1
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Wagenhäuser MU, Mulorz J, Krott KJ, Bosbach A, Feige T, Rhee YH, Chatterjee M, Petzold N, Böddeker C, Ibing W, Krüger I, Popovic AM, Roseman A, Spin JM, Tsao PS, Schelzig H, Elvers M. Crosstalk of platelets with macrophages and fibroblasts aggravates inflammation, aortic wall stiffening, and osteopontin release in abdominal aortic aneurysm. Cardiovasc Res 2024; 120:417-432. [PMID: 37976180 DOI: 10.1093/cvr/cvad168] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/01/2023] [Accepted: 09/23/2023] [Indexed: 11/19/2023] Open
Abstract
AIMS Abdominal aortic aneurysm (AAA) is a highly lethal disease with progressive dilatation of the abdominal aorta accompanied by degradation and remodelling of the vessel wall due to chronic inflammation. Platelets play an important role in cardiovascular diseases, but their role in AAA is poorly understood. METHODS AND RESULTS The present study revealed that platelets play a crucial role in promoting AAA through modulation of inflammation and degradation of the extracellular matrix (ECM). They are responsible for the up-regulation of SPP1 (osteopontin, OPN) gene expression in macrophages and aortic tissue, which triggers inflammation and remodelling and also platelet adhesion and migration into the abdominal aortic wall and the intraluminal thrombus (ILT). Further, enhanced platelet activation and pro-coagulant activity result in elevated gene expression of various cytokines, Mmp9 and Col1a1 in macrophages and Il-6 and Mmp9 in fibroblasts. Enhanced platelet activation and pro-coagulant activity were also detected in AAA patients. Further, we detected platelets and OPN in the vessel wall and in the ILT of patients who underwent open repair of AAA. Platelet depletion in experimental murine AAA reduced inflammation and ECM remodelling, with reduced elastin fragmentation and aortic diameter expansion. Of note, OPN co-localized with platelets, suggesting a potential role of OPN for the recruitment of platelets into the ILT and the aortic wall. CONCLUSION In conclusion, our data strongly support the potential relevance of anti-platelet therapy to reduce AAA progression and rupture in AAA patients.
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Affiliation(s)
- Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Joscha Mulorz
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Kim J Krott
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Agnes Bosbach
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Tobias Feige
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Yae H Rhee
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Madhumita Chatterjee
- Department of Pharmacology, Experimental Therapy and Toxicology, University Hospital Tübingen, Wilhelmstrasse 5, 72074 Tübingen, Germany
| | - Niklas Petzold
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Christopher Böddeker
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Wiebke Ibing
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Irena Krüger
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Ana M Popovic
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Ann Roseman
- VA Palo Alto Health Care System, Palo Alto, 3801 Miranda Avenue, 94304 CA, USA
| | - Joshua M Spin
- VA Palo Alto Health Care System, Palo Alto, 3801 Miranda Avenue, 94304 CA, USA
- Department of Cardiovascular Medicine, Stanford University, 291 Campus Drive Stanford, 94305 CA, USA
| | - Philip S Tsao
- VA Palo Alto Health Care System, Palo Alto, 3801 Miranda Avenue, 94304 CA, USA
- Department of Cardiovascular Medicine, Stanford University, 291 Campus Drive Stanford, 94305 CA, USA
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Margitta Elvers
- Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany
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2
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Mourikis P, Zako S, Dannenberg L, M'Pembele R, Hohlfeld T, Zeus T, Kelm M, Veulemans V, Polzin A. Left ventricular-aortic angle is associated with platelet reactivity in patients with aortic stenosis. Blood Coagul Fibrinolysis 2022; 33:322-326. [PMID: 35867937 DOI: 10.1097/mbc.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The impact of aortic stenosis on platelet reactivity is unclear. Previous studies reported contradicting results. The reason for this is unknown. It is known that flow alterations enhance platelet reactivity. A steep left ventricular-aortic angle (LV-AO-angle) is associated with turbulent flow in the aorta ascendens. Therefore, in this study, we hypothesized that LV-AO-angle is associated with platelet reactivity in patients with severe aortic stenosis. We included 289 patients with severe aortic stenosis and performed cardiac computertomography to assess the LV-AO-angle. Platelet function was evaluated by light transmission aggregometry. Platelet reactivity was higher in patients with a steep LV-AO-angle (ADP: <160°: 66.99% ± 20.72% vs. ≥160°: 60.66% ± 19.85%, P = 0.009; collagen: <160°: 78.67% ± 13.19% vs. ≥160°: 73.85% ± 14.44%, P = 0.003). Using Spearman correlation, ADP and collagen-induced aggregation was associated with LV-AO-angle (ADP: r = -0.19, P = 0.0009, R2 = 0.022; collagen: r = -0.21, P = 0.0004, R2 = 0.027). Apart from platelet reactivity, body weight, history of myocardial infarction and other factors were associated with steep LV-AO-angle. However, multivariate cox-regression (including body weight, comorbidities, history of MI and cardiac surgery, kidney function and laboratory parameters) revealed that LV-AO angle was a robust predictor of ADP and collagen-induced platelet aggregation. Steep LV-AO-angle is associated with enhanced platelet reactivity in patients with aortic stenosis. This could be the reason of contradicting results regarding platelet function in patients with aortic stenosis in previous studies. In addition, enhanced platelet reactivity in steep LV-AO-angle aortic stenosis patients might be a promising target in pathogenesis of aortic stenosis.
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Affiliation(s)
- Philipp Mourikis
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Saif Zako
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Lisa Dannenberg
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Rene M'Pembele
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Thomas Hohlfeld
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Dusseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Verena Veulemans
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
| | - Amin Polzin
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf
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3
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Burban A, Idzik A, Gelo A, Filipiak KJ, Jakimowicz T, Jama K, Grabowski M, Gasecka A, Siniarski A. Platelet function changes in patients undergoing endovascular aortic aneurysm repair: Review of the literature. Front Cardiovasc Med 2022; 9:927995. [PMID: 36035918 PMCID: PMC9417250 DOI: 10.3389/fcvm.2022.927995] [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] [Received: 04/25/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with abdominal aortic aneurysm (AAA) have a higher risk of cardiovascular (CV) events, which seems to be associated with disturbed platelet (PLT) function. Endovascular aneurysm repair (EVAR) is an emerging, less-invasive treatment alternative to surgical AAA repair. Both platelet function abnormalities in patients with AAA and the effect of EVAR on platelet function are poorly understood. In this review, we aim to fill the gap regarding the effect of EVAR on PLT function in AAA patients by discussing PLT function disturbances in patients with AAA, PLT function changes after EVAR, evidence from clinical studies regarding PLT function before and after EVAR, and antiplatelet or and antithrombotic treatment in patients undergoing EVAR. The goal of our review is to summarize the contemporary knowledge and initiate further studies to better understand PLT function changes in patients undergoing EVAR, optimize the pharmacotherapy before and after EVAR and further improve outcomes in this group of patients.
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Affiliation(s)
- Anna Burban
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Idzik
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Gelo
- Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof J Filipiak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Tomasz Jakimowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Jama
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Gasecka
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Siniarski
- Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
- John Paul II Hospital, Cracow, Poland
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4
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Sun W, Zheng J, Gao Y. Targeting Platelet Activation in Abdominal Aortic Aneurysm: Current Knowledge and Perspectives. Biomolecules 2022; 12:biom12020206. [PMID: 35204706 PMCID: PMC8961578 DOI: 10.3390/biom12020206] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/28/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially fatal vascular disease that involves complex multifactorial hemodynamic, thrombotic, inflammatory, and aortic wall remodeling processes. However, its mechanisms are incompletely understood. It has become increasingly clear that platelets are involved in pathological processes of vascular diseases beyond their role in hemostasis and thrombosis. Platelet activation with membrane receptors and secreted mediators promotes thrombus formation and the accumulation of inflammatory cells, which may play an important role in the development of AAA by destroying the structural integrity and stability of the vessel wall. Turbulent blood flow in aortic aneurysms promotes platelet activation and aggregation. Platelet count and heterogeneity are important predictive, diagnostic, and prognostic indicators of AAA. We summarize the relationship between platelet activation and AAA development and propose future research directions and possible clinical applications.
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Affiliation(s)
- Weiliang Sun
- Institute of Clinical Medicine Sciences, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing 100029, China;
| | - Jingang Zheng
- Department of Cardiology, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing 100029, China;
| | - Yanxiang Gao
- Department of Cardiology, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Chaoyang District, Beijing 100029, China;
- Correspondence:
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5
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Stilo F, Catanese V, Nenna A, Montelione N, Codispoti FA, Verghi E, Gabellini T, Jawabra M, Chello M, Spinelli F. Biomarkers in EndoVascular Aneurysm Repair (EVAR) and Abdominal Aortic Aneurysm: Pathophysiology and Clinical Implications. Diagnostics (Basel) 2022; 12:diagnostics12010183. [PMID: 35054350 PMCID: PMC8774611 DOI: 10.3390/diagnostics12010183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Circulating biomarkers have been recently investigated among patients undergoing endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Considering the plethora of small descriptive studies reporting potential associations between biomarkers and clinical outcomes, this review aims to summarize the current literature considering both the treated disease (post EVAR) and the untreated disease (AAA before EVAR). All studies describing outcomes of tissue biomarkers in patients undergoing EVAR and in patients with AAA were included, and references were checked for additional sources. In the EVAR scenario, circulating interleukin-6 (IL-6) is a marker of inflammatory reaction which might predict postoperative morbidity; cystatin C is a promising early marker of post-procedural acute kidney injury; plasma matrix metalloproteinase-9 (MMP-9) concentration after 3 months from EVAR might help in detecting post-procedural endoleak. This review also summarizes the current gaps in knowledge and future direction of this field of research. Among markers used in patients with AAA, galectin and granzyme appear to be promising and should be carefully investigated even in the EVAR setting. Larger prospective trials are required to establish and evaluate prognostic models with highest values with these markers.
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Affiliation(s)
- Francesco Stilo
- Department of Vascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Vincenzo Catanese
- Department of Vascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy;
- Correspondence: or
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Nunzio Montelione
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Francesco Alberto Codispoti
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Emanuele Verghi
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Teresa Gabellini
- Residency Program of Vascular and Endovascular Surgery, University of Ferrara, 44121 Ferrara, Italy;
| | - Mohamad Jawabra
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Massimo Chello
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
| | - Francesco Spinelli
- Department of Cardiovascular Surgery, Campus Bio-Medico University, 00128 Rome, Italy; (A.N.); (N.M.); (F.A.C.); (E.V.); (M.J.); (M.C.); (F.S.)
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6
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Gąsecka A, Zawadka M, Burban A, Idzik A, Gelo A, Graczyńska A, Jama K, Filipiak KJ, Jakimowicz T. Pre-operative platelet reactivity is a strong, independent predictor of bleeding complications after branched endovascular thoracoabdominal aortic aneurysm repair. Platelets 2021; 33:577-585. [PMID: 34355639 DOI: 10.1080/09537104.2021.1961708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Endovascular aortic repair (EVAR) an alternative to open surgical repair of thoracoabdominal aortic aneurysm (TAAA). The effect of EVAR on platelet reactivity is unknown. We prospectively determined the effect of branched EVAR (bEVAR) on platelet reactivity in patients with TAAA, and evaluated the predictive value of preoperative platelet reactivity for post-operative bleeding in 50 consecutive patients undergoing elective bEVAR (mean age 70.9 ± 5.7 years, 66% male). Blood samples were collected within 24 hours before bEVAR, after bEVAR and at hospital discharge. Platelet reactivity was assessed with impedance aggregometry using ASPI, ADP and TRAP tests. Platelet reactivity decreased within 24 hours after bEVAR compared to the measurement before bEVAR in all tests (p ≤ 0.04), with a further decrease in hospital discharge in the ADP test (p = .004). Twenty-three patients experienced post-operative bleeding complications (transfusion ≥2 red blood cell [RBC] units). Preoperative platelet reactivity below the cutoff value of 30 AUC units predicted post-operative bleeding with 78% sensitivity and 59% specificity (p = .045). In the multivariable analysis, platelet reactivity was the only independent predictor of postoperative bleeding (OR 6.507, 95% CI 1.227-34.506, p = .028). We conclude that platelet reactivity decreases following bEVAR of TAAA and is a strong and independent predictor for postoperative bleeding complications.
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Affiliation(s)
- Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mateusz Zawadka
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland.,Department of Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK
| | - Anna Burban
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Idzik
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Gelo
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Agata Graczyńska
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Jama
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof J Filipiak
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Jakimowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
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7
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Sánchez-Infantes D, Nus M, Navas-Madroñal M, Fité J, Pérez B, Barros-Membrilla AJ, Soto B, Martínez-González J, Camacho M, Rodriguez C, Mallat Z, Galán M. Oxidative Stress and Inflammatory Markers in Abdominal Aortic Aneurysm. Antioxidants (Basel) 2021; 10:602. [PMID: 33919749 PMCID: PMC8070751 DOI: 10.3390/antiox10040602] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is increasing due to aging of the population and is a major cause of death among the elderly. Ultrasound screening programs are useful in early diagnosis, but aneurysm size is not always a good predictor of rupture. Our aim was to analyze the value of circulating molecules related to oxidative stress and inflammation as new biomarkers to assist the management of AAA. The markers were quantified by ELISA, and their expression in the aneurysmal wall was studied by real-time PCR and by immunostaining. Correlation analysis of the studied markers with aneurysm diameter and peak wall stress (PWS), obtained by finite element analysis, and multivariate regression analysis to assess potential confounding factors were performed. Our study shows an extensive inflammatory infiltration in the aneurysmal wall, mainly composed by T-cells, macrophages and B-cells and altered levels of reactive oxygen species (ROS), IgM, IgG, CD38, GDF15, S100A4 and CD36 in plasma and in the aneurysmal tissue of AAA patients compared with controls. Circulating levels of IgG, CD38 and GDF15 positively correlated with abdominal aortic diameter, and CD38 was correlated with PWS. Our data show that altered levels of IgG, CD38 and GDF15 have potential diagnostic value in the assessment of AAA.
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Affiliation(s)
- David Sánchez-Infantes
- Department of Basic Sciences of Health, Area of Biochemistry and Molecular Biology, University Rey Juan Carlos, 28922 Alcorcón, Spain;
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, 28029 Madrid, Spain
| | - Meritxell Nus
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (M.N.); (Z.M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
| | - Miquel Navas-Madroñal
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
| | - Joan Fité
- Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.F.); (B.S.)
| | - Belén Pérez
- Faculty of Medicine, Universidad Autónoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
| | - Antonio J. Barros-Membrilla
- Unidad Funcional de Patología de la Aorta (UPA), Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Begoña Soto
- Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.F.); (B.S.)
| | - José Martínez-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
- Instituto de Investigaciones Biomédicas de Barcelona-Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036 Barcelona, Spain
| | - Mercedes Camacho
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
| | - Cristina Rodriguez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
| | - Ziad Mallat
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (M.N.); (Z.M.)
| | - María Galán
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, 28029 Madrid, Spain; (J.M.-G.); (M.C.); (C.R.)
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Instituto de Investigación Biomédica Sant Pau (IB Sant Pau), 08025 Barcelona, Spain
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8
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Inoue K, Furuyama T, Kurose S, Yoshino S, Nakayama K, Yamashita S, Morisaki K, Mori M. Platelet Count Recovery after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm. Ann Vasc Dis 2021; 14:11-18. [PMID: 33786094 PMCID: PMC7991710 DOI: 10.3400/avd.oa.20-00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To find a new predictor of endoleak (EL) and aneurysm sac expansion after endovascular aneurysm repair (EVAR), we evaluated the platelet count recovery (PCR) process after EVAR. Materials and Methods: Two hundred five patients treated with elective EVAR from 2007 to 2015 were retrospectively analyzed. We compared the platelet count ratio until postoperative day (POD) 7 to the presurgical baseline between patients with and without persistent EL (≥ 6 months). Subsequently, we calculated the optimal platelet count ratio for distinguishing persistent EL using receiver-operating characteristics analysis. A platelet count ratio on POD7 ≥118% was defined as the PCR. We evaluated the PCR’s influence on the cumulative aneurysm sac expansion rate. Results: The average platelet count ratio on POD7 rose above baseline (112%), and the ratio was attenuated by persistent EL (103%). Of 205 patients, 126 (61%) were assigned to the disturbed PCR group (PCR(−) group). Cumulative aneurysm sac expansion rate was higher in the PCR(−) group than the PCR(+) group (34.4% vs. 12.8% in 5 years, p=0.01). Conclusion: Disturbed PCR after EVAR may be associated with ELs and eventual aneurysm sac expansion.
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Affiliation(s)
- Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.,Department of Vascular Surgery, Beppu Medical Center, Beppu, Oita, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Shun Kurose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Ken Nakayama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Sho Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
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9
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Inoue K, Furuyama T, Kurose S, Yoshino S, Nakayama K, Yamashita S, Morisaki K, Kume M, Matsumoto T, Mori M. Platelets reflect the fate of type II endoleak after endovascular aneurysm repair. J Vasc Surg 2020; 72:541-548.e1. [PMID: 31980245 DOI: 10.1016/j.jvs.2019.09.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/28/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The management of type II endoleak (T2E) remains controversial because of the heterogeneous outcome. For blood-based screening to detect malignant T2E, we focused on platelets after endovascular aneurysm repair (EVAR) and compared them with the prognosis of T2Es. METHODS From 2007 to 2015, there were 249 patients treated with EVAR for abdominal aortic aneurysm who were evaluated retrospectively. The mean follow-up period was 3.5 ± 0.2 years. T2Es that had aneurysm sac enlargement or converted to type I or type III endoleak were defined as malignant; the other T2Es were considered benign. Cases without any complications, including T2E, were defined as completed. We compared the platelet count on postoperative days (PODs) 1 to 7 with preoperative baseline values among the three groups. Sequentially, we calculated the cutoff of the platelet ratio on POD 7 to the baseline value in relation to malignant T2E using receiver operating characteristic analysis, and the cutoff ratio was 113% (sensitivity, 79%; specificity, 58%). We then reclassified T2E patients into T2E-high platelet (T2E-HP; ≥113%) or T2E-low platelet (T2E-LP; <113%) groups. The influence of platelets on T2E was evaluated with reintervention rate and cumulative aneurysm sac enlargement rate using the Kaplan-Meier method. RESULTS T2Es were found in 70 patients (28%), and 179 patients were assigned to the completed group. Malignant and benign T2Es were found in 33 and 37 patients, respectively. No difference was found in the preoperative baseline values. On POD 7, the platelet count in the malignant T2E group was significantly lower than that in the completed and benign T2E groups (168 × 103/μL vs 207 × 103/μL and 201 × 103/μL; P = .0124). Then, 27 and 43 patients were assigned to the T2E-HP and T2E-LP groups, respectively. The reintervention-free survival rate in the T2E-LP group was lower than that in the completed group (at 3 years, 66.4% ± 8.0% vs 71.9% ± 4.0%; P = .0031). Among T2E patients, the cumulative aneurysm sac enlargement rates in the T2E-LP group were significantly higher than those in the T2E-HP group (at 3 years, 34.6% ± 8.2% vs 20.6% ± 8.2%; P = .0105). Univariate Cox proportional hazards analysis for the cumulative aneurysm sac enlargement rates among T2E patients showed that sex, dual antiplatelet therapy, and lower platelet ratio (<113%) were significant predictors; multivariate analysis showed that T2E-LP was the only significant predictor (hazard ratio, 2.60; P = .0355). CONCLUSIONS The platelet count of patients with malignant T2Es on POD 7 was definitively lower than that of patients with completed EVAR or with benign T2Es. The lower platelet count on POD 7 could be a risk factor for aneurysm sac enlargement among patients with T2Es.
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Affiliation(s)
- Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Vascular Surgery, Beppu Medical Center, Beppu, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shun Kurose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Nakayama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masazumi Kume
- Department of Vascular Surgery, Beppu Medical Center, Beppu, Japan
| | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare, Chiba, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Cameron SJ, Russell HM, Owens AP. Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental? Blood 2018; 132:2619-2628. [PMID: 30228233 PMCID: PMC6302498 DOI: 10.1182/blood-2017-08-743237] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/10/2018] [Indexed: 12/13/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative vascular pathology resulting in significant morbidity and mortality in older adults due to rupture and sudden death. Despite 150 000 new cases and nearly 15 000 deaths annually, the only approved treatment of AAA is surgical or endovascular intervention when the risk for aortic rupture is increased. The goal of the scientific community is to develop novel pharmaceutical treatment strategies to reduce the need for surgical intervention. Because most clinically relevant AAAs contain a complex structure of fibrin, inflammatory cells, platelets, and red blood cells in the aneurysmal sac known as an intraluminal thrombus (ILT), antithrombotic therapies have emerged as potential pharmaceutical agents for the treatment of AAA progression. However, the efficacy of these treatments has not been shown, and the effects of shrinking the ILT may be as detrimental as they are beneficial. This review discusses the prospect of anticoagulant and antiplatelet (termed collectively as antithrombotic) therapies in AAA. Herein, we discuss the role of the coagulation cascade and platelet activation in human and animal models of AAA, the composition of ILT in AAA, a possible role of the ILT in aneurysm stabilization, and the implications of antithrombotic drugs in AAA treatment.
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Affiliation(s)
- Scott J Cameron
- Department of Medicine (Cardiology) and
- Department of Surgery (Cardiac Surgery), University of Rochester School of Medicine, Rochester, NY; and
| | - Hannah M Russell
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
| | - A Phillip Owens
- Division of Cardiovascular Health and Disease and
- Pathobiology and Molecular Medicine, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH
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Yang W, Wu K, Liu X, Jiao Y, Zhou C. Construction and characterization of an antibacterial/anticoagulant dual-functional surface based on poly l-lactic acid electrospun fibrous mats. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 92:726-736. [DOI: 10.1016/j.msec.2018.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 06/15/2018] [Accepted: 07/03/2018] [Indexed: 11/26/2022]
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12
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Kouvelos GN, Arnaoutoglou E, Giannoukas AD, Matsagkas M. Commentary: Postimplantation Syndrome: An Underrecognized EVAR Complication. J Endovasc Ther 2017; 24:675-676. [PMID: 28825328 DOI: 10.1177/1526602817727279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- George N Kouvelos
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Arnaoutoglou
- 2 Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Miltiadis Matsagkas
- 1 Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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