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Krebs JR, Bellotti P, Valisno JAC, Su G, Sharma S, Kollareth DJM, Hartman JB, Adithan A, Spinosa M, Kamat M, Garrett T, Cai G, Sharma AK, Upchurch GR. Pharmacologic Inhibition of Ferroptosis Attenuates Experimental Abdominal Aortic Aneurysm Formation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.18.599427. [PMID: 39149340 PMCID: PMC11326422 DOI: 10.1101/2024.06.18.599427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
The pathogenesis of abdominal aortic aneurysm (AAA) formation involves vascular inflammation, thrombosis formation and programmed cell death leading to aortic remodeling. Recent studies have suggested that ferroptosis, an excessive iron-mediated cell death, can regulate cardiovascular diseases, including AAAs. However, the role of ferroptosis in immune cells, like macrophages, and ferroptosis-related genes in AAA formation remains to be deciphered. Single cell-RNA sequencing of human aortic tissue from AAA patients demonstrates significant differences in ferroptosis-related genes compared to control aortic tissue. Using two established murine models of AAA and aortic rupture in C57BL/6 (WT) mice, we observed that treatment with liproxstatin-1, a specific ferroptosis inhibitor, significantly attenuated aortic diameter, pro-inflammatory cytokine production, immune cell infiltration (neutrophils and macrophages), increased smooth muscle cell α-actin expression and elastic fiber disruption compared to mice treated with inactivated elastase in both pre-treatment and treatment after a small AAA had already formed. Lipidomic analysis using mass spectrometry shows a significant increase in ceramides and a decrease in intact lipid species levels in murine tissue compared to controls in the chronic AAA model on day 28. Mechanistically, in vitro studies demonstrate that liproxstatin-1 treatment of macrophages mitigated the crosstalk with aortic smooth muscle cells (SMCs) by downregulating MMP2 secretion. Taken together, this study demonstrates that pharmacological inhibition by liproxstatin-1 mitigates macrophage-dependent ferroptosis contributing to inhibition of aortic inflammation and remodeling during AAA formation.
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Bellotti P, Ladd Z, Leroy V, Su G, Sharma S, Hartman JB, Krebs J, Viscardi C, Maile R, Moldawer LL, Efron P, Sharma AK, Upchurch GR. Resolvin D2/GPR18 signaling enhances monocytic myeloid-derived suppressor cell function to mitigate abdominal aortic aneurysm formation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.23.581672. [PMID: 38464077 PMCID: PMC10925138 DOI: 10.1101/2024.02.23.581672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Abdominal aortic aneurysm (AAA) formation is a chronic vascular pathology characterized by inflammation, leukocyte infiltration and vascular remodeling. The aim of this study was to delineate the protective role of Resolvin D2 (RvD2), a bioactive isoform of specialized proresolving lipid mediators, via G-protein coupled receptor 18 (GPR18) receptor signaling in attenuating AAAs. Importantly, RvD2 and GPR18 levels were significantly decreased in aortic tissue of AAA patients compared with controls. Furthermore, using an established murine model of AAA in C57BL/6 (WT) mice, we observed that treatment with RvD2 significantly attenuated aortic diameter, pro-inflammatory cytokine production, immune cell infiltration (neutrophils and macrophages), elastic fiber disruption and increased smooth muscle cell α-actin expression as well as increased TGF-β2 and IL-10 expressions compared to untreated mice. Moreover, the RvD2-mediated protection from vascular remodeling and AAA formation was blocked when mice were previously treated with siRNA for GPR18 signifying the importance of RvD2/GPR18 signaling in vascular inflammation. Mechanistically, RvD2-mediated protection significantly enhanced infiltration and activation of monocytic myeloid-derived suppressor cells (M-MDSCs) by increasing TGF-β2 and IL-10 secretions that mitigated smooth muscle cell activation in a GPR18-dependent manner to attenuate aortic inflammation and vascular remodeling via this intercellular crosstalk. Collectively, this study demonstrates RvD2 treatment induces an expansion of myeloid-lineage committed progenitors, such as M-MDSCs, and activates GPR18-dependent signaling to enhance TGF-β2 and IL-10 secretion that contributes to resolution of aortic inflammation and remodeling during AAA formation.
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Lin J, Chen S, Yao Y, Yan M. Status of diagnosis and therapy of abdominal aortic aneurysms. Front Cardiovasc Med 2023; 10:1199804. [PMID: 37576107 PMCID: PMC10416641 DOI: 10.3389/fcvm.2023.1199804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) are characterized by localized dilation of the abdominal aorta. They are associated with several serious consequences, including compression of adjacent abdominal organs, pain, treatment-related financial expenditure. The main complication of AAA is aortic rupture, which is responsible for about 200,000 deaths per year worldwide. An increasing number of researchers are dedicating their efforts to study AAA, resulting in significant progress in this field. Despite the commendable progress made thus far, there remains a lack of established methods to effectively decelerate the dilation of aneurysms. Therefore, further studies are imperative to expand our understanding and enhance our knowledge concerning AAAs. Although numerous factors are known to be associated with the occurrence and progression of AAA, the exact pathway of development remains unclear. While asymptomatic at most times, AAA features a highly unpredictable disease course, which could culminate in the highly deadly rupture of the aneurysmal aorta. Current guidelines recommend watchful waiting and lifestyle adjustment for smaller, slow-growing aneurysms, while elective/prophylactic surgical repairs including open repair and endovascular aneurysm repair are recommended for larger aneurysms that have grown beyond certain thresholds (55 mm for males and 50 mm for females). The latter is a minimally invasive procedure and is widely believed to be suited for patients with a poor general condition. However, several concerns have recently been raised regarding the postoperative complications and possible loss of associated survival benefits on it. In this review, we aimed to highlight the current status of diagnosis and treatment of AAA by an in-depth analysis of the findings from literatures.
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Affiliation(s)
- Jinping Lin
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuwei Chen
- Department of anesthesiology, The First People's Hospital of Fuyang, Hangzhou, China
| | - Yuanyuan Yao
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Yan
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Zhang J, Jiang JZ, Xu J, Xu CY, Mao S, Shi Y, Gu W, Zou CF, Zhao YM, Ye L. Identification of Novel Biomarkers for Abdominal Aortic Aneurysm Promoted by Obstructive Sleep Apnea. Ann Vasc Surg 2023; 92:285-293. [PMID: 36739079 DOI: 10.1016/j.avsg.2023.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND We sought to find new biomarkers for abdominal aortic aneurysms (AAA) caused by chronic intermittent hypoxia (CIH). METHODS The AAA mice model was created using Ang II. The mice were divided into normoxic and CIH groups. The structure of AAA was observed using abdominal ultrasonography, Elastica van Gieson (EVG), and hematoxylin and eosin (HE) staining. The expression of ɑ-SMA was investigated using immunohistochemistry. The novel biomarkers were screened using bioinformatics analysis. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to verify the expression of novel genes in both normal oxygen and CIH. RESULTS CIH appears to cause greater aortic dilation, higher AAA incidence, lower survival rate, thicker vessel wall, and more brittle elastic lamellae when compared to controls. The immunohistochemistry results showed that the expression of ɑ-SMA in the CIH group was reduced significantly. Four novel genes, including Homer2, Robo2, Ehf, and Asic1, were found to be differentially expressed between normal oxygen and CIH using qRT-PCR, indicating the same trend as bioinformatics analysis. CONCLUSIONS We discovered that CIH could hasten the occurrence and progression of AAA. Four genes (Homer2, Robo2, Ehf, and Asic1) may be novel biomarkers for AAA, which could aid in the search for new therapies for patients with AAA caused by CIH.
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Affiliation(s)
- Jing Zhang
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian-Zhong Jiang
- Department of Geriatrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
| | - Jun Xu
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chen-Yu Xu
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shan Mao
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ying Shi
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wei Gu
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chun-Fang Zou
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yue-Ming Zhao
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Liang Ye
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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5
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Wei R, Chang X, Wu Z, Duan C, Xiong J, Guo W. A novel abdominal aortic aneurysm model produced by periarterial application of hydrochloric acid. Exp Anim 2023; 72:38-46. [PMID: 36058844 PMCID: PMC9978129 DOI: 10.1538/expanim.22-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Previous abdominal aortic aneurysm (AAA) animal modeling methodologies were either expensive or complicated. Here, we developed a novel AAA model which was simple to set up and generated minimal calcification. Twenty-four rats were divided randomly into four groups. Groups 1, 2 and 3 underwent surgery in which 15% hydrochloric acid (HCl) was applied periarterially to the abdominal aorta for 5 min, followed by sacrifice 1 week (group 1), 2 weeks (group 2), and 4 weeks (group 3) after surgery. The maximum aortic diameter (MAD) was measured at surgery and before animal sacrifice. Rats in group 4 were sham-treated. The MADs in group 1, 2 and 3 showed significant dilation compared with group 4, with a mean dilation rate of 33.8% in the first week after surgery. Histopathological examination revealed infiltration of macrophages into the adventitia, obvious apoptosis of smooth muscle cells, and rupture and collapse of the elastic fibers. Furthermore, no calcification was observed in the dilated aorta. The mRNA expression levels of inflammatory factors were at least two-fold higher in group 1 than in group 4, indicating significant inflammatory response in the progression of AAA information. In conclusion, periarterial application of 15% HCl is a convenient and reliable model to create an abdominal aortic aneurysm in rats, and the potential development mechanism may be related to the proinflammatory effects of HCl.
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Affiliation(s)
- Ren Wei
- Department of Vascular and Endovascular Surgery, General Hospital of People’s Liberation Army, Beijing, Fuxing Road 28, 100853, P.R. China
| | - Xiaojing Chang
- Department of Vascular and Endovascular Surgery, General Hospital of People’s Liberation Army, Beijing, Fuxing Road 28, 100853, P.R. China
| | - Zhongyin Wu
- Department of General Surgery, Affiliated Hospital of Chengde Medical University, Nanyingzi Street 36, Chengde City, Hebei, 067000, P.R. China
| | - Chen Duan
- Department of Vascular Surgery, Affiliated Hospital of Inner Mongolia Medical University, Tongdao Road 1, Hohhot City, Inner Mongolia, 010017, P.R.
China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, General Hospital of People’s Liberation Army, Beijing, Fuxing Road 28, 100853, P.R. China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, General Hospital of People’s Liberation Army, Beijing, Fuxing Road 28, 100853, P.R. China
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6
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NADPH Oxidases in Aortic Aneurysms. Antioxidants (Basel) 2022; 11:antiox11091830. [PMID: 36139902 PMCID: PMC9495752 DOI: 10.3390/antiox11091830] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) are a progressive dilation of the infrarenal aorta and are characterized by inflammatory cell infiltration, smooth muscle cell migration and proliferation, and degradation of the extracellular matrix. Oxidative stress and the production of reactive oxygen species (ROS) have been shown to play roles in inflammatory cell infiltration, and smooth muscle cell migration and apoptosis in AAAs. In this review, we discuss the principles of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase/NOX) signaling and activation. We also discuss the effects of some of the major mediators of NOX signaling in AAAs. Separately, we also discuss the influence of genetic or pharmacologic inhibitors of NADPH oxidases on experimental pre-clinical AAAs. Experimental evidence suggests that NADPH oxidases may be a promising future therapeutic target for developing pharmacologic treatment strategies for halting AAA progression or rupture prevention in the management of clinical AAAs.
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7
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Kaufmann JO, Brangsch J, Kader A, Saatz J, Mangarova DB, Zacharias M, Kempf WE, Schwaar T, Ponader M, Adams LC, Möckel J, Botnar RM, Taupitz M, Mägdefessel L, Traub H, Hamm B, Weller MG, Makowski MR. ADAMTS4-specific MR probe to assess aortic aneurysms in vivo using synthetic peptide libraries. Nat Commun 2022; 13:2867. [PMID: 35606349 PMCID: PMC9126943 DOI: 10.1038/s41467-022-30464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
The incidence of abdominal aortic aneurysms (AAAs) has substantially increased during the last 20 years and their rupture remains the third most common cause of sudden death in the cardiovascular field after myocardial infarction and stroke. The only established clinical parameter to assess AAAs is based on the aneurysm size. Novel biomarkers are needed to improve the assessment of the risk of rupture. ADAMTS4 (A Disintegrin And Metalloproteinase with ThromboSpondin motifs 4) is a strongly upregulated proteoglycan cleaving enzyme in the unstable course of AAAs. In the screening of a one-bead-one-compound library against ADAMTS4, a low-molecular-weight cyclic peptide is discovered with favorable properties for in vivo molecular magnetic resonance imaging applications. After identification and characterization, it's potential is evaluated in an AAA mouse model. The ADAMTS4-specific probe enables the in vivo imaging-based prediction of aneurysm expansion and rupture.
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Affiliation(s)
- Jan O Kaufmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Humboldt-Universität zu Berlin, Department of Chemistry, Brook-Taylor-Str. 2, 12489, Berlin, Germany
- Federal Institute for Materials Research and Testing (BAM), Division 1.5 Protein Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Julia Brangsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin, Königsweg 67, Building 21, 14163, Berlin, Germany
| | - Avan Kader
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Biology, Freie Universität Berlin, Königin-Luise-Str. 1-3, 14195, Berlin, Germany
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Jessica Saatz
- Federal Institute for Materials Research and Testing (BAM), Division 1.1 Inorganic Trace Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Dilyana B Mangarova
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Str. 15, Building 12, 14163, Berlin, Germany
| | - Martin Zacharias
- Center of Functional Protein Assemblies, Technische Universität München (TUM), Ernst-Otto-Fischer-Str. 9, 85748, Garching, Germany
| | - Wolfgang E Kempf
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München (TUM), 81675, Munich, Germany
| | - Timm Schwaar
- Federal Institute for Materials Research and Testing (BAM), Division 1.0 SAFIA Technologies, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Marco Ponader
- Federal Institute for Materials Research and Testing (BAM), Division 1.5 Protein Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Lisa C Adams
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jana Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Rene M Botnar
- King's College London, School of Biomedical Engineering and Imaging Sciences, London, UK
- Wellcome Trust / EPSRC Centre for Medical Engineering, King's College London, London, UK
- BHF Centre of Excellence, King's College London, London, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute in Intelligent Healthcare Engineering, Santiago de Chile, Campus San Joaquín - Avda.Vicuña Mackenna, 4860, Macul, Santiago, Chile
- St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK
- Denmark Hill Campus, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Matthias Taupitz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lars Mägdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München (TUM), 81675, Munich, Germany
| | - Heike Traub
- Federal Institute for Materials Research and Testing (BAM), Division 1.1 Inorganic Trace Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael G Weller
- Federal Institute for Materials Research and Testing (BAM), Division 1.5 Protein Analysis, Richard-Willstätter-Str. 11, 12489, Berlin, Germany
| | - Marcus R Makowski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Radiology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
- King's College London, School of Biomedical Engineering and Imaging Sciences, London, UK.
- St Thomas' Hospital Westminster Bridge Road, London, SE1 7EH, UK.
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Abstract
Abdominal aortic aneurysms (AAA) are prevalent among older adults and can cause significant morbidity and mortality if not addressed in a timely fashion. Their etiology remains the topic of continued investigation. Known causes include trauma, infection, and inflammatory disorders. Risk factors include cigarette smoking, advanced age, dyslipidemia, hypertension, and coronary artery disease. The pathophysiology of the disease is related to an initial arterial insult causing a cascade of inflammation and extracellular matrix protein breakdown by proteinases leading to arterial wall weakening. When identified early, aneurysms must be monitored for size, growth rate, and other factors which could increase the risk of rupture. Factors predisposing to rupture include size, active smoking, rate of growth, aberrant biomechanical properties of the aneurysmal sac, and female sex. Medical management includes the control of risk factors that may prevent growth, stabilize the aneurysm, and prevent rupture. Surgical management prevents rupture of high risk aneurysms, most commonly predicted by size. Less frequently, surgical management is required when the aneurysm has ruptured. Surgery involves a multidisciplinary approach to evaluate the patient's risk profile and to develop an operative plan involving either an endovascular or an open surgical repair. The patient must be carefully monitored post-operatively for complications and, in the case of endovascular repairs, for endoleaks. AAA management has evolved rapidly in recent years. Technical and technological advances have transformed the diagnosis and treatment of this disease.
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Affiliation(s)
- John Anagnostakos
- Center for Vascular Research, University of Maryland, United States of America
| | - Brajesh K Lal
- Center for Vascular Research, University of Maryland, United States of America; University of Maryland, United States of America; Endovascular Surgery, University of Maryland Medical Center, United States of America; Baltimore VA Medical Center, United States of America.
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9
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Liu Y, Wang X, Wang H, Hu T. Identification of key genes and pathways in abdominal aortic aneurysm by integrated bioinformatics analysis. J Int Med Res 2019; 48:300060519894437. [PMID: 31885343 PMCID: PMC7783286 DOI: 10.1177/0300060519894437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives To identify key genes associated with abdominal aortic aneurysm (AAA) by
integrating a microarray profile and a single-cell RNA-seq dataset. Methods The microarray profile of GSE7084 and the single-cell RNA-seq dataset were
obtained from the Gene Express Omnibus database. Differentially expressed
genes (DEGs) were chosen using the R package and annotated by Gene Ontology
and Kyoto Encyclopedia of Genes and Genomics analysis. The hub genes were
identified based on their degrees of interaction in the protein-protein
interaction (PPI) network. Expression of hub genes was determined using
single-cell RNA-seq analysis. Results In total, 507 upregulated and 842 downregulated DEGs were identified and
associated with AAA. The upregulated DEGs were enriched into 9 biological
processes and 10 biological pathways, which were closely involved in the
pathogenesis and progression of AAA. Based on the PPI network, we focused on
six hub genes, four of which were novel target genes compared with the known
aneurysm gene database. Using single-cell RNA-seq analysis, we explored the
four genes expressed in vascular cells of AAA: CANX,
CD44, DAXX, and
STAT1. Conclusions We identified key genes that may provide insight into the mechanism of AAA
pathogenesis and progression and that have potential to be therapeutic
targets.
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Affiliation(s)
- Yihai Liu
- Department of Cardiology, The
Affiliated Huaian No. 1 People’s Hospital of
Nanjing
Medical University, Huaian, China
| | - Xixi Wang
- Department of Neurology, Affiliated
Shanghai First People’s Hospital of
Nanjing
Medical University, Nanjing, China
| | - Hongye Wang
- Department of Cardiology, The
Affiliated Huaian No. 1 People’s Hospital of
Nanjing
Medical University, Huaian, China
| | - Tingting Hu
- Department of Cardiology, The
Affiliated Huaian No. 1 People’s Hospital of
Nanjing
Medical University, Huaian, China
- Tingting Hu, Department of Cardiology, the
Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Beijing
West Road 6, Huaian 223001, China.
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10
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Abstract
Aortic aneurysms are a common vascular disease in Western populations that can involve virtually any portion of the aorta. Abdominal aortic aneurysms are much more common than thoracic aortic aneurysms and combined they account for >25 000 deaths in the United States annually. Although thoracic and abdominal aortic aneurysms share some common characteristics, including the gross anatomic appearance, alterations in extracellular matrix, and loss of smooth muscle cells, they are distinct diseases. In recent years, advances in genetic analysis, robust molecular tools, and increased availability of animal models have greatly enhanced our knowledge of the pathophysiology of aortic aneurysms. This review examines the various proposed cellular mechanisms responsible for aortic aneurysm formation and identifies opportunities for future studies.
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Affiliation(s)
- Raymundo Alain Quintana
- From the Division of Cardiology, Department of Medicine (R.A.Q., W.R.T.), Emory University School of Medicine, Atlanta, GA
| | - W Robert Taylor
- From the Division of Cardiology, Department of Medicine (R.A.Q., W.R.T.), Emory University School of Medicine, Atlanta, GA.,Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology (W.R.T.), Emory University School of Medicine, Atlanta, GA.,Division of Cardiology, Atlanta VA Medical Center, Decatur, GA (W.R.T.)
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11
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Qiu Y, Yuan D, Wang Y, Wen J, Zheng T. Hemodynamic investigation of a patient-specific abdominal aortic aneurysm with iliac artery tortuosity. Comput Methods Biomech Biomed Engin 2018; 21:824-833. [PMID: 30398069 DOI: 10.1080/10255842.2018.1522531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Wang
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Jun Wen
- School of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
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12
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La diabetes mellitus como factor protector del aneurisma de aorta abdominal: posibles mecanismos. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 30:181-187. [DOI: 10.1016/j.arteri.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/18/2018] [Indexed: 11/22/2022]
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13
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Botnar RM, Brangsch J, Reimann C, Janssen CHP, Razavi R, Hamm B, Makowski MR. In Vivo Molecular Characterization of Abdominal Aortic Aneurysms Using Fibrin-Specific Magnetic Resonance Imaging. J Am Heart Assoc 2018; 7:e007909. [PMID: 29848500 PMCID: PMC6015382 DOI: 10.1161/jaha.117.007909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/24/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The incidence of abdominal aortic aneurysms (AAAs) will significantly increase during the next decade. Novel biomarkers, besides diameter, are needed for a better characterization of aneurysms and the estimation of the risk of rupture. Fibrin is a key protein in the formation of focal hematoma associated with the dissection of the aortic wall and the development of larger thrombi during the progression of AAAs. This study evaluated the potential of a fibrin-specific magnetic resonance (MR) probe for the in vivo characterization of the different stages of AAAs. METHODS AND RESULTS AAAs spontaneously developed in ApoE-/- mice following the infusion of angiotensin-II (Ang-II, 1 μg/kg-1·per minute). An established fibrin-specific molecular MR probe (EP2104R, 10 μmol/kg-1) was administered after 1 to 4 weeks following Ang-II infusion (n=8 per group). All imaging experiments were performed on a clinical 3T Achieva MR system with a microscopy coil (Philips Healthcare, Netherlands). The development of AAA-associated fibrin-rich hematoma and thrombi was assessed. The high signal generated by the fibrin probe enabled high-resolution MR imaging for an accurate assessment and quantification of the relative fibrin composition of focal hematoma and thrombi. Contrast-to-noise-ratios (CNRs) and R1-relaxation rates following the administration of the fibrin probe were in good agreement with ex vivo immunohistomorphometry (R2=0.83 and 0.85) and gadolinium concentrations determined by inductively coupled plasma mass spectroscopy (R2=0.78 and 0.72). CONCLUSIONS The fibrin-specific molecular MR probe allowed the delineation and quantification of changes in fibrin content in early and advanced AAAs. Fibrin MRI could provide a novel in vivo biomarker to improve the risk stratification of patients with aortic aneurysms.
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MESH Headings
- Angiotensin II
- Animals
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/chemically induced
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Abdominal/metabolism
- Disease Models, Animal
- Fibrin/metabolism
- Magnetic Resonance Imaging
- Male
- Mice, Inbred C57BL
- Mice, Knockout, ApoE
- Molecular Imaging/methods
- Predictive Value of Tests
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Affiliation(s)
- René M Botnar
- Division of Imaging Sciences, King's College London, London, United Kingdom
- BHF Centre of Excellence, King's College London, London, United Kingdom
- Wellcome Trust and EPSRC Medical Engineering Center, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre, King's College London, London, United Kingdom
| | | | | | | | - Reza Razavi
- Division of Imaging Sciences, King's College London, London, United Kingdom
- BHF Centre of Excellence, King's College London, London, United Kingdom
- Wellcome Trust and EPSRC Medical Engineering Center, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre, King's College London, London, United Kingdom
| | - Bernd Hamm
- Department of Radiology, Charite, Berlin, Germany
| | - Marcus R Makowski
- Division of Imaging Sciences, King's College London, London, United Kingdom
- Department of Radiology, Charite, Berlin, Germany
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14
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Spinosa M, Lu G, Su G, Bontha SV, Gehrau R, Salmon MD, Smith JR, Weiss ML, Mas VR, Upchurch GR, Sharma AK. Human mesenchymal stromal cell-derived extracellular vesicles attenuate aortic aneurysm formation and macrophage activation via microRNA-147. FASEB J 2018; 32:fj201701138RR. [PMID: 29812968 PMCID: PMC6181641 DOI: 10.1096/fj.201701138rr] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/07/2018] [Indexed: 12/14/2022]
Abstract
The formation of an abdominal aortic aneurysm (AAA) is characterized by inflammation, macrophage infiltration, and vascular remodeling. In this study, we tested the hypothesis that mesenchymal stromal cell (MSC)-derived extracellular vesicles (EVs) immunomodulate aortic inflammation, to mitigate AAA formation via modulation of microRNA-147. An elastase-treatment model of AAA was used in male C57BL/6 wild-type (WT) mice. Administration of EVs in elastase-treated WT mice caused a significant attenuation of aortic diameter and mitigated proinflammatory cytokines, inflammatory cell infiltration, an increase in smooth muscle cell α-actin expression, and a decrease in elastic fiber disruption, compared with untreated mice. A 10-fold up-regulation of microRNA (miR)-147, a key mediator of macrophage inflammatory responses, was observed in murine aortic tissue in elastase-treated mice compared with controls on d 14. EVs derived from MSCs transfected with miR-147 mimic, but not with miR-147 inhibitor, attenuated aortic diameter, inflammation, and leukocyte infiltration in elastase-treated mice. In vitro studies of human aortic tissue explants and murine-derived CD11b+ macrophages induced proinflammatory cytokines after elastase treatment, and the expression was attenuated by cocultures with EVs transfected with miR-147 mimic, but not with miR-147 inhibitor. Thus, our findings define a critical role of MSC-derived EVs in attenuation of aortic inflammation and macrophage activation via miR-147 during AAA formation.-Spinosa, M., Lu, G., Su, G., Bontha, S. V., Gehrau, R., Salmon, M. D., Smith, J. R., Weiss, M. L., Mas, V. R., Upchurch, G. R., Sharma, A. K. Human mesenchymal stromal cell-derived extracellular vesicles attenuate aortic aneurysm formation and macrophage activation via microRNA-147.
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Affiliation(s)
- Michael Spinosa
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Guanyi Lu
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Gang Su
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sai Vineela Bontha
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ricardo Gehrau
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Morgan D. Salmon
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joseph R. Smith
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas, USA
| | - Mark L. Weiss
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas, USA
| | - Valeria R. Mas
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Gilbert R. Upchurch
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ashish K. Sharma
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
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15
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Nordkvist S, Sonestedt E, Acosta S. Adherence to diet recommendations and risk of abdominal aortic aneurysm in the Malmö Diet and Cancer Study. Sci Rep 2018; 8:2017. [PMID: 29386636 PMCID: PMC5792541 DOI: 10.1038/s41598-018-20415-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/17/2018] [Indexed: 12/14/2022] Open
Abstract
The research examining the association between quality of diet and abdominal aortic aneurysm (AAA) is scarce. The aim of the present study was to explore the association between diet quality and development of AAA for middle-aged individuals in the Malmö Diet and Cancer Study (MDCS), a prospective cohort study with baseline data collection carried out between 1991 and 1996. At baseline, the study participants who were eligible for this study (n = 26133) documented their dietary habits in a food diary and questionnaire. Incident AAA cases during an average of 20.7 years of follow-up were identified by using registers. A diet quality index consisting of six components, saturated fat, polyunsaturated fat, fibre, sucrose, fruits and vegetables and fish and shellfish, was used to assess the diet quality. After adjusting for potential confounders, the diet quality index was not associated with incident AAA. However, a tendency of decreased risk was observed among individuals adhering to recommendations for fruit and vegetables compared with non-adherence. When comparing the risk of more extreme intake groups, high intakes of both fruits and vegetables were associated with decreased risk.
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Affiliation(s)
- Sara Nordkvist
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Emily Sonestedt
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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16
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Acosta S, Gottsäter A, Engström G, Melander O, Zarrouk M, Nilsson PM, Smith JG. B-type natriuretic peptide for prediction of incident clinically significant abdominal aortic aneurysm: A population-based prospective study. Vasc Med 2018; 23:46-51. [DOI: 10.1177/1358863x17745150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pathogenesis of abdominal aortic aneurysm (AAA) is unclear. The aim of this study was to evaluate inflammatory and hemodynamic plasma biomarkers as predictors for AAA in the prospective longitudinal cohort of middle-aged individuals from the cardiovascular cohort of the Malmö Diet and Cancer Study ( n=5551; 1991–94). C-reactive protein, cystatin C, copeptin, N-terminal pro-B-type natriuretic peptide (N-BNP), midregional pro-atrial natriuretic peptide (MR-proANP) and conventional risk factors at baseline were measured in patients with incident AAA during follow-up and compared to individuals without a diagnosis of AAA. Subjects were followed until 31 December 2013. Multivariable analyses were expressed in terms of hazard ratios (HR) per 1 standard deviation increment of each respective log-transformed plasma biomarker in the Cox proportional hazard models. Mean follow-up time was 20.7 years. Cumulative incidence of AAA was 1.5% (men 2.9%, women 0.5%). Mean age of individuals with incident AAA was 59.7 years at study entry and AAA was diagnosed on average 14 years later. Adjusting for age, sex, smoking, body mass index, hypertension and diabetes mellitus, N-BNP (HR 1.29; 95% CI 1.03–1.62), but not MR-proANP (HR 1.20; 95% CI 0.95–1.50), was independently associated with incident AAA. In conclusion, the plasma biomarker N-BNP was associated with future development of AAA, which implies that this marker is a sensitive indicator of early subclinical cardiovascular disease.
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Affiliation(s)
- Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Moncef Zarrouk
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - J Gustav Smith
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Cardiology and Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
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17
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Qiu Y, Yuan D, Wen J, Fan Y, Zheng T. Numerical identification of the rupture locations in patient-specific abdominal aortic aneurysmsusing hemodynamic parameters. Comput Methods Biomech Biomed Engin 2017; 21:1-12. [PMID: 29251991 DOI: 10.1080/10255842.2017.1410796] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The rupture of an abdominal aortic aneurysm (AAA) is generally an unexpected event. Up to now, there is no agreement on an accurate criteria to predict the rupture risk of AAAs. This paper aims to numerically investigate the hemodynamics of three ruptured and one non-ruptured patient-specific AAA models to correlate local hemodynamic parameters with the rupture sites, and for the first time, this study introduced helicity as a potential index for the rupture potential of AAAs.3D reconstructions from CT scans were done. The simulation revealed that all the rupture sites were in regions of stagnation with near zero wall shear stress (WSS) but large WSS gradient (WSSG), which may explain the observation by the former researchers that the rupture site in the ruptured AAA has the lowest recorded wall thickness compared to other non-ruptured regions. Moreover, all the ruptures occurred at regions of zero helicity which represents a purely axial or circumferential flow. In addition, this study revealed that the double low region for the non-ruptured AAA was present with a thick layer of plaques, it suggests that the AAA rupture and the formation of atherosclerotic plaques may share a lot common physiological features. However, the fact that there are no plaques present in the walls of three RAAAs also indicates that AAA is not always a result of atherosclerosis. The current computational study may complement the maximum diameter, peak wall stress and other clinically relevant factors in AAA ruptures to identify the rupture sites of AAAs.
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Affiliation(s)
- Yue Qiu
- a Department of Applied Mechanics , Sichuan University , Chengdu , China
| | - Ding Yuan
- b Department Vascular Surgery of West China Hospital , Sichuan University , Chengdu , China
| | - Jun Wen
- c School of Civil Engineering and Architecture , Southwest University of Science and Technology , Mianyang , China
| | - Yubo Fan
- d Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering , Beihang University , Beijing , P.R. China
| | - Tinghui Zheng
- a Department of Applied Mechanics , Sichuan University , Chengdu , China
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18
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Boese AC, Kim SC, Yin KJ, Lee JP, Hamblin MH. Sex differences in vascular physiology and pathophysiology: estrogen and androgen signaling in health and disease. Am J Physiol Heart Circ Physiol 2017. [PMID: 28626075 DOI: 10.1152/ajpheart.00217.2016] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sex differences between women and men are often overlooked and underappreciated when studying the cardiovascular system. It has been long assumed that men and women are physiologically similar, and this notion has resulted in women being clinically evaluated and treated for cardiovascular pathophysiological complications as men. Currently, there is increased recognition of fundamental sex differences in cardiovascular function, anatomy, cell signaling, and pathophysiology. The National Institutes of Health have enacted guidelines expressly to gain knowledge about ways the sexes differ in both normal function and diseases at the various research levels (molecular, cellular, tissue, and organ system). Greater understanding of these sex differences will be used to steer future directions in the biomedical sciences and translational and clinical research. This review describes sex-based differences in the physiology and pathophysiology of the vasculature, with a special emphasis on sex steroid receptor (estrogen and androgen receptor) signaling and their potential impact on vascular function in health and diseases (e.g., atherosclerosis, hypertension, peripheral artery disease, abdominal aortic aneurysms, cerebral aneurysms, and stroke).
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Affiliation(s)
- Austin C Boese
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Seong C Kim
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ke-Jie Yin
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jean-Pyo Lee
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana; and.,Center for Stem Cell Research and Regenerative Medicine, New Orleans, Louisiana
| | - Milton H Hamblin
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana;
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19
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Hori D, Akiyoshi K, Yuri K, Nishi S, Nonaka T, Yamamoto T, Imamura Y, Matsumoto H, Kimura N, Yamaguchi A. Effect of endoskeleton stent graft design on pulse wave velocity in patients undergoing endovascular repair of the aortic arch. Gen Thorac Cardiovasc Surg 2017; 65:506-511. [PMID: 28597335 DOI: 10.1007/s11748-017-0787-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/29/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Pulse wave velocity (PWV), which measures vascular stiffness, is a powerful predictor of cardiovascular event. Treatment of aneurysms with endovascular prosthesis has been reported to increase PWV. The purpose of this study was to evaluate whether an endoskeleton stent graft design has less effect on PWV than the exoskeleton stent graft design. METHODS Between July 2008 and September 2016, 74 patients underwent endovascular treatment of aortic arch aneurysm in our institution. PWV before and after surgery were compared between those who underwent treatment with Najuta, an endoskeleton stent graft (n = 51), and those treated with other commercially available exoskeleton stent grafts (n = 23). RESULTS Preoperative PWV (endoskeleton: 2004 ± 379.2 cm/s vs. exoskeleton: 2083 ± 454.5 cm/s, p = 0.47) was similar between the two groups. Factors that were associated with preoperative PWV were age (r = 0.37, 95% CI 0.15-0.56, p = 0.002) and mean arterial pressure (r = 0.53, 95% CI 0.34-0.68, p < 0.001). There was a significant increase in PWV in patients treated by exoskeleton stent grafts (before: 2083 ± 454.5 cm/s vs. after: 2305 ± 479.7 cm/s, p = 0.023) while endoskeleton stent graft showed no change in PWV (before: 2003 ± 379.2 vs. after: 2010 ± 521.1, p = 0.56). In a multivariate analysis, mean arterial pressure (coef 17.5, 95% CI 6.48-28.59, p = 0.002) and exoskeleton stent graft (coef 359.4, 95% CI 89.36-629.43, p = 0.010) were independently associated with PWV after surgery. CONCLUSIONS Physiological changes after endovascular treatment should be considered including effect on vascular stiffness. Endoskeleton stent graft may provide aneurysm repair with minimum effect in PWV after surgery.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Kei Akiyoshi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Takao Nonaka
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Takahiro Yamamoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yusuke Imamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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20
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Jansen CHP, Reimann C, Brangsch J, Botnar RM, Makowski MR. In vivo MR-angiography for the assessment of aortic aneurysms in an experimental mouse model on a clinical MRI scanner: Comparison with high-frequency ultrasound and histology. PLoS One 2017; 12:e0178682. [PMID: 28582441 PMCID: PMC5459432 DOI: 10.1371/journal.pone.0178682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND MR-angiography currently represents one of the clinical reference-standards for the assessment of aortic-dimensions. For experimental research in mice, dedicated preclinical high-field MRI scanners are used in most studies. This type of MRI scanner is not available in most institutions. The aim of this study was to evaluate the potential of MR-angiography performed on a clinical MR scanner for the assessment of aortic aneurysms in an experimental mouse model, compared to a preclinical high-resolution ultrasound imaging system and histopathology. METHODS All in vivo MR imaging was performed with a clinical 3T MRI system (Philips Achieva) equipped with a clinical gradient system in combination with a single-loop surface-coil (47 mm). All MR sequences were based on clinically used sequences. For ultrasound, a dedicated preclinical high-resolution system (30 MHz linear transducer, Vevo770, VisualSonics) was used. All imaging was performed with an ApoE knockout mouse-model for aortic aneurysms. Histopathology was performed as reference-standard at all stages of aneurysm development. RESULTS MR-angiography on a clinical 3T system enabled the clear visualization of the aortic lumen and aneurysmal dilation at different stages of aneurysm development. A close correlation (R2 = 0.98; p < 0.001) with histological area measurements was found. Additionally, a good agreement between MR and ultrasound area measurements in systole (R2 = 0.91; p < 0.001) and diastole (R2 = 0.94; p < 0.001) were measured. Regarding interobserver reproducibility, MRI measurements yielded a smaller 95% confidence interval and a closer interreader correlation compared to ultrasound measurements (-0.37-0.46; R2 = 0.97 vs. -0.78-0.88; R2 = 0.87). CONCLUSION This study demonstrates that MR-angiography, performed on a clinical 3T MR scanner, enables the reliable detection and quantification of the aortic dilatation at different stages of aneurysm development in an experimental mouse model.
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Affiliation(s)
- Christian H. P. Jansen
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | | | | | - René M. Botnar
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
- BHF Centre of Excellence, King’s College London, London, United Kingdom
- Wellcome Trust and EPSRC Medical Engineering Center, King’s College London, London, United Kingdom
- NIHR Biomedical Research Centre, King’s College London, London, United Kingdom
- School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Marcus R. Makowski
- King’s College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
- Department of Radiology, Charite, Berlin, Germany
- BHF Centre of Excellence, King’s College London, London, United Kingdom
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21
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Li G, Qin L, Wang L, Li X, Caulk AW, Zhang J, Chen PY, Xin S. Inhibition of the mTOR pathway in abdominal aortic aneurysm: implications of smooth muscle cell contractile phenotype, inflammation, and aneurysm expansion. Am J Physiol Heart Circ Physiol 2017; 312:H1110-H1119. [PMID: 28213405 DOI: 10.1152/ajpheart.00677.2016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 12/18/2022]
Abstract
The development of effective pharmacological treatment of abdominal aortic aneurysm (AAA) potentially offers great benefit to patients with preaneurysmal aortic dilation by slowing the expansion of aneurysms and reducing the need for surgery. To date, therapeutic targets for slowing aortic dilation have had low efficacy. Thus, in this study, we aim to elucidate possible mechanisms driving aneurysm progression to identify potential targets for pharmacological intervention. We demonstrate that mechanistic target of rapamycin (mTOR) signaling is overactivated in aortic smooth muscle cells (SMCs), which contributes to murine AAA. Rapamycin, a typical mTOR pathway inhibitor, dramatically limits the expansion of the abdominal aorta following intraluminal elastase perfusion. Furthermore, reduction of aortic diameter is achieved by inhibition of the mTOR pathway, which preserves and/or restores the contractile phenotype of SMCs and downregulates macrophage infiltration, matrix metalloproteinase expression, and inflammatory cytokine production. Taken together, these results highlight the important role of the mTOR cascade in aneurysm progression and the potential application of rapamycin as a therapeutic candidate for AAA. NEW & NOTEWORTHY This study provides novel observations that mechanistic target of rapamycin (mTOR) signaling is overactivated in aortic smooth muscle cells and contributes to mouse abdominal aortic aneurysm (AAA) and that rapamycin protects against aneurysm development. Our data highlight the importance of preservation and/or restoration of the smooth muscle cell contractile phenotype and reduction of inflammation by mTOR inhibition in AAA.
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Affiliation(s)
- Guangxin Li
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Lingfeng Qin
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Lei Wang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xuan Li
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Alexander W. Caulk
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut; and
| | - Jian Zhang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Pei-Yu Chen
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut
| | - Shijie Xin
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
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22
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Maras D, Kontopodis N, Dedes A, Tsanis A, Mazarakis I, Gekas C, Ioannou CV. Selective Spleen Embolization of Splenomegaly to Improve Thrombocytopenia Facilitating Open Aortic Aneurysm Repair: A Staged Approach. Vasc Endovascular Surg 2016; 50:438-42. [PMID: 27581226 DOI: 10.1177/1538574416666222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present an 82-year-old man with a history of hairy cell leukemia, having an 11-cm abdominal aortic aneurysm, who also had severe thrombocytopenia (about 20 000 platelets/μL) and splenomegaly at presentation. The patient had unfavorable anatomy for endovascular aneurysm repair, and therefore, an open procedure was planned. To reduce risk for perioperative bleeding and optimize patient preoperative status, a staged approach was employed. Initially, several sessions of embolization of 2 splenic artery branches were performed with the intent to decrease spleen size and to increase platelet count thus decreasing the perioperative bleeding risk. Then, after successfully increasing platelet count (280 000 PLT/μL), open repair of the aneurysm was conducted. This case demonstrates that selective splenic embolization in patients with hypersplenism and subsequent thrombocytopenia who are in need for major surgery may achieve a significant rise in platelet count and optimize patient's preoperative status in order to avoid bleeding complications.
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Affiliation(s)
- Dimitrios Maras
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
| | - Nikolaos Kontopodis
- Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University of Crete Medical School, Heraklion, Crete, Greece
| | - Athansios Dedes
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
| | - Antonios Tsanis
- Department of Radiology, Interventional Radiology Unit, Red Cross Hospital, Athens, Greece
| | | | - Christos Gekas
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
| | - Christos V Ioannou
- Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University of Crete Medical School, Heraklion, Crete, Greece
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Li H, Lin K, Shahmirzadi D. FSI Simulations of Pulse Wave Propagation in Human Abdominal Aortic Aneurysm: The Effects of Sac Geometry and Stiffness. Biomed Eng Comput Biol 2016; 7:25-36. [PMID: 27478394 PMCID: PMC4951115 DOI: 10.4137/becb.s40094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 11/21/2022] Open
Abstract
This study aims to quantify the effects of geometry and stiffness of aneurysms on the pulse wave velocity (PWV) and propagation in fluid–solid interaction (FSI) simulations of arterial pulsatile flow. Spatiotemporal maps of both the wall displacement and fluid velocity were generated in order to obtain the pulse wave propagation through fluid and solid media, and to examine the interactions between the two waves. The results indicate that the presence of abdominal aortic aneurysm (AAA) sac and variations in the sac modulus affect the propagation of the pulse waves both qualitatively (eg, patterns of change of forward and reflective waves) and quantitatively (eg, decreasing of PWV within the sac and its increase beyond the sac as the sac stiffness increases). The sac region is particularly identified on the spatiotemporal maps with a region of disruption in the wave propagation with multiple short-traveling forward/reflected waves, which is caused by the change in boundary conditions within the saccular region. The change in sac stiffness, however, is more pronounced on the wall displacement spatiotemporal maps compared to those of fluid velocity. We conclude that the existence of the sac can be identified based on the solid and fluid pulse waves, while the sac properties can also be estimated. This study demonstrates the initial findings in numerical simulations of FSI dynamics during arterial pulsations that can be used as reference for experimental and in vivo studies. Future studies are needed to demonstrate the feasibility of the method in identifying very mild sacs, which cannot be detected from medical imaging, where the material property degradation exists under early disease initiation.
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Affiliation(s)
- Han Li
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Kexin Lin
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Danial Shahmirzadi
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
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24
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Sharma AK, Salmon MD, Lu G, Su G, Pope NH, Smith JR, Weiss ML, Upchurch GR. Mesenchymal Stem Cells Attenuate NADPH Oxidase-Dependent High Mobility Group Box 1 Production and Inhibit Abdominal Aortic Aneurysms. Arterioscler Thromb Vasc Biol 2016; 36:908-18. [PMID: 26988591 DOI: 10.1161/atvbaha.116.307373] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/23/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) formation is characterized by inflammation, smooth muscle activation, and matrix degradation. This study tests the hypothesis that macrophage-produced high mobility group box 1 (HMGB1) production is dependent on nicotinamide adenine dinucleotide phosphate oxidase (Nox2), which leads to increase in interleukin (IL)-17 production resulting in AAA formation and that treatment with human mesenchymal stem cells (MSCs) can attenuate this process thereby inhibiting AAA formation. APPROACH AND RESULTS Human aortic tissue demonstrated a significant increase in HMGB1 expression in AAA patients when compared with controls. An elastase-perfusion model of AAA demonstrated a significant increase in HMGB1 production in C57BL/6 (wild-type [WT]) mice, which was attenuated by MSC treatment. Furthermore, anti-HMGB1 antibody treatment of WT mice attenuated AAA formation, IL-17 production, and immune cell infiltration when compared with elastase-perfused WT mice on day 14. Elastase-perfused Nox2(-/y) mice demonstrated a significant attenuation of HMGB1 and IL-17 production, cellular infiltration, matrix metalloproteinase activity, and AAA formation when compared with WT mice on day 14. In vitro studies showed that elastase-treated macrophages from WT mice, but not from Nox2(-/y) mice, produced HMGB1, which was attenuated by MSC treatment. The production of macrophage-dependent HMGB1 involved Nox2 activation and superoxide anion production, which was mitigated by MSC treatment. CONCLUSIONS These results demonstrate that macrophage-produced HMGB1 leads to aortic inflammation and acts as a trigger for CD4(+) T-cell-produced IL-17 during AAA formation. HMGB1 release is dependent on Nox2 activation, which can be inhibited by MSCs leading to attenuation of proinflammatory cytokines, especially IL-17, and protection against AAA formation.
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Affiliation(s)
- Ashish K Sharma
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Morgan D Salmon
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Guanyi Lu
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Gang Su
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Nicolas H Pope
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Joseph R Smith
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Mark L Weiss
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.)
| | - Gilbert R Upchurch
- From the Department of Surgery, University of Virginia, Charlottesville (A.K.S., M.D.S., G.L., G.S., N.H.P., G.R.U.); and Department of Anatomy and Physiology, Kansas State University, Manhattan (J.R.S., M.L.W.).
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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Kontopodis N, Lioudaki S, Pantidis D, Papadopoulos G, Georgakarakos E, Ioannou CV. Advances in determining abdominal aortic aneurysm size and growth. World J Radiol 2016; 8:148-158. [PMID: 26981224 PMCID: PMC4770177 DOI: 10.4329/wjr.v8.i2.148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/06/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Abdominal aortic aneurysm is a common pathology in the aging population of the developed world which carries a significant mortality in excess of 80% in case of rupture. Aneurysmal disease probably represents the only surgical condition in which size is such a critical determinant of the need for intervention and therefore the ability to accurately and reproducibly record aneurysm size and growth over time is of outmost importance. In the same time that imaging techniques may be limited by intra- and inter-observer variability and there may be inconsistencies due to different modalities [ultrasound, computed tomography (CT)], rapid technologic advancement have taken aortic imaging to the next level. Digital imaging, multi-detector scanners, thin slice CT and most- importantly the ability to perform 3-dimensional reconstruction and image post-processing have currently become widely available rendering most of the imaging modalities used in the past out of date. The aim of the current article is to report on various imaging methods and current state of the art techniques used to record aneurysm size and growth. Moreover we aim to emphasize on the future research directions and report on techniques which probably will be widely used and incorporated in clinical practice in the near future.
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27
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Health-related quality-of-life outcomes after open versus endovascular abdominal aortic aneurysm repair. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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28
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Volokh KY. Cavitation instability as a trigger of aneurysm rupture. Biomech Model Mechanobiol 2015; 14:1071-9. [PMID: 25637515 DOI: 10.1007/s10237-015-0655-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/22/2015] [Indexed: 11/26/2022]
Abstract
Aneurysm formation and growth is accompanied by microstructural alterations in the arterial wall. Particularly, the loss of elastin may lead to tissue disintegration and appearance of voids or cavities at the micron scale. Unstable growth and coalescence of voids may be a predecessor and trigger for the onset of macroscopic cracks. In the present work, we analyze the instability of membrane (2D) and bulk (3D) voids under hydrostatic tension by using two experimentally calibrated constitutive models of abdominal aortic aneurysm enhanced with energy limiters. The limiters provide the saturation value for the strain energy, which indicates the maximum energy that can be stored and dissipated by an infinitesimal material volume. We find that the unstable growth of voids can start when the critical stress is considerably less than the aneurysm strength. Moreover, this critical stress may even approach the arterial wall stress in the physiological range. This finding suggests that cavitation instability can be a rational indicator of the aneurysm rupture.
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Affiliation(s)
- K Y Volokh
- Faculty of Civil and Environmental Engineering, Technion - I.I.T., Haifa, Israel,
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29
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Resultados del tratamiento quirúrgico de los aneurismas de aorta abdominal infrarrenal. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Tanweer O, Wilson TA, Metaxa E, Riina HA, Meng H. A comparative review of the hemodynamics and pathogenesis of cerebral and abdominal aortic aneurysms: lessons to learn from each other. J Cerebrovasc Endovasc Neurosurg 2014; 16:335-49. [PMID: 25599042 PMCID: PMC4296046 DOI: 10.7461/jcen.2014.16.4.335] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/13/2014] [Accepted: 10/29/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Cerebral aneurysms (CAs) and abdominal aortic aneurysms (AAAs) are degenerative vascular pathologies that manifest as abnormal dilations of the arterial wall. They arise with different morphologies in different types of blood vessels under different hemodynamic conditions. Although treated as different pathologies, we examine common pathways in their hemodynamic pathogenesis in order to elucidate mechanisms of formation. MATERIALS AND METHODS A systematic review of the literature was performed. Current concepts on pathogenesis and hemodynamics were collected and compared. RESULTS CAs arise as saccular dilations on the cerebral arteries of the circle of Willis under high blood flow, high wall shear stress (WSS), and high wall shear stress gradient (WSSG) conditions. AAAs arise as fusiform dilations on the infrarenal aorta under low blood flow, low, oscillating WSS, and high WSSG conditions. While at opposite ends of the WSS spectrum, they share high WSSG, a critical factor in arterial remodeling. This alone may not be enough to initiate aneurysm formation, but may ignite a cascade of downstream events that leads to aneurysm development. Despite differences in morphology and the structure, CAs and AAAs share many histopathological and biomechanical characteristics. Endothelial cell damage, loss of elastin, and smooth muscle cell loss are universal findings in CAs and AAAs. Increased matrix metalloproteinases and other proteinases, reactive oxygen species, and inflammation also contribute to the pathogenesis of both aneurysms. CONCLUSION Our review revealed similar pathways in seemingly different pathologies. We also highlight the need for cross-disciplinary studies to aid in finding similarities between pathologies.
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Affiliation(s)
- Omar Tanweer
- Department of Neurosurgery, New York University School of Medicine, NY, United States
| | - Taylor A Wilson
- Department of Neurosurgery, New York University School of Medicine, NY, United States
| | - Eleni Metaxa
- Foundation for Research and Technology - Hellas Institute of Applied and Computational Mathematics, Crete, Greece
| | - Howard A Riina
- Department of Neurosurgery, New York University School of Medicine, NY, United States
| | - Hui Meng
- Toshiba Stroke Research Center, University at Buffalo, NY, United States. ; Department of Mechanical and Aerospace Engineering, University at Buffalo, NY, United States. ; Department of Neurosurgery, University at Buffalo, NY, United States
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31
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Botnar RM, Wiethoff AJ, Ebersberger U, Lacerda S, Blume U, Warley A, Jansen CHP, Onthank DC, Cesati RR, Razavi R, Marber MS, Hamm B, Schaeffter T, Robinson SP, Makowski MR. In vivo assessment of aortic aneurysm wall integrity using elastin-specific molecular magnetic resonance imaging. Circ Cardiovasc Imaging 2014; 7:679-89. [PMID: 24871347 DOI: 10.1161/circimaging.113.001131] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of abdominal aortic aneurysms (AAAs) has increased during the last decades. However, there is still controversy about the management of medium-sized AAAs. Therefore, novel biomarkers, besides aneurysmal diameter, are needed to assess aortic wall integrity and risk of rupture. Elastin is the key protein for maintaining aortic wall tensile strength and stability. The progressive breakdown of structural proteins, in particular, medial elastin, is responsible for the inability of the aortic wall to withstand intraluminal hemodynamic forces. Here, we evaluate the usefulness of elastin-specific molecular MRI for the in vivo characterization of AAAs. METHODS AND RESULTS To induce AAAs, ApoE(-/-) mice were infused with angiotensin-II. An elastin-specific magnetic resonance molecular imaging agent (ESMA) was administered after 1, 2, 3, and 4 weeks of angiotensin-II infusion to assess elastin composition of the aorta (n=8 per group). The high signal provided by ESMA allowed for imaging with high spatial resolution, resulting in an accurate assessment of ruptured elastic laminae and the compensatory expression of elastic fibers. In vivo contrast-to-noise ratios and R1-relaxation rates after ESMA administration were in good agreement with ex vivo histomorphometry (Elastica van Gieson stain) and gadolinium concentrations determined by inductively coupled plasma mass spectroscopy. Electron microscopy confirmed colocalization of ESMA with elastic fibers. CONCLUSIONS Changes in elastin content could be readily delineated and quantified at different stages of AAAs by elastin-specific molecular magnetic resonance imaging. ESMA-MRI offers potential for the noninvasive detection of the aortic rupture site prior to dilation of the aorta and the subsequent in vivo monitoring of compensatory repair processes during the progression of AAAs.
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Affiliation(s)
- René M Botnar
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Andrea J Wiethoff
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Ullrich Ebersberger
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Sara Lacerda
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Ulrike Blume
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Alice Warley
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Christian H P Jansen
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - David C Onthank
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Richard R Cesati
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Reza Razavi
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Michael S Marber
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Bernd Hamm
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Tobias Schaeffter
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Simon P Robinson
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.)
| | - Marcus R Makowski
- From the Division of Imaging Sciences (R.M.B., A.J.W., S.L., U.B., C.H.P.J., R.R., T.S., M.R.M.), BHF Centre of Excellence (R.M.B., S.L., R.R., M.S.M., T.S., M.R.M.), Cardiovascular Division (M.S.M.), Centre for Ultrastructural Imaging (A.W.), Wellcome Trust and EPSRC Medical Engineering Center (R.M.B., S.L., R.R., T.S.), and NIHR Biomedical Research Centre (R.M.B., S.L., R.R., M.S.M., T.S.), King's College London, London, United Kingdom; Philips Healthcare, Guildford, United Kingdom (A.J.W.); Lantheus Medical Imaging, North Billerica, MA (D.C.O., R.R.C., S.P.R.); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany (U.E.); and Department of Radiology, Charite, Berlin, Germany (B.H., M.R.M.).
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Vu KN, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux MF, Thérasse E, Soulez G, Tang A. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging 2014; 5:281-93. [PMID: 24789068 PMCID: PMC4035490 DOI: 10.1007/s13244-014-0327-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) rupture has a high mortality rate. Although the diagnosis of a ruptured AAA is usually straightforward, detection of impending rupture signs can be more challenging. Early diagnosis of impending AAA rupture can be lifesaving. Furthermore, differentiating between impending and complete rupture has important repercussions on patient management and prognosis. The purpose of this article is to classify and illustrate the entire spectrum of AAA rupture signs and to review current treatment options for ruptured AAAs. METHODS Using medical illustrations supplemented with computed tomography (CT), this essay showcases the various signs of impending rupture and ruptured AAAs. Endovascular aneurysm repair (EVAR) and open surgical repair are also discussed as treatment options for ruptured AAAs. RESULTS CT imaging findings of ruptured AAAs can be categorised according to location: intramural, luminal, and extraluminal. Intramural signs generally indicate impending AAA rupture, whereas luminal and extraluminal signs imply complete rupture. EVAR has emerged as an alternative and possibly less morbid method to treat ruptured AAAs. CONCLUSIONS AAA rupture occurs at the end of a continuum of growth and wall weakening. This review describes the CT imaging findings that may help identify impending rupture prior to complete rupture. TEACHING POINTS • AAA rupture occurs at the end of a continuum of growth and wall weakening. • Intramural imaging findings indicate impending AAA rupture. • Luminal and extraluminal imaging findings imply complete AAA rupture. • Some imaging findings are not specific to AAA ruptures and can be seen in other pathologies. • EVAR has emerged as an alternative and possibly less morbid method of treating ruptured AAAs.
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Affiliation(s)
- Kim-Nhien Vu
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc, 1058 Saint-Denis, Montréal, Québec, Canada, H2X 3J4
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Kontopodis N, Metaxa E, Papaharilaou Y, Tavlas E, Tsetis D, Ioannou C. Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture. Vascular 2014; 23:65-77. [PMID: 24757027 DOI: 10.1177/1708538114532084] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.
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Affiliation(s)
- Nikolaos Kontopodis
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Eleni Metaxa
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Greece
| | - Yannis Papaharilaou
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Greece
| | - Emmanouil Tavlas
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Interventional Radiology, University of Crete Medical School, Heraklion, Greece
| | - Christos Ioannou
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
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Johnston WF, Salmon M, Su G, Lu G, Ailawadi G, Upchurch GR. Aromatase is required for female abdominal aortic aneurysm protection. J Vasc Surg 2014; 61:1565-74.e1-4. [PMID: 24582702 DOI: 10.1016/j.jvs.2014.01.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The protective effects of female gender on the development of abdominal aortic aneurysms (AAAs) have been attributed to anti-inflammatory effects of estrogen. Estrogen synthesis is dependent on the enzyme aromatase, which is located both centrally in the ovaries and peripherally in adipose tissue, bone, and vascular smooth muscle cells. It is hypothesized that deletion of aromatase in both ovarian and peripheral tissues would diminish the protective effect of female gender and would be associated with increased aortic diameter in female mice. METHODS Male and female 8- to 10-week-old mice with aromatase (wild type: WT) and without aromatase (ArKO) underwent elastase aortic perfusion with aortic harvest 14 days following. For the contribution of central and peripheral estrogen conversion to be evaluated, female WT mice were compared with female WT and ArKO mice that had undergone ovariectomy (ovx) at 6 weeks followed by elastase perfusion at 8 to 10 weeks. At aortic harvest, maximal aortic dilation was measured and samples were collected for immunohistochemistry and protein analysis. Serum was collected for serum estradiol concentrations. Groups were compared with analysis of variance. Human and mouse AAA cross sections were analyzed with confocal immunohistochemistry for aromatase, smooth muscle markers, and macrophage markers. RESULTS Female WT mice had significant reduction in aortic dilation compared with male WT mice (F WT, 51.5% ± 15.1% vs M WT, 78.7% ± 14.9%; P < .005). The protective effects of female gender were completely eliminated with deletion of aromatase (F ArKO, 82.6% ± 13.8%; P < .05 vs F WT). Ovariectomy increased aortic dilation in WT mice (F WT ovx, 70.6% ± 11.7%; P < .05 vs F WT). Aromatase deletion with ovariectomy further increased aortic dilation compared with WT ovx mice (F ArKO ovx, 87.3% ± 14.7%, P < .001 vs F WT and P < .05 vs F WT ovx). Accordingly, female ArKO ovx mice had significantly higher levels of the proinflammatory cytokines monocyte chemoattractant protein 1 and interleukin-1β and were associated with increased macrophage staining and decreased elastin staining. Regarding serum hormone levels, decreasing estradiol levels correlated with increasing aortic diameter (R = -0.565; P < .01). By confocal immunohistochemistry, both human and mouse AAA smooth muscle cells (smooth muscle α-actin positive) and macrophages (CD68 positive or Mac-2 positive) expressed aromatase. CONCLUSIONS The protective effect of female gender on AAAs is due to estrogen synthesis and requires the presence of both ovarian and extragonadal/peripheral aromatase. Peripheral estrogen synthesis accounts for roughly half of the protective effect of female gender. If peripheral aromatase could be targeted, high levels of local estrogen could be produced and may avoid the side effects of systemic estrogen.
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Affiliation(s)
- William F Johnston
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Morgan Salmon
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Gang Su
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Guanyi Lu
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va; Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Va
| | - Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va; Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Va; Department of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Va.
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Morphologic evaluation of ruptured and symptomatic abdominal aortic aneurysm by three-dimensional modeling. J Vasc Surg 2014; 59:894-902.e3. [PMID: 24439318 DOI: 10.1016/j.jvs.2013.10.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify geometric indices of abdominal aortic aneurysms (AAAs) on computed tomography that are associated with higher risk of rupture. METHODS This retrospective case-control, institutional review board-approved study involved 63 cases with ruptured or symptomatic AAA and 94 controls with asymptomatic AAA. Three-dimensional models were generated from computed tomography segmentation and used for the calculation of 27 geometric indices. On the basis of the results of univariate analysis and multivariable sequential logistic regression analyses with a forward stepwise model selection based on likelihood ratios, a traditional model based on gender and maximal diameter (Dmax) was compared with a model that also incorporated geometric indices while adjusting for gender and Dmax. Receiver operating characteristic (ROC) curves were calculated for these two models to evaluate their classification accuracy. RESULTS Univariate analysis revealed that gender (P = .024), Dmax (P = .001), and 14 other geometric indices were associated with AAA rupture at P < .05. In the multivariable analysis, adjusting for gender and Dmax, the AAA with a higher bulge location (P = .020) and lower mean averaged area (P = .005) were associated with AAA rupture. With these two geometric indices, the area under the ROC curve showed an improvement from 0.67 (95% confidence interval, 0.58-0.77) to 0.75 (95% confidence interval, 0.67-0.83; P < .001). Our predictive model showed comparable sensitivity (64% vs 60%) and specificity (79% vs 77%) with current treatment criteria based on gender and diameter at the point optimizing the Youden index (sensitivity + specificity - 1) on the ROC curve. CONCLUSIONS Two geometric indices derived from AAA three-dimensional modeling were independently associated with AAA rupture. The addition of these indices in a predictive model based on current treatment criteria modestly improved the accuracy to detect aneurysm rupture.
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Balakhovsky K, Jabareen M, Volokh KY. Modeling rupture of growing aneurysms. J Biomech 2013; 47:653-8. [PMID: 24359675 DOI: 10.1016/j.jbiomech.2013.11.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
Growth and rupture of aneurysms are driven by micro-structural alterations of the arterial wall yet precise mechanisms underlying the process remain to be uncovered. In the present work we examine a scenario when the aneurysm evolution is dominated by turnover of collagen fibers. In the latter case it is natural to hypothesize that rupture of individual fibers (or their bonds) causes the overall aneurysm rupture. We examine this hypothesis in computer simulations of growing aneurysms in which constitutive equations describe both collagen evolution and failure. Failure is enforced in constitutive equations by limiting strain energy that can be accumulated in a fiber. Within the proposed theoretical framework we find a range of parameters that lead to the aneurysm rupture. We conclude in a qualitative agreement with clinical observations that some aneurysms will rupture while others will not.
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Affiliation(s)
- K Balakhovsky
- Faculty of Civil and Environmental Engineering, Technion - I.I.T., Israel
| | - M Jabareen
- Faculty of Civil and Environmental Engineering, Technion - I.I.T., Israel
| | - K Y Volokh
- Faculty of Civil and Environmental Engineering, Technion - I.I.T., Israel; Department of Structural Engineering, Ben-Gurion University of the Negev, Israel.
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Lu G, Su G, Zhao Y, Johnston WF, Sherman NE, Rissman EF, Lau C, Ailawadi G, Upchurch GR. Dietary phytoestrogens inhibit experimental aneurysm formation in male mice. J Surg Res 2013; 188:326-38. [PMID: 24388399 DOI: 10.1016/j.jss.2013.11.1108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/11/2013] [Accepted: 11/21/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of these experiments was to test the hypothesis that dietary phytoestrogens would diminish experimental aortic aneurysm formation. MATERIALS AND METHODS Six-wk-old C57BL/6 mice were divided into groups, fed either a diet with minimal phytoestrogen content or a regular commercial rodent diet with high phytoestrogen content for 2 wk. At the age of 8 wk, aortic aneurysms were induced by infusing the isolated infrarenal abdominal aorta with 0.4% elastase for 5 min. Mice were recovered and the diameter of the infused aorta was measured at postoperative days 3, 7, and 14. Abdominal aorta samples were collected for histology, cytokine array, and gelatin zymography after aortic diameter measurement. Blood samples were also collected to determine serum phytoestrogens and estradiol levels. Multiple-group comparisons were done using an analysis of variance with post hoc Tukey tests. RESULTS Compared with mice on a minimal phytoestrogen diet, mice on a regular rodent diet had higher levels of serum phytoestrogens (male, 1138 ± 846 ng/dL; female, 310 ± 295 ng/dL). These serum phytoestrogen levels were also much higher than their own endogenous estradiol levels (109-fold higher for males and 35.5-fold higher for females). Although aortic diameters of female mice were unaffected by the phytoestrogen concentration in the diets, male mice on the regular rodent diet (M+ group) developed smaller aortic aneurysms than male mice on the minimal phytoestrogen diet (M- group) on postoperative day 14 (M+ 54.8 ± 8.8% versus M- 109.3 ± 37.6%; P < 0.001). During aneurysm development (postoperative days 3 and 7), there were fewer neutrophils, macrophages, and lymphocytes in the aorta from the M+ group than from the M- group. Concentrations of multiple proinflammatory cytokines (matrix metalloproteinases [MMPs]; interleukin 1β [IL-1β]; IL-6; IL-17; IL-23; monocyte chemoattractant protein-1; regulated on activation, normal T cell expressed and secreted; interferon γ; and tumor necrosis factor α) from aortas of the M+ group were also lower than those from the aortas of the M- group. Zymography also demonstrated that the M+ group had lower levels of aortic MMP-9s than the M- group on postoperative day 14 (P < 0.001 for pro-MMP-9, P < 0.001 for active MMP-9). CONCLUSIONS These results suggest that dietary phytoestrogens inhibit experimental aortic aneurysm formation in male mice via a reduction of the inflammatory response in the aorta wall. The protective effect of dietary phytoestrogens on aneurysm formation warrants further investigation.
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Affiliation(s)
- Guanyi Lu
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Gang Su
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Yunge Zhao
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - William F Johnston
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas E Sherman
- Department of Microbiology, W.M. Keck Biomedical Mass Spectrometry Laboratory, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Emilie F Rissman
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Christine Lau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Gilbert R Upchurch
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Chen X, Rateri DL, Howatt DA, Balakrishnan A, Moorleghen JJ, Morris AJ, Charnigo R, Cassis LA, Daugherty A. Amlodipine reduces AngII-induced aortic aneurysms and atherosclerosis in hypercholesterolemic mice. PLoS One 2013; 8:e81743. [PMID: 24244746 PMCID: PMC3828247 DOI: 10.1371/journal.pone.0081743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this study was to determine effects of amlodipine, a dihydropyridine calcium channel blocker, on development of angiotensin II (AngII)-induced vascular pathologies. Methods and Results Male LDL receptor -/- mice were infused with vehicle, amlodipine (5 mg/kg/d), AngII (1,000 ng/kg/min), or AngII + amlodipine for 4 weeks through osmotic pumps (n=10/group). Mice were fed a saturated fat-enriched diet for 1 week prior to pump implantation and during 4 weeks of infusion. Infusion of amlodipine resulted in plasma concentrations of 32 ± 2 ng/ml and 27 ± 2 ng/ml for mice in saline + amlodipine and AngII + amlodipine groups, respectively. This infusion rate of amlodipine did not affect AngII-induced increases in systolic blood pressure. Three of 10 (30%) mice infused with AngII died of aortic rupture, while aortic rupture did not occur in mice co-infused with AngII + amlodipine. Suprarenal aortic width and intimal area of ascending aortas were measured to define aortic aneurysms. In the absence of AngII infusion, amlodipine did not change suprarenal aortic width and ascending aortic area. Infusion of AngII led to profound increases of suprarenal aortic width (saline + vehicle versus AngII + vehicle: 0.86 ± 0.02 versus 1.72 ± 0.26 mm; P=0.0006), whereas co-infusion of AngII and amlodipine diminished abdominal dilation (1.02 ± 0.14 mm; P=0.003). As expected, AngII infusion increased mean intimal area of ascending aortas (saline + vehicle versus AngII + vehicle: 8.5 ± 0.3 versus 12.5 ± 1.1 mm2; P=0.001), while co-infusion of AngII and amlodipine ablated dilation of the ascending aorta (8.6 ± 0.2 mm2; P=0.03). Co-administration of amlodipine also significantly attenuated AngII-induced atherosclerosis in the thoracic region as quantified by percent lesion area (AngII + vehicle versus AngII + amlodipine: 5.8 ± 2.1 % versus 0.3 ± 0.1%; P=0.05). Conclusions Amlodipine inhibited AngII-induced aortic aneurysms in both the abdominal and ascending regions, and atherosclerosis in hypercholesterolemic mice.
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Affiliation(s)
- Xiaofeng Chen
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, United States of America
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Nchimi A, Cheramy-Bien JP, Gasser TC, Namur G, Gomez P, Seidel L, Albert A, Defraigne JO, Labropoulos N, Sakalihasan N. Multifactorial relationship between 18F-fluoro-deoxy-glucose positron emission tomography signaling and biomechanical properties in unruptured aortic aneurysms. Circ Cardiovasc Imaging 2013; 7:82-91. [PMID: 24190906 DOI: 10.1161/circimaging.112.000415] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The relationship between biomechanical properties and biological activities in aortic aneurysms was investigated with finite element simulations and 18F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography. METHODS AND RESULTS The study included 53 patients (45 men) with aortic aneurysms, 47 infrarenal (abdominal aortic) and 6 thoracic (thoracic aortic), who had ≥1 18F-FDG positron emission tomography/computed tomography. During a 30-month period, more clinical events occurred in patients with increased 18F-FDG uptake on their last examination than in those without (5 of 18 [28%] versus 2 of 35 [6%]; P=0.03). Wall stress and stress/strength index computed by finite element simulations and 18F-FDG uptake were evaluated in a total of 68 examinations. Twenty-five (38%) examinations demonstrated ≥1 aneurysm wall area of increased 18F-FDG uptake. The mean number of these areas per examination was 1.6 (18 of 11) in thoracic aortic aneurysms versus 0.25 (14 of 57) in abdominal aortic aneurysms, whereas the mean number of increased uptake areas colocalizing with highest wall stress and stress/strength index areas was 0.55 (6 of 11) and 0.02 (1 of 57), respectively. Quantitatively, 18F-FDG positron emission tomographic uptake correlated positively with both wall stress and stress/strength index (P<0.05). 18F-FDG uptake was particularly high in subjects with personal history of angina pectoris and familial aneurysm. CONCLUSIONS Increased 18F-FDG positron emission tomographic uptake in aortic aneurysms is strongly related to aneurysm location, wall stress as derived by finite element simulations, and patient risk factors such as acquired and inherited susceptibilities.
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MESH Headings
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/physiopathology
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/etiology
- Aortic Aneurysm, Thoracic/physiopathology
- Aortography/methods
- Biomechanical Phenomena
- Computer Simulation
- Female
- Finite Element Analysis
- Fluorodeoxyglucose F18
- Humans
- Linear Models
- Male
- Middle Aged
- Models, Cardiovascular
- Multimodal Imaging
- Positron-Emission Tomography
- Predictive Value of Tests
- Prognosis
- Radiopharmaceuticals
- Regional Blood Flow
- Risk Factors
- Stress, Mechanical
- Time Factors
- Tomography, X-Ray Computed
- Whole Body Imaging
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Affiliation(s)
- Alain Nchimi
- Departments of Cardiovascular and Thoracic Imaging
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40
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Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings. J Am Coll Radiol 2013; 10:789-94. [DOI: 10.1016/j.jacr.2013.05.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 02/06/2023]
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Hager J, Länne T, Carlsson P, Lundgren F. Lower Prevalence than Expected when Screening 70-year-old Men for Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2013; 46:453-9. [DOI: 10.1016/j.ejvs.2013.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/16/2013] [Indexed: 11/30/2022]
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Rubano E, Mehta N, Caputo W, Paladino L, Sinert R. Systematic Review: Emergency Department Bedside Ultrasonography for Diagnosing Suspected Abdominal Aortic Aneurysm. Acad Emerg Med 2013; 20:128-38. [DOI: 10.1111/acem.12080] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/29/2012] [Accepted: 08/29/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Elizabeth Rubano
- Department of Emergency Medicine; SUNY Downstate Medical Center; Brooklyn; NY
| | - Ninfa Mehta
- Department of Emergency Medicine; SUNY Downstate Medical Center; Brooklyn; NY
| | - William Caputo
- Department of Emergency Medicine; SUNY Downstate Medical Center; Brooklyn; NY
| | - Lorenzo Paladino
- Department of Emergency Medicine; SUNY Downstate Medical Center; Brooklyn; NY
| | - Richard Sinert
- Department of Emergency Medicine; SUNY Downstate Medical Center; Brooklyn; NY
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Reeps C, Bundschuh RA, Pellisek J, Herz M, van Marwick S, Schwaiger M, Eckstein HH, Nekolla SG, Essler M. Quantitative assessment of glucose metabolism in the vessel wall of abdominal aortic aneurysms: correlation with histology and role of partial volume correction. Int J Cardiovasc Imaging 2012; 29:505-12. [PMID: 22772434 DOI: 10.1007/s10554-012-0090-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 06/27/2012] [Indexed: 11/26/2022]
Abstract
Inflammatory-proteolytic processes in the vessel wall are essential in the pathophysiology of abdominal aortic aneurysm (AAA). It has been demonstrated that, (18)F-FDG-PET/CT may be useful for detection of pathological wall metabolism and therefore risk stratification. Quantification of the FDG-uptake in AAA wall is hampered by partial-volume (PV)-effects. For correction and accurate quantitative (18)F-FDG-uptake analysis we designed and validated a novel IDL-based software in correlation to phantom studies, histopathology and clinical presentation of AAA patients. For in vivo studies 23 patients with symptomatic and asymptomatic AAA underwent (18)F-FDG-PET/CT before surgery. In areas with (18)F-FDG-uptake the maximum and mean standardized uptake values in the vessel wall with (PVC-SUV(max), PVC-SUV(mean)) and without (SUV(max), SUV(mean)) PV-correction were determined. Results were correlated with clinical presentation, corresponding macrophage-infiltration and MMP-2- and -9-expression in surgical specimens. In patients, SUV(max), SUV(mean) as well as PVC-SUV(max) or PVC-SUV(mean) enabled a highly significant (p < 0.005) discrimination of symptomatic and asymptomatic AAA. Uncorrected and corrected SUVs showed comparable correlations with macrophage-infiltration and MMP-9 expression. No correlation of (18)F-FDG-uptake and MMP-2 was found. In vivo correlations of detected FDG-uptake with clinical and histological results showed comparable results for corrected and uncorrected SUVs. PV-correction is not mandatory for qualitative clinical assessment of glucose metabolism in the vessel wall of AAA-patients but may be necessary to establish quantitative cut off values to stratify patients for aneurysm repair.
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MESH Headings
- Aged
- Aged, 80 and over
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/enzymology
- Aorta, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/enzymology
- Aortic Aneurysm, Abdominal/metabolism
- Female
- Fluorodeoxyglucose F18/metabolism
- Humans
- Image Interpretation, Computer-Assisted
- Immunohistochemistry
- Linear Models
- Macrophages/metabolism
- Male
- Matrix Metalloproteinase 2/analysis
- Matrix Metalloproteinase 9/analysis
- Middle Aged
- Multimodal Imaging/instrumentation
- Phantoms, Imaging
- Positron-Emission Tomography
- Predictive Value of Tests
- Radiopharmaceuticals/metabolism
- Reproducibility of Results
- Software Validation
- Tomography, X-Ray Computed
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Affiliation(s)
- Christian Reeps
- Klinik für Gefäßchirurgie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Sarda-Mantel L, Alsac JM, Boisgard R, Hervatin F, Montravers F, Tavitian B, Michel JB, Le Guludec D. Comparison of 18F-fluoro-deoxy-glucose, 18F-fluoro-methyl-choline, and 18F-DPA714 for positron-emission tomography imaging of leukocyte accumulation in the aortic wall of experimental abdominal aneurysms. J Vasc Surg 2012; 56:765-73. [PMID: 22726755 DOI: 10.1016/j.jvs.2012.01.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/20/2012] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is a frequent form of atherothrombotic disease, whose natural history is to enlarge and rupture. Indicators other than AAA diameter would be useful for preventive surgery decision-making, including positron-emission tomography (PET) methods permitting visualization of aortic wall leukocyte activation relevant to prognostic AAA evaluation. In this study, we compare three PET tracers of activated leukocytes, 18F-fluoro-deoxy-glucose (FDG), 18F-fluoro-methyl-choline (FCH), and 18F-DPA714 (a peripheral benzodiazepine receptor antagonist) for in vivo PET quantification of aortic wall inflammation in rat experimental AAAs, in correlation with histopathological studies of lesions. METHODS AAAs were induced by orthotopic implantation of decellularized guinea pig abdominal aorta in 46 Lewis rats. FDG-PET (n = 20), FCH-PET (n = 8), or both (n = 12) were performed 2 weeks to 4 months after the graft, 1 hour after tracer injection (30 MBq). Six rats (one of which had FDG-PET) underwent 18F-DPA714-PET. Rats were sacrificed after imaging; AAAs and normal thoracic aortas were cut into axial sections for quantitative autoradiography and histologic studies, including ED1 (macrophages) and CD8 T lymphocyte immunostaining. Ex vivo staining of AAAs and thoracic aortas with 18F-DPA714 and unlabeled competitors was performed. RESULTS AAAs developed in 35 out of 46 cases. FCH uptake in AAAs was lower than that of FDG in all cases on imaging, with lower AAA-to-background maximal standardized uptake value (SUV(max)) ratios (1.78 ± 0.40 vs 2.71 ± 0.54; P < .01 for SUV(max) ratios), and lower AAA-to-normal aorta activity ratios on autoradiography (3.52 ± 1.26 vs 8.55 ± 4.23; P < .005). FDG AAA-to-background SUV(max) ratios correlated with the intensity of CD8 + ED1 staining (r = .76; P < .03). FCH AAA-to-background SUV(max) ratios correlated with the intensity of ED1 staining (r = .80; P < .03). 18F-DPA714 uptake was similar in AAAs and in normal aortas, both in vivo and ex vivo. CONCLUSIONS In rat experimental AAA, characterized by an important aortic wall leukocytes activity, FDG-PET showed higher sensitivity than FCH-PET and 18F-DPA714-PET to detect activated leukocytes. This enhances potential interest of this tracer for prognostic evaluation of AAA in patients.
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Affiliation(s)
- Laure Sarda-Mantel
- Institut National de la Santé et de la Recherche Médicale Unit 698, Paris, France.
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45
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Accelerated aneurysmal dilation associated with apoptosis and inflammation in a newly developed calcium phosphate rodent abdominal aortic aneurysm model. J Vasc Surg 2012; 56:455-61. [PMID: 22560311 DOI: 10.1016/j.jvs.2012.01.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/03/2012] [Accepted: 01/04/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The calcium chloride (CaCl(2)) model is a widely accepted rodent model for abdominal aortic aneurysms (AAAs). Calcium deposition, mainly consisting of calcium phosphate (CaPO(4)) crystals, has been reported to exist in human and experimental aneurysms. CaPO(4) crystals have been used for in vitro DNA transfection by mixing CaCl(2) and phosphate-buffered saline (PBS). Here, we describe accelerated aneurysm formation resulting from a modification of the CaCl(2) model. METHODS A modified CaCl(2) model, the CaPO(4) model, was created by applying PBS onto the mouse infrarenal aorta after CaCl(2) treatment. Morphologic, histologic, and immunohistochemical analyses were performed on arteries treated with the CaPO(4) model and the conventional CaCl(2) model as the control. In vitro methods were performed using a mixture of CaCl(2) and PBS to create CaPO(4) crystals. CaPO(4)- induced apoptosis of primary cultured mouse vascular smooth muscle cells (VSMCs) was measured by DNA fragmentation enzyme-linked immunosorbent assay. RESULTS The CaPO(4) model produces AAA, defined as an increase of ≥50% in the diameter of the aorta, faster than in the CaCl(2) model. The CaPO(4) model showed significantly larger aneurysmal dilation at 7, 28, and 42 days, as reflected by a maximum diameter (measured in mm) fold-change of 1.69 ± 0.07, 1.99 ± 0.14, and 2.13 ± 0.09 vs 1.22 ± 0.04, 1.48 ± 0.07, and 1.68 ± 0.06 in a CaCl(2) model, respectively (n = 6; P < .05). A semiquantitative grading analysis of elastin fiber integrity at 7 days revealed a significant increase in elastin degradation in the CaPO(4) model compared with the CaCl(2) model (2.7 ± 0.2 vs 1.5 ± 0.2; n = 6; P < .05). A significantly higher level of apoptosis occurred in the CaPO(4) model (apoptosis index at 1, 2, and 3 days postsurgery: 0.26 ± 0.14, 0.37 ± 0.14, and 0.33 ± 0.08 vs 0.012 ± 0.10, 0.15 ± 0.02, and 0.12 ± 0.05 in the conventional CaCl(2) model; n = 3; P < .05). An enhancement of macrophage infiltration and calcification was also observed at 3 and 7 days in the CaPO(4) model. CaPO(4) induced approximately 3.7 times more apoptosis in VSMCs than a mixture of CaCl(2) (n = 4; P < .0001) in vitro. CONCLUSIONS The CaPO(4) model accelerates aneurysm formation with the enhancement of apoptosis, macrophage infiltration, and calcium deposition. This modified model, with its rapid and robust dilation, can be used as a new model for AAAs.
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Konofagou E, Lee WN, Luo J, Provost J, Vappou J. Physiologic cardiovascular strain and intrinsic wave imaging. Annu Rev Biomed Eng 2012; 13:477-505. [PMID: 21756144 DOI: 10.1146/annurev-bioeng-071910-124721] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular disease remains the primary killer worldwide. The heart, essentially an electrically driven mechanical pump, alters its mechanical and electrical properties to compensate for loss of normal mechanical and electrical function. The same adjustment also is performed in the vessels, which constantly adapt their properties to accommodate mechanical and geometrical changes related to aging or disease. Real-time, quantitative assessment of cardiac contractility, conduction, and vascular function before the specialist can visually detect it could be feasible. This new physiologic data could open up interactive therapy regimens that are currently not considered. The eventual goal of this technology is to provide a specific method for estimating the position and severity of contraction defects in cardiac infarcts or angina. This would improve care and outcomes as well as detect stiffness changes and overcome the current global measurement limitations in the progression of vascular disease, at little more cost or risk than that of a clinical ultrasound.
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Affiliation(s)
- Elisa Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10023, USA.
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Scott DJA, Prasad P, Philippou H, Rashid ST, Sohrabi S, Whalley D, Kordowicz A, Tang Q, West RM, Johnson A, Woods J, Ajjan RA, Ariëns RA. Clot Architecture Is Altered in Abdominal Aortic Aneurysms and Correlates With Aneurysm Size. Arterioscler Thromb Vasc Biol 2011; 31:3004-10. [DOI: 10.1161/atvbaha.111.236786] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Abdominal aortic aneurysm (AAA) is characterized by widening of the aorta. Once the aneurysm exceeds 5.5 cm, there is a 10% risk of death due to rupture. AAA is also associated with mortality due to other cardiovascular disease. Our aim was to investigate clot structure in AAA and its relationship to aneurysm size.
Methods and Results—
Plasma was obtained from 49 controls, 40 patients with small AAA, and 42 patients with large AAA. Clot formation was studied by turbidity, fibrin pore structure by permeation, and time to half lysis by turbidity with tissue plasminogen activator. Plasma clot pore size showed a stepwise reduction from controls to small to large AAA. Lag phase for plasma clot formation and time to half lysis were prolonged, with smaller AAA samples showing intermediate response. Clot structure was normal in clots made with fibrinogen purified from patients compared with controls, suggesting a role for other plasma factors. Endogenous thrombin potential and turbidity using tissue factor indicated that the effects were independent of changes in thrombin generation.
Conclusion—
Patients with AAA form denser, smaller pored plasma clots that are more resistant to fibrinolysis, and these characteristics correlate with aneurysm size. Clot structure may play a role in AAA development and concomitant cardiovascular disease.
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Affiliation(s)
- D. Julian A. Scott
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Priya Prasad
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Helen Philippou
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Sheikh Tawqeer Rashid
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Soroush Sohrabi
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Daniel Whalley
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Andy Kordowicz
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Quen Tang
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Robert M. West
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Anne Johnson
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Janet Woods
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ramzi A. Ajjan
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Robert A.S. Ariëns
- From the Division of Cardiovascular and Diabetes Research, Section on Mechanisms of Thrombosis (D.J.A.S., P.P., H.P., S.T.R., S.S., D.W., A.K., Q.T., A.J., J.W., R.A.A., R.A.S.A.) Centre of Epidemiology and Biostatistics (R.M.W.), Leeds Institute for Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Moloney MA, McHugh S, O’ Donnell DH, Casey RG, Kavanagh EG, Grace PA, Fitzgerald P, Bouchier-Hayes DJ. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting. Ir J Med Sci 2010; 180:375-8. [DOI: 10.1007/s11845-010-0513-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 05/24/2010] [Indexed: 10/18/2022]
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49
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Volokh K. Comparison of biomechanical failure criteria for abdominal aortic aneurysm. J Biomech 2010; 43:2032-4. [DOI: 10.1016/j.jbiomech.2010.03.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 03/12/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
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50
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Auer M, Gasser TC. Reconstruction and finite element mesh generation of abdominal aortic aneurysms from computerized tomography angiography data with minimal user interactions. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:1022-1028. [PMID: 20335091 DOI: 10.1109/tmi.2009.2039579] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Evaluating rupture risk of abdominal aortic aneurysms is critically important in reducing related mortality without unnecessarily increasing the rate of elective repair. According to the current clinical practice aneurysm rupture risk is (mainly) estimated from its maximum diameter and/or expansion rate; an approach motivated from statistics but known to fail often in individuals. In contrast, recent research demonstrated that patient specific biomechanical simulations can provide more reliable diagnostic parameters, however current structural model development is cumbersome and time consuming. This paper used 2D and 3D deformable models to reconstruct aneurysms from computerized tomography angiography data with minimal user interactions. In particular, formulations of frames and shells, as known from structural mechanics, were used to define deformable modes, which in turn allowed a direct mechanical interpretation of the applied set of reconstruction parameters. Likewise, a parallel finite element implementation of the models allows the segmentation of clinical cases on standard personal computers within a few minutes. The particular topology of the applied 3D deformable models supports a fast and simple hexahedral-dominated meshing of the arising generally polyhedral domain. The variability of the derived segmentations (luminal: 0.50(SD 0.19) mm; exterior 0.89(SD 0.45) mm) with respect to large variations in elastic properties of the deformable models was in the range of the differences between manual segmentations as performed by experts (luminal: 0.57(SD 0.24) mm; exterior: 0.77(SD 0.58) mm), and was particularly independent from the algorithm's initialization. The proposed interaction of deformable models and mesh generation defines finite element meshes suitable to perform accurate and efficient structural analysis of the aneurysm using mixed finite element formulations.
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Affiliation(s)
- M Auer
- Department of Solid Mechanics, School of Engineering Sciences, Royal Institute of Technology, Stockholm, Sweden
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