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Stilo F, Catanese V, Nenna A, Montelione N, Codispoti FA, Verghi E, Gabellini T, Jawabra M, Chello M, Spinelli F. Biomarkers in EndoVascular Aneurysm Repair (EVAR) and Abdominal Aortic Aneurysm: Pathophysiology and Clinical Implications. Diagnostics (Basel) 2022; 12:diagnostics12010183. [PMID: 35054350 PMCID: PMC8774611 DOI: 10.3390/diagnostics12010183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Circulating biomarkers have been recently investigated among patients undergoing endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Considering the plethora of small descriptive studies reporting potential associations between biomarkers and clinical outcomes, this review aims to summarize the current literature considering both the treated disease (post EVAR) and the untreated disease (AAA before EVAR). All studies describing outcomes of tissue biomarkers in patients undergoing EVAR and in patients with AAA were included, and references were checked for additional sources. In the EVAR scenario, circulating interleukin-6 (IL-6) is a marker of inflammatory reaction which might predict postoperative morbidity; cystatin C is a promising early marker of post-procedural acute kidney injury; plasma matrix metalloproteinase-9 (MMP-9) concentration after 3 months from EVAR might help in detecting post-procedural endoleak. This review also summarizes the current gaps in knowledge and future direction of this field of research. Among markers used in patients with AAA, galectin and granzyme appear to be promising and should be carefully investigated even in the EVAR setting. Larger prospective trials are required to establish and evaluate prognostic models with highest values with these markers.
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Affiliation(s)
- Francesco Stilo
- Department of Vascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Vincenzo Catanese
- Department of Vascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy;
- Correspondence: or
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Nunzio Montelione
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Francesco Alberto Codispoti
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Emanuele Verghi
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Teresa Gabellini
- Residency Program of Vascular and Endovascular Surgery, University of Ferrara, 44121 Ferrara, Italy;
| | - Mohamad Jawabra
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Massimo Chello
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Francesco Spinelli
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
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Krishna SM, Li J, Wang Y, Moran CS, Trollope A, Huynh P, Jose R, Biros E, Ma J, Golledge J. Kallistatin limits abdominal aortic aneurysm by attenuating generation of reactive oxygen species and apoptosis. Sci Rep 2021; 11:17451. [PMID: 34465809 PMCID: PMC8408144 DOI: 10.1038/s41598-021-97042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022] Open
Abstract
Inflammation, vascular smooth muscle cell apoptosis and oxidative stress are believed to play important roles in abdominal aortic aneurysm (AAA) pathogenesis. Human kallistatin (KAL; gene SERPINA4) is a serine proteinase inhibitor previously shown to inhibit inflammation, apoptosis and oxidative stress. The aim of this study was to investigate the role of KAL in AAA through studies in experimental mouse models and patients. Serum KAL concentration was negatively associated with the diagnosis and growth of human AAA. Transgenic overexpression of the human KAL gene (KS-Tg) or administration of recombinant human KAL (rhKAL) inhibited AAA in the calcium phosphate (CaPO4) and subcutaneous angiotensin II (AngII) infusion mouse models. Upregulation of KAL in both models resulted in reduction in the severity of aortic elastin degradation, reduced markers of oxidative stress and less vascular smooth muscle apoptosis within the aorta. Administration of rhKAL to vascular smooth muscle cells incubated in the presence of AngII or in human AAA thrombus-conditioned media reduced apoptosis and downregulated markers of oxidative stress. These effects of KAL were associated with upregulation of Sirtuin 1 activity within the aortas of both KS-Tg mice and rodents receiving rhKAL. These results suggest KAL-Sirtuin 1 signalling limits aortic wall remodelling and aneurysm development through reductions in oxidative stress and vascular smooth muscle cell apoptosis. Upregulating KAL may be a novel therapeutic strategy for AAA.
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Affiliation(s)
- Smriti Murali Krishna
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jiaze Li
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Yutang Wang
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,School of Applied and Biomedical Sciences, Faculty of Science and Technology, Federation University Australia, Horsham, VIC, Australia
| | - Corey S Moran
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Alexandra Trollope
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,Division of Anatomy, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Pacific Huynh
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Roby Jose
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Erik Biros
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jianxing Ma
- Department of Physiology, Health Sciences Centre, University of Oklahoma, Oklahoma City, OK, 73104, USA
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. .,Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia.
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He J, Li N, Fan Y, Zhao X, Liu C, Hu X. Metformin Inhibits Abdominal Aortic Aneurysm Formation through the Activation of the AMPK/mTOR Signaling Pathway. J Vasc Res 2021; 58:148-158. [PMID: 33601368 DOI: 10.1159/000513465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Epidemiological evidence suggests that the antidiabetic drug metformin (MET) can also inhibit abdominal aortic aneurysm (AAA) formation. However, the underlying protective mechanism remains unknown. It has been reported that phosphorylated AMP-activated protein kinase (AMPK) levels are significantly lower in AAA tissues than control aortic tissues. AMPK activation can inhibit the downstream signaling molecule called mechanistic target of rapamycin (mTOR), which has also been reported be upregulated in thoracic aneurysms. Thus, blocking mTOR signaling could attenuate AAA progression. MET is a known agonist of AMPK. Therefore, in this study, we investigated if MET could inhibit formation of AAA by activating the AMPK/mTOR signaling pathway. MATERIALS AND METHODS The AAA animal model was induced by intraluminal porcine pancreatic elastase (PPE) perfusion in male Sprague Dawley rats. The rats were treated with MET or compound C (C.C), which is an AMPK inhibitor. AAA formation was monitored by serial ultrasound. Aortas were collected 4 weeks after surgery and subjected to immunohistochemistry, Western blot, and transmission electron microscopy analyses. RESULTS MET treatment dramatically inhibited the formation of AAA 4 weeks after PPE perfusion. MET reduced the aortic diameter, downregulated both macrophage infiltration and matrix metalloproteinase expression, decreased neovascularization, and preserved the contractile phenotype of the aortic vascular smooth muscle cells. Furthermore, we detected an increase in autophagy after MET treatment. All of these effects were reversed by the AMPK inhibitor C.C. CONCLUSION This study demonstrated that MET activates AMPK and suppresses AAA formation. Our study provides a novel mechanism for MET and suggests that MET could be potentially used as a therapeutic candidate for preventing AAA.
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MESH Headings
- AMP-Activated Protein Kinases/metabolism
- Animals
- Aorta, Abdominal/drug effects
- Aorta, Abdominal/enzymology
- Aorta, Abdominal/ultrastructure
- Aortic Aneurysm, Abdominal/chemically induced
- Aortic Aneurysm, Abdominal/enzymology
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/prevention & control
- Dilatation, Pathologic
- Disease Models, Animal
- Enzyme Activation
- Macrophages/drug effects
- Macrophages/metabolism
- Male
- Metformin/pharmacology
- Neovascularization, Pathologic
- Pancreatic Elastase
- Phosphorylation
- Rats, Sprague-Dawley
- Signal Transduction
- TOR Serine-Threonine Kinases/metabolism
- Vascular Remodeling/drug effects
- Rats
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Affiliation(s)
- Jiaan He
- Department of Vascular Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Nan Li
- Department of Vascular Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yichuan Fan
- Department of Vascular Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xingzhi Zhao
- Department of Vascular Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Chengwei Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Xinhua Hu
- Department of Vascular Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China,
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Migacz M, Janoska-Gawrońska A, Holecki M, Chudek J. The role of osteoprotegerin in the development, progression and management of abdominal aortic aneurysms. Open Med (Wars) 2020; 15:457-463. [PMID: 33336003 PMCID: PMC7712403 DOI: 10.1515/med-2020-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 01/16/2023] Open
Abstract
Osteoprotegerin (OPG) appears to be a very promising marker both in the diagnosis of abdominal aortic aneurysms (AAAs) and as a potential target in its treatment. This article presents an overview of the current literature that discusses the role of OPG in the pathogenesis of atherosclerosis and its potential value as a prognostic factor in AAA. Pharmacological modulation of OPG expression has been considered. In conclusion, it seems that further research designed to assess the relationship between OPG and AAA is needed as this may contribute to improved AAA monitoring and more effective treatment of patients with AAA.
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Affiliation(s)
- Maciej Migacz
- Department and Clinic of Internal, Autoimmune and Metabolic Diseases, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Agata Janoska-Gawrońska
- Department and Clinic of Internal, Autoimmune and Metabolic Diseases, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Michał Holecki
- Department and Clinic of Internal, Autoimmune and Metabolic Diseases, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Jerzy Chudek
- Department and Clinic of Internal Medicine and Cancer Chemotherapy, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
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Fan Y, Li N, Liu C, Dong H, Hu X. Excessive Methionine Supplementation Exacerbates the Development of Abdominal Aortic Aneurysm in Rats. J Vasc Res 2019; 56:230-240. [PMID: 31307051 DOI: 10.1159/000501313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The relationship between methionine (Met) and abdominal aortic aneurysm (AAA) has been previously demonstrated, but the mechanisms controlling this association remain unclear. This study investigated the potential contribution of hypermethioninemia (HMet) to the development of AAA. METHODS A model of AAA was induced by intraluminal porcine pancreatic elastase (PPE) infusion in 60 male Sprague-Dawley rats divided into 4 groups (n = 15 per group). Met was supplied by intragastric administration (1 g/kg body weight/day) from 1 week before surgery until 4 weeks after surgery. The aortic diameter was measured by ultrasound. Aortas were collected 4 weeks after surgery and subjected to biochemical analysis, histological assays, and transmission electron microscopy. RESULTS After 5 weeks of Met supplementation, HMet increased the dilation ratio of the HMet + PPE group, and hyperhomocysteinemia was also induced in HMet and HMet + PPE rats. Increased matrix metalloproteinase-2 (MMP-2), osteopontin, and interleukin-6 expression was detected in HMet + PPE rats. Furthermore, increased autophagy was detected in the HMet + PPE group. CONCLUSION This study demonstrates that HMet may exacerbate the formation of AAA due to the increased dilation ratio partially via enhancing MMP-2 and inflammatory responses.
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Affiliation(s)
- Yichuan Fan
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Nan Li
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Chengwei Liu
- Division of Vascular Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Haipeng Dong
- Department of Cardiothoracic Vascular Surgery, Affiliated Hospital of Beihua University, Jilin City, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China,
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Filis KA, Galyfos G, Sigala F, Tsioufis K, Tsagos I, Karantzikos G, Bakoyiannis C, Zografos G. Proximal Aortic Neck Progression: Before and After Abdominal Aortic Aneurysm Treatment. Front Surg 2017; 4:23. [PMID: 28523269 PMCID: PMC5415558 DOI: 10.3389/fsurg.2017.00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Several risk factors including short or highly angulated proximal aortic neck have been associated with long-term outcomes after endovascular or open abdominal aortic aneurysm (AAA) repair. However, research data have emerged recently concerning the behavior of proximal aortic neck, and several authors have tried to evaluate this behavior after endovascular or open repair. Additionally, computed tomography angiography (CTA) remains the golden standard for detecting and observing the morphology of an AAA, both before and after treatment. Moreover, the question of whether the proximal neck’s progression independently affects postoperative morbidity and reintervention risks still remains. Therefore, this focused review aims to present all relevant data on the behavior of an AAAs neck, based on CTA imaging before and after repair, in order to produce useful conclusions for future clinical practice.
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Affiliation(s)
- Konstantinos A Filis
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Galyfos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Tsagos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karantzikos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Bakoyiannis
- First Department of Surgery, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Zografos
- First Department of Propedeutic Surgery, Ippokrateion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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