson
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Andrew G. Sherrah
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Sorour Jarrah
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Haibo Li
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Zhaoxiong Zhou
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Brett D. Hambly
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - David R. Richmond
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Richmond W. Jeremy
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Paul G. Bannon
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Mathew A. Vadas
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| | - Jennifer R. Gamble
- From the Agnes Ginges Laboratory for Diseases of the Aorta, Vascular Biology Program (R.L., L.L., H.L.) and Centre for the Endothelium, Vascular Biology Program (A.J.L., Y.Z., K.K.T., S.J., Z.Z., M.A.V., J.R.G.), Centenary Institute, Camperdown, New South Wales, Australia; Discipline of Pathology and Bosch Institute, Charles Perkins Center (E.N.R., B.D.H.) and Sydney Medical School (R.L., E.N.R., R.W.J., P.G.B., M.A.V., J.R.G.), University of Sydney, New South Wales, Australia; The Baird Institute
| |
Collapse
|
5
|
Kirsch EWM, Radu NC, Allaire E, Loisance DY. Pathobiology of Idiopathic Ascending Aortic Aneurysms. Asian Cardiovasc Thorac Ann 2016; 14:254-60. [PMID: 16714709 DOI: 10.1177/021849230601400320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The pathobiology of ascending aortic aneurysms remains incompletely understood. Data from direct study are still scarce and often limited because of patient heterogenicity. Currently available information suggests that destructive remodeling of the aortic wall, inflammation and angiogenesis, biomechanical wall stress, and molecular genetics are relevant mechanisms of idiopathic ascending aortic aneurysm formation and progression. Further understanding of these mechanisms will likely provide novel diagnostic, prognostic, and therapeutical tools for the clinician.
Collapse
Affiliation(s)
- E W Matthias Kirsch
- Department of Cardiothoracic Surgery, Hospital Henri Mondor, 51 Avenue Mal de Lattre de Tassigny, Créteil Cedex 94 000, France.
| | | | | | | |
Collapse
|
6
|
Ladich E, Butany J, Virmani R. Aneurysms of the Aorta. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
7
|
Verma S, Gupta S, Guglin M. Dissecting heart failure. Am J Emerg Med 2014; 32:689.e1-2. [DOI: 10.1016/j.ajem.2013.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/03/2013] [Indexed: 11/26/2022] Open
|
8
|
Wu D, Shen YH, Russell L, Coselli JS, LeMaire SA. Molecular mechanisms of thoracic aortic dissection. J Surg Res 2013; 184:907-24. [PMID: 23856125 PMCID: PMC3788606 DOI: 10.1016/j.jss.2013.06.007] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/31/2013] [Accepted: 06/05/2013] [Indexed: 12/22/2022]
Abstract
Thoracic aortic dissection (TAD) is a highly lethal vascular disease. In many patients with TAD, the aorta progressively dilates and ultimately ruptures. Dissection formation, progression, and rupture cannot be reliably prevented pharmacologically because the molecular mechanisms of aortic wall degeneration are poorly understood. The key histopathologic feature of TAD is medial degeneration, a process characterized by smooth muscle cell depletion and extracellular matrix degradation. These structural changes have a profound impact on the functional properties of the aortic wall and can result from excessive protease-mediated destruction of the extracellular matrix, altered signaling pathways, and altered gene expression. Review of the literature reveals differences in the processes that lead to ascending versus descending and sporadic versus hereditary TAD. These differences add to the complexity of this disease. Although tremendous progress has been made in diagnosing and treating TAD, a better understanding of the molecular, cellular, and genetic mechanisms that cause this disease is necessary to developing more effective preventative and therapeutic treatment strategies.
Collapse
Affiliation(s)
- Darrell Wu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 390, One Baylor Plaza, Houston, Texas 77030
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke’s Episcopal Hospital, 6770 Bertner Ave., Houston, Texas 77030
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, BCM 335, One Baylor Plaza, Houston, Texas 77030
| | - Ying H. Shen
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 390, One Baylor Plaza, Houston, Texas 77030
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke’s Episcopal Hospital, 6770 Bertner Ave., Houston, Texas 77030
| | - Ludivine Russell
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 390, One Baylor Plaza, Houston, Texas 77030
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke’s Episcopal Hospital, 6770 Bertner Ave., Houston, Texas 77030
| | - Joseph S. Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 390, One Baylor Plaza, Houston, Texas 77030
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke’s Episcopal Hospital, 6770 Bertner Ave., Houston, Texas 77030
| | - Scott A. LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, BCM 390, One Baylor Plaza, Houston, Texas 77030
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke’s Episcopal Hospital, 6770 Bertner Ave., Houston, Texas 77030
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, BCM 335, One Baylor Plaza, Houston, Texas 77030
| |
Collapse
|
9
|
De Backer J, Campens L, De Paepe A. Genes in thoracic aortic aneurysms/dissections - do they matter? Ann Cardiothorac Surg 2013; 2:73-82. [PMID: 23977562 DOI: 10.3978/j.issn.2225-319x.2012.12.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/05/2012] [Indexed: 01/05/2023]
Affiliation(s)
- Julie De Backer
- Centre for Medical Genetics, University Hospital Ghent, Belgium; ; Department of Cardiology, University Hospital Ghent, Belgium
| | | | | |
Collapse
|
10
|
De Backer J, Renard M, Campens L, François K, Callewaert B, Coucke P, De Paepe A. Genes in Thoracic Aortic Aneurysms and Dissections - Do they Matter?: Translation and Integration of Research and Modern Genetic Techniques into Daily Clinical Practice. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:135-45. [PMID: 26798687 DOI: 10.12945/j.aorta.2013.13-024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/03/2013] [Indexed: 11/18/2022]
Abstract
Since the identification of the fibrillin-1 gene as the causal gene for Marfan syndrome, our knowledge of molecular genetics and the applicability of genetic testing in clinical practice have expanded dramatically. Several new syndromes related to thoracic aortic aneurysms and dissections (TAAD) have been described and the list of underlying genes in syndromal and nonsyndromal TAAD already includes more than 10 different genes and is rapidly expanding. Based on this knowledge, our insights into the underlying pathophysiology of TAAD have improved significantly, and new opportunities for targeted treatment have emerged. Clinicians involved in the care of TAAD patients require a basic knowledge of the disease entities and need to be informed on the applicability of genetic testing in their patients and families. Gene-tailored treatment and management is indeed no science fiction anymore and should now be considered as part of good clinical practice. We provide a systematic overview of genetic TAAD entities and practical recommendations for genetic testing and patient management.
Collapse
Affiliation(s)
| | - Marjolijn Renard
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | | | - Katrien François
- Department of Cardiovascular Surgery, University Hospital Ghent, Ghent, Belgium
| | - Bert Callewaert
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | - Paul Coucke
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | - Anne De Paepe
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
11
|
Transforming growth factor-β and abdominal aortic aneurysms. Cardiovasc Pathol 2013; 22:126-32. [DOI: 10.1016/j.carpath.2012.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 07/22/2012] [Accepted: 07/30/2012] [Indexed: 12/22/2022] Open
|
12
|
Cormack SM, Owens WA. Aneurysmal dilation of the ascending thoracic aorta and the aortic arch following surgical repair of type A dissection. BMJ Case Rep 2012; 2012:bcr-2012-006963. [PMID: 23076699 DOI: 10.1136/bcr-2012-006963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This report describes the case of a 71-year-old lady who was diagnosed with a Stanford type A dissecting aortic aneurysm which resulted in paraplegia secondary to spinal artery injury at T12 level. She had surgical repair with a tube graft. At a routine review CT scan 2 years postdissection, she presents with asymptomatic but significant dilation, of maximum diameter 78 mm, of the superior part of the ascending thoracic aorta, extending into the arch, suggestive of false aneurysm formation at the surgical anastomoses. There was also thrombosis of the false lumen in the distal arch and descending thoracic aorta. She is a candidate for urgent resection of the aortic arch and reimplantation of the brachiocephalic vessels.
Collapse
|
13
|
Dramatic decrease of aortic longitudinal elastic strength in a rat model of aortic dissection. Ann Vasc Surg 2012; 26:996-1001. [PMID: 22819525 DOI: 10.1016/j.avsg.2012.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/16/2012] [Accepted: 02/19/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to evaluate thoracic aortic longitudinal elastic strength in a rat model of aortic dissection (AD). METHODS Young Sprague Dawley rats were fed 0.25% β-aminopropionitrile (BAPN). Biomechanical and biochemistry properties of the aorta were analyzed. Elasticity modulus, maximum stretching length, draw ratio, maximum load, maximum strength, and maximum extensibility were measured. RESULTS More than one-half of BAPN-treated rats (52.9%) died of aortic rupture secondary to AD during the experiment. The diameter of the aneurysms was 6.33 ± 1.17 mm and the length was 9.33 ± 4.95 mm. The maximum diameter was significantly increased in BAPN-treated rats with AD (group B2) compared with rats without AD (group B1) and control group (group A) (P = 0.001 and P < 0.001, respectively), but was not different between group B1 and group A (P = 0.108). Thickness of media and initial area in aorta of BAPN-treated rats were significantly increased compared with control group (P = 0.001 and P < 0.001, respectively), but no difference in initial area was observed between group B1 and group B2 (P = 0.54). Maximum stretching length, draw ratio, maximum load, maximum strength, maximum extensibility, and elasticity modulus were dramatically decreased in group B2 compared with group B1 and group A (group B2 vs. group B1: P < 0.001; group B1 vs. group A: P < 0.001). CONCLUSIONS We successfully established a rat model of AD with a high incidence of rupture and mortality. Examinations of strain and stress parameters as well as elasticity modulus of the dissected and the nondissected aorta help understand pathogenesis of AD.
Collapse
|
14
|
Zhang L, Liao MF, Tian L, Zou SL, Lu QS, Bao JM, Pei YF, Jing ZP. Overexpression of interleukin-1β and interferon-γ in type I thoracic aortic dissections and ascending thoracic aortic aneurysms: possible correlation with matrix metalloproteinase-9 expression and apoptosis of aortic media cells. Eur J Cardiothorac Surg 2011; 40:17-22. [PMID: 21349736 DOI: 10.1016/j.ejcts.2010.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/01/2010] [Accepted: 09/05/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To examine the expression of interleukin-1β and interferon-γ and their possible roles in aortic dissections and aneurysms. METHODS Aortic specimens were obtained from patients with type I thoracic aortic dissection, ascending thoracic aortic aneurysms, and control organ donors. The expression of interleukin-1β, interferon-γ, matrix metalloproteinase-9, and signal transduction factors phospho-p38 and phosphorylated c-jun N-terminal kinase (phospho-JNK) were detected by real time reverse transcription-polymerase chain reaction (real time RT-PCR), Western blot, and immunohistochemistry, respectively. Terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining was performed to detect apoptosis of media cells. The correlation of these factors and apoptosis was also studied. RESULTS Apoptosis in the media of thoracic aortic dissection and in ascending thoracic aortic aneurysms was dramatically higher than in the control group. The expression of interleukin-1β gradually increased from the control group, thoracic aortic dissection to ascending thoracic aortic aneurysms (p < 0.01, respectively). The expression of interferon-γ and matrix metalloproteinase-9 was significantly increased in the media of thoracic aortic dissection and ascending thoracic aortic aneurysms compared with the control group (p < 0.01, respectively). There were positive correlations between interleukin-1β versus matrix metalloproteinase-9, interleukin-1β versus phospho-p38 in thoracic aortic dissection (p < 0.01, respectively), and interferon-γ versus matrix metalloproteinase-9, interferon-γ versus phospho-JNK, interferon-γ versus apoptosis, and interleukin-1β versus apoptosis in ascending thoracic aortic aneurysms (p = 0.02, 0.02, p < 0.01, p < 0.01). CONCLUSIONS Interleukin-1β and interferon-γ might effect the formation of thoracic aortic dissection and ascending thoracic aortic aneurysms possibly through the up-regulation of matrix metalloproteinase-9 and the apoptosis of media cells in humans.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Liao M, Zou S, Weng J, Hou L, Yang L, Zhao Z, Bao J, Jing Z. A microRNA profile comparison between thoracic aortic dissection and normal thoracic aorta indicates the potential role of microRNAs in contributing to thoracic aortic dissection pathogenesis. J Vasc Surg 2011; 53:1341-1349.e3. [PMID: 21334170 DOI: 10.1016/j.jvs.2010.11.113] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/15/2010] [Accepted: 11/19/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Our aim was to identify important microRNAs (miRNAs) that might play an important role in contributing to aortic dissection by conducting a miRNA profile comparison between thoracic aortic dissection (TAD) and normal thoracic aorta. METHODS The differentially expressed miRNA profiles of the aortic tissue between TAD patients (n = 6) and age-matched donors without aortic diseases (NA; n = 6) were analyzed by miRNA microarray. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was further performed to verify the expression of 12 selected miRNAs with an increased number of samples (TAD n = 12; NA n = 8). The potential targets of the differentially expressed miRNAs were predicted using computational searches. Bioinformatic analyses of the predicted target genes (gene ontology, pathway and network analysis) were done for further research. Additionally, Western blotting was performed to confirm the bioinformatics findings. RESULTS The miRNA microarray revealed differentially expressed miRNAs between the TAD and NA groups. In the TAD group, 18 miRNAs were upregulated and 56 were downregulated (fold change >2, P < .01). qRT-PCR verified statistically consistent expression of seven selected miRNAs with microarray analysis. Combined with our previous proteomics study, target gene prediction revealed that some miRNAs reciprocally expressed with their targeted proteins. Target gene-related pathway analysis showed a significant change in five pathways in the TAD group compared with the NA group, especially the focal adhesion and the mitogen-activated protein kinase (MAPK) signaling pathways. By further conducting miRNA gene network analysis, we found that the mir-29 and mir-30 families are likely to play a role in the regulation of these two pathways, respectively. CONCLUSIONS Our results indicate that miRNAs expression profiles in aortic media from TAD were significantly changed. These results may provide important insights into TAD disease mechanisms. This study also suggests that the focal adhesion and MAPK signaling pathways might play important roles in the pathogenesis of TAD.
Collapse
Affiliation(s)
- Mingfang Liao
- Department of Vascular Surgery, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Tian L, Liao MF, Zhang L, Lu QS, Jing ZP. A study of the expression and interaction of Destrin, cofilin, and LIMK in Debakey I type thoracic aortic dissection tissue. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:523-8. [DOI: 10.3109/00365513.2010.521572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
18
|
Barbey F, Qanadli SD, Juli C, Brakch N, Palacek T, Rizzo E, Jeanrenaud X, Eckhardt B, Linhart A. Aortic remodelling in Fabry disease. Eur Heart J 2009; 31:347-53. [DOI: 10.1093/eurheartj/ehp426] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
19
|
Dissecting aneurysm of the aorta secondary to idiopathic cystic medionecrosis. COR ET VASA 2009. [DOI: 10.33678/cor.2009.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
20
|
Golledge J, Clancy P, Jones GT, Cooper M, Palmer LJ, van Rij AM, Norman PE. Possible association between genetic polymorphisms in transforming growth factor beta receptors, serum transforming growth factor beta1 concentration and abdominal aortic aneurysm. Br J Surg 2009; 96:628-32. [PMID: 19434696 DOI: 10.1002/bjs.6633] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have suggested a role for transforming growth factor (TGF) beta and its receptor in thoracic aortic aneurysm, but their role in abdominal aortic aneurysm (AAA) is unknown. This study examined the possible association between TGF-beta receptor 1 and 2 (TGFBR-1 and -2) single nucleotide polymorphisms (SNPs) and serum TGF-beta1 with AAA. METHODS Serum concentrations of TGF-beta1 and 58 SNPs for TGFBR-1 and -2 were examined in 1003 and 1711 men respectively from the Health In Men Study. Validation of SNPs was examined in a second referral cohort of 1043 subjects from New Zealand, of whom 654 had an AAA. RESULTS Serum TGF-beta1 was not associated with AAA. Only one SNP in TGFBR-2 was weakly associated with AAA; TGFBR2 g.42917C > T, SNP ID rs1078985CC; odds ratio 0.64 (95 per cent confidence interval (c.i.) 0.45 to 0.93); P = 0.020 uncorrected; but this association did not hold after adjusting for multiple testing and was not validated in the New Zealand cohort: odds ratio 0.98 (95 per cent c.i. 0.50 to 1.94); P = 0.960. CONCLUSION These findings suggest there is no important role of genetic polymorphisms in the main receptors for TGF-beta and circulating TGF-beta1 in AAA in older individuals. (c) 2009 British Journal of Surgery Society Ltd.
Collapse
Affiliation(s)
- J Golledge
- Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Queensland, Australia.
| | | | | | | | | | | | | |
Collapse
|
21
|
Caglayan AO, Dundar M. Inherited diseases and syndromes leading to aortic aneurysms and dissections. Eur J Cardiothorac Surg 2009; 35:931-40. [DOI: 10.1016/j.ejcts.2009.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 01/06/2009] [Accepted: 01/07/2009] [Indexed: 01/15/2023] Open
|
22
|
Butany J, Vaideeswar P, Dixit V, Lad V, Vegas A, David TE. Ascending aortic aneurysms in unicommissural aortic valve disease. Cardiovasc Pathol 2009; 18:11-8. [DOI: 10.1016/j.carpath.2007.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Revised: 12/03/2007] [Accepted: 12/17/2007] [Indexed: 10/22/2022] Open
|
23
|
[Pathobiology of idiopathic ascending aortic aneurysms]. Presse Med 2008; 38:1076-88. [PMID: 19070988 DOI: 10.1016/j.lpm.2008.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 08/09/2008] [Accepted: 09/18/2008] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The incidence of this disease is increasing in the population of the developed countries but its pathobiology is poorly understood. AIM This article is reviewing the publications concerning the pathobiology of idiopathic ascending aortic aneurysms. SOURCES A PubMed search on articles published in English or French, between January 1965 and December 2007, on key-words << aortic root >>, << ascending aorta >>, << aortic arch >>, << thoracic aorta >>, << aneurysm >>, << dilatation >> and << dissection >> was undertaken. Articles on aneurysms related to inflammatory and infectious diseases, congenital or genetic syndromes were excluded. RESULTS The presented data suggests that destructive remodeling of the aortic wall, inflammation and angiogenesis, biomechanical wall stress, and molecular genetics are relevant mechanisms of idiopathic ascending aortic aneurysm formation and progression. LIMITS Sparse data available from few direct studies offer limited knowledge on pathobiology of idiopathic ascending aortic aneurysms. CONCLUSION A more intimate knowledge of the triggers and perpetrating factors of this disease might offer new diagnostic and treatment options.
Collapse
|
24
|
An FBN1 pseudoexon mutation in a patient with Marfan syndrome: confirmation of cryptic mutations leading to disease. J Hum Genet 2008; 53:1007-1011. [DOI: 10.1007/s10038-008-0334-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 08/16/2008] [Indexed: 10/21/2022]
|
25
|
Pearson GD, Devereux R, Loeys B, Maslen C, Milewicz D, Pyeritz R, Ramirez F, Rifkin D, Sakai L, Svensson L, Wessels A, Van Eyk J, Dietz HC. Report of the National Heart, Lung, and Blood Institute and National Marfan Foundation Working Group on research in Marfan syndrome and related disorders. Circulation 2008; 118:785-91. [PMID: 18695204 DOI: 10.1161/circulationaha.108.783753] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Gail D Pearson
- National Heart, Lung, and Blood Institute, National Institutes of Health, Division of Cardiovascular Diseases, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ovaert C, Cano A, Chabrol B. Aortic dilatation in Cockayne syndrome. Am J Med Genet A 2008; 143A:2604-6. [PMID: 17935247 DOI: 10.1002/ajmg.a.31986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cockayne syndrome is a rare growth failure and premature aging disorder featuring abnormal ultraviolet sensitivity and impaired transcription-coupled DNA repair. Cardiac involvement has not been described in Cockayne patients except for one recently described case of dilated cardiomyopathy. We describe one patient in whom marked ascending aorta dilatation was observed together with mild aortic regurgitation. Ascending aorta dilatation might be another feature of premature aging in Cockayne syndrome and may require cardiovascular investigation and monitoring.
Collapse
Affiliation(s)
- Caroline Ovaert
- Paediatric Cardiology, La Timone Children's Hospital, Marseille, France.
| | | | | |
Collapse
|
27
|
von Kodolitsch Y, Rybczynski M, Detter C, Robinson PN. Diagnosis and management of Marfan syndrome. Future Cardiol 2008; 4:85-96. [PMID: 19804274 DOI: 10.2217/14796678.4.1.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Marfan syndrome is a disorder of the connective tissue that is inherited in an autosomal-dominant fashion and is caused by mutations in the gene coding for fibrillin-1, FBN1. Although complications of the syndrome may involve the eye, the lung and the skeleton, the high mortality of untreated cases results almost exclusively from cardiovascular complications, including aortic dissection and rupture. Recently, a series of experiments has begun to elucidate the complex molecular etiology of Marfan syndrome, and a number of new heritable syndromes with an associated risk for aortic complications, such as Loeys–Dietz syndrome types I and II, have been described. The multiorgan involvement of many of these syndromes requires multidisciplinary expert centers that can increase the average life expectancy of affected patients from only 32 years to over 60 years. The present article both reviews classical standards of managing cardiovascular manifestations and outlines significant advances in recent research with focus on their impact on future diagnostic and therapeutic options.
Collapse
Affiliation(s)
- Yskert von Kodolitsch
- University Hospital Hamburg, Centre of Cardiology & Cardiovascular Surgery, Department of Cardiology/Angiology, University Hospital Hamburg – Eppendorf, Hamburg Martinistrasse 52, 20246 Hamburg, Germany
| | - Meike Rybczynski
- University Hospital Hamburg, Centre of Cardiology & Cardiovascular Surgery, Department of Cardiology/Angiology, University Hospital Eppendorf, Hamburg, Germany
| | - Christian Detter
- University Hospital Hamburg, Centre of Cardiology & Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Peter N Robinson
- Humboldt University, Institute of Medical Genetics, Charité Universitätsmedizin, Humboldt University, Berlin, Germany
| |
Collapse
|
28
|
Collins MJ, Dev V, Strauss BH, Fedak PWM, Butany J. Variation in the histopathological features of patients with ascending aortic aneurysms: a study of 111 surgically excised cases. J Clin Pathol 2007; 61:519-23. [DOI: 10.1136/jcp.2006.046250] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Ascending aortic aneurysms (AA) are a common, though poorly understood medical condition.Aims:To document the histological changes in a large series of human ascending AA, and to correlate these changes with clinical variables.Methods:111 ascending AA were excised at surgery over a 3 year period. Each aneurysm was received as a continuous ring of tissue. Sections were taken from the anterior, posterior, greater and lesser curvature of the aorta and graded in a semi-quantitative fashion for the degree of elastin fragmentation, elastin loss, smooth muscle cell (SMC) loss, intimal changes and inflammation.Results:Mean patient age at surgery was 58.7 (15.6) years; there were 70 men and 41 women. 12 patients had Marfan syndrome, 34 (30.6%) had a bicuspid aortic valve (BAV), while 71 (64.0%) had a tricuspid aortic valve (TAV). Inflammatory cells were present in 28 cases (25.2%) and were confined to the adventitia. No particular region of the aortic circumference was more severely affected, however a BAV was associated with significantly less intimal change, and less fragmentation and loss of elastic tissue compared with patients with a TAV. Advanced age (>65 years), female gender and Marfan syndrome were all associated with more severe elastin degeneration and smooth muscle cell loss (p<0.05 for all).Conclusion:Results indicate a wide variation in the histological appearance in ascending AA, depending on patient characteristics. They suggest that the underlying aneurysm pathogenesis may also be highly variable; this warrants further investigation.
Collapse
|
29
|
Affiliation(s)
- Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, Department of Cardiology and Angiology, University Hospital Eppendorf, Hamburg, Germany.
| | | |
Collapse
|
30
|
Wennberg PW, Kalsi H. Aneurysms of the Peripheral Arteries. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
31
|
|
32
|
Albornoz G, Coady MA, Roberts M, Davies RR, Tranquilli M, Rizzo JA, Elefteriades JA. Familial thoracic aortic aneurysms and dissections--incidence, modes of inheritance, and phenotypic patterns. Ann Thorac Surg 2006; 82:1400-5. [PMID: 16996941 DOI: 10.1016/j.athoracsur.2006.04.098] [Citation(s) in RCA: 314] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 04/17/2006] [Accepted: 04/19/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND We examined the genetic nature and phenotypic features of thoracic aortic aneurysms (TAAs) and dissections in a large cohort of patients. METHODS Interviews were conducted with 520 patients with TAAs and their pedigrees were compiled to identify family members with aneurysms. Study patients were divided into three groups: 101 non-Marfan patients, in 88 pedigrees, had a family pattern for TAA (familial group), 369 had no family pattern (sporadic group), and 50 had Marfan syndrome (MFS). We determined incidence of familial clustering, age at presentation, rate of aneurysm growth, incidence of hypertension, correlation of aneurysm sites among kindred, and pedigree inheritance patterns. RESULTS An inherited pattern for TAA was present in 21.5% of non-MFS patients. The predominant inheritance pattern was autosomal dominant (76.9%), with varying degrees of penetrance and expressivity. The familial TAA group was significantly younger than the sporadic group (p < 0.0001), but not as young as the MFS group (p < 0.0001) (mean ages, 58.2 versus 65.7 versus 27.4 years). Among all 197 probands and kindred with aneurysm, 131 (66.5%) had TAA, 49 (24.9%) had abdominal aortic aneurysm (AAA), and 17 (8.6%) had cerebral or other aneurysms. Ascending aneurysm paired most commonly with ascending, and descending with abdominal. Abdominal aortic aneurysms (AAAs) and hypertension were more often associated with descending than with ascending TAAs (p < 0.001). Aortic growth rate was highest for the familial group (0.21 cm/y), intermediate for the sporadic group (0.16 cm/y), and lowest for the Marfan group (0.1 cm/y; p < 0.01). CONCLUSIONS TAAs are frequently familial diseases. The predominant mode of inheritance is autosomal dominant. Familial TAAs have a relatively early age of onset. Aneurysms in relatives may be seen in the thoracic aorta, the abdominal aorta, or the cerebral circulation. Screening of first-order relatives of probands with TAA is essential. Familial TAAs tend to grow at a higher rate, exemplifying a more aggressive clinical entity.
Collapse
Affiliation(s)
- Gonzalo Albornoz
- Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | |
Collapse
|
33
|
Hemminki K, Li X, Johansson SE, Sundquist K, Sundquist J. Familial risks of aortic aneurysms among siblings in a nationwide Swedish study. Genet Med 2006; 8:43-9. [PMID: 16418598 DOI: 10.1097/01.gim.0000195973.60136.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Aortic aneurysms have a high fatality rate that could be reduced with control of risk factors and use of available screening methods for detection of early changes in aortic walls. The available data on familial risks, a potential indication for screening, are mainly limited to abdominal aortic aneurysms. METHODS A nationwide Swedish cohort was constructed by linking the Multigeneration Register on 0- to 69-year-old siblings to the Hospital Discharge Register and the Cause of Death Register for data on aortic aneurysms from years 1987 to 2001. Standardized incidence ratios (SIRs) were calculated for affected siblings by comparing with those whose siblings had no aneurysm. RESULTS A total of 71 affected siblings were identified with a familial SIR of 8.71; when one sibling was diagnosed before age 50 years, the SIR was 19.69. For concordant thoracic or concordant abdominal aneurysms, the SIRs were 21.68 and 13.06, respectively. For brothers, the risk of abdominal aneurysms was 14.63, and 49.50 for diagnosis before age 50 years. Familial risks and the effects of early diagnostic age were shared by the anatomic subtypes of aneurysms. Within limits of the sample size, no gender differences could be observed. Affected siblings constituted 2.2% of all diagnosed patients. CONCLUSIONS A family history of any aortic aneurysms and age groups younger than 50 years should be considered in recommendations for screening. The high familial risks are likely to be the result of heritable genes, the identification of which would allow gene testing and preventive counseling.
Collapse
Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- Dianna M Milewicz
- Department of Internal Medicine, University of Texas Medical School at Houston, 6431 Fannin, MSB 4.202, Houston, TX 77030, USA.
| | | | | |
Collapse
|
35
|
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
|
36
|
Abstract
Four inherited disorders known to effect major arteries will be discussed, including Marfan syndrome (MS), Ehlers-Danlos syndrome (EDS), bicuspid aortic valve (BAV) and nonsyndromic familial aortic dissection. Recent advances in understanding their pathophysiology are presented, and how this knowledge impacts on diagnosis, prevention and treatment is discussed.
Collapse
|
37
|
Cordera F, Bowen JM, Aubry MC, Gloviczki P. Type IV thoracoabdominal aortic aneurysm with lymphoplasmacytic aortitis and cystic medial degeneration in a 32-year-old patient with Marfan syndrome. J Vasc Surg 2005; 42:168-71. [PMID: 16012468 DOI: 10.1016/j.jvs.2005.03.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aortitis identified in approximately 12% of all thoracoabdominal aneurysms. The most common subtype of inflammatory aortitis is giant cell aortitis, followed by lymphoplasmacytic aortitis. Inflammatory aortitis may occur in isolation or as part of a systemic inflammatory disorder such as Takayasu arteritis, systemic lupus erythematosus, rheumatoid arthritis, and giant cell arteritis. Aortitis has not been described in patients with Marfan syndrome. We report the case of a 32-year-old man with Marfan syndrome and a strong family history of aneurysmal disease who presented with an asymptomatic Crawford type IV thoracoabdominal aneurysm. His aneurysm had no associated dissection, and surgical pathology revealed severe medial degeneration and lymphoplasmacytic aortitis. To our knowledge, this is the first report of such a finding in a patient with Marfan syndrome.
Collapse
Affiliation(s)
- Fernando Cordera
- Division of General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | |
Collapse
|
38
|
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is associated with high mortality and medical expense. These poor outcomes are preventable by surgical repair; however, identifying at-risk individuals is difficult. Researchers are actively surveying the human genome (the repository of human genes) to characterize the genetic determinants of TAAD by identifying chromosomal regions likely to harbor such predisposing genes. In previous studies, investigators identified genetic markers shared by a subset of families who were ascertained to have the disease, which clustered into 2 chromosomal regions: 5q13-q15 (TAAD1) and 11q23.2-q24 (familial aortic aneurysm [FAA1]). In a subsequent study, a third chromosomal region at 3p24-25 (TAAD2) was found to contribute to TAAD in a 4-generation, 52-member family that displayed little evidence of sharing either the TAAD1 or FAA1 regions. Although additional regions of the genome may contribute to TAAD, investigators are focusing their efforts on identifying the actual genes and the specific mutations that participate in the disease process. The goal of these endeavors is to develop screening tests to identify individuals at risk for familial TAAD. This genetic discovery has significant clinical implications because high-risk individuals and families can be closely monitored and can benefit from preventative surgical repairs.
Collapse
MESH Headings
- Aortic Dissection/classification
- Aortic Dissection/epidemiology
- Aortic Dissection/genetics
- Aortic Dissection/prevention & control
- Aortic Aneurysm, Thoracic/classification
- Aortic Aneurysm, Thoracic/epidemiology
- Aortic Aneurysm, Thoracic/genetics
- Aortic Aneurysm, Thoracic/prevention & control
- Causality
- Chromosome Mapping
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 5/genetics
- Genes, Dominant/genetics
- Genetic Markers/genetics
- Genetic Predisposition to Disease/epidemiology
- Genetic Predisposition to Disease/genetics
- Genetic Predisposition to Disease/prevention & control
- Genetic Testing
- Humans
- Mutation/genetics
- Pedigree
- Penetrance
- Phenotype
- Prevalence
- Severity of Illness Index
Collapse
Affiliation(s)
- Shu-Fen Wung
- Division of Nursing Practice, College of Nursing, University of Arizona, Tucson 85721, USA.
| | | |
Collapse
|
39
|
Butany J, El Demellawy D, Collins MJ, Nair V, Graba J, Taebong C, David TE. Ascending aortic aneurysm with dissection and aortic insufficiency. J Card Surg 2005; 20:85-9. [PMID: 15673419 DOI: 10.1111/j.0886-0440.2005.200379.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jagdish Butany
- Department of Pathology, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Abstract
PURPOSE OF REVIEW The dilated aortic root is often completely asymptomatic and found incidentally on routine imaging studies such as chest radiograph, echocardiography, chest computed tomography, or magnetic resonance imaging. The dilated aortic root may be associated with underlying aortic valve abnormalities as seen with bicuspid aortic valve. It may also lead to the awareness of important underlying connective tissue disorders like the Marfan syndrome. It is imperative that the dilated aortic root be observed carefully over time with serial imaging studies and that timely resection of the aneurysm be carried out before catastrophic complications such as aortic dissection, aortic rupture, or congestive heart failure from aortic insufficiency occur. RECENT FINDINGS In recent years, the advent of molecular genetics has heightened awareness of familial aortic disease such as the Marfan syndrome, bicuspid aortic valve disease, and hereditary aortic aneurysm and dissection. In addition to hypertension and inflammatory aortic disease, these hereditary aortopathies are important to consider in the evaluation of patients with a dilated aorta and have implications for screening of the relatives of the patient with aortic aneurysm. SUMMARY Because there is often uncertainty regarding the dilated aortic root, this review will summarize the approach to diagnosis, evaluation, and management of aortic root aneurysms. Clinical features, diagnostic approaches, screening of relatives, and long term follow-up will be highlighted.
Collapse
Affiliation(s)
- John K Boyer
- Department of Medicine, and the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | | | | |
Collapse
|
42
|
Hasham SN, Lewin MR, Tran VT, Pannu H, Muilenburg A, Willing M, Milewicz DM. Nonsyndromic genetic predisposition to aortic dissection: a newly recognized, diagnosable, and preventable occurrence in families. Ann Emerg Med 2004; 43:79-82. [PMID: 14707946 DOI: 10.1016/s0196-0644(03)00818-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The major diseases affecting the aorta are aortic aneurysms and dissections, with patients with acute dissections often presenting in the emergency department (ED). Recent studies demonstrate a strong genetic predisposition to thoracic aortic aneurysms and dissections, independent of syndromes traditionally considered to predispose to aortic disease (such as Marfan syndrome). Nonsyndromic familial thoracic aortic aneurysms and dissections are inherited in families as an autosomal dominant disorder and a variable age of onset of the aortic disease. The case reported here illustrates the critical importance of obtaining a family history of thoracic aortic aneurysms and dissections, along with unexplained sudden death, when assessing an individual with chest pain in the ED, regardless of age and in the absence of a known genetic syndrome.
Collapse
Affiliation(s)
- Sumera N Hasham
- Division of Medical Genetics, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Liu X, Zhao Y, Gao J, Pawlyk B, Starcher B, Spencer JA, Yanagisawa H, Zuo J, Li T. Elastic fiber homeostasis requires lysyl oxidase–like 1 protein. Nat Genet 2004; 36:178-82. [PMID: 14745449 DOI: 10.1038/ng1297] [Citation(s) in RCA: 470] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Accepted: 12/29/2003] [Indexed: 11/08/2022]
Abstract
Elastic fibers are components of the extracellular matrix and confer resilience. Once laid down, they are thought to remain stable, except in the uterine tract where cycles of active remodeling occur. Loss of elastic fibers underlies connective tissue aging and important diseases including emphysema. Failure to maintain elastic fibers is explained by a theory of antielastase-elastase imbalance, but little is known about the role of renewal. Here we show that mice lacking the protein lysyl oxidase-like 1 (LOXL1) do not deposit normal elastic fibers in the uterine tract post partum and develop pelvic organ prolapse, enlarged airspaces of the lung, loose skin and vascular abnormalities with concomitant tropoelastin accumulation. Distinct from the prototypic lysyl oxidase (LOX), LOXL1 localizes specifically to sites of elastogenesis and interacts with fibulin-5. Thus elastin polymer deposition is a crucial aspect of elastic fiber maintenance and is dependent on LOXL1, which serves both as a cross-linking enzyme and an element of the scaffold to ensure spatially defined deposition of elastin.
Collapse
Affiliation(s)
- Xiaoqing Liu
- Berman-Gund Laboratory for the Study of Retinal Degenerations, Harvard Medical School and Massachusetts Eye & Ear Infirmary, Boston, Massachusetts 02114, USA
| | | | | | | | | | | | | | | | | |
Collapse
|