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Cai Z, Satyanarayana G, Song P, Zhao F, You S, Liu Z, Mu J, Ding Y, He B, Zou MH. Regulation of Ptbp1-controlled alternative splicing of pyruvate kinase muscle by Liver kinase b1 governs vascular smooth muscle cell plasticity in vivo. Cardiovasc Res 2024:cvae187. [PMID: 39189621 DOI: 10.1093/cvr/cvae187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 04/12/2024] [Accepted: 08/25/2024] [Indexed: 08/28/2024] Open
Abstract
AIMS Vascular smooth muscle cell (VSMC) plasticity is a state in which VSMCs undergo phenotypic switching from a quiescent contractile phenotype into other functionally distinct phenotypes. Although emerging evidence suggest that VSMC plasticity plays critical roles in the development of vascular diseases, little is known about the key determinant for controlling VSMC plasticity and fate. METHODS AND RESULTS We found that smooth muscle cell-specific deletion of Lkb1 in tamoxifen-inducible Lkb1flox/flox; Myh11-Cre/ERT2 mice spontaneously and progressively induced aortic/arterial dilation, aneurysm, rupture, and premature death. Single-cell RNA sequencing and imaging-based lineage tracing showed that Lkb1-deficient VSMCs transdifferentiated gradually from early modulated VSMCs to fibroblast-like and chondrocyte-like cells, leading to ossification and blood-vessel rupture. Mechanistically, Lkb1 regulates polypyrimidine tract binding protein 1 (Ptbp1) expression and controls alternative splicing of pyruvate kinase muscle (PKM) isoforms 1 and 2. Lkb1 loss in VSMC results in an increased PKM2/PKM1 ratio and alters the metabolic profile by promoting aerobic glycolysis. Treatment with PKM2 activator TEPP-46 rescues VSMC transformation and aortic dilation in Lkb1flox/flox; Myh11-Cre/ERT2 mice. Furthermore, we found that Lkb1 expression decreased in human aortic aneurysm tissue compared to control tissue, along with changes in markers of VSMC fate. CONCLUSIONS Lkb1, via its regulation of Ptbp1-dependent alterative splicing of PKM, maintains VSMC in contractile states by suppressing VSMC plasticity.
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Affiliation(s)
- Zhaohua Cai
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ganesh Satyanarayana
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
| | - Ping Song
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
| | - Fujie Zhao
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
| | - Shaojin You
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhixue Liu
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
| | - Jing Mu
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
| | - Ye Ding
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ming-Hui Zou
- Center for Molecular and Translational Medicine, Georgia State University, Atlanta, GA, 30303
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Liu C, Peng J, Liu Y, Peng Y, Ma Q. Genetic evidence for lifestyle and cardiometabolic factors on the risk of aortic aneurysms: A comprehensive Mendelian randomization study. Atherosclerosis 2024; 397:118572. [PMID: 39216229 DOI: 10.1016/j.atherosclerosis.2024.118572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Aortic aneurysm (AAs) is a chronic and severe aortic disease, which is extremely life-threatening due to its delayed diagnosis and a high risk of rupture. In current studies, the association between lifestyle and metabolic factors remains controversial given the complexity of pathogenesis and progression in AAs. Consequently, more reliable and robust evidence should be provided. METHODS Genome-wide association studies summary statistics were obtained for 25 factors (6 lifestyle factors and 19 cardiometabolic factors) and AAs. Univariable Mendelian randomization (UVMR) and multivariable MR (MVMR) were used to estimate the causal effect of these factors on AAs. Meanwhile, mediation analysis was applied to assess the mediated effect of lifestyle on the association of cardiometabolic factors with AAs. RESULTS Several factors were associated with AA risk, among which triglyceride (TG) (OR = 1.32, 95 % CI = [1.18-1.47], p < 0.001) and high-density lipoprotein cholesterol (HDL-C) (OR = 0.70, 95 % CI = [0.61-0.82], p < 0.001) remain consistently associated with AA risk, with an idependent effect on AAs after adjusting for body mass index (BMI). In addition, TG mediated 15.6 % of BMI effects and 3.7 % of smoking effects on AAs, and HDL-C mediated 5.3 % of the effects of cigarette smoking on AAs. CONCLUSIONS TG and HDL-C may be the most reliable factors in the risk of AAs. More scientific management of lifestyle and regular monitoring for cardiometabolic traits may serve as a new and effective direction for the prevention and control of the occurrence of AAs.
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Affiliation(s)
- Chenxi Liu
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, No. 150 Jimo Road, Shanghai, 200120, China
| | - Jia Peng
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yubo Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Peng
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qilin Ma
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Cao L, Zhang H, Niu Z, Ma T, Guo W. Aortic mineralization triggers the risk of acute type B aortic dissection. Atherosclerosis 2024; 395:118519. [PMID: 38944894 DOI: 10.1016/j.atherosclerosis.2024.118519] [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: 03/19/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND AIMS The role of aortic mineralization in the pathogenesis of acute type B aortic dissection (TBAD) is unclear. Whether thoracic aortic calcification (TAC) and circulating alkaline phosphatase (ALP) activity are associated with acute TBAD risk remains elusive. METHODS Observational and Mendelian randomization (MR) studies were conducted sequentially. Using propensity score matching (1:1) by age and sex, patients with acute TBAD (n = 125) were compared with control patients (n = 125). Qualitative (score) and quantitative (volume) analyses of the TAC burden on different thoracic aortic segments were conducted using non-enhanced computed tomography. Univariate and multivariate analyses were used to identify significant independent risk factors for TBAD and TAC burden, respectively. MR was finally used to determine the causal relationship between elevated ALP activity and TBAD risk. RESULTS The qualitative and quantitative analyses revealed that TAC burden was significantly higher in the TBAD group, except for in the ascending aortic segment (both p < 0.05). Preoperative circulating ALP was significantly elevated in the TBAD group (p < 0.001). The elevated TAC burden score on the descending thoracic aortic segment (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31-8.37) and increased ALP activity (OR 1.03, 95% CI 1.01-1.06) was independently associated with TBAD risk. Interestingly, ALP was significantly positively associated with TAC burden, and MR analyses confirmed that ALP genetically predicted TBAD risk. CONCLUSIONS Elevated ALP may trigger TBAD risk via the increased volume of TAC. Aortic mineralization may not protect the aorta itself.
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Affiliation(s)
- Long Cao
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China; Medical School of Chinese PLA, Beijing, China; Department of General Surgery, The 983rd Hospital of Joint Logistic Support Force of PLA, Tianjin, 300142, China
| | - Hongpeng Zhang
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zelin Niu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Tianfeng Ma
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China; Medical School of Chinese PLA, Beijing, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
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Brückner A, Brandtner A, Rieck S, Matthey M, Geisen C, Fels B, Stei M, Kusche-Vihrog K, Fleischmann BK, Wenzel D. Site-specific genetic and functional signatures of aortic endothelial cells at aneurysm predilection sites in healthy and AngII ApoE -/- mice. Angiogenesis 2024:10.1007/s10456-024-09933-9. [PMID: 38965173 DOI: 10.1007/s10456-024-09933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
Aortic aneurysm is characterized by a pathological dilation at specific predilection sites of the vessel and potentially results in life-threatening vascular rupture. Herein, we established a modified "Häutchen method" for the local isolation of endothelial cells (ECs) from mouse aorta to analyze their spatial heterogeneity and potential role in site-specific disease development. When we compared ECs from aneurysm predilection sites of healthy mice with adjacent control segments we found regulation of genes related to extracellular matrix remodeling, angiogenesis and inflammation, all pathways playing a critical role in aneurysm development. We also detected enhanced cortical stiffness of the endothelium at these sites. Gene expression of ECs from aneurysms of the AngII ApoE-/- model when compared to sham animals mimicked expression patterns from predilection sites of healthy animals. Thus, this work highlights a striking genetic and functional regional heterogeneity in aortic ECs of healthy mice, which defines the location of aortic aneurysm formation in disease.
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Affiliation(s)
- Alexander Brückner
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Adrian Brandtner
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Sarah Rieck
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Michaela Matthey
- Department of Systems Physiology, Medical Faculty, Institute of Physiology, Ruhr University of Bochum, Universitätsstr. 150, 44801, Bochum, Germany
| | - Caroline Geisen
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Benedikt Fels
- Institute of Physiology, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner SiteHamburg/Luebeck/Kiel, Luebeck, Germany
| | - Marta Stei
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Kristina Kusche-Vihrog
- Institute of Physiology, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner SiteHamburg/Luebeck/Kiel, Luebeck, Germany
| | - Bernd K Fleischmann
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Daniela Wenzel
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany.
- Department of Systems Physiology, Medical Faculty, Institute of Physiology, Ruhr University of Bochum, Universitätsstr. 150, 44801, Bochum, Germany.
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Mouhanni S, Hassani AA, Lekehal M, Bounssir A, Bakkali T, Lekehal B. Ruptured abdominal aortic aneurysm in psoriasis: A case report and review of literature. Int J Surg Case Rep 2024; 120:109829. [PMID: 38870660 PMCID: PMC11225200 DOI: 10.1016/j.ijscr.2024.109829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Psoriasis, a chronic inflammatory skin condition, affects 4 % of the population and is associated with various comorbidities, making it a public health concern. CASE REPORT We discuss the case of a 50-year-old man with severe erythrodermic psoriasis who presented with a ruptured saccular abdominal aortic aneurysm (AAA), requiring emergency surgery with good postoperative follow-up. shedding light on the link between psoriasis and cardiovascular complications. DISCUSSION Psoriasis severity correlates with cardiovascular risk and shares common development pathways with aortic aneurysms such as systemic and aortic inflammation, and arterial stiffness, emphasizing the importance of managing both skin symptoms and systemic inflammation to reduce vascular comorbidities. Psoriasis patients have a higher risk of AAA, warranting consideration for AAA screening. Controversies exist regarding corticosteroid therapy and choice of surgical intervention for AAA in psoriatic patients. CONCLUSION Psoriasis patients face an increased risk of AAA, highlighting the need for vigilant screening and comprehensive management. Further research is essential to understanding the pathophysiological connections between psoriasis and arterial diseases, guiding preventive strategies and optimal medical treatments for these high-risk patients.
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Affiliation(s)
- Safaa Mouhanni
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco.
| | - Amine Azami Hassani
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Mehdi Lekehal
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Ayoub Bounssir
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Tarik Bakkali
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
| | - Brahim Lekehal
- Mohammed V University in Rabat, Rabat, Morocco; Vascular Surgery Department, Ibn Sina University Hospital Centre, Rabat 10104, Morocco
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Koo HY, Cho IY, Han K, Lee KN, Cho MH, Jin SM, Cho YH, Lee JH, Park YJ, Shin DW. Glycaemic Status and Risk of Abdominal Aortic Aneurysm: A Nationwide Cohort Study of Four Million Adults using Korean National Health Screening Data. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00469-6. [PMID: 38844129 DOI: 10.1016/j.ejvs.2024.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/10/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE This retrospective cohort study aimed to confirm the previously reported inverse association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) using large population based data. It also investigated the associations between AAA and impaired fasting glucose (IFG) and new onset DM (not yet treated). METHODS A representative dataset was obtained from the Korean National Health Insurance Service. Participants who were aged ≥ 50 years and received a national health examination in 2009 were included and followed until 31 December 2019. Glycaemic status was defined based on fasting plasma glucose level and the relevant diagnostic codes. AAA was ascertained using medical facility use records with relevant diagnostic codes or aneurysm repair surgery. A Cox proportional hazards model was used to examine the association between glycaemic status and AAA, with adjustment for confounders. Additionally, the interactions between glycaemic status and subgroups based on baseline characteristics were examined. RESULTS The study population comprised 4 162 640 participants. Participants with IFG or DM were significantly more likely to be male, older, and have comorbidities compared with normoglycaemic participants at baseline. The incidence of AAA was lower in participants with IFG or DM compared with normoglycaemic participants. The AAA risk was lower in patients with DM than in patients with IFG, and decreased linearly according to glycaemic status: the adjusted hazard ratio was 0.88 (95% confidence interval [CI] 0.85 - 0.91) for IFG, 0.72 (95% CI 0.67 - 0.78) for newly diagnosed DM, 0.65 (95% CI 0.61 - 0.69) for DM duration < 5 years, and 0.47 (95% CI 0.44 - 0.51) for DM duration ≥ 5 years compared with the normoglycaemia group. Both IFG and DM were related to reduced AAA risk in all subgroups, suggesting an independent association. CONCLUSION Both IFG and DM, even when not treated with antihyperglycaemic medication, were associated with a lower incidence of AAA. The AAA risk decreased linearly according to DM duration.
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Affiliation(s)
- Hye Yeon Koo
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine & Supportive Care Centre, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyu Na Lee
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hee Cho
- Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Centre, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation/Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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Dong H, Leach JR, Kao E, Zhou A, Chitiboi T, Zhu C, Ballweber M, Jiang F, Lee YJ, Iannuzzi J, Gasper W, Saloner D, Hope MD, Mitsouras D. Measurement of Abdominal Aortic Aneurysm Strain Using MR Deformable Image Registration: Accuracy and Relationship to Recent Aneurysm Progression. Invest Radiol 2024; 59:425-432. [PMID: 37855728 PMCID: PMC11026303 DOI: 10.1097/rli.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Management of asymptomatic abdominal aortic aneurysm (AAA) based on maximum aneurysm diameter and growth rate fails to preempt many ruptures. Assessment of aortic wall biomechanical properties may improve assessment of progression and rupture risk. This study aimed to assess the accuracy of AAA wall strain measured by cine magnetic resonance imaging (MRI) deformable image registration (MR strain) and investigate its relationship with recent AAA progression. METHODS The MR strain accuracy was evaluated in silico against ground truth strain in 54 synthetic MRIs generated from a finite element model simulation of an AAA patient's abdomen for different aortic pulse pressures, tissue motions, signal intensity variations, and image noise. Evaluation included bias with 95% confidence interval (CI) and correlation analysis. Association of MR strain with AAA growth rate was assessed in 25 consecutive patients with >6 months of prior surveillance, for whom cine balanced steady-state free-precession imaging was acquired at the level of the AAA as well as the proximal, normal-caliber aorta. Univariate and multivariate regressions were used to associate growth rate with clinical variables, maximum AAA diameter (D max ), and peak circumferential MR strain through the cardiac cycle. The MR strain interoperator variability was assessed using bias with 95% CI, intraclass correlation coefficient, and coefficient of variation. RESULTS In silico experiments revealed an MR strain bias of 0.48% ± 0.42% and a slope of correlation to ground truth strain of 0.963. In vivo, AAA MR strain (1.2% ± 0.6%) was highly reproducible (bias ± 95% CI, 0.03% ± 0.31%; intraclass correlation coefficient, 97.8%; coefficient of variation, 7.14%) and was lower than in the nonaneurysmal aorta (2.4% ± 1.7%). D max ( β = 0.087) and MR strain ( β = -1.563) were both associated with AAA growth rate. The MR strain remained an independent factor associated with growth rate ( β = -0.904) after controlling for D max . CONCLUSIONS Deformable image registration analysis can accurately measure the circumferential strain of the AAA wall from standard cine MRI and may offer patient-specific insight regarding AAA progression.
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Affiliation(s)
- Huiming Dong
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., Y.J.L., D.S., M.H., D.M.); Vascular Imaging Research Center, San Francisco Veteran Affairs Medical Center, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., D.S., M.H., D.M.); Siemens Healthineers (T.C.); Department of Radiology, University of Washington, Seattle, WA (C.Z.); Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (F.J.); Department of Surgery, University of California, San Francisco, San Francisco, CA (J.I., W. G.); and Department of Vascular Surgery, San Francisco Veteran Affairs Medical Center, San Francisco, CA (J.I., W.G.)
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Dalbosco M, Terzano M, Carniel TA, Fancello EA, Holzapfel GA. A two-scale numerical study on the mechanobiology of abdominal aortic aneurysms. J R Soc Interface 2023; 20:20230472. [PMID: 37907092 PMCID: PMC10618057 DOI: 10.1098/rsif.2023.0472] [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: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) are a serious condition whose pathophysiology is related to phenomena occurring at different length scales. To gain a better understanding of the disease, this work presents a multi-scale computational study that correlates AAA progression with microstructural and mechanical alterations in the tissue. Macro-scale geometries of a healthy aorta and idealized aneurysms with increasing diameter are developed on the basis of existing experimental data and subjected to physiological boundary conditions. Subsequently, microscopic representative volume elements of the abluminal side of each macro-model are employed to analyse the local kinematics at the cellular scale. The results suggest that the formation of the aneurysm disrupts the micromechanics of healthy tissue, which could trigger collagen growth and remodelling by mechanosensing cells. The resulting changes to the macro-mechanics and microstructure of the tissue seem to establish a new homeostatic state at the cellular scale, at least for the diameter range investigated.
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Affiliation(s)
- Misael Dalbosco
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- GRANTE—Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Michele Terzano
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | - Thiago A. Carniel
- Polytechnic School, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil
- Graduate Program in Health Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil
| | - Eduardo A. Fancello
- GRANTE—Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- LEBm—University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Gerhard A. Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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9
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Atkins E, Milner R, Delaney CL. Raised BMI is associated with fewer Type I endoleaks in patients treated with the Gore Excluder device: data from the Global Registry for Endovascular Aortic Treatment (GREAT). THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:513-520. [PMID: 37458731 DOI: 10.23736/s0021-9509.23.12572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Obesity is increasing in prevalence globally and within the cohort of vascular surgical patients, leading to poorer outcomes. There are few data on endoleak as a complication of AAA surgery in obese patients. The aim of this study was to use large scale registry data from the Global Registry for Endovascular Aortic Treatment (GREAT) to interrogate any relationship between obesity and endoleak following endovascular aneurysm repair (EVAR) using a Gore Excluder device (W. L. Gore & Associates, Newark, DE, USA), in order to guide treatment recommendations in the future. METHODS A retrospective review of the GREAT Registry was carried out and patients who were recorded as having a postoperative endoleak requiring intervention were included. Patient demographics including Body Mass Index (BMI), aneurysm parameters and on- or off-instructions for use (IFU) were recorded. Ruptured AAA were excluded. RESULTS Data were obtained for 3326 patients with an operation date between August 25, 2010 and September 22, 2019. Obese patients were significantly less likely to have a Type 1 endoleak (Fisher's Exact P value=0.006), and the association was maintained in a multiple logistic regression model which controlled for age, gender, neck angulation and off IFU device use (OR=0.33, P=0.01). CONCLUSIONS Among AAA patients treated with a Gore Excluder device (W. L. Gore & Associates), a higher BMI category was associated with a lower risk of Type 1 endoleak requiring reintervention. Further work needs to be carried out to assess our findings in other patient cohorts.
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Affiliation(s)
- Eleanor Atkins
- Department of Vascular and Endovascular Surgery, Flinders Medical Center, Adelaide, Australia -
| | - Ross Milner
- University of Chicago Pritzker School of Medicine, Division of Vascular Surgery and Endovascular Therapy, Chicago, IL, USA
| | - Christopher L Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Center, Adelaide, Australia
- Flinders University, Adelaide, Australia
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Cosentino F, Sherifova S, Sommer G, Raffa G, Pilato M, Pasta S, Holzapfel GA. Regional biomechanical characterization of human ascending aortic aneurysms: Microstructure and biaxial mechanical response. Acta Biomater 2023; 169:107-117. [PMID: 37579911 DOI: 10.1016/j.actbio.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
The ascending thoracic aortic aneurysm (ATAA) is a permanent dilatation of the vessel with a high risk of adverse events, and shows heterogeneous properties. To investigate regional differences in the biomechanical properties of ATAAs, tissue samples were collected from 10 patients with tricuspid aortic valve phenotype and specimens from minor, anterior, major, and posterior regions were subjected to multi-ratio planar biaxial extension tests and second-harmonic generation (SHG) imaging. Using the data, parameters of a microstructure-motivated constitutive model were obtained considering fiber dispersion. SHG imaging showed disruptions in the organization of the layers. Structural and material parameters did not differ significantly between regions. The non-symmetric fiber dispersion model proposed by Holzapfel et al. [25] was used to fit the data. The mean angle of collagen fibers was negatively correlated between minor and anterior regions, and the parameter associated with collagen fiber stiffness was positively correlated between minor and major regions. Furthermore, correlations were found between the stiffness of the ground matrix and the mean fiber angle, and between the parameter associated with the collagen fiber stiffness and the out-of-plane dispersion parameter in the posterior and minor regions, respectively. The experimental data collected in this study contribute to the biomechanical data available in the literature on human ATAAs. Region-specific parameters for the constitutive models are fundamental to improve the current risk stratification strategies, which are mainly based on aortic size. Such investigations can facilitate the development of more advanced finite element models capable of capturing the regional heterogeneity of pathological tissues. STATEMENT OF SIGNIFICANCE: Tissue samples of human ascending thoracic aortic aneurysms (ATAA) were collected. Samples from four regions underwent multi-ratio planar biaxial extension tests and second-harmonic generation imaging. Region-specific parameters of a microstructure-motivated model considering fiber dispersion were obtained. Structural and material parameters did not differ significantly between regions, however, the mean fiber angle was negatively correlated between minor and anterior regions, and the parameter associated with collagen fiber stiffness was positively correlated between minor and major regions. Furthermore, correlations were found between the stiffness of the ground matrix and the mean fiber angle, and between the parameter associated with the collagen fiber stiffness and the out-of-plane dispersion parameter in the posterior and minor regions, respectively. This study provides a unique set of mechanical and structural data, supporting the microstructural influence on the tissue response. It may facilitate the development of better finite element models capable of capturing the regional tissue heterogeneity.
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Affiliation(s)
- Federica Cosentino
- Ri.MED Foundation, Palermo, Italy; Department of Engineering, University of Palermo, Italy
| | - Selda Sherifova
- Institute of Biomechanics, Graz University of Technology, Austria
| | - Gerhard Sommer
- Institute of Biomechanics, Graz University of Technology, Austria
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, University of Palermo, Italy; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Austria; Department of Structural Engineering, Norwegian Institute of Science and Technology (NTNU), Trondheim, Norway.
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11
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Lu Y, Kiechl SJ, Wang J, Xu Q, Kiechl S, Pechlaner R. Global distributions of age- and sex-related arterial stiffness: systematic review and meta-analysis of 167 studies with 509,743 participants. EBioMedicine 2023; 92:104619. [PMID: 37229905 PMCID: PMC10327869 DOI: 10.1016/j.ebiom.2023.104619] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Arterial stiffening is central to the vascular ageing process and a powerful predictor and cause of diverse vascular pathologies and mortality. We investigated age and sex trajectories, regional differences, and global reference values of arterial stiffness as assessed by pulse wave velocity (PWV). METHODS Measurements of brachial-ankle or carotid-femoral PWV (baPWV or cfPWV) in generally healthy participants published in three electronic databases between database inception and August 24th, 2020 were included, either as individual participant-level or summary data received from collaborators (n = 248,196) or by extraction from published reports (n = 274,629). Quality was appraised using the Joanna Briggs Instrument. Variation in PWV was estimated using mixed-effects meta-regression and Generalized Additive Models for Location, Scale, and Shape. FINDINGS The search yielded 8920 studies, and 167 studies with 509,743 participants from 34 countries were included. PWV depended on age, sex, and country. Global age-standardised means were 12.5 m/s (95% confidence interval: 12.1-12.8 m/s) for baPWV and 7.45 m/s (95% CI: 7.11-7.79 m/s) for cfPWV. Males had higher global levels than females of 0.77 m/s for baPWV (95% CI: 0.75-0.78 m/s) and 0.35 m/s for cfPWV (95% CI: 0.33-0.37 m/s), but sex differences in baPWV diminished with advancing age. Compared to Europe, baPWV was substantially higher in the Asian region (+1.83 m/s, P = 0.0014), whereas cfPWV was higher in the African region (+0.41 m/s, P < 0.0001) and differed more by country (highest in Poland, Russia, Iceland, France, and China; lowest in Spain, Belgium, Canada, Finland, and Argentina). High vs. other country income was associated with lower baPWV (-0.55 m/s, P = 0.048) and cfPWV (-0.41 m/s, P < 0.0001). INTERPRETATION China and other Asian countries featured high PWV, which by known associations with central blood pressure and pulse pressure may partly explain higher Asian risk for intracerebral haemorrhage and small vessel stroke. Reference values provided may facilitate use of PWV as a marker of vascular ageing, for prediction of vascular risk and death, and for designing future therapeutic interventions. FUNDING This study was supported by the excellence initiative VASCage funded by the Austrian Research Promotion Agency, by the National Science Foundation of China, and the Science and Technology Planning Project of Hunan Province. Detailed funding information is provided as part of the Acknowledgments after the main text.
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Affiliation(s)
- Yao Lu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China; School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Sophia J Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Jie Wang
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qingbo Xu
- Centre for Clinical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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12
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Schellinger IN, Naumann J, Hoffmann A, Barnard SJ, Düsing S, Wagenhäuser MU, Haunschild J, Scheinert D, Hasenfuß G, Etz CD, Raaz U. Abdominal Aortic Endograft Implantation Immediately Induces Vascular Stiffness Gradients That May Promote Adverse Aortic Neck Dilatation: Results of A Porcine Ex Vivo Study. J Endovasc Ther 2023:15266028231169178. [PMID: 37154344 DOI: 10.1177/15266028231169178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE Endovascular aortic repair (EVAR) is the method of choice for most abdominal aortic aneurysm (AAA) patients requiring intervention. However, chronic aortic neck dilatation (AND) following EVAR progressively weakens the structural seal between vessel and endograft and compromises long-term results of the therapy. This experimental ex vivo study seeks to investigate mechanisms of AND. MATERIALS AND METHODS Porcine abdominal aortas (n=20) were harvested from slaughterhouse pigs and connected to a mock circulation. A commercially available endograft was implanted (n=10) or aortas were left untreated as controls (n=10). Vascular circumferential strain was assessed via ultrasound in defined aortic segments as a parameter of aortic stiffness. Histology and aortic gene expression analysis were performed to investigate potential changes of aortic wall structure and molecular differences due to endograft implantation. RESULTS We found that endograft implantation acutely induces a significant stiffness gradient directly at the interface between stented and unstented aortic segments under pulsatile pressure. Comparing stented aortas with unstented controls, we detected increased aortic expression levels of inflammatory cytokines (Il6 and Ccl2) and matrix metalloproteinases (Mmp2 and Mmp9) after 6 hours of pulsatile pressurization. This effect, however, was abolished when repeating the same experiment under 6 hours of static pressure. CONCLUSIONS We identified endograft-induced aortic stiffness gradients as an early trigger of inflammatory aortic remodeling processes that might promote AND. These results highlight the importance of adequate endograft designs to minimize vascular stiffness gradients and forestall late complications, such as AND. CLINICAL IMPACT AND may compromise the long-term results following endovascular aortic repair. However, the mechanisms behind the underlying detrimental aortic remodeling are still unclear. In this study we find that endograft-induced aortic stiffness gradients induce an inflammatory aortic remodeling response consistent with AND. This novel pathomechanistic insight may guide the design of new aortic endografts that minimize vascular stiffness gradients and forestall late complications such as AND.
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Affiliation(s)
- Isabel N Schellinger
- Department of Angiology, University Medical Center Leipzig, Leipzig University, Leipzig, Germany
| | - Jörg Naumann
- University Department for Cardiac surgery, Leipzig Heart Center, Leipzig, Germany
| | - Annett Hoffmann
- Department for Endocrinology, Nephrology, Rheumatology, University Medical Center Leipzig, Leipzig University, Leipzig, Germany
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Sarah-Jane Barnard
- University Department for Cardiac surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sandra Düsing
- Department of Angiology, University Medical Center Leipzig, Leipzig University, Leipzig, Germany
| | - Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Josephina Haunschild
- University Department for Cardiac surgery, Leipzig Heart Center, Leipzig, Germany
| | - Dierk Scheinert
- Department of Angiology, University Medical Center Leipzig, Leipzig University, Leipzig, Germany
| | - Gerd Hasenfuß
- Molecular and Translational Vascular Medicine, Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
- Partner site Göttingen, German Center for Cardiovascular Research e.V., Göttingen, Germany
| | - Christian D Etz
- University Department for Cardiac surgery, Leipzig Heart Center, Leipzig, Germany
| | - Uwe Raaz
- Molecular and Translational Vascular Medicine, Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
- Partner site Göttingen, German Center for Cardiovascular Research e.V., Göttingen, Germany
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13
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Mulorz J, Spin JM, Mulorz P, Wagenhäuser MU, Deng A, Mattern K, Rhee YH, Toyama K, Adam M, Schelzig H, Maegdefessel L, Tsao PS. E-cigarette exposure augments murine abdominal aortic aneurysm development: role of Chil1. Cardiovasc Res 2023; 119:867-878. [PMID: 36413508 PMCID: PMC10409905 DOI: 10.1093/cvr/cvac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Abdominal aortic aneurysm (AAA) is a common cardiovascular disease with a strong correlation to smoking, although underlying mechanisms have been minimally explored. Electronic cigarettes (e-cigs) have gained recent broad popularity and can deliver nicotine at comparable levels to tobacco cigarettes, but effects on AAA development are unknown. METHODS AND RESULTS We evaluated the impact of daily e-cig vaping with nicotine on AAA using two complementary murine models and found that exposure enhanced aneurysm development in both models and genders. E-cigs induced changes in key mediators of AAA development including cytokine chitinase-3-like protein 1 (CHI3L1/Chil1) and its targeting microRNA-24 (miR-24). We show that nicotine triggers inflammatory signalling and reactive oxygen species while modulating miR-24 and CHI3L1/Chil1 in vitro and that Chil1 is crucial to e-cig-augmented aneurysm formation using a knockout model. CONCLUSIONS In conclusion our work shows increased aneurysm formation along with augmented vascular inflammation in response to e-cig exposure with nicotine. Further, we identify Chil1 as a key mediator in this context. Our data raise concerns regarding the potentially harmful long-term effects of e-cig nicotine vaping.
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Affiliation(s)
- Joscha Mulorz
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Joshua M Spin
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Pireyatharsheny Mulorz
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Markus Udo Wagenhäuser
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alicia Deng
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Karin Mattern
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Göttingen, Germany
| | - Yae H Rhee
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Kensuke Toyama
- Department of Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Hubert Schelzig
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
- German Center for Cardiovascular Research (DZHK), Berlin, Germany (partner site: Munich)
| | - Philip S Tsao
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
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14
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Li C, Liu Z, Yuan G, Liu Y, Wang W. Abdominal Aortic Aneurysm and PET/CT: From Molecular Mechanisms to Potential Molecular Imaging Targets. Rev Cardiovasc Med 2023; 24:132. [PMID: 39076752 PMCID: PMC11273052 DOI: 10.31083/j.rcm2405132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 07/31/2024] Open
Abstract
Abdominal aortic aneurysm (AAA) is the most common and critical aortic disease. Bleeding is the most serious complication from a ruptured AAA, which often results in death. Therefore, early diagnosis and treatment are the only effective means to reduce AAA associated mortality. Positron emission tomography/computed tomography (PET/CT) combines functional and anatomical imaging. The expanded application of PET/CT in the medical field could have benefits for the diagnosis and treatment of patients with AAA. This review explores the efficiency of PET/CT in the diagnosis of AAA based on our understanding of the underlying molecular mechanisms of AAA development.
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Affiliation(s)
- Chenhao Li
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Zhiyin Liu
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Gang Yuan
- The State Key Laboratory of Quality Research in Chinese Medicine of Macau University of Science and Technology, Avenida Wai Long, 999078 Taipa, Macau
| | - Yong Liu
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, 646000 Luzhou, Sichuan, China
| | - Weiming Wang
- Department of General Surgery (Vascular Surgery), The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, 646000 Luzhou, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, 646000 Luzhou, Sichuan, China
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15
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Bianchi D, Conti M, Bissacco D, Domanin M, Trimarchi S, Auricchio F. Impact of thoracic endovascular aortic repair on aortic biomechanics: Integration of in silico and ex vivo analysis using porcine model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3594. [PMID: 35340129 DOI: 10.1002/cnm.3594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/09/2022] [Accepted: 03/16/2022] [Indexed: 05/12/2023]
Abstract
Thoracic endovascular aortic repair (TEVAR) is widespread in clinical practice for treating aortic diseases but it has relevant systemic complications, such as increase of the cardiac workload due to post-TEVAR aortic stiffening, and local issues such as re-entry tears due to the tissue damage caused by endograft interaction. The present study aims to elucidate these aortic biomechanical mechanisms by coupling ex vivo and in silico analysis. By ex vivo tests, the pulse wave velocity before and after TEVAR is measured. Uni-axial tensile tests are performed to measure regional mechanical response of tissue samples, supplied as input data for the in silico analysis. Numerical analysis is finally performed to compute the wall stress induced by the stent-graft deployment and the arterial pressurization. The ex vivo results highlight an increase of baseline PWV by a mean .78 m/s or 12% after TEVAR with a 100 mm stent-graft (p <.013). In the in silico analysis, the average von Mises stress in the landing zone increases of about 15% and 20% using, respectively stent-graft with radial oversizing of 10% and 20%. This work shows the effectiveness of integrated framework to analyze the biomechanical post TEVAR mechanisms. Moreover, the obtained results quantify the effect of prosthesis selection on the stiffening of the aorta after TEVAR and on the local increase of the aortic wall stress that is proportional to the stent-graft oversizing.
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Affiliation(s)
- Daniele Bianchi
- Department of Civil Engineering and Architecture (DICAr), University of Pavia, Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture (DICAr), University of Pavia, Pavia, Italy
| | - Daniele Bissacco
- Department of Health and Community Sciences, University of Milan, Milan, Italy
- Operative Unit of Vascular Surgery, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Maurizio Domanin
- Department of Health and Community Sciences, University of Milan, Milan, Italy
- Operative Unit of Vascular Surgery, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Santi Trimarchi
- Department of Health and Community Sciences, University of Milan, Milan, Italy
- Operative Unit of Vascular Surgery, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture (DICAr), University of Pavia, Pavia, Italy
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16
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Hulshoff MS, Schellinger IN, Xu X, Fledderus J, Rath SK, Wong FC, Maamari S, Haunschild J, Krenning G, Raaz U, Zeisberg EM. miR-132-3p and KLF7 as novel regulators of aortic stiffening-associated EndMT in type 2 diabetes mellitus. Diabetol Metab Syndr 2023; 15:11. [PMID: 36698180 PMCID: PMC9875453 DOI: 10.1186/s13098-022-00966-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus has risen considerably and currently affects more than 422 million people worldwide. Cardiovascular diseases including myocardial infarction and heart failure represent the major cause of death in type 2 diabetes (T2D). Diabetes patients exhibit accelerated aortic stiffening which is an independent predictor of cardiovascular disease and mortality. We recently showed that aortic stiffness precedes hypertension in a mouse model of diabetes (db/db mice), making aortic stiffness an early contributor to cardiovascular disease development. Elucidating how aortic stiffening develops is a pressing need in order to halt the pathophysiological process at an early time point. METHODS To assess EndMT occurrence, we performed co-immunofluorescence staining of an endothelial marker (CD31) with mesenchymal markers (α-SMA/S100A4) in aortic sections from db/db mice. Moreover, we performed qRT-PCR to analyze mRNA expression of EndMT transcription factors in aortic sections of db/db mice and diabetic patients. To identify the underlying mechanism by which EndMT contributes to aortic stiffening, we used aortas from db/db mice and diabetic patients in combination with high glucose-treated human umbilical vein endothelial cells (HUVECs) as an in vitro model of diabetes-associated EndMT. RESULTS We demonstrate robust CD31/α-SMA and CD31/S100A4 co-localization in aortic sections of db/db mice which was almost absent in control mice. Moreover, we demonstrate a significant upregulation of EndMT transcription factors in aortic sections of db/db mice and diabetic patients. As underlying regulator, we identified miR-132-3p as the most significantly downregulated miR in the micronome of db/db mice and high glucose-treated HUVECs. Indeed, miR-132-3p was also significantly downregulated in aortic tissue from diabetic patients. We identified Kruppel-like factor 7 (KLF7) as a target of miR-132-3p and show a significant upregulation of KLF7 in aortic sections of db/db mice and diabetic patients as well as in high glucose-treated HUVECs. We further demonstrate that miR-132-3p overexpression and KLF7 downregulation ameliorates EndMT in high glucose-treated HUVECs. CONCLUSIONS We demonstrate for the first time that EndMT contributes to aortic stiffening in T2D. We identified miR-132-3p and KLF7 as novel EndMT regulators in this context. Altogether, this gives us new insights in the development of aortic stiffening in T2D.
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Affiliation(s)
- Melanie S Hulshoff
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Isabel N Schellinger
- University Heart Center, Göttingen, Germany
- Department of Endocrinology, Nephrology and Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Xingbo Xu
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
- University Heart Center, Göttingen, Germany
| | - Jolien Fledderus
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Sandip K Rath
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
| | - Fang Cheng Wong
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Sabine Maamari
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
- University Heart Center, Göttingen, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Guido Krenning
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Uwe Raaz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
- University Heart Center, Göttingen, Germany
| | - Elisabeth M Zeisberg
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany.
- University Heart Center, Göttingen, Germany.
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17
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Dolmaci OB, El Mathari S, Driessen AHG, Klautz RJM, Poelmann RE, Lindeman JHN, Grewal N. Are Thoracic Aortic Aneurysm Patients at Increased Risk for Cardiovascular Diseases? J Clin Med 2022; 12:jcm12010272. [PMID: 36615072 PMCID: PMC9821759 DOI: 10.3390/jcm12010272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives: Abdominal aortic aneurysms are associated with a sharply increased cardiovascular risk. Cardiovascular risk management is therefore recommended in prevailing guidelines for abdominal aneurysm patients. It has been hypothesized that associated risk relates to loss of aortic compliance. If this hypothesis is correct, observations for abdominal aneurysms would also apply to thoracic aortic aneurysms. The objective of this study is to test whether thoracic aneurysms are also associated with an increased cardiovascular risk burden. Methods: Patients who underwent aortic valve or root surgery were included in the study (n = 239). Cardiovascular risk factors were studied and atherosclerosis was scored based on the preoperative coronary angiographies. Multivariate analyses were performed, controlling for cardiovascular risk factors and aortic valve morphology. Comparisons were made with the age- and gender-matched general population and non-aneurysm patients as control groups. A thoracic aortic aneurysm was defined as an aortic aneurysm of ≥45 mm. Results: Thoracic aortic aneurysm was not associated with an increased coronary atherosclerotic burden (p = 0.548). Comparison with the general population revealed a significantly higher prevalence of hypertension (61.4% vs. 32.2%, p < 0.001) and a lower prevalence of diabetes (1.4% vs. 13.1%, p = 0.001) in the thoracic aneurysm group. Conclusions: The extreme cardiovascular risk associated with abdominal aortic aneurysms is location-specific and not explained by loss of aortic compliance. Thoracic aortic aneurysm, in contrast to abdominal, is not part of the atherosclerotic disease spectrum and, therefore, cardiovascular risk management does not need to be implemented in treatment guidelines of isolated thoracic aneurysms. Hypertension should be treated.
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Affiliation(s)
- Onur B. Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Antoine H. G. Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Animal Sciences and Health, Leiden University, 2333 ZA Leiden, The Netherlands
| | - Jan H. N. Lindeman
- Department of Vascular Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), 2333 ZA Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
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18
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Lin S, Morgant MC, Marín-Castrillón DM, Walker PM, Glélé LSA, Boucher A, Presles B, Bouchot O, Lalande A. Aortic local biomechanical properties in ascending aortic aneurysms. Acta Biomater 2022; 149:40-50. [PMID: 35714897 DOI: 10.1016/j.actbio.2022.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
Ascending aortic aneurysm (AsAA) is a high-risk cardiovascular disease with an increased incidence over years. In this study, we compare different risk factors based on the pre-failure behavior (from a biomechanical point of view) obtained ex-vivo from an equi-biaxial tensile test. A total of 100 patients (63 ± 12 years, 72 males) with AsAA replacement, were recruited. Equi-biaxial tensile tests of AsAA walls were performed on freshly sampled aortic wall tissue after ascending aortic replacement. The aneurysmal aortic walls were divided into four quadrants (medial, anterior, lateral, and posterior) and two directions (longitudinal and circumferential) were considered. The stiffness was represented by the maximum Young Modulus (MYM). Based on patient information, the following subgroups were considered: age, gender, hypertension, obesity, dyslipidemia, diabetes, smoking history, aortic insufficiency, aortic stenosis, coronary artery disease, aortic diameter and aortic valve type. In general, when the aortic diameter increased, the aortic wall became thicker. In terms of the MYM, the longitudinal direction was significantly higher than that in the circumferential direction. In the multivariant analysis, the impact factors of age (p = 0.07), smoking (p = 0.05), diabetes (p = 0.03), aortic stenosis (p = 0.02), coronary artery disease (p < 10-3), and aortic diameters (p = 0.02) were significantly influencing the MYM. There was no significant MYM difference when the patients presented arterial hypertension, dyslipidemia, obesity, or bicuspid aortic valve. To conclude, the pre-failure aortic stiffness is multi-factorial, according to our population of 100 patients with AsAA. STATEMENT OF SIGNIFICANCE: : Our research on the topic of "Aortic local biomechanical properties in case of ascending aortic aneurysms" is about the biomechanical properties on one hundred aortic samples according to the aortic wall quadrants and the direction. More than ten factors and risks which may impact ascending aortic aneurysms have been studied. According to our knowledge, so far, this article involved the largest population on this topic. It will be our pleasure to share this information with all the readers.
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Affiliation(s)
- Siyu Lin
- ImViA laboratory, University of Burgundy, Dijon, France.
| | - Marie Catherine Morgant
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | | | - Paul M Walker
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Medical Imaging, University Hospital of Dijon, Dijon, France
| | | | | | | | - Olivier Bouchot
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Alain Lalande
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Medical Imaging, University Hospital of Dijon, Dijon, France
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19
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Ning H, Liu X, Ma C, Yang J, Li T. The Evaluation of Longitudinal Strain of Large and Small Abdominal Aortic Aneurysm by Two-Dimensional Speckle-Tracking Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1085-1093. [PMID: 34296470 DOI: 10.1002/jum.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) is a dangerous and lethal vascular disease. Non-invasive two-dimensional speckle-tracking imaging (2D STI) plays an important role in assessing aortic biomechanical properties. Our study aimed to evaluate the alterations of biomechanical characteristics using 2D STI in 91 AAA patients with different size. METHODS Aneurysm strain, elastic modulus, stiffness index β, and aortic distensibility determined by M-Mode ultrasound (US), and longitudinal strain (LS) derived from 2D STI were compared in 40 large AAA patients (diameter ≥ 55 mm) and 51 small AAA patients (diameter < 55 mm). RESULTS Compared with small AAA group, anterior wall longitudinal strain (ALS) and posterior wall longitudinal strain (PLS) were significantly decreased in large AAA group (all P < .05) and not affected by age, symptom, hypertension, and thrombus. Meanwhile, ALS and PLS correlated negatively with maximal aneurysm diameters (r = -0.628 and -0.469, respectively, all P < .001). And only ALS was associated with M-Mode US parameters (all P < .05). Based on receiver operating characteristic (ROC) analysis, ALS and PLS had strong diagnostic values for large AAA with the area under the curve (AUC) of 0.82 and 0.72, and cut-off points of 1.71 and 1.64% with a sensitivity of 78 and 72%, and a specificity of 75 and 70%, respectively. CONCLUSIONS LS measured by 2D STI could evaluate the biomechanical properties of aneurysm wall with different size, and add additional diagnostic value in distinguishing between small and large AAA.
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Affiliation(s)
- Hongxia Ning
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaozheng Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
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20
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Nishibe T, Dardik A, Maekawa K, Kano M, Akiyama S, Nukaga S, Koizumi J, Ogino H. The Presence of Simple Renal Cysts Is Associated With Increased Arterial Stiffness in Patients With Abdominal Aortic Aneurysm. Angiology 2022; 73:863-868. [PMID: 35466709 DOI: 10.1177/00033197221087781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Simple renal cysts (SRC) are associated with the development of abdominal aortic aneurysms (AAA). We hypothesized that patients with AAA and SRC have increased arterial stiffness (AS) compared with patients without SRC. Patients (n=223) with an infrarenal AAA undergoing pulse wave analysis were recruited. Brachial-ankle pulse wave velocity (PWV) was measured (automated oscillometric method) as an index of AS. Participants were categorized into those with increased AS and those with normal/borderline AS (threshold: 1800 cm/s); 134 patients (60.1%) had increased AS and 89 (39.9%) patients had normal/borderline AS. Multivariable analyses showed that age ≥75 years (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.51-5.72; P=.002), systolic blood pressure ≥140 mmHg (OR, 5.05; 95% CI, 2.35-10.83; P<.001), hypertension (OR, 2.28; 95% CI, 1.08-4.79; P=.030), and presence of SRC (OR, 1.89; 95% CI, 1.03-3.46; P=.040) were independent risk factors for increased AS. The presence of SRC is an independent risk factor for increased AS in patients with an AAA. This association suggests that patients with SRC may have severe aortic wall degeneration and thus the presence of SRC may be pathologically linked to the development of AAA.
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Affiliation(s)
- Toshiya Nishibe
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Alan Dardik
- Department of Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Koki Maekawa
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Masaki Kano
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Shinobu Akiyama
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Saori Nukaga
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Jun Koizumi
- Department of Radiology, 47708Chiba University School of Medicine, Chiba, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
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21
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Microskeletal stiffness promotes aortic aneurysm by sustaining pathological vascular smooth muscle cell mechanosensation via Piezo1. Nat Commun 2022; 13:512. [PMID: 35082286 PMCID: PMC8791986 DOI: 10.1038/s41467-021-27874-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/15/2021] [Indexed: 12/27/2022] Open
Abstract
Mechanical overload of the vascular wall is a pathological hallmark of life-threatening abdominal aortic aneurysms (AAA). However, how this mechanical stress resonates at the unicellular level of vascular smooth muscle cells (VSMC) is undefined. Here we show defective mechano-phenotype signatures of VSMC in AAA measured with ultrasound tweezers-based micromechanical system and single-cell RNA sequencing technique. Theoretical modelling predicts that cytoskeleton alterations fuel cell membrane tension of VSMC, thereby modulating their mechanoallostatic responses which are validated by live micromechanical measurements. Mechanistically, VSMC gradually adopt a mechanically solid-like state by upregulating cytoskeleton crosslinker, α-actinin2, in the presence of AAA-promoting signal, Netrin-1, thereby directly powering the activity of mechanosensory ion channel Piezo1. Inhibition of Piezo1 prevents mice from developing AAA by alleviating pathological vascular remodeling. Our findings demonstrate that deviations of mechanosensation behaviors of VSMC is detrimental for AAA and identifies Piezo1 as a novel culprit of mechanically fatigued aorta in AAA.
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22
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Grossmannova K, Barathova M, Belvoncikova P, Lauko V, Csaderova L, Tomka J, Dulka T, Pastorek J, Madaric J. Hypoxia Marker Carbonic Anhydrase IX Is Present in Abdominal Aortic Aneurysm Tissue and Plasma. Int J Mol Sci 2022; 23:ijms23020879. [PMID: 35055064 PMCID: PMC8778372 DOI: 10.3390/ijms23020879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
Abdominal aortic aneurysms (AAA) are a significant cause of premature deaths worldwide. Since there is no specific treatment for reducing AAA progression, it is crucial to understand the pathogenesis leading to aneurysm wall weakening/remodeling and identify new proteins involved in this process which could subsequently serve as novel therapeutic targets. In this study, we analyzed the presence of the hypoxia-related proteins carbonic anhydrase IX (CA IX), hypoxia-inducible factor 1α (HIF-1α), and AKT as the key molecule in the phosphoinositide-3-kinase pathway in the AAA wall. Additionally, we used a blood-based assay to examine soluble CA IX (s-CA IX) levels in the plasma of AAA patients. Using western blotting, we detected CA IX protein in 12 out of 15 AAA tissue samples. Immunohistochemistry staining proved CA IX expression in the media of the aneurysmal wall. Evaluation of phosphorylated (p-AKT) and total AKT showed elevated levels of both forms in AAA compared to normal aorta. Using ELISA, we determined the concentration of s-CA IX >20 pg/mL in 13 out of 15 AAA patients. Results obtained from in silico analysis of CA9 and aneurysm-associated genes suggest a role for CA IX in aneurysmal wall remodeling. Our results prove the presence of hypoxia-related CA IX in AAA tissues and indicate a possible role of CA IX in hypoxia-associated cardiovascular diseases.
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Affiliation(s)
- Katarina Grossmannova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
| | - Monika Barathova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
- Correspondence: ; Tel.: +421-2-59302439
| | - Petra Belvoncikova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
| | - Viliam Lauko
- Department of Laboratory Medicine, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia;
| | - Lucia Csaderova
- Department of Cancer Biology, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská Cesta 9, 84505 Bratislava, Slovakia; (K.G.); (P.B.); (L.C.)
| | - Jan Tomka
- Department of Vascular Surgery, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia; (J.T.); (T.D.)
| | - Tomas Dulka
- Department of Vascular Surgery, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia; (J.T.); (T.D.)
| | | | - Juraj Madaric
- Department of Angiology, National Institute of Cardiovascular Disease, Pod Krásnou Hôrkou 1, 83101 Bratislava, Slovakia;
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Huang Z, Su H, Zhang T, Li Y. Double-edged sword of diabetes mellitus for abdominal aortic aneurysm. Front Endocrinol (Lausanne) 2022; 13:1095608. [PMID: 36589814 PMCID: PMC9800781 DOI: 10.3389/fendo.2022.1095608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) has been proved to contribute to multiple comorbidities that are risk factors for abdominal aortic aneurysm (AAA). Remarkably, evidences from epidemiologic studies have demonstrated a negative association between the two disease states. On the other hand, hyperglycemic state was linked to post-operative morbidities following AAA repair. This review aims to provide a thorough picture on the double-edged nature of DM and major hypoglycemic medications on prevalence, growth rate and rupture of AAA, as well as DM-associated prognosis post AAA repair. METHODS We performed a comprehensive search in electronic databases to look for literatures demonstrating the association between DM and AAA. The primary focus of the literature search was on the impact of DM on the morbidity, enlargement and rupture rate, as well as post-operative complications of AAA. The role of antidiabetic medications was also explored. RESULTS Retrospective epidemiological studies and large database researches associated the presence of DM with decreased prevalence, slower expansion and limited rupture rate of AAA. Major hypoglycemic drugs exert similar protective effect as DM against AAA by targeting pathological hallmarks involved in AAA formation and progression, which were demonstrated predominantly by animal studies. Nevertheless, presence of DM or postoperative hyperglycemia was linked to poorer short-term and long-term prognosis, primarily due to greater risk of infection, longer duration of hospital stays and death. CONCLUSION While DM is a positive factor in the formation and progression of AAA, it is also associated with higher risk of negative outcomes following AAA repair. Concomitant use of antidiabetic medications may contribute to the protective mechanism of DM in AAA, but further studies are still warranted to explore their role following AAA repair.
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Affiliation(s)
- Zijia Huang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huiling Su
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiejun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Tiejun Zhang, ; Yuwen Li,
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Tiejun Zhang, ; Yuwen Li,
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24
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Precision Medicine in Aortic Anastomosis: A Numerical and Experimental Study of a Novel Double-Sided Needle. J Pers Med 2021; 11:jpm11121385. [PMID: 34945857 PMCID: PMC8707865 DOI: 10.3390/jpm11121385] [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: 11/25/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Hand-sewn anastomosis is a crucial part of aortic reconstruction surgery and significantly affects its outcome. The present study presents a novel, bidirectional surgical needle aimed to improve aortic anastomosis in terms of speed and ease of use. Our objective was to assess the efficacy of the new design in comparison with the conventional needle. Methods: A series of simulations were conducted with COMSOL software in order to perform a fatigue comparative analysis between the new and the conventional needle design. Ease of penetration into a piece of polydimethylsiloxane was evaluated. Lastly, the prototype was tested under in-vitro conditions in comparison with the conventional needle. Results: Based on fatigue analysis, the new needle design improves durability, provided the two tips are equally used. The polytetrafluoroethylene coating improves penetration into the tissue by 7% to 17%, while electropolishing improves penetration up to 19%. When using the novel needle design, the average anastomotic task completion time was significantly reduced by 22% and the overall distance of hand movements was significantly reduced by 20%. Conclusions: The proposed design exhibited a shorter anastomotic time and seems promising in relation to ease of use and simplicity of the anastomotic technique it introduces.
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25
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Busch A, Bleichert S, Ibrahim N, Wortmann M, Eckstein HH, Brostjan C, Wagenhäuser MU, Goergen CJ, Maegdefessel L. Translating mouse models of abdominal aortic aneurysm to the translational needs of vascular surgery. JVS Vasc Sci 2021; 2:219-234. [PMID: 34778850 PMCID: PMC8577080 DOI: 10.1016/j.jvssci.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Abdominal aortic aneurysm (AAA) is a condition that has considerable socioeconomic impact and an eventual rupture is associated with high mortality and morbidity. Despite decades of research, surgical repair remains the treatment of choice and no medical therapy is currently available. Animal models and, in particular, murine models, of AAA are a vital tool for experimental in vivo research. However, each of the different models has individual limitations and provide only partial mimicry of human disease. This narrative review addresses the translational potential of the available mouse models, highlighting unanswered questions from a clinical perspective. It is based on a thorough presentation of the available literature and more than a decade of personal experience, with most of the available models in experimental and translational AAA research. Results From all the models published, only the four inducible models, namely the angiotensin II model (AngII), the porcine pancreatic elastase perfusion model (PPE), the external periadventitial elastase application (ePPE), and the CaCl2 model have been widely used by different independent research groups. Although the angiotensin II model provides features of dissection and aneurysm formation, the PPE model shows reliable features of human AAA, especially beyond day 7 after induction, but remains technically challenging. The translational value of ePPE as a model and the combination with β-aminopropionitrile to induce rupture and intraluminal thrombus formation is promising, but warrants further mechanistic insights. Finally, the external CaCl2 application is known to produce inflammatory vascular wall thickening. Unmet translational research questions include the origin of AAA development, monitoring aneurysm growth, gender issues, and novel surgical therapies as well as novel nonsurgical therapies. Conclusion New imaging techniques, experimental therapeutic alternatives, and endovascular treatment options provide a plethora of research topics to strengthen the individual features of currently available mouse models, creating the possibility of shedding new light on translational research questions.
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Affiliation(s)
- Albert Busch
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
| | - Sonja Bleichert
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Nahla Ibrahim
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus Wortmann
- Department of Vascular and Endovascular Surgery, Universitaetsklinik Heidelberg, Heidelberg, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany
| | - Christine Brostjan
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery, Heinrich-Heine-University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Ind
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
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26
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Mulorz J, Shayan M, Hu C, Alcazar C, Chan AHP, Briggs M, Wen Y, Walvekar AP, Ramasubramanian AK, Spin JM, Chen B, Tsao PS, Huang NF. peri-Adventitial delivery of smooth muscle cells in porous collagen scaffolds for treatment of experimental abdominal aortic aneurysm. Biomater Sci 2021; 9:6903-6914. [PMID: 34522940 PMCID: PMC8511090 DOI: 10.1039/d1bm00685a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abdominal aortic aneurysm (AAA) is associated with the loss of vascular smooth muscle cells (SMCs) within the vessel wall. Direct delivery of therapeutic cells is challenging due to impaired mechanical integrity of the vessel wall. We hypothesized that porous collagen scaffolds can be an effective vehicle for the delivery of human-derived SMCs to the site of AAA. The purpose was to evaluate if the delivery of cell-seeded scaffolds can abrogate progressive expansion in a mouse model of AAA. Collagen scaffolds seeded with either primary human aortic SMCs or induced pluripotent stem cell derived-smooth muscle progenitor cells (iPSC-SMPs) had >80% in vitro cell viability and >75% cell penetrance through the scaffold's depth, while preserving smooth muscle phenotype. The cell-seeded scaffolds were successfully transplanted onto the murine aneurysm peri-adventitia on day 7 following AAA induction using pancreatic porcine elastase infusion. Ultrasound imaging revealed that SMC-seeded scaffolds significantly reduced the aortic diameter by 28 days, compared to scaffolds seeded with iPSC-SMPs or without cells (acellular scaffold), respectively. Bioluminescence imaging demonstrated that both cell-seeded scaffold groups had cellular localization to the aneurysm but a decline in survival with time. Histological analysis revealed that both cell-seeded scaffold groups had more SMC retention and less macrophage invasion into the medial layer of AAA lesions, when compared to the acellular scaffold treatment group. Our data suggest that scaffold-based SMC delivery is feasible and may constitute a platform for cell-based AAA therapy.
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Affiliation(s)
- Joscha Mulorz
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Mahdis Shayan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Caroline Hu
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Cynthia Alcazar
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Alex H P Chan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Mason Briggs
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - Yan Wen
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - Ankita P Walvekar
- Department of Chemical and Materials Engineering, San Jose State University, San Jose, CA, USA
| | - Anand K Ramasubramanian
- Department of Chemical and Materials Engineering, San Jose State University, San Jose, CA, USA
| | - Joshua M Spin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Bertha Chen
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, CA, USA
| | - Philip S Tsao
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ngan F Huang
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Department Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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27
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Ikezoe T, Shoji T, Guo J, Shen F, Lu HS, Daugherty A, Nunokawa M, Kubota H, Miyata M, Xu B, Dalman RL. No Effect of Hypercholesterolemia on Elastase-Induced Experimental Abdominal Aortic Aneurysm Progression. Biomolecules 2021; 11:1434. [PMID: 34680067 PMCID: PMC8533453 DOI: 10.3390/biom11101434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Epidemiological studies link hyperlipidemia with increased risk for abdominal aortic aneurysms (AAAs). However, the influence of lipid-lowering drugs statins on prevalence and progression of clinical and experimental AAAs varies between reports, engendering controversy on the association of hyperlipidemia with AAA disease. This study investigated the impact of hypercholesterolemia on elastase-induced experimental AAAs in mice. METHODS Both spontaneous (targeted deletion of apolipoprotein E) and induced mouse hypercholesterolemia models were employed. In male wild type (WT) C57BL/6J mice, hypercholesterolemia was induced via intraperitoneal injection of an adeno-associated virus (AAV) encoding a gain-of-function proprotein convertase subtilisin/kexin type 9 mutation (PCSK9) followed by the administration of a high-fat diet (HFD) (PCSK9+HFD) for two weeks. As normocholesterolemic controls for PCSK9+HFD mice, WT mice were infected with PCSK9 AAV and fed normal chow, or injected with phosphate-buffered saline alone and fed HFD chow. AAAs were induced in all mice by intra-aortic infusion of porcine pancreatic elastase and assessed by ultrasonography and histopathology. RESULTS In spontaneous hyper- and normo-cholesterolemic male mice, the aortic diameter enlarged at a constant rate from day 3 through day 14 following elastase infusion. AAAs, defined as a more than 50% diameter increase over baseline measurements, formed in all mice. AAA progression was more pronounced in male mice, with or without spontaneous hyperlipidemia. The extent of elastin degradation and smooth muscle cell depletion were similar in spontaneous hyper- (score 3.5 for elastin and 4.0 for smooth muscle) and normo- (both scores 4.0) cholesterolemic male mice. Aortic mural macrophage accumulation was also equivalent between the two groups. No differences were observed in aortic accumulation of CD4+ or CD8+ T cells, B cells, or mural angiogenesis between male spontaneous hyper- and normocholesterolemic mice. Similarly, no influence of spontaneous hypercholesterolemia on characteristic aneurysmal histopathology was noted in female mice. In confirmatory experiments, induced hypercholesterolemia also exerted no appreciable effect on AAA progression and histopathologies. CONCLUSION This study demonstrated no recognizable impact of hypercholesterolemia on elastase-induced experimental AAA progression in both spontaneous and induced hypercholesterolemia mouse models. These results add further uncertainty to the controversy surrounding the efficacy of statin therapy in clinical AAA disease.
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Affiliation(s)
- Toru Ikezoe
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.I.); (T.S.); (J.G.); (F.S.)
- Department of Cardiovascular Surgery, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan; (M.N.); (H.K.)
| | - Takahiro Shoji
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.I.); (T.S.); (J.G.); (F.S.)
- Department of Emergency Medicine, Saiseikai Central Hospital, Minatoku, Tokyo 108-0073, Japan
| | - Jia Guo
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.I.); (T.S.); (J.G.); (F.S.)
| | - Fanru Shen
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.I.); (T.S.); (J.G.); (F.S.)
| | - Hong S. Lu
- Saha Cardiovascular Research Center, Department of Physiology, University of Kentucky, Lexington, KY 40536, USA; (H.S.L.); (A.D.)
| | - Alan Daugherty
- Saha Cardiovascular Research Center, Department of Physiology, University of Kentucky, Lexington, KY 40536, USA; (H.S.L.); (A.D.)
| | - Masao Nunokawa
- Department of Cardiovascular Surgery, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan; (M.N.); (H.K.)
| | - Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan; (M.N.); (H.K.)
| | - Masaaki Miyata
- Faculty of Medicine, School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Baohui Xu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.I.); (T.S.); (J.G.); (F.S.)
| | - Ronald L. Dalman
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.I.); (T.S.); (J.G.); (F.S.)
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28
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Sarafidis P, Martens S, Saratzis A, Kadian-Dodov D, Murray PT, Shanahan CM, Hamdan AD, Engelman DT, Teichgräber U, Herzog CA, Cheung M, Jadoul M, Winkelmayer WC, Reinecke H, Johansen K. Diseases of the Aorta and Kidney Disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Cardiovasc Res 2021; 118:2582-2595. [PMID: 34469520 PMCID: PMC9491875 DOI: 10.1093/cvr/cvab287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for the development of abdominal aortic aneurysm (AAA), as well as for cardiovascular and renal events and all-cause mortality following surgery for AAA or thoracic aortic dissection. In addition, the incidence of acute kidney injury (AKI) after any aortic surgery is particularly high, and this AKI per se is independently associated with future cardiovascular events and mortality. On the other hand, both development of AKI after surgery and the long-term evolution of kidney function differ significantly depending on the type of AAA intervention (open surgery vs. the various subtypes of endovascular repair). Current knowledge regarding AAA in the general population may not be always applicable to CKD patients, as they have a high prevalence of co-morbid conditions and an elevated risk for periprocedural complications. This summary of a Kidney Disease: Improving Global Outcomes Controversies Conference group discussion reviews the epidemiology, pathophysiology, diagnosis, and treatment of Diseases of the Aorta in CKD and identifies knowledge gaps, areas of controversy, and priorities for future research.
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Affiliation(s)
- Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sven Martens
- Department of Cardiothoracic Surgery - Division of Cardiac Surgery, Münster, University Hospital, Universitätsklinikum, Münster, Germany
| | - Athanasios Saratzis
- Department of Vascular Surgery, Leicester University Hospital and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick T Murray
- Department of Nephrology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Catherine M Shanahan
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Allen D Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel T Engelman
- Heart, Vascular & Critical Care Services Baystate Medical Center, and University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Holger Reinecke
- Department of Cardiology I: Coronary and peripheral vessel disease, heart failure; Münster University Hospital, Universitätsklinikum, Münster, Germany
| | - Kirsten Johansen
- Division of Nephrology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
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29
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Nettersheim FS, Lemties J, Braumann S, Geißen S, Bokredenghel S, Nies R, Hof A, Winkels H, Freeman BA, Klinke A, Rudolph V, Baldus S, Mehrkens D, Mollenhauer M, Adam M. Nitro-oleic acid (NO2-OA) reduces thoracic aortic aneurysm progression in a mouse model of Marfan syndrome. Cardiovasc Res 2021; 118:2211-2225. [PMID: 34324651 DOI: 10.1093/cvr/cvab256] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/28/2021] [Indexed: 01/07/2023] Open
Abstract
AIMS Marfan syndrome (MFS) is a connective tissue disorder caused by mutations in the Fibrillin-1 gene. It is associated with formation of thoracic aortic aneurysms that can potentially be a life-threatening condition due to aortic rupture or dissection. Excessive non-canonical transforming growth factor beta signalling, mediated by activation of extracellular-signal regulated kinases 1/2 (ERK1/2), as well as inducible nitric oxide synthase (NOS2)-dependent nitric oxide production have been identified to drive aortic pathology in MFS through induction of elastin fragmentation and smooth muscle cell apoptosis. Despite promising results in animal studies, specific pharmacological interventions approved for clinical use in patients with MFS-related aortic disease are rare. Nitro-oleic acid (NO2-OA) is an endogenously generated signalling modulator, which is available as an oral compound and has been shown to inhibit ERK1/2 activation and NOS2 expression in different disease models, thereby exerting promising therapeutic effects. In this study, we investigated whether NO2-OA decreases aortic dilation in MFS. METHODS AND RESULTS Eight-week-old MFS (Fbn1C1041G/+) mice were treated with NO2-OA or vehicle for four weeks via subcutaneously implanted osmotic minipumps. Echocardiography indicated progressive ascending aortic dilation and wall stiffening in MFS mice, which was significantly attenuated by NO2-OA treatment. This protective effect was mediated by inhibition of aortic ERK1/2, Smad2 as well as nuclear factor kappa B overactivation and consequent attenuation of elastin fragmentation by matrix metalloproteinase 2, apoptosis and collagen deposition. Critically, the therapeutic efficacy of NO2-OA in MFS was further emphasized by demonstrating its capability to reduce lethal aortic complications in Fbn1C1041G/+mice challenged with Angiotensin II. CONCLUSION NO2-OA distinctly attenuates progression of aortic dilation in MFS via modulation of well-established disease-mediating pathways, thereby meriting further investigation into its application as a therapeutic agent for the treatment of this condition. TRANSLATIONAL PERSPECTIVE Thoracic aortic aneurysm formation is the major life-threatening complication of Marfan syndrome, a relatively common genetic connective tissue disorder. Although various potential therapeutic targets have been identified, specific pharmacological treatment options are still unavailable. In this study, we demonstrate that Nitro-oleic acid reduces ascending aortic elastin fragmentation, apoptosis, and fibrotic remodelling in Marfan syndrome through inhibition of extracellular-signal regulated kinases 1/2, Smad2 as well as nuclear factor kappa B overactivation and thereby mitigates aneurysm formation. Thus, Nitro-oleic acid, which has been developed as an oral compound, emerges as a potential treatment option for Marfan-related aortic disease.
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Affiliation(s)
- Felix Sebastian Nettersheim
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Julian Lemties
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Simon Braumann
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Simon Geißen
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Senai Bokredenghel
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Richard Nies
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Alexander Hof
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Holger Winkels
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Bruce A Freeman
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, USA
| | - Anna Klinke
- Agnes-Wittenborg-Institute, Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Agnes-Wittenborg-Institute, Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Stephan Baldus
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Dennis Mehrkens
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Martin Mollenhauer
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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30
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In Vivo Aortic Magnetic Resonance Elastography in Abdominal Aortic Aneurysm: A Validation in an Animal Model. Invest Radiol 2021; 55:463-472. [PMID: 32520516 DOI: 10.1097/rli.0000000000000660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Using maximum diameter of an abdominal aortic aneurysm (AAA) alone for management can lead to delayed interventions or unnecessary urgent repairs. Abdominal aortic aneurysm stiffness plays an important role in its expansion and rupture. In vivo aortic magnetic resonance elastography (MRE) was developed to spatially measure AAA stiffness in previous pilot studies and has not been thoroughly validated and evaluated for its potential clinical value. This study aims to evaluate noninvasive in vivo aortic MRE-derived stiffness in an AAA porcine model and investigate the relationships between MRE-derived AAA stiffness and (1) histopathology, (2) uniaxial tensile test, and (3) burst testing for assessing MRE's potential in evaluating AAA rupture risk. MATERIALS AND METHODS Abdominal aortic aneurysm was induced in 31 Yorkshire pigs (n = 226 stiffness measurements). Animals were randomly divided into 3 cohorts: 2-week, 4-week, and 4-week-burst. Aortic MRE was sequentially performed. Histopathologic analyses were performed to quantify elastin, collagen, and mineral densities. Uniaxial tensile test and burst testing were conducted to measure peak stress and burst pressure for assessing the ultimate wall strength. RESULTS Magnetic resonance elastography-derived AAA stiffness was significantly higher than the normal aorta. Significant reduction in elastin and collagen densities as well as increased mineralization was observed in AAAs. Uniaxial tensile test and burst testing revealed reduced ultimate wall strength. Magnetic resonance elastography-derived aortic stiffness correlated to elastin density (ρ = -0.68; P < 0.0001; n = 60) and mineralization (ρ = 0.59; P < 0.0001; n = 60). Inverse correlations were observed between aortic stiffness and peak stress (ρ = -0.32; P = 0.0495; n = 38) as well as burst pressure (ρ = -0.55; P = 0.0116; n = 20). CONCLUSIONS Noninvasive in vivo aortic MRE successfully detected aortic wall stiffening, confirming the extracellular matrix remodeling observed in the histopathologic analyses. These mural changes diminished wall strength. Inverse correlation between MRE-derived aortic stiffness and aortic wall strength suggests that MRE-derived stiffness can be a potential biomarker for clinically assessing AAA wall status and rupture potential.
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31
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Suh GY, Bondesson J, Zhu YD, Lee JT, Dake MD, Cheng CP. Multiaxial pulsatile dynamics of the thoracic aorta and impact of thoracic endovascular repair. Eur J Radiol Open 2021; 8:100333. [PMID: 33748348 PMCID: PMC7957153 DOI: 10.1016/j.ejro.2021.100333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Altered motion of the thoracic aorta after thoracic endovascular aortic repair. Geometric analysis with cardiac-gated computed tomography and computer modeling. Decreased motion of the stented aorta and increased motion above the stented aorta. Longitudinal curvature and diametric deformation affected by presence of endograft.
Purpose The thoracic aorta is a highly mobile organ whose dynamics are altered by thoracic endovascular aorta repair (TEVAR). The aim of this study was to quantify cardiac pulsatility-induced multi-axial deformation of the thoracic aorta before and after descending aortic TEVAR. Methods Eleven TEVAR patients (8 males and 3 females, age 57–89) underwent retrospective cardiac-gated CT angiography before and after TEVAR. 3D geometric models of the thoracic aorta were constructed, and lumen centerlines, inner and outer surface curves, and cross-sections were extracted to measure aortic arclength, centerline, inner surface, and outer surface longitudinal curvatures, as well as cross-sectional effective diameter and eccentricity for the ascending and stented aortic portions. Results From pre- to post-TEVAR, arclength deformation was increased at the ascending aorta from 5.9 ± 3.1 % to 8.8 ± 4.4 % (P < 0.05), and decreased at the stented aorta from 7.5 ± 5.1 % to 2.7 ± 2.5 % (P < 0.05). Longitudinal curvature and diametric deformations were reduced at the stented aorta. Centerline curvature, inner surface curvature, and cross-sectional eccentricity deformations were increased at the distal ascending aorta. Conclusions Deformations were reduced in the stented thoracic aorta after TEVAR, but increased in the ascending aorta near the aortic arch, possibly as a compensatory mechanism to maintain overall thoracic compliance in the presence of reduced deformation in the stiffened stented aorta.
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Affiliation(s)
- Ga-Young Suh
- Department of Biomedical Engineering, California State University, Long Beach: 1250 Bellflower Blvd, Long Beach, CA, 90840, USA.,Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Johan Bondesson
- Division of Dynamics, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden
| | - Yufei D Zhu
- Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Jason T Lee
- Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Christopher P Cheng
- Department of Vascular Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
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32
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Schellinger IN, Wagenhäuser M, Chodisetti G, Mattern K, Dannert A, Petzold A, Jakubizka-Smorag J, Emrich F, Haunschild J, Schuster A, Schwob E, Schulz K, Maegdefessel L, Spin JM, Stumvoll M, Hasenfuß G, Tsao PS, Raaz U. MicroRNA miR-29b regulates diabetic aortic remodeling and stiffening. MOLECULAR THERAPY-NUCLEIC ACIDS 2021; 24:188-199. [PMID: 33767915 PMCID: PMC7957025 DOI: 10.1016/j.omtn.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
Patients with type 2 diabetes (T2D) are threatened by excessive cardiovascular morbidity and mortality. While accelerated arterial stiffening may represent a critical mechanistic factor driving cardiovascular risk in T2D, specific therapies to contain the underlying diabetic arterial remodeling have been elusive. The present translational study investigates the role of microRNA-29b (miR-29b) as a driver and therapeutic target of diabetic aortic remodeling and stiffening. Using a murine model (db/db mice), as well as human aortic tissue samples, we find that diabetic aortic remodeling and stiffening is associated with medial fibrosis, as well as fragmentation of aortic elastic layers. miR-29b is significantly downregulated in T2D and miR-29b repression is sufficient to induce both aortic medial fibrosis and elastin breakdown through upregulation of its direct target genes COL1A1 and MMP2 thereby increasing aortic stiffness. Moreover, antioxidant treatment restores aortic miR-29b levels and counteracts diabetic aortic remodeling. Concluding, we identify miR-29b as a comprehensive—and therefore powerful—regulator of aortic remodeling and stiffening in T2D that moreover qualifies as a (redox-sensitive) target for therapeutic intervention.
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Affiliation(s)
- Isabel N Schellinger
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK) e.V., Partner site Göttingen, Göttingen, Germany.,Department for Endocrinology, Nephrology and Rheumatology, University Medical Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Markus Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Giriprakash Chodisetti
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
| | - Karin Mattern
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
| | - Angelika Dannert
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
| | - Anne Petzold
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
| | - Joanna Jakubizka-Smorag
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany
| | - Fabian Emrich
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany.,Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Andreas Schuster
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK) e.V., Partner site Göttingen, Göttingen, Germany
| | - Elisabeth Schwob
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Kei Schulz
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.,Karolinska Institute, Department of Medicine, Stockholm, Sweden
| | - Joshua M Spin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Michael Stumvoll
- Department for Endocrinology, Nephrology and Rheumatology, University Medical Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK) e.V., Partner site Göttingen, Göttingen, Germany
| | - Philip S Tsao
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Uwe Raaz
- Department of Cardiology and Pneumology, Heart Center at the University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK) e.V., Partner site Göttingen, Göttingen, Germany
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33
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Di Giuseppe M, Farzaneh S, Zingales M, Pasta S, Avril S. Patient-specific computational evaluation of stiffness distribution in ascending thoracic aortic aneurysm. J Biomech 2021; 119:110321. [PMID: 33662747 DOI: 10.1016/j.jbiomech.2021.110321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 12/21/2022]
Abstract
Quantifying local aortic stiffness properties in vivo is acknowledged as essential to assess the severity of an ascending thoracic aortic aneurysm (ATAA). Recently, the LESI (local extensional stiffness identification) methodology has been established to quantify non-invasively local stiffness properties of ATAAs using electrocardiographic-gated computed tomography (ECG-gated CT) scans. The aim of the current study was to determine the most sensitive markers of local ATAA stiffness estimation with the hypothesis that direct measures of local ATAA stiffness could better detect the high-risk patients. A cohort of 30 patients (12 BAV and 18 TAV) referred for aortic size evaluation by ECG-gated CT were recruited. For each patient, the extensional stiffness Q was evaluated by the LESI methodology whilst computational flow analyses were also performed to derive hemodynamics markers such as the wall shear stress (WSS). A strong positive correlation was found between the extensional stiffness and the aortic pulse pressure (R = 0.644 and p < 0.001). Interestingly, a significant positive correlation was also found between the extensional stiffness and patients age for BAV ATAAs (R = 0.619 and p = 0.032), but not for TAV ATAAs (R = -0.117 and p = 0.645). No significant correlation was found between the extensional stiffness and WSS evaluated locally. There was no significant difference either in the extensional stiffness between BAV ATAAs and TAV ATAAs (Q = 3.6 ± 2.5 MPa.mm for BAV ATAAs vs Q = 5.3 ± 3.1 MPa.mm for TAV ATAAs, p = 0.094). Future work will focus on relating the extensional stiffness to the patient-specific rupture risk of ATAAs on larger cohorts to confirm the promising interest of the LESI methodology.
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Affiliation(s)
- Marzio Di Giuseppe
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90128 Palermo, Italy
| | - Solmaz Farzaneh
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 SAINBIOSE, Saint-Étienne 42023, France
| | - Massimiliano Zingales
- Department of Engineering, Viale delle Scienze, Ed.8, University of Palermo, 90128 Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, Viale delle Scienze, Ed.8, University of Palermo, 90128 Palermo, Italy
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 SAINBIOSE, Saint-Étienne 42023, France.
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34
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The long-term fate of ascending aorta aneurysm after wrapping versus replacement. J Thorac Cardiovasc Surg 2021; 164:463-474.e4. [PMID: 33597100 DOI: 10.1016/j.jtcvs.2020.12.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The study objective was to examine the long-term fate of aortic diameter expansion at 4 cardiac regions (annulus, sinus, ascending aorta, and proximal arch) after wrapping or replacement during aortic valve surgery of the moderately dilated ascending aorta. METHODS From January 1995 to December 2018, 964 consecutive patients who underwent aortic valve replacement at our institution were reviewed. Of them, 204 (mean age, 60.7 ± 7.4 years) underwent ascending aorta wrapping (n = 96) or replacement (n = 108) for a moderately dilated ascending aorta (40 to 55 mm). The overall fate of the aortic diameter was analyzed with a linear mixed-effect model. The median follow-up duration was 7.1 years. RESULTS After propensity score matching, the baseline maximal ascending aortic diameter median value was 47.3 ± 3.1 mm and 49.4 ± 13.5 mm in the wrapping and replacement groups, respectively. The annulus, sinus, and ascending aorta did not redilate in either group. The proximal aortic arch diameter significantly increased over time (0.343 mm/year; P = .006) in the wrapping group but not in the replacement group (0.066 mm/year; P = .649). Multivariable competing risk analysis identified the initial ascending aorta diameter at the wrapping procedure as an independent risk factor of proximal arch redilation (0.071 ± 0.037, P < .001). The cutoff value was an initial ascending aorta diameter of 47.2 mm for the prediction proximal arch redilation (area under the curve, 0.703; P = .014). CONCLUSIONS Aortic wrapping and replacement may be long-term durable treatment options in patients with a moderately enlarged ascending aorta. We suggest careful evaluation of redilation in the proximal arch after an aorta wrapping procedure.
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35
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Wu X, Liu X, Yang H, Chen Q, Zhang N, Li Y, Du X, Liu X, Jiang X, Jiang Y, Zhou Z, Yang Z. P-Selectin Glycoprotein Ligand-1 Deficiency Protects Against Aortic Aneurysm Formation Induced by DOCA Plus Salt. Cardiovasc Drugs Ther 2021; 36:31-44. [PMID: 33432452 DOI: 10.1007/s10557-020-07135-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE P-selectin glycoprotein ligand-1 (PSGL-1) acts as a crucial regulator for the inflammatory cells infiltration by mediating the adhesion of leukocytes. However, the role of PSGL-1 in aortic aneurysm remains elusive. Here, we investigated the role of PSGL-1 in aortic aneurysm (AA) development. METHODS We first detected PSGL-1 expression in samples from aortic aneurysm patients and mouse AA models via western blotting, immunofluorescence, and flow cytometry, and then we used global PSGL-1 knockout mice and their wild type controls to establish an aortic aneurysm model induced by deoxycorticosterone acetate (DOCA) plus high salt (HS). The incidence, fatality rates, and the pathological changes of aortic aneurysm were analyzed in each group. The inflammation, adhesion molecules expression, and PSGL-1 mediated leukocyte-endothelial adhesion and their underlying mechanisms were explored further. RESULTS Increased PSGL-1 levels were observed in human and mouse aortic aneurysm, and on leukocytes of mice treated with DOCA+HS. PSGL-1 deficiency reduced the incidence and severity of aortic aneurysm significantly, as well as decreased elastin fragmentation, collagen accumulation, and smooth muscle cells degeneration. Mechanistically, the protective effect of PSGL-1 inhibition was mediated by the reduced adhesion molecules, and the subsequently reduced leukocyte-endothelial adhesion through the NF-κB pathway, which finally led to reduced inflammatory cells infiltration and decreased inflammatory factors expression. CONCLUSION PSGL-1 deficiency is protective against inflammatory cells migration and recruitment in the condition of AA through attenuation of leukocyte-endothelial adhesion. Inhibition of PSGL-1 may be a potential therapeutic target for the prevention and treatment of human AA.
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Affiliation(s)
- Xianxian Wu
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Centre, Peking Union Medical College (PUMC), 5 Pan Jia Yuan Nan Li Chaoyang District, Beijing, 100021, People's Republic of China
| | - Xing Liu
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Centre, Peking Union Medical College (PUMC), 5 Pan Jia Yuan Nan Li Chaoyang District, Beijing, 100021, People's Republic of China
| | - Hang Yang
- State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Diagnostic Laboratory Service, Center of Laboratory Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Qianlong Chen
- State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Diagnostic Laboratory Service, Center of Laboratory Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Na Zhang
- Institute of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750001, Ningxia, China
| | - Yuhan Li
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Xingchen Du
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Xue Liu
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Centre, Peking Union Medical College (PUMC), 5 Pan Jia Yuan Nan Li Chaoyang District, Beijing, 100021, People's Republic of China
| | - Xiaoliang Jiang
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Centre, Peking Union Medical College (PUMC), 5 Pan Jia Yuan Nan Li Chaoyang District, Beijing, 100021, People's Republic of China
| | - Yideng Jiang
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, China
| | - Zhou Zhou
- State Key Laboratory of Cardiovascular Disease, Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Diagnostic Laboratory Service, Center of Laboratory Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
| | - Zhiwei Yang
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical Diseases, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Centre, Peking Union Medical College (PUMC), 5 Pan Jia Yuan Nan Li Chaoyang District, Beijing, 100021, People's Republic of China.
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Wang S, Tian X, Liu D, Zhang X, Yan C, Han Y. TRPV5 attenuates abdominal aortic aneurysm in mice by regulating KLF4-dependent phenotype switch of aortic vascular smooth muscle cells. Arch Biochem Biophys 2020; 698:108724. [PMID: 33309615 DOI: 10.1016/j.abb.2020.108724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a fatal vascular disease with insidious symptoms. However, the mechanism behind its development remains unclear. The transient receptor potential vanilloid (TRPV) family has crucial protective effects against cardiovascular diseases, but the role of TRPV5 in AAA has yet to be reported. In this study, ApoE-/- mice were intraperitoneally injected with AAV-GFP or AAV-TRPV5. After 30 days, mice were further administered with angiotensin II (Ang II, 1.44 mg/kg/day) by using osmotic pumps to induce the AAA model or Saline for 28 days, (i.e., Saline + AAV-GFP, Saline + AAV-TRPV5, Ang II + AAV-GFP and Ang II + AAV-TRPV5 groups were established). Compared with the control group, the incidence of AAA and the maximal diameter of the abdominal aorta markedly decreased in Ang II + AAV-TRPV5, which was detected by vascular ultrasound at 28 day. Meanwhile, less collagen and elastin degradation were observed in the Ang II + AAV-TRPV5 group by using Masson and Elastin stains. Moreover, more α-SMA and less MMP2 was observed in the abdominal aortas collected at 28 day by immunohistochemistry. In vitro, primary mouse vascular smooth muscle cells (VSMCs) were treated with Ang II (1 μM) to induce phenotype switch. Sh-TRPV5 and AdTRPV5 were used to transfect VSMCs. PCR and Western blotting were used to access the expression of contractile marker, including α-SMA and SM-22α. The results showed that the mRNA and protein level of α-SMA and SM-22α were decreased under the stimulation of Ang II, but could be attenuated by TRPV5 overexpression. The cell scratch assay demonstrated that the migration ability of VSMCs was increased in Ang II treated group and could be ameliorated by TRPV5 overexpression. Above all, VSMCs transformed from the contractile into secretory phenotype under Ang II stimuli, but could be rescued by TRPV5 overexpression. Furthermore, TRPV5 overexpression suppressed the increased expression of KLF4 induced by Ang II treatment in VSMCs. The data demonstrated that TRPV5 could inhibit AAA formation and play a critical role in the VSMC phenotype switch by downregulating KLF4, suggesting TRPV5 as a new strategy for treating AAA.
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Affiliation(s)
- Shuo Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China; Department of Cardiology and Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaoxiang Tian
- Department of Cardiology and Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Dan Liu
- Department of Cardiology and Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaolin Zhang
- Department of Cardiology and Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Chenghui Yan
- Department of Cardiology and Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China; Department of Cardiology and Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, China.
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DAPT, a potent Notch inhibitor regresses actively growing abdominal aortic aneurysm via divergent pathways. Clin Sci (Lond) 2020; 134:1555-1572. [PMID: 32490531 DOI: 10.1042/cs20200456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a localized pathological dilation of the aorta exceeding the normal diameter (∼20 mm) by more than 50% of its original size (≥30 mm), accounting for approximately 150000-200000 deaths worldwide per year. We previously reported that Notch inhibition does not decrease the size of pre-established AAA at late stage of the disease. Here, we examined whether a potent pharmacologic inhibitor of Notch signaling (DAPT (N-[N-(3,5-Difluorophenacetyl)-l-alanyl]-S-phenylglycine t-butyl ester)), regresses an actively growing AAA. In a mouse model of an aneurysm (Apoe-/- mice; n=44); DAPT (n=17) or vehicle (n=17) was randomly administered at day 14 of angiotensin II (AngII; 1 µg/min/kg), three times a week and mice were killed on day 42. Progressive increase in aortic stiffness and maximal intraluminal diameter (MILD) was observed in the AngII + vehicle group, which was significantly prevented by DAPT (P<0.01). The regression of aneurysm with DAPT was associated with reduced F4/80+Cd68+ (cluster of differentiation 68) inflammatory macrophages. DAPT improved structural integrity of aorta by reducing collagen fibrils abnormality and restoring their diameter. Mechanistically, C-C chemokine receptor type 7 (Ccr7)+F4/80- dendritic cells (DCs), implicated in the regression of aneurysm, were increased in the aorta of DAPT-treated mice. In the macrophages stimulated with AngII or lipopolysaccharide (LPS), DAPT reverted the expression of pro-inflammatory genes Il6 and Il12 back to baseline within 6 h compared with vehicle (P<0.05). DAPT also significantly increased the expression of anti-inflammatory genes, including c-Myc, Egr2, and Arg1 at 12-24 h in the LPS-stimulated macrophages (P<0.05). Overall, these regressive effects of Notch signaling inhibitor emphasize its therapeutic implications to prevent the progression of active AAAs.
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Yu X, Feng X, Xia L, Cao S, Wei X. Risk of aortic aneurysm in patients with psoriasis: A systematic review and meta-analysis of cohort studies. Clin Cardiol 2020; 43:1266-1272. [PMID: 32757333 PMCID: PMC7661651 DOI: 10.1002/clc.23438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association between psoriasis and the risk of aortic aneurysm is still unclear. HYPOTHESIS Patients with psoriasis have a higher risk of aortic aneurysm than healthy individuals. METHODS PubMed, Embase, and Scopus from inception to 20 July 2019 were searched. We included cohort studies if they reported estimate effects on the risk of aortic aneurysm in patient with psoriasis. We used Newcastle-Ottawa Scale to evaluate methodology quality of eligible studies. Random-effect meta-analyses were used to estimate the overall risk. Subgroup analyses were conducted for analysis of influencing factors. RESULTS After a view of 2207 citations, we included three large cohort studies enrolling 5 706 525 participants in this systematic review. Psoriasis patients have an increased risk of development of aortic aneurysm (hazard ratio [HR]: 1.30, 95%confidence intervals [CI], 1.10-1.55, I2 = 53.1%). The risk is not statistically different between patients with severe psoriasis (HR, 1.51, 95%CI, 1.04-2.19, I2 = 40.2%) and patients with mild psoriasis (HR, 1.24, 95%CI, 1.08-1.42, I2 = 24.1%). The risk was not statistically increased in female patients (HR, 1.55, 95%CI, 0.65-3.72), patients ≥50 years old (HR, 4.05, 95%CI, 0.69-23.75, I2 = 97.3%), and patients with diabetes (HR, 0.97, 95%CI, 0.83-1.14). CONCLUSIONS Current evidence from observational studies suggests that psoriasis increases the risk of aortic aneurysm, and screening of aortic aneurysm might be considered among psoriasis patients.
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Affiliation(s)
- Xinyu Yu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Feng
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangtao Xia
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
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39
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Aykan AÇ, Çetin M, Kalaycıoğlu E, Menteşe Ü. Assessment of cardio-ankle vascular index in patients with abdominal aortic aneurysm: An observational study. Vascular 2020; 29:190-195. [PMID: 32757746 DOI: 10.1177/1708538120946549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Arterial stiffness is associated with major adverse cardiovascular events. The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with abdominal aortic aneurysm (AAA). METHODS This observational and cross-sectional study involved 59 subjects with AAA and 32 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. RESULTS Mean abdominal aortic diameter of AAA patients and controls were 43.88 ± 9.28 mm and 20.43 ± 3.14 mm, consecutively. Baseline clinical characteristics of the patients and controls were similar for age, presence of hypertension, diabetes, dyslipidemia, coronary artery disease and smoking. Left ventricle ejection fraction and Left ventricle mass index (LVMI) were similar between groups. CAVI was significantly higher in patients with AAA than controls (9.74 ± 1.50 vs. 7.60 ± 1.07, p < 0.001). CAVI was positively correlated with AAA diameter (r = 0.461, p < 0.001) and negatively correlated with left ventricle ejection fraction (r= -0.254, p = 0.015). CAVI >8.3 had a sensitivity 89.8% and a specificity of 78.1% for predicting the presence of AAA in ROC analysis (area under curve = 0.897, 95%CI = 0.816-0.951, p < 0.001). CONCLUSION CAVI is increased in patients with AAA. Increased arterial stiffness may be a mechanical link between AAA, coronary artery disease and peripheral artery disease or a common mechanism effects the arterial stiffness, coronary artery disease, peripheral artery disease and AAA. Therefore, CAVI may be used as a valuable marker for risk stratification for the development of AAA in susceptible patients.
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Affiliation(s)
- Ahmet Çağrı Aykan
- Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.,Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Faculty of Medicine, Rize Recep Tayyip Erdoğan University, Rize, Turkey
| | - Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Ümit Menteşe
- Department of Cardiovascular Surgery, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
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40
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Li L, Ma W, Pan S, Li Y, Wang H, Wang B, Khalil RA. MiR-126a-5p limits the formation of abdominal aortic aneurysm in mice and decreases ADAMTS-4 expression. J Cell Mol Med 2020; 24:7896-7906. [PMID: 32469162 PMCID: PMC7348185 DOI: 10.1111/jcmm.15422] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/06/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a serious vascular disease featured by inflammatory infiltration in aortic wall, aortic dilatation and extracellular matrix (ECM) degradation. Dysregulation of microRNAs (miRNAs) is implicated in AAA progress. By profiling miRNA expression in mouse AAA tissues and control aortas, we noted that miR-126a-5p was down-regulated by 18-fold in AAA samples, which was further validated with real-time qPCR. This study was performed to investigate miR-126a-5p's role in AAA formation. In vivo, a 28-d infusion of 1 μg/kg/min Angiotensin (Ang) II was used to induce AAA formation in Apoe-/- mice. MiR-126a-5p (20 mg/kg; MIMAT0000137) or negative control (NC) agomirs were intravenously injected to mice on days 0, 7, 14 and 21 post-Ang II infusion. Our data showed that miR-126a-5p overexpression significantly improved the survival and reduced aortic dilatation in Ang II-infused mice. Elastic fragment and ECM degradation induced by Ang II were also ameliorated by miR-126a-5p. A strong up-regulation of ADAM metallopeptidase with thrombospondin type 1 motif 4 (ADAMTS-4), a secreted proteinase that regulates matrix degradation, was observed in smooth muscle cells (SMCs) of aortic tunica media, which was inhibited by miR-126a-5p. Dual-luciferase results demonstrated ADAMTS-4 as a new and valid target for miR-126a-5p. In vitro, human aortic SMCs (hASMCs) were stimulated by Ang II. Gain- and loss-of-function experiments further confirmed that miR-126-5p prevented Ang II-induced ECM degradation, and reduced ADAMTS-4 expression in hASMCs. In summary, our work demonstrates that miR-126a-5p limits experimental AAA formation and reduces ADAMTS-4 expression in abdominal aortas.
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Affiliation(s)
- Lei Li
- Department of Vascular SurgeryThe Second Affiliated Hospital of Dalian Medical UniversityDalianChina
- Vascular Surgery Research LaboratoriesDivision of Vascular and Endovascular SurgeryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Wei Ma
- Department of AnatomyDalian Medical UniversityDalianChina
| | - Shuang Pan
- Department of PhysiologySchool of Basic MedicineJinzhou Medical UniversityJinzhouChina
| | - Yongqi Li
- Graduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaJapan
| | - Han Wang
- Department of Vascular SurgeryDalian University Affiliated Xinhua HospitalDalianChina
| | - Biao Wang
- Department of Biochemistry and Molecular BiologySchool of Life SciencesChina Medical UniversityShenyangChina
| | - Raouf A. Khalil
- Vascular Surgery Research LaboratoriesDivision of Vascular and Endovascular SurgeryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
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41
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Haunschild J, Schellinger IN, Barnard SJ, von Aspern K, Davierwala P, Misfeld M, Petroff D, Borger MA, Etz CD. Bicuspid aortic valve patients show specific epigenetic tissue signature increasing extracellular matrix destruction. Interact Cardiovasc Thorac Surg 2020; 29:937-943. [PMID: 31501876 DOI: 10.1093/icvts/ivz210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Patients with a bicuspid aortic valve (BAV) have an increased risk for developing thoracic aortic aneurysm, which is characterized by the destruction of the elastic media of the aortic wall. Several important enzymes have been characterized to play key roles in extracellular matrix homeostasis, namely matrix metalloproteinases (MMPs). In this study, we investigated MMP-2 levels and their epigenetic regulation via the miR-29 family. METHODS Aortic tissue samples from 58 patients were collected during cardiac surgery, of which 30 presented with a BAV and 28 with a tricuspid aortic valve. Polymerase chain reaction, western blot analysis and immunohistochemistry were performed to analyse MMP-2. In addition, enzyme-linked immunosorbent assay measurements were carried out to investigate both MMP-2 and tissue inhibitor of metalloproteinase-2 levels. To examine the epigenetic regulation of aortic extracellular matrix homeostasis, we furthermore studied the expression levels of miR-29 via qRT-PCR. RESULTS Patients with a BAV were significantly younger at the time of surgery, presented significantly less frequently with arterial hypertension and displayed more often with an additional valvular disease. On a molecular level, we found that MMP-2 is increased on gene and protein level in BAV patients. Tissue inhibitor of metalloproteinase-2 levels do not differ between the groups. Interestingly, we also found that only miR-29A is significantly downregulated in BAVs. CONCLUSIONS Our findings highlight the importance of MMP-2 in the context of extracellular matrix destruction in BAV patients. We present new evidence that miR-29A is a crucial epigenetic regulator of these pathomechanistic processes and might hold promise for future translational research.
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Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| | - Isabel N Schellinger
- Department of Endocrinology and Nephrology, University Medical Center Leipzig, Leipzig, Germany
| | - Sarah J Barnard
- Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| | | | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Petroff
- Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
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42
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Lane BA, Wang X, Lessner SM, Vyavahare NR, Eberth JF. Targeted Gold Nanoparticles as an Indicator of Mechanical Damage in an Elastase Model of Aortic Aneurysm. Ann Biomed Eng 2020; 48:2268-2278. [PMID: 32240423 DOI: 10.1007/s10439-020-02500-5] [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: 12/11/2019] [Accepted: 03/27/2020] [Indexed: 12/23/2022]
Abstract
Elastin is a key structural protein and its pathological degradation deterministic in aortic aneurysm (AA) outcomes. Unfortunately, using current diagnostic and clinical surveillance techniques the integrity of the elastic fiber network can only be assessed invasively. To address this, we employed fragmented elastin-targeting gold nanoparticles (EL-AuNPs) as a diagnostic tool for the evaluation of unruptured AAs. Electron dense EL-AuNPs were visualized within AAs using micro-computed tomography (micro-CT) and the corresponding Gold-to-Tissue volume ratios quantified. The Gold-to-Tissue volume ratios correlated strongly with the concentration (0, 0.5, or 10 U/mL) of infused porcine pancreatic elastase and therefore the degree of elastin damage. Hyperspectral mapping confirmed the spatial targeting of the EL-AuNPs to the sites of damaged elastin. Nonparametric Spearman's rank correlation indicated that the micro-CT-based Gold-to-Tissue volume ratios had a strong correlation with loaded (ρ = 0.867, p-val = 0.015) and unloaded (ρ = 0.830, p-val = 0.005) vessel diameter, percent dilation (ρ = 0.976, p-val = 0.015), circumferential stress (ρ = 0.673, p-val = 0.007), loaded (ρ = - 0.673, p-val = 0.017) and unloaded (ρ = - 0.697, p-val = 0.031) wall thicknesses, circumferential stretch (ρ = - 0.7234, p-val = 0.018), and lumen area compliance (ρ = - 0.831, p-val = 0.003). Likewise, in terms of axial force and axial stress vs. stretch, the post-elastase vessels were stiffer. Collectively, these findings suggest that, when combined with CT imaging, EL-AuNPs can be used as a powerful tool in the non-destructive estimation of mechanical and geometric features of AAs.
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Affiliation(s)
- Brooks A Lane
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoying Wang
- Bioengineering Department, Clemson University, Clemson, SC, USA
| | - Susan M Lessner
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, 29208, USA.,Cell Biology and Anatomy Department, University of South Carolina, Columbia, SC, USA
| | | | - John F Eberth
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, 29208, USA. .,Cell Biology and Anatomy Department, University of South Carolina, Columbia, SC, USA.
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43
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Lu Y, Pechlaner R, Cai J, Yuan H, Huang Z, Yang G, Wang J, Chen Z, Kiechl S, Xu Q. Trajectories of Age-Related Arterial Stiffness in Chinese Men and Women. J Am Coll Cardiol 2020; 75:870-880. [DOI: 10.1016/j.jacc.2019.12.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
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Sharma N, Sun Z, Hill MA, Hans CP. Measurement of Pulse Propagation Velocity, Distensibility and Strain in an Abdominal Aortic Aneurysm Mouse Model. J Vis Exp 2020:10.3791/60515. [PMID: 32150160 PMCID: PMC7890464 DOI: 10.3791/60515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the abdominal aorta that exceeds the maximal intraluminal diameter (MILD) by 1.5 times of its original size. Clinical and experimental studies have shown that small aneurysms may rupture, while a subpopulation of large aneurysms may remain stable. Thus, in addition to the measurement of intraluminal diameter of the aorta, knowledge of structural traits of the vessel wall may provide important information to assess the stability of the AAA. Aortic stiffening has recently emerged as a reliable tool to determine early changes in the vascular wall. Pulse propagation velocity (PPV) along with the distensibility and radial strain are highly useful ultrasound-based methods relevant for assessing aortic stiffness. The primary purpose of this protocol is to provide a comprehensive technique for the use of ultrasound imaging system to acquire images and analyze the structural and functional properties of the aorta as determined by MILD, PPV, distensibility and radial strain.
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Affiliation(s)
- Neekun Sharma
- Division of Cardiovascular Medicine, University of Missouri; Dalton Cardiovascular Research Center, University of Missouri
| | - Zhe Sun
- Medical Pharmacology and Physiology, University of Missouri; Dalton Cardiovascular Research Center, University of Missouri
| | - Michael A Hill
- Division of Cardiovascular Medicine, University of Missouri; Medical Pharmacology and Physiology, University of Missouri; Dalton Cardiovascular Research Center, University of Missouri
| | - Chetan P Hans
- Division of Cardiovascular Medicine, University of Missouri; Medical Pharmacology and Physiology, University of Missouri; Dalton Cardiovascular Research Center, University of Missouri;
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Góes Junior AMDO, Albuquerque FBAD, Beckmann FA, Centeno FV, Andrade MCD, Vieira WDB. Sexo e idade e sua influência sobre a anatomia da aorta abdominal e seus ramos. J Vasc Bras 2020; 19:e20200073. [PMID: 34211522 PMCID: PMC8218012 DOI: 10.1590/1677-5449.200073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto Não se sabe ao certo como a idade e o sexo do paciente influenciam na anatomia da aorta abdominal e de seus ramos. Objetivos Determinar os padrões anatômicos (diâmetro e angulações) mais frequentes da aorta abdominal e de seus ramos e a influência do sexo e da idade dos pacientes sobre esses padrões. Métodos Foram avaliadas tomografias computadorizadas de abdome com contraste endovenoso de 157 pacientes. Foram aferidos calibre e angulação de artérias abdominais em indivíduos de ambos os sexos, agrupados em cinco faixas etárias: 20 a 30 anos, 31 a 40 anos, 41 a 50 anos, 51 a 60 anos e 61 a 70 anos. Foram analisadas 18 variáveis: seis ângulos de emergências arteriais, nove diâmetros arteriais, taxas de dilatação, sexo e faixa etária. Para a obtenção das medidas, utilizou-se o programa de computador RadiAnt 4.2.1 DICOM viewer (Medixant, Poznan, Polônia). Resultados Entre as 157 tomografias, 69 eram de homens e 88, de mulheres. Apresentaram diferença estatística (p < 0,05): ângulo de origem e diâmetro da artéria mesentérica superior; ângulo e diâmetro das artérias renais; diâmetro das artérias ilíacas comuns; diâmetro e taxa de dilatação em diversos segmentos da aorta, exceto na porção proximal ao tronco celíaco. Conclusões Os diâmetros da aorta (em diversos segmentos) e de seus ramos (exceto da artéria renal esquerda) aumentam progressivamente com o passar da idade em ambos os sexos e são maiores e possuem taxa de dilatação mais elevada em homens do que em mulheres da mesma faixa etária. Entre os sexos, o ângulo de emergência da artéria mesentérica superior foi maior em homens, exceto entre 20 e 30 anos; o ângulo de origem da artéria renal esquerda foi maior em mulheres entre 51 e 60 anos.
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Sharma N, Dev R, Belenchia AM, Aroor AR, Whaley-Connell A, Pulakat L, Hans CP. Deficiency of IL12p40 (Interleukin 12 p40) Promotes Ang II (Angiotensin II)-Induced Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2019; 39:212-223. [PMID: 30580570 DOI: 10.1161/atvbaha.118.311969] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective- Abdominal aortic aneurysm is caused by the accumulation of inflammatory cells in the aortic wall. Our recent studies demonstrated that inhibition of Notch signaling attenuates abdominal aortic aneurysm formation by shifting the macrophage balance towards anti-inflammatory (M2) phenotype. Using IL12p40-/- (interleukin 12 p40) mice, we investigated the effects of M2-predominant macrophages on the development of abdominal aortic aneurysm. Approach and Results- Male (8-10 week-old) wild-type and IL12p40-/- mice (n=15) on C57BL/6 background were infused with Ang II (angiotensin II, 1000 ng/kg per minute) by implanting osmotic pumps subcutaneously for 28 days. In the IL12p40-/- mice, Ang II significantly increased the maximal intraluminal diameter (9/15) as determined by transabdominal ultrasound imaging. In addition, IL12p40-deletion significantly increased aortic stiffness in response to Ang II as measured by pulse wave velocity and atomic force microscopy. Histologically, IL12p40-/- mice exhibited increased maximal external diameter of aorta and aortic lesions associated with collagen deposition and increased elastin fragmentation compared with wild-type mice infused with Ang II. Mechanistically, IL12p40 deficiency by siRNA (small interfering RNA) augmented the Tgfβ2-mediated Mmp2 expression in wild-type bone marrow-derived macrophages without affecting the expression of Mmp9. No such effects of IL12p40 deficiency on MMP2/MMP9 was observed in human aortic smooth muscle cells or fibroblasts. Depletion of macrophages in IL12p40-/- mice by clodronate liposomes significantly decreased the maximal external diameter of aorta and aortic stiffness in response to Ang II as determined by imaging and atomic force microscopy. Conclusions- IL12p40 depletion promotes the development of abdominal aortic aneurysm, in part, by facilitating recruitment of M2-like macrophages and potentiating aortic stiffness and fibrosis mediated by Tgfβ2.
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Affiliation(s)
- Neekun Sharma
- From the Department of Cardiovascular Medicine (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia
| | - Rishabh Dev
- From the Department of Cardiovascular Medicine (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia
| | - Anthony M Belenchia
- From the Department of Cardiovascular Medicine (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia
| | - Annayya R Aroor
- Department of Medical Pharmacology and Physiology (A.R.A., C.P.H.), University of Missouri, Columbia
| | - Adam Whaley-Connell
- Harry S. Truman Memorial Veterans' Hospital (A.W.-C.), University of Missouri, Columbia
| | - Lakshmi Pulakat
- From the Department of Cardiovascular Medicine (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia
| | - Chetan P Hans
- From the Department of Cardiovascular Medicine (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia.,Department of Medical Pharmacology and Physiology (A.R.A., C.P.H.), University of Missouri, Columbia.,Dalton Cardiovascular Research Center (N.S., R.D., A.M.B., L.P., C.P.H.), University of Missouri, Columbia
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47
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Shen Y, Zhang S, Zhu G, Chen Y, Chen Z, Jing Z, Lu Q. Risk factors of distal segment aortic enlargement after complicated type B aortic dissection. J Interv Med 2019; 2:154-159. [PMID: 34805893 PMCID: PMC8562164 DOI: 10.1016/j.jimed.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Distal segment aortic enlargement (DSAE) is a common complication that influences the long-term prognosis of type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). In this study, a multivariate analysis was performed to find potential factors predictive of DSAE. Methods A single-center retrospective study was performed from 1999 to 2016. Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears. Based on the diameter of the distal segment of the uncovered aorta, we assigned patients to an enlargement group and a non-enlargement group. Data extracted from the medical records included demographic and clinical characteristics and follow-up computed tomography angiography data. The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period. Results For the 333 patients, all-cause mortality was 38 (11.41%), and 76 (22.82%) patients underwent reintervention. A total of 70 (21.02%) patients experienced DSAE, among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention. Multivariate analysis reviewed independent risk factors of postoperative DSAE, including current smoking, the residual length of the patent false lumen, the postoperative number of dissection tears in the thoracic aorta and type III aortic arch; as well as protective factors, including the application of a restrictive bare stent (RBS), the length of covered stent in the descending thoracic aorta, and the distance from the residual first tear to the left subclavian artery (LSA). Conclusion DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit, the residual length of patent false lumen, the postoperative number of dissection tears in the thoracic aorta and the aortic arch type. Meanwhile, RBS usage, the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.
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Affiliation(s)
- Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Simeng Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China.,Department of Congenital Heart Disease, Fuwai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Yanqing Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zheng Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
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48
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Subclavian artery pseudoaneurysm long after the division of modified Blalock-Taussig shunt. Gen Thorac Cardiovasc Surg 2019; 68:848-850. [PMID: 31625084 DOI: 10.1007/s11748-019-01228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
A massive but asymptomatic left subclavian artery pseudoaneurysm was diagnosed in a 30-year-old female patient with transposition of the great arteries, ventricular septal defect, and pulmonary atresia. After undergoing bilateral modified Blalock-Taussig shunts at the age of 4 months and 3 years, respectively, she underwent the Rastelli operation and division of both shunts at the age of 6 years of age. The pseudoaneurysm was not discovered at the follow-up investigation at age 14. During the time period from age 18 to 30 years, she was lost to follow-up, she was confirmed to be free from infectious disease, traumatic accident, or vasculitis. Pregnancy-induced hypertension was not associated during her pregnancy. Graft replacement of the left subclavian artery and redo right ventricular outflow tract reconstruction were successfully performed under deep hypothermic circulatory arrest at the age of 33 years.
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49
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Perissiou M, Bailey TG, Windsor M, Greaves K, Nam MCY, Russell FD, O'Donnell J, Magee R, Jha P, Schulze K, Leicht AS, Golledge J, Askew CD. Aortic and Systemic Arterial Stiffness Responses to Acute Exercise in Patients With Small Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2019; 58:708-718. [PMID: 31631005 DOI: 10.1016/j.ejvs.2019.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/24/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/BACKGROUND Elevated arterial stiffness is a characteristic of abdominal aortic aneurysm (AAA), and is associated with AAA growth and cardiovascular mortality. A bout of exercise transiently reduces aortic and systemic arterial stiffness in healthy adults. Whether the same response occurs in patients with AAA is unknown. The effect of moderate- and higher intensity exercise on arterial stiffness was assessed in patients with AAA and healthy adults. METHODS Twenty-two men with small diameter AAAs (36 ± 5 mm; mean age 74 ± 6 years) and 22 healthy adults (mean age 72 ± 5 years) were included. Aortic stiffness was measured using carotid to femoral pulse wave velocity (PWV), and systemic arterial stiffness was estimated from the wave reflection magnitude (RM) and augmentation index (Alx75). Measurements were performed at rest and during 90 min of recovery following three separate test sessions in a randomised order: (i) moderate intensity continuous exercise; (ii) higher intensity interval exercise; or (iii) seated rest. RESULTS At rest, PWV was higher in patients with AAA than in healthy adults (p < .001), while AIx75 and RM were similar between groups. No differences were observed between AAA patients and healthy adults in post-exercise aortic and systemic arterial stiffness after either exercise protocol. When assessed as the change from baseline (delta, Δ), post-exercise ΔAIx75 was not different to the seated rest protocol. Conversely, post-exercise ΔPWV and ΔRM were both lower at all time points than seated rest (p < .001). ΔPWV was lower immediately after higher intensity than after moderate intensity exercise (p = .015). CONCLUSION High resting aortic stiffness in patients with AAA is not exacerbated after exercise. There was a similar post-exercise attenuation in arterial stiffness between patients with AAA and healthy adults compared with seated rest. This effect was most pronounced following higher intensity interval exercise, suggesting that this form of exercise may be a safe and effective adjunctive therapy for patients with small AAAs.
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Affiliation(s)
- Maria Perissiou
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Tom G Bailey
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia; Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Mark Windsor
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Kim Greaves
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia; Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Michael C Y Nam
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Fraser D Russell
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jill O'Donnell
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Rebecca Magee
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Pankaj Jha
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Karl Schulze
- Sunshine Vascular Surgery, Buderim, QLD, Australia
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Townsville, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and the Townsville Hospital, Townsville, QLD, Australia.
| | - Christopher D Askew
- VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia; Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia.
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50
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Chim YH, Davies HA, Mason D, Nawaytou O, Field M, Madine J, Akhtar R. Bicuspid valve aortopathy is associated with distinct patterns of matrix degradation. J Thorac Cardiovasc Surg 2019; 160:e239-e257. [PMID: 31679706 PMCID: PMC7674632 DOI: 10.1016/j.jtcvs.2019.08.094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To explore the micromechanical, biochemical, and microstructural differences between bicuspid aortic valve aneurysm (BAV-A) and tricuspid aortic valve idiopathic degenerative aneurysm (DA), compared with normal aorta. METHODS Aortic tissue was obtained from patients undergoing aneurysmal repair surgery (BAV-A; n = 15 and DA; n = 15). Control tissue was obtained from aortic punch biopsies during coronary artery bypass graft surgery (n = 9). Nanoindentation was used to determine the elastic modulus on the medial layer. Glycosaminoglycan, collagen, and elastin levels were measured using biochemical assays. Verhoeff Van Gieson-stained cross-sections were imaged for elastin microstructural quantification. RESULTS The elastic modulus was more than 20% greater for BAV-A relative to control and DA (signifying a loss of compliance). No significance difference between control and DA were observed. Collagen levels for BAV-A (36.9 ± 7.4 μg/mg) and DA (49.9 ± 10.9 μg/mg) were greater compared with the control (30.2 ± 13.1 μg/mg). Glycosaminoglycan and elastin levels were not significant between the groups. Elastin segments were uniform throughout the control. Aneurysmal tissues had less elastin segments close to the intima and adventitia layers. Both BAV-A and DA had elastin segments compacted in the media; however, elastin segments were highly fragmented in DA. CONCLUSIONS BAV-A has a greater loss of aortic wall compliance relative to DA and the control. Although elastin levels were equal for all groups, spatial distribution of elastin provided a unique profile of matrix degradation for BAV-A. Elastin compaction within the media of BAV-A may have resulted from the altered hemodynamic pressure against the wall, which could explain for the stiffness of the tissue.
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Affiliation(s)
- Ya Hua Chim
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Hannah A Davies
- Institute of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom
| | - David Mason
- Institute of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Omar Nawaytou
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Jillian Madine
- Institute of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Riaz Akhtar
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom.
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