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Vats S, Sundquist K, Grundberg A, Sundquist J, Wang X, Zarrouk M, Gottsäter A, Memon AA. Hemoglobin homeostasis in abdominal aortic aneurysm: diagnostic and prognostic potential of hemoglobin/heme and scavenger molecules. BMC Cardiovasc Disord 2024; 24:452. [PMID: 39192217 DOI: 10.1186/s12872-024-04131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND There is increasing evidence implicating hemoglobin/heme and their scavengers in oxidative stress-mediated pathologies, but information is limited in abdominal aortic aneurysm (AAA). METHODS AND RESULTS In this case-control study, we assessed heme/heme-related markers in 142 men with AAA and 279 men with a normal aortic diameter consecutively recruited from an ultrasound screening program in Sweden. Enzyme-linked immunosorbent assays (ELISAs) were used to measure heme oxygenase-1 (HO-1) and hemopexin (Hpx) plasma levels, colorimetric assays for cell-free heme and whole blood hemoglobin (Hb) levels, and droplet digital PCR (ddPCR) and real-time PCR to determine haptoglobin (Hp) (pheno)type and genotype, respectively. Hpx and heme plasma levels at baseline were elevated, while HO-1 levels were lower in men with AAA (p < 0.001) and were significantly associated with AAA prevalence independently of potential confounders. A combination of heme and HO-1 showed the best diagnostic potential based on the area under the curve (AUC): 0.76, sensitivity: 80%, specificity: 48%. Additionally, when previously described inflammatory biomarker interleukin-6 (IL-6), was added to our model it significantly improved the diagnostic value (AUC: 0.87, sensitivity: 80%, specificity: 79%) compared to IL-6 alone (AUC: 0.73, sensitivity: 80%, specificity: 49%). Finally, Hb (positively) and Hpx (negatively) levels at baseline were associated with AAA growth rate (mm/year), and their combination showed the best prognostic value for discriminating fast and slow-growing AAA (AUC: 0.76, sensitivity: 80%, specificity: 62%). CONCLUSIONS This study reports the distinct disruption of heme and related markers in both the development and progression of AAA, underscoring their potential in aiding risk stratification and therapeutic strategies.
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Affiliation(s)
- Sakshi Vats
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
- Center for Primary Health Care Research, Wallenberg Laboratory, 5th floor, Inga Marie Nilsson's gata 53, Malmö, 214 28, Sweden.
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Malmö, Sweden
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Anton Grundberg
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Malmö, Sweden
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Xiao Wang
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Moncef Zarrouk
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund University, Malmö, S-205 02, Sweden
| | - Anders Gottsäter
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund University, Malmö, S-205 02, Sweden
- Department of Medicine, Skåne University Hospital, Lund University, Malmö, S-205 02, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Tepkit N, Wongkongkam K, Chayaput P, Chinsakchai K. Factors predicting acute kidney injury in patients after abdominal aortic aneurysm repair. JOURNAL OF VASCULAR NURSING 2024; 42:99-104. [PMID: 38823978 DOI: 10.1016/j.jvn.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 01/07/2024] [Accepted: 02/04/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) is one of the most frequent complications in abdominal aortic aneurysm (AAA) patients after open and endovascular aortic aneurysm repair. AKI decreases the efficiency of kidney function, allowing accumulation of waste products in the body, and an imbalance of water, acid and electrolytes in the body. As a result, the functioning of various organs throughout the body is affected. These effects may raise the cost of treatment, length of stay, and mortality rate. OBJECTIVE This study aims to examine the predictive factors of AKI - preoperative of estimated glomerular filtration rate (eGFR), preoperative of hemoglobin level, types of abdominal aortic aneurysms repair, and intraoperative of cardiac arrhythmias - after open and endovascular aortic repair among AAA patients within 72 h. METHODS This is a retrospective study of 196 patients with AAA after elective open and endovascular aortic aneurysm repair within the first 72 h who met the inclusion criteria recruited from a tertiary care hospital in Bangkok, Thailand. Postoperative AKI after elective open and endovascular aortic repair among AAA patients is defined by the 2012 Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines. RESULTS A total of 196 AAA patients, 75.5% were male with an average age of 75.12 years (SD = 8.45). Endovascular aortic aneurysm repair was used more frequently than open aortic aneurysm repair (64.8% vs 35.2%) and 37.2% of the AAA patients had intraoperative cardiac arrhythmias. The occurrence of AKI among the AAA patients after abdominal aortic aneurysm repair within 72 h was 54.1%. The AKI rate of EVAR patients was 69.8% while the AKI rate for OAR patients was 30.2%. The preoperative estimated glomerular filtration rate (eGFR) and hemoglobin level were found to jointly predict AKI and explain 32.2% of the variance (Nagelkerke R2 = 0.322, p < .05). However, the type of abdominal aortic aneurysms repair and intraoperative cardiac arrhythmias did not correlate with the incidence of AKI in AAA repair patients. The predictive factors for AKI among AAA patients after aortic aneurysm repair were preoperative eGFR < 60 mL/min/1.73 m2 (OR = 4.436, 95% CI: 2.202-8.928, p < .001) and preoperative hemoglobin level between 8.1-10.0 g/dL (OR = 4.496, 95% CI: 1.831-11.040, p = .001). CONCLUSION Preoperative eGFR < 60 mL/min/1.73 m2 and preoperative hemoglobin level between 8.1-10.0 g/dL were the predictive factors for AKI among AAA patients after both open and endovascular AAA repair. Therefore, healthcare providers should be aware of and monitor signs of AKI after surgery in AAA patients, especially those undergoing EVAR with lower eGFR and hemoglobin levels.
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Affiliation(s)
| | - Kessiri Wongkongkam
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Prangtip Chayaput
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zhang F, Li K, Zhang W, Zhao Z, Chang F, Du J, Zhang X, Bao K, Zhang C, Shi L, Liu Z, Dai X, Chen C, Wang DW, Xian Z, Jiang H, Ai D. Ganglioside GM3 Protects Against Abdominal Aortic Aneurysm by Suppressing Ferroptosis. Circulation 2024; 149:843-859. [PMID: 38018467 DOI: 10.1161/circulationaha.123.066110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a potentially life-threatening vascular condition, but approved medical therapies to prevent AAA progression and rupture are currently lacking. Sphingolipid metabolism disorders are associated with the occurrence and development of AAA. It has been discovered that ganglioside GM3, a sialic acid-containing type of glycosphingolipid, plays a protective role in atherosclerosis, which is an important risk factor for AAA; however, the potential contribution of GM3 to AAA development has not been investigated. METHODS We performed a metabolomics study to evaluated GM3 level in plasma of human patients with AAA. We profiled GM3 synthase (ST3GAL5) expression in the mouse model of aneurysm and human AAA tissues through Western blotting and immunofluorescence staining. RNA sequencing, affinity purification and mass spectrometry, proteomic analysis, surface plasmon resonance analysis, and functional studies were used to dissect the molecular mechanism of GM3-regulating ferroptosis. We conditionally deleted and overexpressed St3gal5 in smooth muscle cells (SMCs) in vivo to investigate its role in AAA. RESULTS We found significantly reduced plasma levels of GM3 in human patients with AAA. GM3 content and ST3GAL5 expression were decreased in abdominal aortic vascular SMCs in patients with AAA and an AAA mouse model. RNA sequencing analysis showed that ST3GAL5 silencing in human aortic SMCs induced ferroptosis. We showed that GM3 interacted directly with the extracellular domain of TFR1 (transferrin receptor 1), a cell membrane protein critical for cellular iron uptake, and disrupted its interaction with holo-transferrin. SMC-specific St3gal5 knockout exacerbated iron accumulation at lesion sites and significantly promoted AAA development in mice, whereas GM3 supplementation suppressed lipid peroxidation, reduced iron deposition in aortic vascular SMCs, and markedly decreased AAA incidence. CONCLUSIONS Together, these results suggest that GM3 dysregulation promotes ferroptosis of vascular SMCs in AAA. Furthermore, GM3 may constitute a new therapeutic target for AAA.
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Affiliation(s)
- Fangni Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin Institute of Cardiology, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), The Second Hospital of Tianjin Medical University, Tianjin Medical University, China (F.Z., D.A.)
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
| | - Kan Li
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
| | - Wenhui Zhang
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
| | - Ziyan Zhao
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
| | - Fangyuan Chang
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
| | - Jie Du
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
- Beijing Anzhen Hospital, Capital Medical University, China (J.D.)
- The Key Laboratory of Remodeling Cardiovascular Diseases, Ministry of Education, China (J.D.)
- Collaborative Innovation Center for Cardiovascular Disorders, Beijing, China (J.D.)
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (J.D.)
| | - Xu Zhang
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
| | - Kaiwen Bao
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences (K.B., C.Z., L.S.), Tianjin Medical University, China
| | - Chunyong Zhang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences (K.B., C.Z., L.S.), Tianjin Medical University, China
| | - Lei Shi
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences (K.B., C.Z., L.S.), Tianjin Medical University, China
| | - Zongwei Liu
- Department of Vascular Surgery, Tianjin Medical University General Hospital, China (Z.L., X.D.)
| | - Xiangchen Dai
- Department of Vascular Surgery, Tianjin Medical University General Hospital, China (Z.L., X.D.)
| | - Chen Chen
- Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China (C.C., D.W.W.)
| | - Dao Wen Wang
- Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China (C.C., D.W.W.)
| | - Zhong Xian
- Experimental Research Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, China (Z.X., H.J.)
| | - Hongfeng Jiang
- Experimental Research Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, China (Z.X., H.J.)
| | - Ding Ai
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin Institute of Cardiology, The Province and Ministry Co-Sponsored Collaborative Innovation Center for Medical Epigenetics, Key Laboratory of Immune Microenvironment and Disease (Ministry of Education), The Second Hospital of Tianjin Medical University, Tianjin Medical University, China (F.Z., D.A.)
- Department of Physiology and Pathophysiology (F.Z., K.L., W.Z., Z.Z., F.C., J.D., X.Z., D.A.)
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Loick P, Mohammad GH, Cassimjee I, Chandrashekar A, Lapolla P, Carrington A, Vera-Aviles M, Handa A, Lee R, Lakhal-Littleton S. Protective Role for Smooth Muscle Cell Hepcidin in Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2023; 43:713-725. [PMID: 36951059 PMCID: PMC10125116 DOI: 10.1161/atvbaha.123.319224] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Hepcidin is a liver-derived hormone that controls systemic iron homeostasis, by inhibiting the iron exporter ferroportin in the gut and spleen, respective sites of iron absorption and recycling. Hepcidin is also expressed ectopically in the context of cardiovascular disease. However, the precise role of ectopic hepcidin in underlying pathophysiology is unknown. In patients with abdominal aortic aneurysm (AAA), hepcidin is markedly induced in smooth muscle cells (SMCs) of the aneurysm wall and inversely correlated with the expression of LCN2 (lipocalin-2), a protein implicated in AAA pathology. In addition, plasma hepcidin levels were inversely correlated with aneurysm growth, suggesting hepcidin has a potential disease-modifying role. METHODS To probe the role of SMC-derived hepcidin in the setting of AAA, we applied AngII (Angiotensin-II)-induced AAA model to mice harbouring an inducible, SMC-specific deletion of hepcidin. To determine whether SMC-derived hepcidin acted cell-autonomously, we also used mice harboring an inducible SMC-specific knock-in of hepcidin-resistant ferroportinC326Y. The involvement of LCN2 was established using a LCN2-neutralizing antibody. RESULTS Mice with SMC-specific deletion of hepcidin or knock-in of hepcidin-resistant ferroportinC326Y had a heightened AAA phenotype compared with controls. In both models, SMCs exhibited raised ferroportin expression and reduced iron retention, accompanied by failure to suppress LCN2, impaired autophagy in SMCs, and greater aortic neutrophil infiltration. Pretreatment with LCN2-neutralizing antibody restored autophagy, reduced neutrophil infiltration, and prevented the heightened AAA phenotype. Finally, plasma hepcidin levels were consistently lower in mice with SMC-specific deletion of hepcidin than in controls, indicating that SMC-derived hepcidin contributes to the circulating pool in AAA. CONCLUSIONS Hepcidin elevation in SMCs plays a protective role in the setting of AAA. These findings are the first demonstration of a protective rather than deleterious role for hepcidin in cardiovascular disease. They highlight the need to further explore the prognostic and therapeutic value of hepcidin outside disorders of iron homeostasis.
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Affiliation(s)
- Paul Loick
- Department of Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Germany (P. Loick)
| | - Goran Hamid Mohammad
- Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (G.H.M., A. Carrington, M.V.-A., S.L.-L.)
| | - Ismail Cassimjee
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, United Kingdom (I.C., A. Chandrashekar, P. Lapolla, A.H., R.L.)
| | - Anirudh Chandrashekar
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, United Kingdom (I.C., A. Chandrashekar, P. Lapolla, A.H., R.L.)
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, United Kingdom (I.C., A. Chandrashekar, P. Lapolla, A.H., R.L.)
| | - Alison Carrington
- Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (G.H.M., A. Carrington, M.V.-A., S.L.-L.)
| | - Mayra Vera-Aviles
- Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (G.H.M., A. Carrington, M.V.-A., S.L.-L.)
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, United Kingdom (I.C., A. Chandrashekar, P. Lapolla, A.H., R.L.)
| | - Regent Lee
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, United Kingdom (I.C., A. Chandrashekar, P. Lapolla, A.H., R.L.)
| | - Samira Lakhal-Littleton
- Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom (G.H.M., A. Carrington, M.V.-A., S.L.-L.)
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Michel JB, Lagrange J, Regnault V, Lacolley P. Conductance Artery Wall Layers and Their Respective Roles in the Clearance Functions. Arterioscler Thromb Vasc Biol 2022; 42:e253-e272. [PMID: 35924557 DOI: 10.1161/atvbaha.122.317759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evolutionary organization of the arterial wall into layers occurred concomitantly with the emergence of a highly muscularized, pressurized arterial system that facilitates outward hydraulic conductance and mass transport of soluble substances across the arterial wall. Although colliding circulating cells disperse potential energy within the arterial wall, the different layers counteract this effect: (1) the endothelium ensures a partial barrier function; (2) the media comprises smooth muscle cells capable of endocytosis/phagocytosis; (3) the outer adventitia and perivascular adipocytic tissue are the final receptacles of convected substances. While the endothelium forms a physical and a biochemical barrier, the medial layer is avascular, relying on the specific permeability properties of the endothelium for metabolic support. Different components of the media interact with convected molecules: medial smooth muscle cells take up numerous molecules via scavenger receptors and are capable of phagocytosis of macro/micro particles. The outer layers-the highly microvascularized innervated adventitia and perivascular adipose tissue-are also involved in the clearance functions of the media: the adventitia is the seat of immune response development, inward angiogenesis, macromolecular lymphatic drainage, and neuronal stimulation. Consequently, the clearance functions of the arterial wall are physiologically essential, but also may favor the development of arterial wall pathologies. This review describes how the walls of large conductance arteries have acquired physiological clearance functions, how this is determined by the attributes of the endothelial barrier, governed by endocytic and phagocytic capacities of smooth muscle cells, impacting adventitial functions, and the role of these clearance functions in arterial wall diseases.
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Rodríguez-Carrio J, Cerro-Pardo I, Lindholt JS, Bonzon-Kulichenko E, Martínez-López D, Roldán-Montero R, Escolà-Gil JC, Michel JB, Blanco-Colio LM, Vázquez J, Suárez A, Martín-Ventura JL. Malondialdehyde-modified HDL particles elicit a specific IgG response in abdominal aortic aneurysm. Free Radic Biol Med 2021; 174:171-181. [PMID: 34364980 DOI: 10.1016/j.freeradbiomed.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
High Density Lipoprotein (HDL) plays a protective role in abdominal aortic aneurysm (AAA); however, recent findings suggest that oxidative modifications could lead to dysfunctional HDL in AAA. This study aimed at testing the effect of oxidized HDL on aortic lesions and humoral immune responses in a mouse model of AAA induced by elastase, and evaluating whether antibodies against modified HDL can be found in AAA patients. HDL particles were oxidized with malondialdehyde (HDL-MDA) and the changes were studied by biochemical and proteomics approaches. Experimental AAA was induced in mice by elastase perfusion and then mice were treated with HDL-MDA, HDL or vehicle for 14 days. Aortic lesions were studied by histomorphometric analysis. Levels of anti-HDL-MDA IgG antibodies were measured by an in-house immunoassay in the mouse model, in human tissue-supernatants and in plasma samples from the VIVA cohort. HDL oxidation with MDA was confirmed by enhanced susceptibility to diene formation. Proteomics demonstrated the presence of MDA adducts on Lysine residues of HDL proteins, mainly ApoA-I. MDA-modification of HDL abrogated the protective effect of HDL on cultured endothelial cells as well as on AAA dilation in mice. Exposure to HDL-MDA elicited an anti-HDL-MDA IgG response in mice. Anti-HDL-MDA were also detected in tissue-conditioned media from AAA patients, mainly in intraluminal thrombus. Higher plasma levels of anti-HDL-MDA IgG antibodies were found in AAA patients compared to controls. Anti-HDL-MDA levels were associated with smoking and were independent predictors of overall mortality in AAA patients. Overall, MDA-oxidized HDL trigger a specific humoral immune response in mice. Besides, antibodies against HDL-MDA can be detected in tissue and plasma of AAA patients, suggesting its potential use as surrogate stable biomarkers of oxidative stress in AAA.
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Affiliation(s)
- Javier Rodríguez-Carrio
- Area of Immunology, University of Oviedo, Instituto de Salud Del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | | | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Elena Bonzon-Kulichenko
- Laboratorio de Proteómica Cardiovascular, CNIC, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Joan-Carles Escolà-Gil
- Institut de Investigació Biomédica Sant Pau, Spain; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Barcelona, Spain
| | | | - Luis Miguel Blanco-Colio
- IIS-Fundación Jiménez-Díaz, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jesús Vázquez
- Laboratorio de Proteómica Cardiovascular, CNIC, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Suárez
- Area of Immunology, University of Oviedo, Instituto de Salud Del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - José Luis Martín-Ventura
- IIS-Fundación Jiménez-Díaz, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Neutrophils as Regulators and Biomarkers of Cardiovascular Inflammation in the Context of Abdominal Aortic Aneurysms. Biomedicines 2021; 9:biomedicines9091236. [PMID: 34572424 PMCID: PMC8467789 DOI: 10.3390/biomedicines9091236] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
Neutrophils represent up to 70% of circulating leukocytes in healthy humans and combat infection mostly by phagocytosis, degranulation and NETosis. It has been reported that neutrophils are centrally involved in abdominal aortic aneurysm (AAA) pathogenesis. The natural course of AAA is growth and rupture, if left undiagnosed or untreated. The rupture of AAA has a very high mortality and is currently among the leading causes of death worldwide. The use of noninvasive cardiovascular imaging techniques for patient screening, surveillance and postoperative follow-up is well established and recommended by the current guidelines. Neutrophil-derived biomarkers may offer clinical value to the monitoring and prognosis of AAA patients, allowing for potential early therapeutic intervention. Numerous promising biomarkers have been studied. In this review, we discuss neutrophils and neutrophil-derived molecules as regulators and biomarkers of AAA, and our aim was to specifically highlight diagnostic and prognostic markers. Neutrophil-derived biomarkers may potentially, in the future, assist in determining AAA presence, predict size, expansion rate, rupture risk, and postoperative outcome once validated in highly warranted future prospective clinical studies.
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Zhang M, Sui W, Cheng C, Xue F, Tian Z, Cheng J, Zhang J, Zhang T, Zhang J, Wang W, Xiong W, Hao P, Ma J, Xu X, Wang S, Sun S, Zhang M, Zhang Y, Zhang C. Erythropoietin promotes abdominal aortic aneurysms in mice through angiogenesis and inflammatory infiltration. Sci Transl Med 2021; 13:13/603/eaaz4959. [PMID: 34290056 DOI: 10.1126/scitranslmed.aaz4959] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/04/2020] [Accepted: 06/30/2021] [Indexed: 12/19/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a potentially fatal vascular disease, but the underlying mechanisms remain unknown. Here, we tested the hypothesis that erythropoietin (EPO) may promote the formation of AAA. We found that EPO dose-dependently promoted the formation of AAA in both Apoe -/- (66.7%) and wild-type (WT) (60%) mice receiving a high dose of EPO. EPO monoclonal antibodies given to Apoe -/- mice receiving angiotensin II (AngII) stimulation resulted in a markedly lower incidence of AAA (from 86.7 to 20%, P < 0.001), and EPO receptor (EPOR) knockdown in Epor +/- Apoe -/- mice substantially reduced the incidence of AAA compared to Apoe -/- mice after AngII stimulation (from 86.7 to 45.5%, P < 0.05), further supporting the finding that EPO is a contributor to AAA formation. EPO-induced AAA resulted in increased microvessels, phagocyte infiltration, and matrix metalloproteinase secretion, as well as reduced collagen and smooth muscle cells (SMCs). Experiments in vitro and ex vivo demonstrated that EPO induced proliferation, migration, and tube formation of endothelial cells via the JAK2/STAT5 signaling pathway. In humans, serum EPO concentrations were higher in patients with AAA than in healthy individuals and correlated with the size of the AAA, suggesting a potential link between EPO and the severity of AAA in humans. In conclusion, we found that EPO promotes the formation of AAA in both Apoe -/- and WT mice by enhancing angiogenesis, inflammation, collagen degradation, and apoptosis of SMCs and that EPO/EPOR signaling is essential for AngII-induced AAA. The association between EPO and AAA in humans warrants further study.
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Affiliation(s)
- Meng Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Wenhai Sui
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Cheng Cheng
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Fei Xue
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Zhenyu Tian
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Jing Cheng
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Jie Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Tao Zhang
- Department of Vascular Surgery, First Affiliated Hospital of Shandong First Medical University, Jinan 250013, Shandong, China
| | - Jianlin Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Weiwei Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Wenjing Xiong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Panpan Hao
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Jing Ma
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Xingli Xu
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Shuangxi Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Shangwen Sun
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Meng Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China.
| | - Yun Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China.
| | - Cheng Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China.
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9
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Böhm EW, Pavlaki M, Chalikias G, Mikroulis D, Georgiadis GS, Tziakas DN, Konstantinides S, Schäfer K. Colocalization of Erythrocytes and Vascular Calcification in Human Atherosclerosis: A Systematic Histomorphometric Analysis. TH OPEN 2021; 5:e113-e124. [PMID: 33870075 PMCID: PMC8046517 DOI: 10.1055/s-0041-1725042] [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] [Received: 10/29/2020] [Accepted: 01/18/2021] [Indexed: 11/03/2022] Open
Abstract
Background Intimal calcification typically develops in advanced atherosclerosis, and microcalcification may promote plaque progression and instability. Conversely, intraplaque hemorrhage and erythrocyte extravasation may stimulate osteoblastic differentiation and intralesional calcium phosphate deposition. The presence of erythrocytes and their main cellular components (membranes, hemoglobin, and iron) and colocalization with calcification has never been systematically studied. Methods and Results We examined three types of diseased vascular tissue specimens, namely, degenerative aortic valve stenosis ( n = 46), atherosclerotic carotid artery plaques ( n = 9), and abdominal aortic aneurysms ( n = 14). Biomaterial was obtained from symptomatic patients undergoing elective aortic valve replacement, carotid artery endatherectomy, or aortic aneurysm repair, respectively. Serial sections were stained using Masson-Goldner trichrome, Alizarin red S, and Perl's iron stain to visualize erythrocytes, extracelluar matrix and osteoid, calcium phosphate deposition, or the presence of iron and hemosiderin, respectively. Immunohistochemistry was employed to detect erythrocyte membranes (CD235a), hemoglobin or the hemoglobin scavenger receptor (CD163), endothelial cells (CD31), myofibroblasts (SMA), mesenchymal cells (osteopontin), or osteoblasts (periostin). Our analyses revealed a varying degree of intraplaque hemorrhage and that the majority of extravasated erythrocytes were lysed. Osteoid and calcifications also were frequently present, and erythrocyte membranes were significantly more prevalent in areas with calcification. Areas with extravasated erythrocytes frequently contained CD163-positive cells, although calcification also occurred in areas without CD163 immunosignals. Conclusion Our findings underline the presence of extravasated erythrocytes and their membranes in different types of vascular lesions, and their association with areas of calcification suggests an active role of erythrocytes in vascular disease processes.
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Affiliation(s)
- Elsa Wilma Böhm
- Department of Cardiology, University Medical Center, Mainz, Germany
| | - Maria Pavlaki
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Chalikias
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Mikroulis
- Department of Cardiothoracic Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios N Tziakas
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Katrin Schäfer
- Department of Cardiology, University Medical Center, Mainz, Germany
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10
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Li B, Wang Z, Hong J, Che Y, Chen R, Hu Z, Hu X, Wu Q, Hu J, Zhang M. Iron deficiency promotes aortic medial degeneration via destructing cytoskeleton of vascular smooth muscle cells. Clin Transl Med 2021; 11:e276. [PMID: 33463069 PMCID: PMC7805404 DOI: 10.1002/ctm2.276] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Aortic dissection (AD) and aortic aneurysm (AA) are critical illnesses with an unclear pathogenetic mechanism that seriously threaten human life. Aortic medial degeneration (AMD) is the main pathological feature of AD and AA. Diseases of iron metabolism can cause a variety of physiological dysfunctions. In this study, we aimed to clarify the state of iron metabolism in patients with AD and AA, and to explore the effect of iron metabolism on AMD. METHODS A total of 200 patients with AD or AA, and 60 patients with hypertension were included in the study. Blood samples were drawn immediately when patients were admitted to the hospital. Aortic specimens from patients with Stanford type A AD were obtained at the time of surgery. The status of iron metabolism in the circulation and the aortic wall was analyzed. In addition, apolipoprotein E knockout mice were fed chow with a different iron content, and angiotensin II (Ang II) was used to induce AMD. Furthermore, transferrin receptor 1 knockout (TFR1-/-) mice were used to study the effects of iron deficiency (ID) on aortic development, to observe the effects of different iron metabolism status on the formation of AMD in mice, and to explore the cytoskeleton of vascular smooth muscle cells (VSMCs) under different iron metabolism. RESULTS Patients with AMD were iron deficient. ID is associated with the development of AMD in hypertensive patients. Iron-deficient feeding combined with Ang II pumping promoted the formation of AMD and significantly shortened the survival time of mice. ID significantly impaired the cytoskeleton of VSMCs. CONCLUSIONS Our results highlighted that ID was associated with the formation of AMD in patients with hypertension. In this study, we identified a novel mechanism behind VSMCs dysfunction that was induced by ID, thereby suggesting iron homeostasis as a future precaution in patients with hypertension based on its important role in the maintenance of VSMC function.
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Affiliation(s)
- Bowen Li
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Zhiwei Wang
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Junmou Hong
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Yanjia Che
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Ruoshi Chen
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Zhipeng Hu
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Xiaoping Hu
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Qi Wu
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Junxia Hu
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Min Zhang
- Department of Cardiovascular SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Surgery LaboratoryRenmin Hospital of Wuhan UniversityWuhanChina
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11
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Michel JB. Phylogenic Determinants of Cardiovascular Frailty, Focus on Hemodynamics and Arterial Smooth Muscle Cells. Physiol Rev 2020; 100:1779-1837. [DOI: 10.1152/physrev.00022.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The evolution of the circulatory system from invertebrates to mammals has involved the passage from an open system to a closed in-parallel system via a closed in-series system, accompanying the increasing complexity and efficiency of life’s biological functions. The archaic heart enables pulsatile motion waves of hemolymph in invertebrates, and the in-series circulation in fish occurs with only an endothelium, whereas mural smooth muscle cells appear later. The present review focuses on evolution of the circulatory system. In particular, we address how and why this evolution took place from a closed, flowing, longitudinal conductance at low pressure to a flowing, highly pressurized and bifurcating arterial compartment. However, although arterial pressure was the latest acquired hemodynamic variable, the general teleonomy of the evolution of species is the differentiation of individual organ function, supported by specific fueling allowing and favoring partial metabolic autonomy. This was achieved via the establishment of an active contractile tone in resistance arteries, which permitted the regulation of blood supply to specific organ activities via its localized function-dependent inhibition (active vasodilation). The global resistance to viscous blood flow is the peripheral increase in frictional forces caused by the tonic change in arterial and arteriolar radius, which backscatter as systemic arterial blood pressure. Consequently, the arterial pressure gradient from circulating blood to the adventitial interstitium generates the unidirectional outward radial advective conductance of plasma solutes across the wall of conductance arteries. This hemodynamic evolution was accompanied by important changes in arterial wall structure, supported by smooth muscle cell functional plasticity, including contractility, matrix synthesis and proliferation, endocytosis and phagocytosis, etc. These adaptive phenotypic shifts are due to epigenetic regulation, mainly related to mechanotransduction. These paradigms actively participate in cardio-arterial pathologies such as atheroma, valve disease, heart failure, aneurysms, hypertension, and physiological aging.
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12
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Red Blood Cells and Hemoglobin in Human Atherosclerosis and Related Arterial Diseases. Int J Mol Sci 2020; 21:ijms21186756. [PMID: 32942605 PMCID: PMC7554753 DOI: 10.3390/ijms21186756] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
As the main particulate component of the circulating blood, RBCs play major roles in physiological hemodynamics and impact all arterial wall pathologies. RBCs are the main determinant of blood viscosity, defining the frictional forces exerted by the blood on the arterial wall. This function is used in phylogeny and ontogeny of the cardiovascular (CV) system, allowing the acquisition of vasomotricity adapted to local metabolic demands, and systemic arterial pressure after birth. In pathology, RBCs collide with the arterial wall, inducing both local retention of their membranous lipids and local hemolysis, releasing heme-Fe++ with a high toxicity for arterial cells: endothelial and smooth muscle cells (SMCs) cardiomyocytes, neurons, etc. Specifically, overloading of cells by Fe++ promotes cell death. This local hemolysis is an event associated with early and advanced stages of human atherosclerosis. Similarly, the permanent renewal of mural RBC clotting is the major support of oxidation in abdominal aortic aneurysm. In parallel, calcifications promote intramural hemorrhages, and hemorrhages promote an osteoblastic phenotypic shift of arterial wall cells. Different plasma or tissue systems are able, at least in part, to limit this injury by acting at the different levels of this system.
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13
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Janssen TL, Steyerberg EW, van Gammeren AJ, Ho GH, Gobardhan PD, van der Laan L. Intravenous Iron in a Prehabilitation Program for Older Surgical Patients: Prospective Cohort Study. J Surg Res 2020; 257:32-41. [PMID: 32818782 DOI: 10.1016/j.jss.2020.07.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older patients often have iron deficiency anemia before surgery, which can be effectively treated with intravenous iron supplementation (IVIS). Anemia and blood transfusions are associated with an increased risk of delirium. The aim of this research was to assess the effectiveness and safety of using IVIS in a prehabilitation program. MATERIAL AND METHODS Patients ≥70 y who underwent abdominal surgery between November 2015 and June 2018 were included in this single-center prospective cohort study. All patients were prehabilitated; however, only anemic patients received a single dose of 1000 mg intravenous iron (ferric carboxymaltose) to increase preoperative hemoglobin levels (IVIS group). Nonanemic patients received standard care (SC). The hemoglobin levels (primary outcome) were assessed at the outpatient clinic visit, at admission, and at discharge. Secondary outcomes were postoperative delirium, postoperative anemia, blood transfusion, complications other than delirium, and length of hospital stay. All outcomes were compared between the IVIS group and SC group. RESULTS Of all patients (n = 248), 97 anemic patients received IVIS (39%). Of the anemic patients, 50 patients (52%) had iron deficiency. Initial differences in hemoglobin concentrations between the IVIS group and SC group at T1 and T2 (7.2 versus 8.8; P < 0.001 and 7.4 versus 8.6; P = 0.023, respectively) were no longer present at discharge (6.6 versus 7.2; P = 0.35). No statistically significant differences were observed for all secondary outcomes between the IVIS group and the SC group. No infusion-related adverse events occurred. CONCLUSIONS Adding IVIS to prehabilitation programs is safe and diminishes differences in these concentrations between preoperatively anemic and nonanemic patients. IVIS may be worthwhile as an additional component of prehabilitation programs. Results merit further investigation.
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Affiliation(s)
- Ties L Janssen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adriaan J van Gammeren
- Department of Clinical Chemistry and Haematology, Amphia Hospital, Breda, the Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Cardiovascular Science, University Hospital Leuven, Belgium
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14
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Xiao J, Borné Y, Gottsäter A, Pan J, Acosta S, Engström G. Red Cell Distribution Width is Associated with Future Incidence of Abdominal Aortic Aneurysm in a Population-Based Cohort Study. Sci Rep 2020; 10:7230. [PMID: 32350354 PMCID: PMC7190826 DOI: 10.1038/s41598-020-64331-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022] Open
Abstract
Red cell distribution width (RDW) has been suggested to have a predictive potential for several cardiovascular diseases, but its association with abdominal aortic aneurysm (AAA) is unknown. We examined whether RDW is associated with the risk of AAA among 27,260 individuals from the population-based Malmö Diet and Cancer Study cohort. Data of baseline characteristics were collected during 1991–1996. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for AAA across quartiles of RDW. During a median follow-up of 21.7 years, 491 subjects developed AAA. After adjustment for other confounding factors, participants in the highest quartile of RDW experienced 61% increased risk of AAA as compared to those with the lowest quartile (HR = 1.61, CI = 1.20, 2.12). RDW showed similar relationship with severe (i.e. ruptured or surgically repaired) AAA or non-severe AAA (adjusted HR 1.58 and 1.60, respectively). The observed association between RDW and AAA risk was significant in current smokers (adjusted HR = 1.68, CI = 1.18, 2.38) but not in former smokers (adjusted HR = 1.13, CI = 0.72, 1.79), or never-smokers (adjusted HR = 1.77, CI = 0.74, 4.22). Elevated RDW is associated with increased future incidence of AAA, however the causal and pathophysiological mechanisms remain to be explored.
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Affiliation(s)
- Jun Xiao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
| | - Yan Borné
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jingxue Pan
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.,Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
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15
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Martínez-López D, Camafeita E, Cedó L, Roldan-Montero R, Jorge I, García-Marqués F, Gómez-Serrano M, Bonzon-Kulichenko E, Blanco-Vaca F, Blanco-Colio LM, Michel JB, Escola-Gil JC, Vázquez J, Martin-Ventura JL. APOA1 oxidation is associated to dysfunctional high-density lipoproteins in human abdominal aortic aneurysm. EBioMedicine 2019; 43:43-53. [PMID: 30982767 PMCID: PMC6562066 DOI: 10.1016/j.ebiom.2019.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/15/2019] [Accepted: 04/04/2019] [Indexed: 01/10/2023] Open
Abstract
Background High-density lipoproteins (HDL) are a complex mixture of lipids and proteins with vasculoprotective properties. However, HDL components could suffer post-translational modifications (PTMs) under pathological conditions, leading to dysfunctional HDL. We studied whether HDL are modified in abdominal aortic aneurysm (AAA) and the effect on HDL functionality. Methods HDL were isolated by ultracentrifugation from AAA tissue (HDL-T) and from plasma of healthy volunteers and then incubated with AAA tissue-conditioned medium (HDL-AAA CM). PTMs from these particles were characterized using Comet-PTM. The ability of HDL-AAA CM for promoting cholesterol efflux was determined ex vivo and in vivo by using J774A.1 [3H]cholesterol-labeled mouse macrophages and after injecting [3H]cholesterol-labeled mouse macrophages and HDL into the peritoneal cavity of wild-type C57BL/6 mice, respectively. Trp50 and Trp108 oxidized forms of APOA1 in HDL incubated with conditioned-medium of activated neutrophils and in plasma of AAA patients and controls were measured by targeted parallel reaction monitoring. Findings Oxidation was the most prevalent PTM in apolipoproteins, particularly in APOA1. Trp50 and Trp108 in APOA1 were the residues most clearly affected by oxidation in HDL-T and in HDL-AAA CM, when compared to their controls. In addition, cholesterol efflux was decreased in macrophages incubated with HDL-AAA CM in vitro and a decreased macrophage-to-serum reverse cholesterol transport was also observed in mice injected with HDL-AAA CM. Finally, both oxidized Trp50 and Trp108 forms of APOA1 were increased in HDL incubated with conditioned-medium of activated neutrophils and in plasma of AAA patients in relation to controls. Interpretation Oxidative modifications of HDL present in AAA tissue and plasma were closely associated with the loss of vasculoprotective properties of HDL in AAA. Fund MINECO, ISCiii-FEDER, CIBERDEM, CIBERCV and LA CAIXA.
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Affiliation(s)
- Diego Martínez-López
- Laboratorio de Patología Vascular, FIIS-Fundación Jiménez Díaz-Universidad Autónoma, Madrid, Spain
| | - Emilio Camafeita
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lídia Cedó
- Institut d'Investigacions Biomèdiques (IIB) Sant Pau, CIBERDEM, Barcelona, Spain
| | - Raquel Roldan-Montero
- Laboratorio de Patología Vascular, FIIS-Fundación Jiménez Díaz-Universidad Autónoma, Madrid, Spain
| | - Inmaculada Jorge
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando García-Marqués
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - María Gómez-Serrano
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Elena Bonzon-Kulichenko
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Luis Miguel Blanco-Colio
- Laboratorio de Patología Vascular, FIIS-Fundación Jiménez Díaz-Universidad Autónoma, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Jesús Vázquez
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Jose Luis Martin-Ventura
- Laboratorio de Patología Vascular, FIIS-Fundación Jiménez Díaz-Universidad Autónoma, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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16
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Sakalihasan N, Michel JB, Katsargyris A, Kuivaniemi H, Defraigne JO, Nchimi A, Powell JT, Yoshimura K, Hultgren R. Abdominal aortic aneurysms. Nat Rev Dis Primers 2018; 4:34. [PMID: 30337540 DOI: 10.1038/s41572-018-0030-7] [Citation(s) in RCA: 294] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal aorta. AAA is a multifactorial disease, and genetic and environmental factors play a part; smoking, male sex and a positive family history are the most important risk factors, and AAA is most common in men >65 years of age. AAA results from changes in the aortic wall structure, including thinning of the media and adventitia due to the loss of vascular smooth muscle cells and degradation of the extracellular matrix. If the mechanical stress of the blood pressure acting on the wall exceeds the wall strength, the AAA ruptures, causing life-threatening intra-abdominal haemorrhage - the mortality for patients with ruptured AAA is 65-85%. Although AAAs of any size can rupture, the risk of rupture increases with diameter. Intact AAAs are typically asymptomatic, and in settings where screening programmes with ultrasonography are not implemented, most cases are diagnosed incidentally. Modern functional imaging techniques (PET, CT and MRI) may help to assess rupture risk. Elective repair of AAA with open surgery or endovascular aortic repair (EVAR) should be considered to prevent AAA rupture, although the morbidity and mortality associated with both techniques remain non-negligible.
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Affiliation(s)
- Natzi Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium. .,Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium.
| | - Jean-Baptiste Michel
- UMR 1148, INSERM Paris 7, Denis Diderot University, Xavier Bichat Hospital, Paris, France
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Helena Kuivaniemi
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Jean-Olivier Defraigne
- Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium.,Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium
| | - Alain Nchimi
- Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium.,Department of Medical Imaging, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Koichi Yoshimura
- Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, Japan.,Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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17
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Affiliation(s)
- Jean-Baptiste Michel
- Unité mixte de Recherche 1148 Inserm-Paris7 University, Xavier Bichat Hospital, Paris, France
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grégory Franck
- Unité mixte de Recherche 1148 Inserm-Paris7 University, Xavier Bichat Hospital, Paris, France
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18
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Molina-Sánchez P, Jorge I, Martinez-Pinna R, Blanco-Colio LM, Tarin C, Torres-Fonseca MM, Esteban M, Laustsen J, Ramos-Mozo P, Calvo E, Lopez JA, Ceniga MVD, Michel JB, Egido J, Andrés V, Vazquéz J, Meilhac O, Burillo E, Lindholt JS, Martin-Ventura JL. ApoA-I/HDL-C levels are inversely associated with abdominal aortic aneurysm progression. Thromb Haemost 2017; 113:1335-46. [DOI: 10.1160/th14-10-0874] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/21/2015] [Indexed: 12/18/2022]
Abstract
SummaryAbdominal aortic aneurysm (AAA) evolution is unpredictable, and there is no therapy except surgery for patients with an aortic size > 5 cm (large AAA). We aimed to identify new potential biomarkers that could facilitate prognosis and treatment of patients with AAA. A differential quantitative proteomic analysis of plasma proteins was performed in AAA patients at different stages of evolution [small AAA (aortic size=3�5cm) vs large AAA] using iTRAQ labelling, highthroughput nano-LC-MS/MS and a novel multi-layered statistical model. Among the proteins identified, ApoA-I was decreased in patients with large AAA compared to those with small AAA. These results were validated by ELISA on plasma samples from small (n=90) and large AAA (n=26) patients (150 ± 3 vs 133 ± 5 mg/dl, respectively, p< 0.001). ApoA-I levels strongly correlated with HDL-Cholesterol (HDL-C) concentration (r=0.9, p< 0.001) and showed a negative correlation with aortic size (r=-0.4, p< 0.01) and thrombus volume (r=-0.3, p< 0.01), which remained significant after adjusting for traditional risk factors. In a prospective study, HDL-C independently predicted aneurysmal growth rate in multiple linear regression analysis (n=122, p=0.008) and was inversely associated with need for surgical repair (Adjusted hazard ratio: 0.18, 95 % confidence interval: 0.04�0.74, p=0.018). In a nation-wide Danish registry, we found lower mean HDL-C concentration in large AAA patients (n=6,560) compared with patients with aorto-iliac occlusive disease (n=23,496) (0.89 ± 2.99 vs 1.59 ± 5.74 mmol/l, p< 0.001). Finally, reduced mean aortic AAA diameter was observed in AngII-infused mice treated with ApoA-I mimetic peptide compared with saline-injected controls. In conclusion, ApoAI/ HDL-C systemic levels are negatively associated with AAA evolution. Therapies targeting HDL functionality could halt AAA formation.
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Martin-Ventura JL, Rodrigues-Diez R, Martinez-Lopez D, Salaices M, Blanco-Colio LM, Briones AM. Oxidative Stress in Human Atherothrombosis: Sources, Markers and Therapeutic Targets. Int J Mol Sci 2017; 18:ijms18112315. [PMID: 29099757 PMCID: PMC5713284 DOI: 10.3390/ijms18112315] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022] Open
Abstract
Atherothrombosis remains one of the main causes of morbidity and mortality worldwide. The underlying pathology is a chronic pathological vascular remodeling of the arterial wall involving several pathways, including oxidative stress. Cellular and animal studies have provided compelling evidence of the direct role of oxidative stress in atherothrombosis, but such a relationship is not clearly established in humans and, to date, clinical trials on the possible beneficial effects of antioxidant therapy have provided equivocal results. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is one of the main sources of reactive oxygen species (ROS) in human atherothrombosis. Moreover, leukocyte-derived myeloperoxidase (MPO) and red blood cell-derived iron could be involved in the oxidative modification of lipids/lipoproteins (LDL/HDL) in the arterial wall. Interestingly, oxidized lipoproteins, and antioxidants, have been analyzed as potential markers of oxidative stress in the plasma of patients with atherothrombosis. In this review, we will revise sources of ROS, focusing on NADPH oxidase, but also on MPO and iron. We will also discuss the impact of these oxidative systems on LDL and HDL, as well as the value of these modified lipoproteins as circulating markers of oxidative stress in atherothrombosis. We will finish by reviewing some antioxidant systems and compounds as therapeutic strategies to prevent pathological vascular remodeling.
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Affiliation(s)
- Jose Luis Martin-Ventura
- Vascular Research Lab, FIIS-Fundación Jiménez Díaz-Autonoma University, 28040 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain.
| | - Raquel Rodrigues-Diez
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain.
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain.
| | - Diego Martinez-Lopez
- Vascular Research Lab, FIIS-Fundación Jiménez Díaz-Autonoma University, 28040 Madrid, Spain.
| | - Mercedes Salaices
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain.
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain.
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain.
| | - Luis Miguel Blanco-Colio
- Vascular Research Lab, FIIS-Fundación Jiménez Díaz-Autonoma University, 28040 Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain.
| | - Ana M Briones
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain.
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain.
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain.
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20
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Plasma ferritin concentrations are not associated with abdominal aortic aneurysm diagnosis, size or growth. Atherosclerosis 2016; 251:19-24. [DOI: 10.1016/j.atherosclerosis.2016.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/04/2016] [Accepted: 05/11/2016] [Indexed: 01/26/2023]
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21
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Nagai S, Kudo T, Inoue Y, Akaza M, Sasano T, Sumi Y. Preoperative Predictors of Long-Term Mortality after Elective Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm. Ann Vasc Dis 2016; 9:42-7. [PMID: 27087872 DOI: 10.3400/avd.oa.15-00129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/07/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to clarify long-term mortality and its predictors in patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Patients with AAA who underwent elective EVAR at Tokyo Medical and Dental University hospital between 2008 and 2011 were reviewed. The patients' data were retrospectively collected from medical records. RESULTS Sixty-four patients were identified for this study. In long-term follow-up, the survival rate was significantly lower in patients with high preoperative C-reactive protein (CRP) levels. Patients with obstructive lung disease (FEV1/FVC <70%) or anemia tended to have a poorer prognosis but the association was not statistically significant. Age, concurrent hyperlipidemia, and blood pressure levels were not predictors of mortality rates. DISCUSSION High CRP level, COPD, and anemia reflect inflammation, which is associated with the pathogenesis of AAA. These inflammatory markers are predictors of long-term mortality after EVAR for AAA as well as for other diseases. CONCLUSIONS A high preoperative CRP level was a predictor of increased long-term mortality in patients with AAA who underwent EVAR. No specific leading causes of death were identified for this increase in the mortality rate.
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Affiliation(s)
- Saya Nagai
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Professional Development, Tokyo Medical and Dental University, Tokyo, Japan; Division of Peripheral Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Peripheral Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Akaza
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Sumi
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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22
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Barisione C, Garibaldi S, Brunelli C, Balbi M, Spallarossa P, Canepa M, Ameri P, Viazzi F, Verzola D, Lorenzoni A, Baldassini R, Palombo D, Pane B, Spinella G, Ghigliotti G. Prevalent cardiac, renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms. Intern Emerg Med 2016; 11:205-12. [PMID: 26510876 DOI: 10.1007/s11739-015-1328-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m(2) (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.
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Affiliation(s)
- Chiara Barisione
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Silvano Garibaldi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Claudio Brunelli
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Manrico Balbi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Paolo Spallarossa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Marco Canepa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Pietro Ameri
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Francesca Viazzi
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Daniela Verzola
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Alessandra Lorenzoni
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Riccardo Baldassini
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Domenico Palombo
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Bianca Pane
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giovanni Spinella
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giorgio Ghigliotti
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy.
- Unit of Vascular and Endovascular Surgery, University of Genova, Genova, Italy.
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23
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Multimodality imaging assessment of the deleterious role of the intraluminal thrombus on the growth of abdominal aortic aneurysm in a rat model. Eur Radiol 2015; 26:2378-86. [PMID: 26396112 DOI: 10.1007/s00330-015-4010-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate imaging changes occurring in a rat model of elastase-induced abdominal aortic aneurysm (AAA), with emphasis on the intraluminal thrombus (ILT) occurrence. METHODS The post-induction growth of the AAA diameter was characterized using ultrasound in 22 rats. ILT was reported on 13 rats that underwent 14 magnetic resonance imaging (MRI) 2-18 days post-surgery, and on 10 rats that underwent 18 fluoro-deoxyglucose (FDG) positron emission tomography (PET)/microcomputed tomography examinations 2-27 days post-surgery. Logistic regressions were used to establish the evolution with time of AAA length, diameter, ILT thickness, volume, stratification, MRI and FDG PET signalling properties, and histological assessment of inflammatory infiltrates. RESULTS All of the following significantly increased with time post-induction (p < 0.001): AAA length, AAA diameter, ILT maximal thickness, ILT volume, ILT iron content and related MRI signalling changes, quantitative uptake on FDG PET, and the magnitude of inflammatory infiltrates on histology. However, the aneurysm growth peak followed occurrence of ILT approximately 6 days after elastase infusion. CONCLUSION Our model emphasizes that occurrence of ILT precedes AAA peak growth. Aneurysm growth is associated with increasing levels of iron, signalling properties changes in both MRI and FDG PET, relating to its biological activities. KEY POINTS • ILT occurrence in AAA is associated with increasing FDG uptake and growth. • MRI signalling changes in ILT reflect activities such as haemorrhage and RBC trapping. • Monitoring ILT activities using MRI may require no exogenous contrast agent.
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24
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Rubio-Navarro A, Amaro Villalobos JM, Lindholt JS, Buendía I, Egido J, Blanco-Colio LM, Samaniego R, Meilhac O, Michel JB, Martín-Ventura JL, Moreno JA. Hemoglobin induces monocyte recruitment and CD163-macrophage polarization in abdominal aortic aneurysm. Int J Cardiol 2015; 201:66-78. [PMID: 26296046 DOI: 10.1016/j.ijcard.2015.08.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/21/2015] [Accepted: 08/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Increased hemoglobin (Hb) accumulation was reported in abdominal aortic aneurysms (AAAs). CD163 is a macrophage receptor involved in tissue Hb clearance, however its role in AAA has not been reported. We investigated the role of Hb on monocyte recruitment and differentiation towards CD163 expressing macrophages ex vivo, in vitro and in human AAA. METHODS AND RESULTS CD163 mRNA and protein expression was significantly higher in human AAA (n=7) vs. healthy wall (n=6). CD163 was predominantly found in adventitia of AAA, coinciding with areas rich in hemosiderin and adjacent to neoangiogenic microvessels. Dual CD14/CD163 expression was observed in recently infiltrated monocytes surrounding microvessels. A higher release of soluble CD163 was observed in the conditioned medium from AAA (AAA-CM, n=10), mainly in the adventitial layer. Similar to Hb, AAA-CM induced CD163-dependent monocyte chemotaxis, especially on circulating monocytes from AAA patients. Hb or AAA-CM promoted differentiation towards CD163(high)/HLA-DR(low)-expressing macrophages, with enhanced Hb uptake, increased anti-inflammatory IL-10 secretion and decreased pro-inflammatory IL-12p40 release. All these effects were partially suppressed when Hb was removed from AAA-CM. Separate analysis on circulating monocytes reported increased percentage of pre-infiltrating CD14(++)CD16(+) monocytes in patients with AAA (n=21), as compared to controls (n=14). A significant increase in CD163 expression in CD14(++)CD16(+) monocyte subpopulation was observed in AAA patients. CONCLUSIONS The presence of Hb in the adventitial AAA-wall promotes the migration and differentiation of activated circulating monocytes in AAA patients, explaining the existence of a protective CD163-macrophage phenotype that could take up the Hb present in the AAA-wall, avoiding its injurious effects.
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Affiliation(s)
- Alfonso Rubio-Navarro
- Vascular, Renal and Diabetes Research Lab., IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain
| | | | - Jes S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | - Irene Buendía
- Vascular, Renal and Diabetes Research Lab., IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain
| | - Jesús Egido
- Vascular, Renal and Diabetes Research Lab., IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain
| | - Luis Miguel Blanco-Colio
- Vascular, Renal and Diabetes Research Lab., IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain
| | - Rafael Samaniego
- Confocal Microscopy Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Olivier Meilhac
- INSERM U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, Saint-Denis, France
| | - Jean Baptiste Michel
- INSERM UMRS 1148 Laboratory for Vascular Translational Science, Bichat Hospital, Paris, France
| | - José Luis Martín-Ventura
- Vascular, Renal and Diabetes Research Lab., IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain
| | - Juan Antonio Moreno
- Vascular, Renal and Diabetes Research Lab., IIS-Fundación Jiménez Díaz, Autónoma University, Madrid, Spain.
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Sawada H, Hao H, Naito Y, Oboshi M, Hirotani S, Mitsuno M, Miyamoto Y, Hirota S, Masuyama T. Aortic Iron Overload With Oxidative Stress and Inflammation in Human and Murine Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2015; 35:1507-14. [DOI: 10.1161/atvbaha.115.305586] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 03/30/2015] [Indexed: 01/28/2023]
Abstract
Objective—
Although iron is an essential element for maintaining physiological function, excess iron leads to tissue damage caused by oxidative stress and inflammation. Oxidative stress and inflammation play critical roles for the development of abdominal aortic aneurysm (AAA). However, it has not been investigated whether iron plays a role in AAA formation through oxidative stress and inflammation. We, therefore, examined whether iron is involved in the pathophysiology of AAA formation using human AAA walls and murine AAA models.
Approach and Results—
Human aortic walls were collected from 53 patients who underwent cardiovascular surgery (non-AAA=34; AAA=19). Murine AAA was induced by infusion of angiotensin II to apolipoprotein E knockout mice. Iron was accumulated in human and murine AAA walls compared with non-AAA walls. Immunohistochemistry showed that both 8-hydroxy-2′-deoxyguanosine and CD68-positive areas were increased in AAA walls compared with non-AAA walls. The extent of iron accumulated area positively correlated with that of 8-hydroxy-2′-deoxyguanosine expression area and macrophage infiltration area in human and murine AAA walls. We next investigated the effects of dietary iron restriction on AAA formation in mice. Iron restriction reduced the incidence of AAA formation with attenuation of oxidative stress and inflammation. Aortic expression of transferrin receptor 1, intracellular iron transport protein, was increased in human and murine AAA walls, and transferrin receptor 1–positive area was similar to areas where iron accumulated and F4/80 were positive.
Conclusions—
Iron is involved in the pathophysiology of AAA formation with oxidative stress and inflammation. Dietary iron restriction could be a new therapeutic strategy for AAA progression.
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Affiliation(s)
- Hisashi Sawada
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroyuki Hao
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshiro Naito
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Makiko Oboshi
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Hirotani
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masataka Mitsuno
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuji Miyamoto
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Seiichi Hirota
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tohru Masuyama
- From the Cardiovascular Division, Department of Internal Medicine (H.S., Y.N., M.O., S. Hirotani, T.M.), Department of Surgical Pathology (H.H., S. Hirota), and Department of Cardiovascular Surgery (M.M., Y.M.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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26
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Martinez-Pinna R, Burillo E, Madrigal-Matute J, Lopez JA, Camafeita E, Torres-Fonseca MM, Llamas-Granda P, Egido J, Michel JB, Blanco-Colio LM, Martin-Ventura JL. Label-free proteomic analysis of red blood cell membrane fractions from abdominal aortic aneurysm patients. Proteomics Clin Appl 2014; 8:626-30. [DOI: 10.1002/prca.201400035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/02/2014] [Accepted: 06/24/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | - Elena Burillo
- Vascular Research Lab, IIS-Fundación Jiménez Díaz; Universidad Autónoma de Madrid
| | | | | | - Emilio Camafeita
- Centro Nacional de Investigaciones Cardiovasculares; Madrid Spain
| | | | | | - Jesus Egido
- Vascular Research Lab, IIS-Fundación Jiménez Díaz; Universidad Autónoma de Madrid
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Novel biomarkers of abdominal aortic aneurysm disease: identifying gaps and dispelling misperceptions. BIOMED RESEARCH INTERNATIONAL 2014; 2014:925840. [PMID: 24967416 PMCID: PMC4055358 DOI: 10.1155/2014/925840] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/29/2014] [Accepted: 05/04/2014] [Indexed: 11/17/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a prevalent and potentially life-threatening disease. Early detection by screening programs and subsequent surveillance has been shown to be effective at reducing the risk of mortality due to aneurysm rupture. The aim of this review is to summarize the developments in the literature concerning the latest biomarkers (from 2008 to date) and their potential screening and therapeutic values. Our search included human studies in English and found numerous novel biomarkers under research, which were categorized in 6 groups. Most of these studies are either experimental or hampered by their low numbers of patients. We concluded that currently no specific laboratory markers allow screeing for the disease and monitoring its progression or the results of treatment. Further studies and studies in larger patient groups are required in order to validate biomarkers as cost-effective tools in the AAA disease.
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