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Abell-Hart K, Hajagos J, Garcia V, Kaan J, Zhu W, Saltz M, Saltz J, Tassiopoulos A. Investigation of commonly used aortic aneurysm growth rate metrics: Comparing their suitability for clinical and research applications. PLoS One 2023; 18:e0289078. [PMID: 37566584 PMCID: PMC10420361 DOI: 10.1371/journal.pone.0289078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/11/2023] [Indexed: 08/13/2023] Open
Abstract
An aneurysm is a pathological widening of a blood vessel. Aneurysms of the aorta are often asymptomatic until they rupture, killing approximately 10,000 Americans per year. Fortunately, rupture can be prevented through early detection and surgical repair. However, surgical risk outweighs rupture risk for small aortic aneurysms, necessitating a policy of surveillance. Understanding the growth rate of aneurysms is essential for determining appropriate surveillance windows. Further, identifying risk factors for fast growth can help identify potential interventions. However, studies in the literature have applied many different methods for defining the growth rate of abdominal aortic aneurysms. It is unclear which of these methods is most accurate and clinically meaningful, and whether these heterogeneous methodologies may have contributed to the varied results reported in the literature. To help future researchers best plan their studies and to help clinicians interpret existing studies, we compared five different models of aneurysmal growth rate. We examined their noise tolerance, temporal bias, predictive accuracy, and statistical power to detect risk factors. We found that hierarchical mixed effects models were more noise tolerant than traditional, unpooled models. We also found that linear models were sensitive to temporal bias, assigning lower growth rates to aneurysms that were detected earlier in their course. Our exponential mixed model was noise-tolerant, resistant to temporal bias, and detected the greatest number of clinical risk factors. We conclude that exponential mixed models may be optimal for large studies. Because our results suggest that choice of method can materially impact a study's findings, we recommend that future studies clearly state the method used and demonstrate its appropriateness.
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Affiliation(s)
- Kayley Abell-Hart
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States of America
| | - Janos Hajagos
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States of America
| | - Victor Garcia
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States of America
| | - James Kaan
- Department of Vascular Surgery, Stony Brook University Hospital, Stony Brook, NY, United States of America
| | - Wei Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, United States of America
| | - Mary Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States of America
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States of America
| | - Apostolos Tassiopoulos
- Department of Vascular Surgery, Stony Brook University Hospital, Stony Brook, NY, United States of America
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Abdominal Aortic Aneurysm Formation with a Focus on Vascular Smooth Muscle Cells. Life (Basel) 2022; 12:life12020191. [PMID: 35207478 PMCID: PMC8880357 DOI: 10.3390/life12020191] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/29/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a lethal degenerative vascular disease that affects, mostly, the elder population, with a high mortality rate (>80%) upon rupture. It features a dilation of the aortic diameter to larger than 30 mm or more than 50%. Diverse pathological processes are involved in the development of AAA, including aortic wall inflammation, elastin breakdown, oxidative stress, smooth muscle cell (SMC) phenotypic switching and dysfunction, and extracellular matrix degradation. With open surgery being the only therapeutic option up to date, the lack of pharmaceutical treatment approach calls for identifying novel and effective targets and further understanding the pathological process of AAA. Both lifestyle and genetic predisposition have an important role in increasing the risk of AAA. Several cell types are closely related to the pathogenesis of AAA. Among them, vascular SMCs (VSMCs) are gaining much attention as a critical contributor for AAA initiation and/or progression. In this review, we summarize what is known about AAA, including the risk factors, the pathophysiology, and the established animal models of AAA. In particular, we focus on the VSMC phenotypic switching and dysfunction in AAA formation. Further understanding the regulation of VSMC phenotypic changes may provide novel therapeutic targets for the treatment or prevention of AAA.
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Do HN, Ijaz A, Gharahi H, Zambrano B, Choi J, Lee W, Baek S. Prediction of Abdominal Aortic Aneurysm Growth Using Dynamical Gaussian Process Implicit Surface. IEEE Trans Biomed Eng 2018; 66:609-622. [PMID: 29993480 DOI: 10.1109/tbme.2018.2852306] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We propose a novel approach to predict the Abdominal Aortic Aneurysm (AAA) growth in future time, using longitudinal computer tomography (CT) scans of AAAs that are captured at different times in a patient-specific way. METHODS We adopt a formulation that considers a surface of the AAA as a manifold embedded in a scalar field over the three dimensional (3D) space. For this formulation, we develop our Dynamical Gaussian Process Implicit Surface (DGPIS) model based on observed surfaces of 3D AAAs as visible variables while the scalar fields are hidden. In particular, we use Gaussian process regression to construct the field as an observation model from CT training image data. We then learn a dynamic model to represent the evolution of the field. Finally, we derive the predicted AAA surface from the predicted field along with uncertainty quantified in future time. RESULTS A dataset of 7 subjects (4-7 scans) was collected and used to evaluate the proposed method by comparing its prediction Hausdorff distance errors against those of simple extrapolation. In addition, we evaluate the prediction results with respect to a conventional shape analysis technique such as Principal Component Analysis (PCA). All comparative results show the superior prediction performance of the proposed approach. CONCLUSION We introduce a novel approach to predict the AAA growth and its predicted uncertainty in future time, using longitudinal CT scans in a patient-specific fashion. SIGNIFICANCE The capability to predict the AAA shape and its confidence region by our approach establish the potential for guiding clinicians with informed decision in conducting medical treatment and monitoring of AAAs.
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Fiotti N, Calvagna C, Sgorlon G, Altamura N, Pitacco P, Zamolo F, Di Girolamo FG, Chiarandini S, Biolo G, Adovasio R. Multiple sites of vascular dilation or aneurysmal disease and matrix metalloproteinase genetic variants in patients with abdominal aortic aneurysm. J Vasc Surg 2017; 67:1727-1735. [PMID: 29291905 DOI: 10.1016/j.jvs.2017.09.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/25/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to assess whether functional genetic polymorphisms of matrix metalloproteinases (MMPs) 1, 3, 9, and 12 are associated with arterial enlargements or aneurysms of the thoracic aorta or popliteal arteries in patients with abdominal aortic aneurysm (AAA). METHODS The associations between MMP1 (-1607 G in/del, rs1799750), MMP3 (-1171 A in/del rs35068180), MMP9 (13-26 CA repeats around -90, rs2234681, rs917576, rs917577), and MMP12 (G/T missense variation, rs652438) polymorphisms and enlargements or aneurysms of the thoracic aorta and popliteal arteries were tested in 169 consecutive AAA patients. RESULTS Thoracic aorta enlargement or aneurysm (TE/A; maximum diameter, >35 mm) was detected in 34 patients (20.1% prevalence). MMP9 rs2234681 microsatellite was the only genetic determinant of TE/A in AAA patients (P = .003), followed by hypercholesterolemia and antiplatelet use. Carriers of both alleles with ≥22 CA repeats had a 5.9 (95% confidence interval, 1.9-18.6; P < .0001) increased odds of TE/A, and a score considering all three variables showed 98% negative predictive value and 30% positive predictive value for thoracic aortic aneurysm detection. Eighty-two popliteal artery enlargements or aneurysms (diameter >10 mm) occurred in 55 patients (33.1% prevalence). Carriers of MMP12 rs652438 C allele showed an 18% (P = .006) increased diameter in popliteal arteries and a 2.8 (95% confidence interval, 1.3-6; P = .008) increased odds of popliteal artery enlargement or aneurysm compared with TT genotype. CONCLUSIONS Among patients with AAA, carriers of homozygous ≥22 CA repeats in MMP9 rs12234681 and of C allele in MMP12 rs652438 have a substantial risk of carrying thoracic and popliteal enlargements, respectively.
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MESH Headings
- Aged
- Aged, 80 and over
- Alleles
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/enzymology
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/enzymology
- Aortic Aneurysm, Thoracic/genetics
- Computed Tomography Angiography
- DNA/genetics
- Dilatation, Pathologic/diagnosis
- Dilatation, Pathologic/enzymology
- Dilatation, Pathologic/genetics
- Female
- Genetic Predisposition to Disease
- Genetic Variation
- Genotype
- Humans
- Male
- Matrix Metalloproteinases/genetics
- Matrix Metalloproteinases/metabolism
- Polymorphism, Genetic
- Popliteal Artery
- Risk Factors
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Affiliation(s)
- Nicola Fiotti
- Unit of Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Cristiano Calvagna
- Unit of Vascular Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giada Sgorlon
- Unit of Vascular Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicola Altamura
- Unit of Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paola Pitacco
- Unit of Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Zamolo
- Unit of Vascular Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Filippo Giorgio Di Girolamo
- Unit of Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefano Chiarandini
- Unit of Vascular Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianni Biolo
- Unit of Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberto Adovasio
- Unit of Vascular Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Li T, Lv Z, Jing JJ, Yang J, Yuan Y. Matrix metalloproteinase family polymorphisms and the risk of aortic aneurysmal diseases: A systematic review and meta-analysis. Clin Genet 2017; 93:15-32. [PMID: 28485889 DOI: 10.1111/cge.13050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 01/04/2023]
Abstract
It has been suggested that matrix metalloproteinase (MMP) polymorphisms are associated with the pathogenesis of aortic aneurysmal diseases. In this study, we conducted a systematic review with an update meta-analysis to investigate the relationship between MMP family polymorphisms and aortic aneurysmal diseases. We systematically reviewed 24 polymorphisms in 8 MMP genes related to the risk of abdominal aortic aneurysm (AAA), thoracic AA or thoracic aortic dissection (TAD). A total of 19 case-control studies with 15 highly studied MMP polymorphisms were included in our meta-analysis. Our results suggested that MMP2rs243865, MMP3rs3025058, MMP13rs2252070 polymorphisms were significantly associated with AAA risk, MMP2rs11643630, MMP8rs11225395 polymorphisms were correlated with TAD risk, and MMP9rs3918242 under the dominant model could increase AAA risk in hospital-based subgroup. No associations with aortic aneurysmal diseases were identified for other polymorphisms assessed in our meta-analysis. In summary, some studied MMP polymorphisms associated with the risk of aortic aneurysmal diseases are potential predictive biomarkers for the clinical application. Moreover, other MMP polymorphisms with limited studies but relevant to aortic aneurysmal formation and progression need further prospective and large investigations to confirm results.
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Affiliation(s)
- T Li
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Affiliated Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, Shenyang, China.,Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Z Lv
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Affiliated Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, Shenyang, China
| | - J-J Jing
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Affiliated Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, Shenyang, China
| | - J Yang
- Department of Cardiovascular Ultrasound, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Y Yuan
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, the First Affiliated Hospital of China Medical University, and Key Laboratory of Cancer Etiology and Prevention (China Medical University), Liaoning Provincial Education Department, Shenyang, China
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Saratzis A, Bown MJ, Wild B, Nightingale P, Smith J, Johnson C, Melas N, Kitas GD. Association between seven single nucleotide polymorphisms involved in inflammation and proteolysis and abdominal aortic aneurysm. J Vasc Surg 2015; 61:1120-8.e1. [DOI: 10.1016/j.jvs.2013.11.099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/20/2013] [Accepted: 11/24/2013] [Indexed: 11/16/2022]
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The study of t-PA, u-PA and PAI-1 genes polymorphisms in patients with abdominal aortic aneurysm. Mol Biol Rep 2014; 41:2859-64. [PMID: 24452721 PMCID: PMC4013441 DOI: 10.1007/s11033-014-3141-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/11/2014] [Indexed: 01/25/2023]
Abstract
The most important feature of abdominal aortic aneurysm (AAA) pathogenesis is an enzymatic degradation of elastic lamellae and extracellular matrix proteins particularly with participation of matrix metalloproteinases. Plasmin, which is responsible for the dissolution of fibrin in blood vessels, plays also a key role in the cascade for activation of the metalloproteinases. The purpose of this study was to evaluate the influence of selected polymorphisms in genes coding for tissue plasminogen activator (−7351 C/T polymorphism), urokinase-type plasminogen activator (1788 C/T polymorphism) and plasminogen activator inhibitor 1 (−675 4G/5G and −844 G/A polymorphism) on the susceptibility to AAA. We performed a case–control study of 153 polish patients hospitalized due to AAA and compared them with matched healthy control subjects. The polymorphisms were ascertained through genotyping by polymerase chain reaction and restriction digestion of amplified fragments or through high-resolution melting analysis. In this study we have found lower frequency of wild-type GG genotype of the −844G/A PAI-1 polymorphism in cases than in controls, what may suggest the protective effect of this genotype for the risk of AAA development. None of the remaining polymorphisms tested were associated with AAA occurrence.
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Morris DR, Biros E, Cronin O, Kuivaniemi H, Golledge J. The association of genetic variants of matrix metalloproteinases with abdominal aortic aneurysm: a systematic review and meta-analysis. Heart 2013; 100:295-302. [DOI: 10.1136/heartjnl-2013-304129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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9
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DiMusto PD, Lu G, Ghosh A, Roelofs KJ, Su G, Zhao Y, Lau CL, Sadiq O, McEvoy B, Laser A, Diaz JA, Wakefield TW, Henke PK, Eliason JL, Upchurch GR. Increased PAI-1 in females compared with males is protective for abdominal aortic aneurysm formation in a rodent model. Am J Physiol Heart Circ Physiol 2012; 302:H1378-86. [PMID: 22307671 DOI: 10.1152/ajpheart.00620.2011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The serine proteases, along with their inhibitor plasmin activator inhibitor-1 (PAI-1), have been shown to play a role in abdominal aortic aneurysm (AAA) formation. The aim of this study is to determine if PAI-1 may be a protective factor for AAA formation and partially responsible for the gender difference observed in AAAs. Male and female wild-type (WT) C57BL/6 and PAI-1(-/-) mice 8-12 wk of age underwent aortic perfusion with porcine pancreatic elastase. Animals were harvested 14 days following perfusion and analyzed for phenotype, PAI-1 protein levels, and matrix metalloproteinase (MMP)-9 and -2 activity. WT males had an average increase in aortic diameter of 80%, whereas females only increased 32% (P < 0.001). PAI-1(-/-) males increased 204% and females 161%, significantly more than their WT counterparts (P < 0.001). Western blot revealed 61% higher PAI-1 protein levels in the WT females compared with the WT males (P = 0.01). Zymography revealed higher levels of pro-MMP-2 and active MMP-2 in the PAI-1(-/-) males and females compared with their WT counterparts. PAI-1(-/-) females had significantly higher serum plasmin levels compared with WT females (P = 0.003). In conclusion, WT female mice are protected from aneurysm formation and have higher levels of PAI-1 compared with males during experimental aneurysm formation. Additionally, both male and female PAI-1(-/-) animals develop significantly larger aneurysms than WT animals, correlating with higher pro- and active MMP-2 levels. These findings suggest that PAI-1 is protective for aneurysm formation in the elastase model of AAA and plays a role in the gender differences seen in AAA formation.
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Affiliation(s)
- Paul D DiMusto
- Jobst Vascular Research Laboratory, Department of Surgery, University of Michigan, Ann Arbor, USA
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Saracini C, Bolli P, Sticchi E, Pratesi G, Pulli R, Sofi F, Pratesi C, Gensini GF, Abbate R, Giusti B. Polymorphisms of genes involved in extracellular matrix remodeling and abdominal aortic aneurysm. J Vasc Surg 2011; 55:171-179.e2. [PMID: 22094117 DOI: 10.1016/j.jvs.2011.07.051] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 07/06/2011] [Accepted: 07/08/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) has a multifactorial etiology and the relevance of genetic factors is getting increasing interest, in particular those related to the destructive remodeling of extracellular matrix. METHODS We performed a candidate gene association study of polymorphisms in genes coding matrix metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs), and elastin (ELN) in AAA. DNA samples from 423 AAA patients and 423 controls were genotyped for 12 polymorphisms in 10 genes: MMP1 (-1607G/GG), MMP2 (-735C/T; -1306C/T; -1575 G/A), MMP3 (5A/6A), MMP9 (-1562C/T), MMP10 (A180G), MMP-12 (-82A/G), MMP-13 (-77A/G), TIMP1 (C434T), TIMP3 (-1296T/C), and ELN (G1355A). RESULTS Genotype distribution was significantly different between patients and controls for the following polymorphisms: -1306C/T MMP2; 5A/6A MMP3; -77A/G MMP-13; G1355A ELN; and C434T TIMP1. In a multivariable logistic regression analysis adjusted for traditional cardiovascular risk factors and chronic obstructive pulmonary disease, -1306C/T MMP2 (odds ratios [OR] = 0.55 [95% confidence interval, CI .34-.85], P < .007) and G1355A ELN (OR = 0.64 ([95% CI .41-.99], P = .046) polymorphisms resulted in independent protective factors for abdominal aortic aneurysm (AAA), whereas 5A/6A MMP3 (OR = 1.82 [95% CI 1.04-3.12], P = .034) and -77 A/G MMP-13 (OR = 2.14 [95% CI 1.18-3.86], P = .012) polymorphisms resulted in independent risk factors for AAA. In a multivariable logistic regression analysis adjusted for traditional cardiovascular factors and chronic obstructive pulmonary disease, the prevalence of the contemporary presence of three or four genetic risk conditions was a strong and independent determinant of AAA disease (OR = 2.96, 95% CI 1.67-5.24, P < .0001). For those polymorphisms independently associated with AAA in this study (-1306C/T MMP2, 5A/6A MMP3, -77A/G MMP-13, and G1355A ELN polymorphisms), we performed a meta-analysis of the available data (this paper and literature data). We found a significant association with an increased risk of AAA for MMP3 (AAA patients n = 1258, controls n = 1406: OR = 1.48 [95% CI = 1.23-1.78], I(2) = 0%) and MMP-13 (AAA patients n = 800, controls n = 843: OR = 1.37 [95% CI = 1.04-1.82], I(2) = 25%) polymorphisms and a trend that did not reach the statistical significance, toward a decreased risk of AAA for MMP2 (AAA patients n = 1090, controls n = 1077: OR = 0.83 [95% CI = .60-1.15], I(2) =7 1%) and ELN (AAA patients n = 904, controls n = 1069: OR = 0.79 [95% CI = .53-1.18], I(2) = 72%) polymorphisms. CONCLUSIONS These findings suggest that polymorphisms in MMP2, MMP3, MMP-13, and ELN genes may independently contribute to the pathogenesis of AAA.
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Affiliation(s)
- Claudia Saracini
- Department of Medical and Surgical Critical Care, University of Florence, Atherothrombotic Diseases Center, Florence, Italy
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11
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Abstract
Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since the first candidate gene studies were published 20 years ago, approximately 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. These studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, only when appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called contactin-3, which is located on chromosome 3p12.3. However, two follow-up studies could not replicate this association. Two other SNPs, which are located on chromosome 9p21 and 9q33, were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense ribonucleic acid that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute toward AAA pathogenesis.
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12
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Arapoglou V, Kondi-Pafiti A, Rizos D, Carvounis E, Frangou-Plemenou M, Kotsis T, Katsenis K. The Influence of Diabetes on Degree of Abdominal Aortic Aneurysm Tissue Inflammation. Vasc Endovascular Surg 2010; 44:454-9. [DOI: 10.1177/1538574410363748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abdominal aortic aneurysm (AAA) progression and disease resistance are related to transmural degenerative processes and an inflammatory infiltration (INF). Diabetes is associated with low prevalence and growth rate of AAA. We sought to characterize INF in established AAA (INFAAA), in diabetic patients. From 89 male patients aged 52 to 83 years, aneurysm specimens obtained at open asymptomatic nonruptured AAA repair were graded for INF and immunostained using antibodies against T-lymphocytes (CD3) and macrophages (CD68). Diabetic patients had an odds ratio (OR) 3.8, 95% confidence interval ([CI] 1.14-12.96), P = .03, of experiencing above-median INFAAA. These associations were affected by serum glucose (SG) levels (OR 3.6, 95% CI [0.72-18.77]; P = .1). Macrophage subpopulations higher in diabetic patients (1.44 ± 0.78 versus 0.98 ± 0.76; P = .02) were correlated with SG (r = .21, P = .044). Abdominal aortic aneurysms in diabetic patients are associated with higher INF. Macrophage densities are correlated with SG.
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Affiliation(s)
- Vassilis Arapoglou
- Vascular Surgical Unit, 2nd Surgical Department, Aretaeion Hospital, Medical School, University of Athens, Greece,
| | - Agathi Kondi-Pafiti
- Pathology Laboratory, Areteion Hospital, Medical School, University of Athens, Greece
| | - Demetrios Rizos
- Hormone Laboratory, Areteion Hospital, Medical School, University of Athens, Greece
| | - Eleni Carvounis
- Pathology Laboratory, Areteion Hospital, Medical School, University of Athens, Greece
| | | | - Thomas Kotsis
- Vascular Surgical Unit, 2nd Surgical Department, Aretaeion Hospital, Medical School, University of Athens, Greece
| | - Konstantinos Katsenis
- Vascular Surgical Unit, 2nd Surgical Department, Aretaeion Hospital, Medical School, University of Athens, Greece
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Saratzis A, Abbas AA, Kiskinis D, Melas N, Saratzis N, Kitas GD. Abdominal aortic aneurysm: a review of the genetic basis. Angiology 2010; 62:18-32. [PMID: 20566578 DOI: 10.1177/0003319710373092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a complex disease with a largely unknown pathophysiological background and a strong genetic component. Various studies have tried to link specific genetic variants with AAA. METHODS Systematic review of the literature (1947-2009). RESULTS A total of 249 studies were identified, 89 of which were eventually deemed relevant to this review. Genetic variants (polymorphisms) in a wide variety of genes, most of which encode proteolytic enzymes and inflammatory molecules, have been associated with AAA development and progression. CONCLUSION The genetic basis of AAA remains unknown, and most results from ''candidate-gene'' association studies are contradictory. Further analyses in appropriately powered studies in large, phenotypically well-characterized populations, including genome-wide association studies, are necessary to elucidate the exact genetic contribution to the pathophysiology of AAA.
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Affiliation(s)
- Athanasios Saratzis
- Russell's Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, West Midlands, UK.
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14
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Smallwood L, Warrington N, Allcock R, van Bockxmeer F, Palmer L, Iacopetta B, Golledge J, Norman P. Matrix Metalloproteinase-2 Gene Variants and Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2009; 38:169-71. [DOI: 10.1016/j.ejvs.2009.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 04/24/2009] [Indexed: 11/25/2022]
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15
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Woodrum DT, Ford JW, Cho BS, Hannawa KK, Stanley JC, Henke PK, Upchurch GR. Differential effect of 17-beta-estradiol on smooth muscle cell and aortic explant MMP2. J Surg Res 2009; 155:48-53. [PMID: 19041098 PMCID: PMC2913053 DOI: 10.1016/j.jss.2008.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 06/21/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The present investigation tested the hypothesis that intrinsic gender-related differences exist in rat aortic smooth muscle cell matrix metalloproteinase 2 (MMP2). METHODS This investigation comprised 3 sets of experiments. Experiment I: Adult male and female rat aortic smooth muscle cells (RASMCs) at passages 4-8 were stimulated in serum-free media for 48 h with interleukin(IL)1beta at doses encountered in human abdominal aortic aneurysms (2 ng/mL). Messenger RNA was extracted from the RASMCs, and gene expression of MMP2 and tissue inhibitor of metalloproteinase 2 (TIMP2), a major MMP2 inhibitor, was measured by real-time polymerase chain reaction. MMP2 protein levels in conditioned media were measured by Western blotting, and MMP2 and TIMP2 activity quantified by standard and reverse gelatin zymography. Experiment II: Male and female RASMCs were incubated for 48 h in Dulbecco's modified Eagler's medium containing IL-1beta and 17-beta-estradiol at doses from 1x10(-10) to 1x10(-6) molar. MMP2 activity in the conditioned media was then determined. Experiment III: Male rats underwent sustained 17-beta-estradiol exposure for 21 d using extended-release, subcutaneously implanted pellets prior to sacrifice and aortic explantation. Aortas from males, females, and estradiol-treated males were stimulated with IL-1beta for 48-h, and MMP2 activity in the conditioned media was determined. RESULTS Experiment I: MMP2 gene expression was 3-fold higher in male compared with female IL-1beta stimulated RASMCs (P<0.0001). MMP2:TIMP2 gene expression ratio was 7.5-fold greater in male versus female RASMCs. MMP2 protein levels were 3-fold higher (2.68 versus 0.96 o.d./mg total protein, P=0.003) in male versus female RASMCs. Gelatinolytic activity was more than 6-fold higher (15,010 versus 2,472 o.d./mg total protein, P=0.002) in male versus female RASMCs. Experiment II: MMP2 activity in male and female RASMCs was not altered by a wide range of 17-beta-estradiol concentrations. Experiment III: When pretreated with 17-beta-estradiol, MMP2 activity in the media of male rat whole-aortic explants decreased 2-fold (P=0.002). This post-17-beta-estradiol treatment male level was not different than baseline female aortic explant MMP2 levels. CONCLUSIONS MMP2 is higher in male RASMCs compared to female RASMCs. Exogenous 17-beta-estradiol did not alter MMP2 activity in vitro, but in vivo 17-beta-estradiol exposure greatly decreased male aortic MMP2 production to levels seen in the female aorta. Gender differences in MMP2 are speculated to be associated with phenotypic differences in human abdominal aortic aneurysm formation.
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Affiliation(s)
- Derek T Woodrum
- Department of Surgery, Section of Vascular Surgery, Jobst Vascular Research Laboratories, University of Michigan, Ann Arbor, Michigan 48109-0329, USA
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Smallwood L, Allcock R, van Bockxmeer F, Warrington N, Palmer LJ, Iacopetta B, Golledge J, Norman PE. Polymorphisms of the matrix metalloproteinase 9 gene and abdominal aortic aneurysm. Br J Surg 2008; 95:1239-44. [PMID: 18763261 DOI: 10.1002/bjs.6345] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Increased matrix metalloproteinase (MMP) 9 activity has been implicated in the formation of abdominal aortic aneurysm (AAA). The aim was to explore the association between potentially functional variants of the MMP-9 gene and AAA. METHODS The -1562C > T and -1811A > T variants of the MMP-9 gene were genotyped in 678 men with an AAA (at least 30 mm in diameter) and 659 control subjects (aortic diameter 19-22 mm) recruited from a population-based trial of screening for AAA. Levels of MMP-9 were measured in a random subset of 300 cases and 84 controls. The association between genetic variants (including haplotypes) and AAA was assessed by multivariable logistic regression. RESULTS There was no association between the MMP-9-1562C > T (odds ratio (OR) 0.70 (95 per cent confidence interval (c.i.) 0.27 to 1.82)) or -1811A > T (OR 0.71 (95 per cent c.i. 0.28 to 1.85)) genotypes, or the most common haplotype (OR 0.81 (95 per cent c.i. 0.62 to 1.05)) and AAA. The serum MMP-9 concentration was higher in cases than controls, and in minor allele carriers in cases and controls, although the differences were not statistically significant. CONCLUSION In this study, the genetic tendency to higher levels of circulating MMP-9 was not associated with AAA.
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Affiliation(s)
- L Smallwood
- Schools of Surgery, University of Western Australia, Fremantle, Western Australia
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Thompson A, Drenos F, Hafez H, Humphries S. Candidate Gene Association Studies in Abdominal Aortic Aneurysm Disease: A Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2008; 35:19-30. [DOI: 10.1016/j.ejvs.2007.07.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 07/04/2007] [Indexed: 10/22/2022]
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Sandford RM, Bown MJ, London NJ, Sayers RD. The Genetic Basis of Abdominal Aortic Aneurysms: A Review. Eur J Vasc Endovasc Surg 2007; 33:381-90. [PMID: 17276705 DOI: 10.1016/j.ejvs.2006.10.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 10/25/2006] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The pathogenesis of abdominal aortic aneurysm (AAA) remains poorly understood, however significant evidence has emerged in recent years to suggest a chronic inflammatory process. Observational studies have highlighted a familial trend towards AAA development among relatives of affected individuals and it is thought that inflammatory genes may influence an individual's susceptibility. Conflicting reports exist over single gene versus multiple gene inheritance patterns in addition to a collection of studies examining individual inflammatory genes. This paper reviews the evidence for a genetic predisposition to aneurysm formation including familial and segregation studies in addition to experimental evidence investigating specific candidate genes. METHOD Medline and Pubmed database searches were conducted using the search terms abdominal aortic aneurysm and gene. Papers were reviewed and references manually searched for further relevant publications which were added to the data. Papers were categorised under the headings familial, segregation and candidate gene studies. RESULTS A review of 58 papers is presented under sub-headings as above. In the case of the candidate gene section, a brief report of the functional relevance of each gene is included. CONCLUSION A summary of the evidence presented is given and the direction of future work in this field is briefly considered.
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Affiliation(s)
- R M Sandford
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
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Abstract
The aim of the study was to investigate the effect of functional polymorphisms in promoters of the MMP-2 (-1306 C > T), MMP-3 (-1171 5A > 6A), MMP-9 (-1562 C > T), MMP-12 (-82 A > G), TIMP-1 (-372 C > T), and PAI-1 (-675 4G > 5G and -847 A > G) genes on the growth rate of small abdominal aortic aneurysms. The patients with small aneurysms were recruited from the surveillance arm of the U.K. Small Aneurysm Trial and monitored for aneurysm growth, mean follow-up 2.6 years. Mean linear aneurysm growth rates were calculated by flexible modeling. For MMP-2, MMP-3, MMP-9, MMP-12, and TIMP-1 polymorphisms there were no clear associations with aneurysm growth. The increased growth rates for patients of 5G5G PAI-1 genotype were of borderline significance (P = 0.06). However, PAI-1 haplotype analysis showed that 5G5G/GG patients had significantly faster aneurysm growth (mean 0.46 mm/year faster). There was no evidence that any specific MMP polymorphism had a clinically significant effect on aneurysm growth. However the plasminogen system (via PAI-1) appears to have a small, but clinically significant, role in aneurysm growth.
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Affiliation(s)
- J T Powell
- Imperial College, Charing Cross Campus, St. Dunstan's Rd., London W6 8RP, UK.
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Norman PE, Davis TME, Le MTQ, Golledge J. Matrix biology of abdominal aortic aneurysms in diabetes: mechanisms underlying the negative association. Connect Tissue Res 2007; 48:125-31. [PMID: 17522995 DOI: 10.1080/03008200701331524] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Several case-control studies have shown a significant negative association between diabetes and abdominal aortic aneurysm (AAA). This interaction has the potential to further our understanding of these two diseases but has attracted little research. The changes seen in the walls of aneurysmal aortas include inflammation and the activation of proteolytic pathways resulting in loss of elastin and other structural proteins. In contrast, diabetes is associated with increased synthesis and reduced degradation of matrix. The deposition of advanced glycation end products also renders vascular matrix resistant to proteolysis in diabetic patients. The aim of our present minireview is to compare the changes in matrix biology seen in diabetes and AAA and to explore molecular mechanisms that may explain the negative association and identify possible therapeutic implications.
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Affiliation(s)
- Paul E Norman
- School of Surgery and Pathology, University of Western Australia, Fremantle, Western Australia.
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Abstract
BACKGROUND Changes in the proteoglycan metabolism of the intima of arteries belong to the initial lesions of atherosclerosis (AS). The accumulation of proteoglycans, alterations of pericellular glycoproteins and modulations of collagen turnover also play a fundamental role in the progression of AS. They influence lipid retention, cell behavior and calcinosis. The decisive role played by the matrix metalloproteinases (MMPs) and their inhibiting factors (tissue inhibitors of metalloproteinases [TIMPs]) in these processes is not yet fully understood and therefore the subject of this overview. The causes of the abrupt change of a long-term existing stabile AS to a vulnerable plaque as well as the participation of age-related vascular wall remodeling in the progression of AS also remain open questions. DISCUSSION Apart from the well-known risk factors for AS, less well-known influences like the disturbances of gene expression in vascular smooth muscle cells affect an MMP/TIMP imbalance. The various consequences of this imbalance range from intima cell proliferation as an early change in AS as well as accelerated progression to the destabilization of fibrous plaques by increased collagenolysis as well as the formation of aneurysms. Infectious or toxic influences may trigger these mechanisms; an involvement of age-related vessel wall changes should also be considered. The prognostic significance of circulating MMP concentrations for the existence of instabile plaques are of great interest, as is the plaque stabilizing effect of statins by suppression of MMPs. CONCLUSIONS MMPs navigate the behavior of vascular wall cells in different AS stages, in adaptive remodeling, in normal aging and in non-atherosclerotic vessel disease. The clinical relevance of a disturbance in the MMP/TIMP balance is demonstrated firstly by the initiation of AS due to migration and proliferation of intima cells and secondly in the collagenolysis, necrotic transformation and apoptosis of existing fibrous lesions resulting in instabile rupture proned plaques. Investigations into the genetic typing of MMPs and the results of experimental gene deficiency models have significantly contributed to the clarification of these facts.
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