1
|
Huhta A, Paavonen T, Mennander A, Kholová I. Interplay of atherosclerosis and medial degeneration in human ascending aorta. Cardiovasc Pathol 2025; 74:107702. [PMID: 39389219 DOI: 10.1016/j.carpath.2024.107702] [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: 02/24/2024] [Revised: 09/18/2024] [Accepted: 10/08/2024] [Indexed: 10/12/2024] Open
Abstract
The previous understanding has been that atherosclerosis tends to increase distally from the ascending aorta, but recent studies and practical experience have indicated that atherosclerosis occurs in the ascending aorta more than previously thought. Medial degeneration is linked to aortic aneurysms, dissection and dilatation and has been related to increased mortality. There is a lack of data on the coexistence of atherosclerosis and medial degeneration in the ascending aorta and its outcome to clinical morbidity and mortality. Earlier studies have shown coexisting atherosclerosis and medial degeneration as significant risk indicators for coronary and cerebrovascular events. We aimed to analyze aortic specimens classified according to the consensus documents of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology particularly the comparison of variable morphological features with the atherosclerotic grade to gain more data about the coexistence of atherosclerosis and medial degeneration. We evaluated 217 specimens of human ascending aorta resected at Tampere University Heart Hospital because of aortic aneurysm, dissection or dilatation. None of the samples contained normal aortic morphology; atherosclerosis was found in a total of 75.8 % of the samples and medial degeneration in all the samples. The present study is mostly in agreement with earlier research regarding the prevalence of different histological findings, even though a higher prevalence of atherosclerosis was found compared with most studies. There was no statistically significant association between atherosclerosis and medial degeneration, but a higher atherosclerotic grade was significantly associated with the presence of smooth muscle cell nuclei loss, smooth muscle cell disorganisation, elastic fibre thinning and medial fibrosis. Our study reinforces the perception that atherosclerotic lesions significantly occur in the ascending aorta and coexist with individual components of the medial degeneration.
Collapse
Affiliation(s)
- Aaron Huhta
- Department of Pathology, Fimlab Laboratories, Arvo Ylpön katu 4, 33520, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Timo Paavonen
- Department of Pathology, Fimlab Laboratories, Arvo Ylpön katu 4, 33520, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Ari Mennander
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland; Division of Cardiothoracic Surgery, Tampere University Heart Hospital, Elämänaukio 1, 33520, Tampere, Finland.
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Arvo Ylpön katu 4, 33520, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| |
Collapse
|
2
|
Pucci A, Rossetti M, Lenzi C, Buja ML. The cardiovascular pathologist in the aortic team. Cardiovasc Pathol 2024; 72:107649. [PMID: 38703970 DOI: 10.1016/j.carpath.2024.107649] [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: 11/11/2023] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
Aortic diseases require a multidisciplinary management for diagnosis, treatment and follow-up with better outcomes in referral centers using a team-based approach. The setting up of a multi-disciplinary aortic team for the discussion of complex cases has been already proposed; it is also supported by the ACC/AHA. Surgeons and radiologists, more or less other physicians such as cardiologists, geneticists, rheumatologists/internal medicine specialists and pathologists are involved into such a team. The role of the cardiovascular pathologist is to examine the aortic specimens, to diagnose and classify the aortic lesions. Herein, the role of the pathologist in the aortic team is discussed and the pathobiology of aortic diseases is reviewed for reference by pathologists. The aortic specimens are mainly obtained from emergency or elective surgical procedures on the thoracic aorta, less frequently from organ/tissue (including cardiac or heart valve) donors, post-mortem procedures or abdominal aortic surgery. In the last decade, together with the progress of medical sciences, the histological definitions and classifications of the aortic pathology are undergoing thorough revisions that are addressed to an etiopathogenetic approach because of possible clinico-pathological correlations, therapeutic and prognostic impact. Pathologists may also have an important role in research and teaching. Therefore, histological analyses of the aortic specimens require adequate sample processing and pathologist expertise because histology contributes to definite diagnosis, correct management of patients and even (in genetic diseases) families, but also to research in the challenging field of aortopathies.
Collapse
Affiliation(s)
- Angela Pucci
- Department of Histopathology, Pisa University Hospital, Pisa, Italy.
| | - Martina Rossetti
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Chiara Lenzi
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Maximilian L Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
3
|
Pham MHC, Sigvardsen PE, Fuchs A, Kühl JT, Sillesen H, Afzal S, Nordestgaard BG, Køber LV, Kofoed KF. Aortic aneurysms in a general population cohort: prevalence and risk factors in men and women. Eur Heart J Cardiovasc Imaging 2024; 25:1235-1243. [PMID: 38662458 DOI: 10.1093/ehjci/jeae103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 08/18/2024] Open
Abstract
AIMS The prevalence and difference in risk factors for having thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) in men compared with women in the general population is not well described. This study aimed to test the hypotheses that (i) cardiovascular risk factors for TAA and AAA differ and (ii) the prevalence of TAA and AAA is sex specific. METHODS AND RESULTS Aortic examination using computed tomography angiography was performed in 11 294 individuals (56% women), with a mean age of 62 (range 40-95) years participating in the Copenhagen General Population Study. TAAs were defined as an ascending aortic diameter ≥45 mm and a descending aortic diameter ≥35 mm, while AAAs were defined as an abdominal aortic diameter ≥30 mm. Demographic data were obtained from questionnaires. Overall prevalence of aortic aneurysms (AAs) in the study population included: total population 2.1%, men 4.0% and women 0.7% (P-value men vs. women P < 0.001). AAs were independently associated with male sex, increasing age, and body surface area (BSA). While TAAs were associated with hypertension, odds ratio (OR) = 2.0 [95% confidence interval (CI): 1.5-2.8], AAAs were associated with hypercholesterolaemia and smoking, OR = 2.4 (95% CI: 1.6-3.6) and 3.2 (95% CI: 1.9-5.4). CONCLUSION Subclinical AAs are four times more prevalent in men than in women. In both sexes, increasing age and BSA are risk factors for AAs of any anatomical location. Whereas arterial hypertension is a risk factor for TAAs, hypercholesterolaemia and smoking are risk factors for AAAs.
Collapse
Affiliation(s)
- Michael Huy Cuong Pham
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per Ejlstrup Sigvardsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, The Heart Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, 2730 Herlev, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, 2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte Hospital, 2730 Herlev, Denmark
- Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, 2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Valeur Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, The Heart Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Radiology, The Diagnostic Center, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| |
Collapse
|
4
|
De Gaspari M, Ascione A, Baldovini C, Marzullo A, Pucci A, Rizzo S, Salzillo C, Angelini A, Basso C, d’Amati G, di Gioia CRT, van der Wal AC, Giordano C, On behalf of the Italian Study Group of Cardiovascular Pathology. Cardiovascular pathology in vasculitis. Pathologica 2024; 116:78-92. [PMID: 38767541 PMCID: PMC11138763 DOI: 10.32074/1591-951x-993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/22/2024] Open
Abstract
Vasculitides are diseases that can affect any vessel. When cardiac or aortic involvement is present, the prognosis can worsen significantly. Pathological assessment often plays a key role in reaching a definite diagnosis of cardiac or aortic vasculitis, particularly when the clinical evidence of a systemic inflammatory disease is missing. The following review will focus on the main histopathological findings of cardiac and aortic vasculitides.
Collapse
Affiliation(s)
- Monica De Gaspari
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Andrea Ascione
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Chiara Baldovini
- Department of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Marzullo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Angela Pucci
- Histopathology Department, University Hospital of Pisa, Pisa, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cecilia Salzillo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Giulia d’Amati
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | | | - Allard C. van der Wal
- Department of Pathology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Carla Giordano
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | | |
Collapse
|
5
|
Hariri O, Al Laham O, Haffar L, Ghannam M, Mohammad A. Intimomedial mucoid degeneration resulting in a dissecting infrarenal abdominal aortic aneurysm in a young Middle Eastern male: a case report. Ann Med Surg (Lond) 2024; 86:1798-1804. [PMID: 38463128 PMCID: PMC10923297 DOI: 10.1097/ms9.0000000000001793] [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: 11/28/2023] [Accepted: 01/25/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Intimomedial mucoid degeneration is a rare vascular disorder first depicted in 1977. It involves mucin deposition in arterial layers. This will cause elastic tissue degeneration and aneurysm formation. This pathology predominantly affects the aorta. However, it could involve other smaller vessels. Surgical treatment could become complicated by a bleeding diathesis. Therefore, a precise surgical technique is necessary to avoid the ensuing complications. Case presentation We present the case of a previously healthy 27-year-old Middle Eastern male who presented to our surgical clinic following the incidental discovery of an infrarenal abdominal aortic aneurysm following a blunt trauma to the left flank incurred during a fall. Preoperative radiology unveiled a dissecting an infrarenal aortic aneurysm with a concurrent dissection flap at the left renal artery level. Furthermore, an additional dissection flap was observed at the abdominal aortic bifurcation devoid of thrombosis. Clinical discussion We planned to perform a bilateral aortoiliac bypass. However, due to the fragility of the artery wall, bleeding diathesis, and the tearing that occurred due to the anastomotic suture, the irreparable tear in the anastomosis complicated the situation, we decided to ligate the aorta and perform an axillary-bi-femoral bypass. Conclusion Intimomedial mucoid degeneration presenting as a dissecting infrarenal abdominal aortic aneurysm is an exceptionally rare pathology. This underscores the crucial need for extensive epidemiological research to document and raise awareness about these cases. Our literature review confirms that our case is the first documented instance in our country, and this emphasizes the significance of our findings.
Collapse
Affiliation(s)
- Omar Hariri
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Omar Al Laham
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Lina Haffar
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Pathology, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Mohammad Ghannam
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Vascular and Endovascular Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Ammar Mohammad
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Vascular and Endovascular Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| |
Collapse
|
6
|
Hu S, Qiu S, Wan B, Ruan L, Zhu L, Wang S, Su L, Guo Q, Xu J, Wei Y. Association Between Serum Uric Acid and Abdominal Aortic Calcification in Adults Aged 40 to 80 years: A Retrospective Cross-Sectional Study. Angiology 2024:33197241227275. [PMID: 38212979 DOI: 10.1177/00033197241227275] [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: 01/13/2024]
Abstract
There are numerous causes of abdominal aortic calcification (AAC), among which the relationship between serum uric acid and AAC still needs to be investigated further. The aim of this research was to ascertain whether serum uric acid is correlated with AAC. Our study included 3007 participants. We described the study population characteristics and utilized univariate analysis, stratified analysis, multiple equation regression analysis, smoothed curve fitting, and threshold effects analysis. AAC Total 24 score is used to reflect the range of aortic calcification at each vertebral level. As serum uric acid increased, the AAC Total 24 score first decreased and then increased. The fold point is located when serum uric is at 3.5 mg/dL. After adjusting for 16 covariates, the beta values for the groups with moderate and high serum uric acid levels were 0.34 and 0.53, respectively, compared with the low serum uric acid tertile group (P < .05). Our research indicates a negative correlation between serum acid level and AAC when serum uric acid <3.5 mg/dl, but it is positively correlated with the formation of AAC when serum uric acid >3.5 mg/dl.
Collapse
Affiliation(s)
- Sheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengyu Qiu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bingen Wan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liancheng Ruan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingxiao Zhu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Siling Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lang Su
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiang Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianjun Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
7
|
Reddy P, Nair KS, Kumar V, Bowen JM, Deyle DR, Pochettino A, Connolly HM, Anavekar NS. Thoracic Aortic Aneurysmal Disease: Comprehensive Recommendations for the Primary Care Physician. Mayo Clin Proc 2024; 99:111-123. [PMID: 38176819 DOI: 10.1016/j.mayocp.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 01/06/2024]
Abstract
Thoracic aortic aneurysm (TAA) is a commonly encountered disease that is defined as aortic dilation with an increase in diameter of at least 50% greater than the expected age- and sex-adjusted size. Thoracic aortic aneurysms are described by their size, location, morphology, and cause. Primary care clinicians and other noncardiologists are often the first point of contact for patients with TAA. This review is intended to provide them with basic information on the differential diagnosis, diagnostic evaluation, and medical and surgical management of TAAs. Management decisions depend on having as precise a diagnosis as possible. Fortunately, this can often be achieved with a stepwise diagnostic approach that incorporates imaging and targeted genetic testing. Our review includes recommendations. In this review, we discuss these issues at a basic level and include recommendations for patients considering pregnancy.
Collapse
Affiliation(s)
- Prajwal Reddy
- Department of Cardiology, Mayo Clinic, Rochester, MN.
| | - Kaavya S Nair
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO
| | - Vinayak Kumar
- Department of Cardiology, Mayo Clinic, Rochester, MN
| | - Juan M Bowen
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | | | | | - Nandan S Anavekar
- Department of Cardiology, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN
| |
Collapse
|
8
|
Debono S, Nash J, Fletcher AJ, Syed M, van Beek EJR, Williams MC, Falah O, Tambyraja A, Dweck MR, Newby DE, Forsythe RO. Aortic sodium [ 18F]fluoride uptake following endovascular aneurysm repair. Heart 2023; 109:1677-1682. [PMID: 37164479 PMCID: PMC10646867 DOI: 10.1136/heartjnl-2023-322514] [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: 02/08/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE In patients with abdominal aortic aneurysms, sodium [18F]fluoride positron emission tomography identifies aortic microcalcification and disease activity. Increased uptake is associated with aneurysm expansion and adverse clinical events. The effect of endovascular aneurysm repair (EVAR) on aortic disease activity and sodium [18F]fluoride uptake is unknown. This study aimed to compare aortic sodium [18F]fluoride uptake before and after treatment with EVAR. METHODS In a preliminary proof-of-concept cohort study, preoperative and post-operative sodium [18F]fluoride positron emission tomography-computed tomography angiography was performed in patients with an infrarenal abdominal aortic aneurysm undergoing EVAR according to current guideline-directed size treatment thresholds. Regional aortic sodium [18F]fluoride uptake was assessed using aortic microcalcification activity (AMA): a summary measure of mean aortic sodium [18F]fluoride uptake. RESULTS Ten participants were recruited (76±6 years) with a mean aortic diameter of 57±2 mm at time of EVAR. Mean time from EVAR to repeat scan was 62±21 months. Prior to EVAR, there was higher abdominal aortic AMA when compared with the thoracic aorta (AMA 1.88 vs 1.2; p<0.001). Following EVAR, sodium [18F]fluoride uptake was markedly reduced in the suprarenal (ΔAMA 0.62, p=0.03), neck (ΔAMA 0.72, p=0.02) and body of the aneurysm (ΔAMA 0.69, p=0.02) while it remained unchanged in the thoracic aorta (ΔAMA 0.11, p=0.41). CONCLUSIONS EVAR is associated with a reduction in AMA within the stented aortic segment. This suggests that EVAR can modify aortic disease activity and aortic sodium [18F]fluoride uptake is a promising non-invasive surrogate measure of aneurysm disease activity.
Collapse
Affiliation(s)
- Samuel Debono
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jennifer Nash
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Child Health, University of Glasgow, Glasgow, UK
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Michelle Claire Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Orwa Falah
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Andrew Tambyraja
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- The Edinburgh Vascular Service, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| |
Collapse
|
9
|
Atkinson G, Bianco R, Di Gregoli K, Johnson JL. The contribution of matrix metalloproteinases and their inhibitors to the development, progression, and rupture of abdominal aortic aneurysms. Front Cardiovasc Med 2023; 10:1248561. [PMID: 37799778 PMCID: PMC10549934 DOI: 10.3389/fcvm.2023.1248561] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) account for up to 8% of deaths in men aged 65 years and over and 2.2% of women. Patients with AAAs often have atherosclerosis, and intimal atherosclerosis is generally present in AAAs. Accordingly, AAAs are considered a form of atherosclerosis and are frequently referred to as atherosclerotic aneurysms. Pathological observations advocate inflammatory cell infiltration alongside adverse extracellular matrix degradation as key contributing factors to the formation of human atherosclerotic AAAs. Therefore, macrophage production of proteolytic enzymes is deemed responsible for the damaging loss of ECM proteins, especially elastin and fibrillar collagens, which characterise AAA progression and rupture. Matrix metalloproteinases (MMPs) and their regulation by tissue inhibitors metalloproteinases (TIMPs) can orchestrate not only ECM remodelling, but also moderate the proliferation, migration, and apoptosis of resident aortic cells, alongside the recruitment and subsequent behaviour of inflammatory cells. Accordingly, MMPs are thought to play a central regulatory role in the development, progression, and eventual rupture of abdominal aortic aneurysms (AAAs). Together, clinical and animal studies have shed light on the complex and often diverse effects MMPs and TIMPs impart during the development of AAAs. This dichotomy is underlined from evidence utilising broad-spectrum MMP inhibition in animal models and clinical trials which have failed to provide consistent protection from AAA progression, although more encouraging results have been observed through deployment of selective inhibitors. This review provides a summary of the supporting evidence connecting the contribution of individual MMPs to AAA development, progression, and eventual rupture. Topics discussed include structural, functional, and cell-specific diversity of MMP members; evidence from animal models of AAA and comparisons with findings in humans; the dual role of MMPs and the requirement to selectively target individual MMPs; and the advances in identifying aberrant MMP activity. As evidenced, our developing understanding of the multifaceted roles individual MMPs perform during the progression and rupture of AAAs, should motivate clinical trials assessing the therapeutic potential of selective MMP inhibitors, which could restrict AAA-related morbidity and mortality worldwide.
Collapse
Affiliation(s)
| | | | | | - Jason L. Johnson
- Laboratory of Cardiovascular Pathology, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
10
|
Espitia O, Bruneval P, Assaraf M, Pouchot J, Liozon E, de Boysson H, Gaudric J, Chiche L, Achouh P, Roussel JC, Miranda S, Mirault T, Boussouar S, Redheuil A, Serfaty JM, Bénichou A, Agard C, Guédon AF, Cacoub P, Paraf F, Fouret PJ, Toquet C, Biard L, Saadoun D. Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis. J Am Coll Cardiol 2023; 82:1053-1064. [PMID: 37673506 DOI: 10.1016/j.jacc.2023.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known. OBJECTIVES The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis. METHODS This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis. RESULTS Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died. CONCLUSIONS This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.
Collapse
Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France.
| | - Patrick Bruneval
- Department of cardiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Morgane Assaraf
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jacques Pouchot
- Department of Internal Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Liozon
- Department of Internal Medicine, CHU Limoges, France
| | | | - Julien Gaudric
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Paul Achouh
- Department of Cardiothoracic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Christian Roussel
- Department of Cardiothoracic Surgery, Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | | | - Tristan Mirault
- Université Paris Cité, Department of Vascular Medicine, Hôpital Européen Georges Pompidou, APHP, INSERM U970 PARCC, Paris, France
| | - Samia Boussouar
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Alban Redheuil
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Department of Cardiovascular Imaging, Paris, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Department of Cardiovascular Imaging, Nantes, France
| | - Antoine Bénichou
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Alexis F Guédon
- Nantes Université, CHU Nantes, Department of Vascular Medicine, Nantes, France; l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, Nantes, France
| | - Patrice Cacoub
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre-Jean Fouret
- Sorbonne Universités, Pitié-Salpêtrière University Hospital, Service d'anatomopathologie, UPMC-Paris VI, Paris, France
| | - Claire Toquet
- Nantes Université, CHU Nantes, Department of Pathology, Nantes, France
| | - Lucie Biard
- APHP Department of Biostatistics and Medical Information, Saint-Louis Hospital, Paris, France; ECSTRRA Team, CRESS UMR 1153, INSERM, Paris Cité University, Paris, France
| | - David Saadoun
- Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire (CEREMAIA), Paris, France; INSERM, UMR_S 959, Paris, France; DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
| |
Collapse
|
11
|
Li Y, Li B, Chen WD, Wang YD. Role of G-protein coupled receptors in cardiovascular diseases. Front Cardiovasc Med 2023; 10:1130312. [PMID: 37342437 PMCID: PMC10277692 DOI: 10.3389/fcvm.2023.1130312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/09/2023] [Indexed: 06/22/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally, with CVDs accounting for nearly 30% of deaths worldwide each year. G-protein-coupled receptors (GPCRs) are the most prominent family of receptors on the cell surface, and play an essential regulating cellular physiology and pathology. Some GPCR antagonists, such as β-blockers, are standard therapy for the treatment of CVDs. In addition, nearly one-third of the drugs used to treat CVDs target GPCRs. All the evidence demonstrates the crucial role of GPCRs in CVDs. Over the past decades, studies on the structure and function of GPCRs have identified many targets for the treatment of CVDs. In this review, we summarize and discuss the role of GPCRs in the function of the cardiovascular system from both vascular and heart perspectives, then analyze the complex ways in which multiple GPCRs exert regulatory functions in vascular and heart diseases. We hope to provide new ideas for the treatment of CVDs and the development of novel drugs.
Collapse
Affiliation(s)
- Yuanqiang Li
- State Key Laboratory of Chemical Resource Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Boyu Li
- Department of Gastroenterology and Hematology, The People's Hospital of Hebi, Henan, China
| | - Wei-Dong Chen
- Key Laboratory of Receptors-Mediated Gene Regulation and Drug Discovery, School of Basic Medical Science, Inner Mongolia Medical University, Hohhot, China
- Key Laboratory of Receptors-Mediated Gene Regulation, School of Medicine, The People’s Hospital of Hebi, Henan University, Kaifeng, China
| | - Yan-Dong Wang
- State Key Laboratory of Chemical Resource Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| |
Collapse
|
12
|
Jo EA, Seong S, Ahn S, Mo H, Jung IM, Kim HK, Ko H, Han A, Min S, Min SK. Validation of I71.3 code for ruptured abdominal aortic aneurysm in Korea: misplaced diagnosis in claims data. Ann Surg Treat Res 2023; 104:170-175. [PMID: 36910559 PMCID: PMC9998958 DOI: 10.4174/astr.2023.104.3.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose Studies in western countries have shown a decline in the incidence of ruptured abdominal aortic aneurysm (rAAA) with advancements in endovascular repair and screening. However, according to health insurance data in Korea based on rAAA code (I71.3), overall rAAA has been increasing. This study aimed to validate the I71.3 code for rAAA and attempt to define the true incidence of rAAA in Korea. Methods A 20-year multicenter retrospective review of rAAA was undertaken from the period of January 1, 2000 to December 31, 2020. All patients were diagnosed with the rAAA code I71.3 in each of the 4 hospitals. The CT images and surgical records of these patients were reviewed to differentiate true rAAA and misdiagnosis. Further data on true rAAA patient outcomes including mortality and treatment success were also collected. Results A total of 305 rAAA (I71.3) codes were identified in the 4 centers. However, medical record review showed true rAAA in only 131 (43.0%). The remaining 174 cases (57.0%) were misdiagnosed. Impending ruptures were the most common misdiagnoses (37.9%). The total in-hospital mortality including deaths before treatment was 38.9% (n = 51), while mortality of treated patients was 24.4% (n = 15). Conclusion The analysis of I71.3 code for rAAA showed that only 43.0% were true rAAA and the remaining 57.0% were misdiagnosed. This indicates that the I71.3 code is overestimated in National Health Insurance-based data and that the true incidence of rAAA could be much lower.
Collapse
Affiliation(s)
- Eun-Ah Jo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sujeong Seong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyejin Mo
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - In-Mok Jung
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyo Kee Kim
- Department of Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Hyunmin Ko
- Department of Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Vos A, Houben IB, Celeng C, Takx RAP, Isgum I, Mali WPTM, Vink A, de Jong PA. Aortic calcification: A postmortem CT validation study in a middle-aged population. Eur J Radiol 2023; 159:110687. [PMID: 36610325 DOI: 10.1016/j.ejrad.2023.110687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Computed tomography (CT)-detected aortic calcification is strongly associated with aortic stiffness and is an accurate predictor of cardiovascular and all-cause mortality and cognitive decline. Some previous pathologic studies have shown calcium accumulation in the medial layer of the vessel wall, while others have suggested localisation in the atherosclerotic intimal layer. OBJECTIVES The aim of this study was to histologically validate CT findings of aortic calcification for detectability and location in the aortic wall. METHODS We acquired postmortem CT images and collected 170 aortic tissue samples from five different locations in the thoracic and abdominal aorta of 40 individuals who underwent autopsy. Microscopic slides were stained with haematoxylin and eosin and elastic van Gieson stain. Calcified lesions were characterised and calcifications were manually annotated in the intima and media. The presence and morphology of calcifications were scored on CT images. RESULTS The mean age of the autopsied individuals was 63 years, and 28 % died of cardiovascular disease. Calcifications were present in 74/170 (44 %) samples. Calcification was more common in the abdominal aorta than in the thoracic aorta. In all samples with calcifications, 99 % were located in the intimal layer. Only 16/170 samples had a small amount of medial arterial calcification. The histological results showed an 85 % concordance for the presence or absence of CT calcifications. There was complete inter-method agreement for annularity of calcifications in 68 % of the samples (linear weighted kappa 0.68 (95 %CI 0.60-0.77). CONCLUSIONS Aortic calcifications visible on CT are located in the intimal layer of the abdominal aorta wall, at least in aortas that are not aneurysmatic or dissected. The presence and annularity of these calcifications can be reliably determined by CT.
Collapse
Affiliation(s)
- Annelotte Vos
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Ignas B Houben
- University Medical Center Utrecht and Utrecht University, Department of Vascular Surgery, The Netherlands; Frankel Cardiovascular Center, University of Michigan, Department of Cardiac Surgery, United States
| | - Csilla Celeng
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Richard A P Takx
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Ivana Isgum
- Amsterdam University Medical Centers, The Netherlands
| | - Willem P T M Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Aryan Vink
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Pim A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands.
| |
Collapse
|
14
|
Yu YL, Ma JR, Li SN, Liao MQ, Xu S, Chen HE, Dai SH, Peng XL, Zhao D, Lou YM, Yu XX, Gao XP, Liu YH, Liu J, Ke XY, Ping Z, Wang L, Wang CY, Zeng FF. Association between Periodontitis and Aortic Calcification: A Cohort Study. Angiology 2023; 74:129-138. [PMID: 35503367 DOI: 10.1177/00033197221094713] [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: 12/24/2022]
Abstract
The present study investigated the association between the presence of periodontitis and aortic calcification (AC) risk among Chinese adults. A total of 6059 individuals who underwent regular health check-ups and received a diagnosis of periodontitis between 2009 and 2016 were included. The outcome was AC, assessed by a chest low-dose spiral CT scan. Cox proportional hazards regression analysis was used to assess the association between periodontitis and AC risk after adjusting for several confounders. After a median follow-up period of 2.3 years (interquartile range: 1.03-4.97 years), 843 cases of AC were identified, with 532 (12.13%) and 311 (18.59%) patients in the non-periodontitis group and periodontitis group, respectively. Multivariate analyses demonstrated that, compared with those without periodontitis, the hazard ratio and 95% confidence interval for AC risk in participants with periodontitis was 1.18 (1.02-1.36) (P = .025) in the fully adjusted model. Stratified analyses showed that the positive relationship between periodontitis and AC was more evident in males and participants <65 years of age (pinteraction = .005 and .004, respectively). Our results show that the presence of periodontitis was positively associated with AC among Chinese adults, especially among males and younger participants.
Collapse
Affiliation(s)
- Ying-Lin Yu
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| | - Jun-Rong Ma
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| | - Shu-Na Li
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| | - Min-Qi Liao
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| | - Shan Xu
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Hong-En Chen
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Shu-Hong Dai
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xiao-Lin Peng
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Dan Zhao
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yan-Mei Lou
- Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, China
| | - Xiao-Xuan Yu
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| | - Xu-Ping Gao
- Department of Child and Adolescent Psychiatry, 74577Peking University Sixth Hospital (Institute of Mental Health), Beijing, China
| | - Yan-Hua Liu
- Department of Nutrition, 191599The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Liu
- Experimental Teaching Demonstration Center for Preventive Medicine of Guizhou Province, 66367Zunyi Medical University, Zunyi, China
| | - Xing-Yao Ke
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| | - Zhao Ping
- Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, China
| | - Li Wang
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Chang-Yi Wang
- Department of Non-communicable Disease Prevention and Control, 557960Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Fang-Fang Zeng
- Department of Epidemiology, School of Medicine, 47885Jinan University, Guangdong, China
| |
Collapse
|
15
|
Hur B, Koster MJ, Jang JS, Weyand CM, Warrington KJ, Sung J. Global Transcriptomic Profiling Identifies Differential Gene Expression Signatures Between Inflammatory and Noninflammatory Aortic Aneurysms. Arthritis Rheumatol 2022; 74:1376-1386. [PMID: 35403833 PMCID: PMC9902298 DOI: 10.1002/art.42138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 03/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify hallmark genes and biomolecular processes in aortitis using high-throughput gene expression profiling, and to provide a range of potentially new drug targets (genes) and therapeutics from a pharmacogenomic network analysis. METHODS Bulk RNA sequencing was performed on surgically resected ascending aortic tissues from inflammatory aneurysms (giant cell arteritis [GCA] with or without polymyalgia rheumatica, n = 8; clinically isolated aortitis [CIA], n = 17) and noninflammatory aneurysms (n = 25) undergoing surgical aortic repair. Differentially expressed genes (DEGs) between the 2 patient groups were identified while controlling for clinical covariates. A protein-protein interaction model, drug-gene target information, and the DEGs were used to construct a pharmacogenomic network for identifying promising drug targets and potentially new treatment strategies in aortitis. RESULTS Overall, tissue gene expression patterns were the most associated with disease state than with any other clinical characteristic. We identified 159 and 93 genes that were significantly up-regulated and down-regulated, respectively, in inflammatory aortic aneurysms compared to noninflammatory aortic aneurysms. We found that the up-regulated genes were enriched in immune-related functions, whereas the down-regulated genes were enriched in neuronal processes. Notably, gene expression profiles of inflammatory aortic aneurysms from patients with GCA were no different than those from patients with CIA. Finally, our pharmacogenomic network analysis identified genes that could potentially be targeted by immunosuppressive drugs currently approved for other inflammatory diseases. CONCLUSION We performed the first global transcriptomics analysis in inflammatory aortic aneurysms from surgically resected aortic tissues. We identified signature genes and biomolecular processes, while finding that CIA may be a limited presentation of GCA. Moreover, our computational network analysis revealed potential novel strategies for pharmacologic interventions and suggests future biomarker discovery directions for the precise diagnosis and treatment of aortitis.
Collapse
Affiliation(s)
- Benjamin Hur
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew J. Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jin Sung Jang
- Medical Genome Facility, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Cornelia M. Weyand
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jaeyun Sung
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
16
|
Tian WB, Zhang WS, Jiang CQ, Liu XY, Jin YL, Lam TH, Cheng KK, Xu L. Aortic arch calcification and risk of all-cause mortality and cardiovascular disease: The Guangzhou Biobank Cohort Study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 23:100460. [PMID: 35542894 PMCID: PMC9079300 DOI: 10.1016/j.lanwpc.2022.100460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background There were no reports on the associations of aortic arch calcification (AAC) measured by chest X-ray with all-cause mortality and cardiovascular disease (CVD) in older general population. Moreover, previous studies of hemodialysis patients showed that AAC was correlated with left ventricular hypertrophy (LVH) and predicted CVD jointly. Whether the effects remained in the general population is unknown. We examined the associations of AAC with all-cause mortality and CVD in general population and the risk associated with the coexistence of AAC and LVH. Methods Presence and severity (grades 0-2) of AAC were measured by chest X-ray, and LVH was identified by 12-lead electrocardiogram in 27,166 Chinese aged 50+ years free of CVD from Guangzhou Biobank Cohort Study. Multivariate Cox regressions were used to examine associations of AAC and LVH with outcomes. Findings During an average follow-up of 14·3 years, 5,350 deaths and 4,012 CVD occurred. Compared to those without AAC at baseline, those with AAC had higher risks of all-cause mortality (HR 1·24, 95% CI 1·17-1·31) and CVD (HR 1·22, 95% CI 1·14-1·30), with dose-response relationship (P ≤ 0·001). Furthermore, those with coexistence of AAC and LVH had higher risks of all-cause mortality (HR 1·72, 95% CI 1·37-2·15) and CVD (HR 1·80, 95% CI 1·40-2·32) than those without AAC and LVH. Interpretation As chest X-ray has been performed commonly for health screening and in hospital patients when first admitted, AAC measured by chest X-ray can be further applied to assist cardiovascular risk stratification in the community and clinical settings. Funding The Natural Science Foundation of China (No. 81941019).
Collapse
|
17
|
Celi S, Vignali E, Capellini K, Gasparotti E. On the Role and Effects of Uncertainties in Cardiovascular in silico Analyses. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:748908. [PMID: 35047960 PMCID: PMC8757785 DOI: 10.3389/fmedt.2021.748908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
The assessment of cardiovascular hemodynamics with computational techniques is establishing its fundamental contribution within the world of modern clinics. Great research interest was focused on the aortic vessel. The study of aortic flow, pressure, and stresses is at the basis of the understanding of complex pathologies such as aneurysms. Nevertheless, the computational approaches are still affected by sources of errors and uncertainties. These phenomena occur at different levels of the computational analysis, and they also strongly depend on the type of approach adopted. With the current study, the effect of error sources was characterized for an aortic case. In particular, the geometry of a patient-specific aorta structure was segmented at different phases of a cardiac cycle to be adopted in a computational analysis. Different levels of surface smoothing were imposed to define their influence on the numerical results. After this, three different simulation methods were imposed on the same geometry: a rigid wall computational fluid dynamics (CFD), a moving-wall CFD based on radial basis functions (RBF) CFD, and a fluid-structure interaction (FSI) simulation. The differences of the implemented methods were defined in terms of wall shear stress (WSS) analysis. In particular, for all the cases reported, the systolic WSS and the time-averaged WSS (TAWSS) were defined.
Collapse
Affiliation(s)
- Simona Celi
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Emanuele Vignali
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Katia Capellini
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Emanuele Gasparotti
- BioCardioLab, UOC Bioingegneria, Fondazione Toscana Gabriele Monasterio, Massa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
| |
Collapse
|
18
|
Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
19
|
Zhu RR, Gao XP, Liao MQ, Cui YF, Tan SX, Zeng FF, Lou YM, Wang CY, Xu S, Peng XL, Dai SH, Zhao D, Wang L, Ping Z, Dai XY, Feng PN, Han LY. Non-alcoholic Fatty Liver Disease Is Associated With Aortic Calcification: A Cohort Study With Propensity Score Matching. Front Endocrinol (Lausanne) 2022; 13:880683. [PMID: 35651978 PMCID: PMC9150367 DOI: 10.3389/fendo.2022.880683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) greatly affects cardiovascular disease, but evidence on the associations between NAFLD and markers of aortic calcification is limited. We aim to evaluate the association between NAFLD and aortic calcification in a cohort of Chinese adults using propensity score-matching (PSM) analysis. METHODS This prospective cohort study involved adults who underwent health-screening examinations from 2009 to 2016. NAFLD was diagnosed by abdominal ultrasonography at baseline, and aortic calcification was identified using a VCT LightSpeed 64 scanner. Analyses included Cox proportional-hazards regression analysis and PSM with predefined covariates (age, gender, marital and smoking status, and use of lipid-lowering drugs) to achieve a 1:1 balanced cohort. RESULTS Of the 6,047 eligible participants, 2,729 (45.13%) were diagnosed with NAFLD at baseline, with a median age of 49.0 years [interquartile range, 44.0-55.0]. We selected 2,339 pairs of participants with and without NAFLD at baseline for the PSM subpopulation. Compared with those without NAFLD, patients with NAFLD were at a higher risk of developing aortic calcification during follow-up; significant results were observed before and after matching, with the full-adjusted hazard ratios and corresponding 95% confidence intervals being 1.19 (1.02-1.38) and 1.18 (1.01-1.38), respectively (both p < 0.05). In subgroup analyses, no interaction was detected according to age, gender, smoking status, body mass index, total cholesterol, low-density lipoprotein cholesterol, use of lipid-lowering drugs, hypertension, or type 2 diabetes. CONCLUSIONS NAFLD may be independently associated with aortic calcification. Further studies are warranted to elucidate the possible underlying mechanisms.
Collapse
Affiliation(s)
- Rong-Rong Zhu
- Department of Pharmacy, Hua Mei Hospital, University of Chinese Academy of Sciences, Zhejiang, China
| | - Xu-Ping Gao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, China
- Department of Child & Adolescent Psychiatry, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health (Peking University Sixth Hospital), Beijing, China
| | - Min-Qi Liao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, China
| | - Yun-Feng Cui
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, China
| | - Si-Xian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, China
| | - Fang-Fang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, China
| | - Yan-Mei Lou
- Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, China
| | - Chang-Yi Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Shan Xu
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xiao-Lin Peng
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Shu-Hong Dai
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Dan Zhao
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li Wang
- Department of Non-communicable Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zhao Ping
- Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, China
| | - Xiao-Yu Dai
- Department of Anus & Intestine Surgery, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- *Correspondence: Xiao-Yu Dai, ; Pin-Ning Feng, ; Li-Yuan Han,
| | - Pin-Ning Feng
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Xiao-Yu Dai, ; Pin-Ning Feng, ; Li-Yuan Han,
| | - Li-Yuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
- *Correspondence: Xiao-Yu Dai, ; Pin-Ning Feng, ; Li-Yuan Han,
| |
Collapse
|
20
|
Toral M, de la Fuente-Alonso A, Campanero MR, Redondo JM. The NO signalling pathway in aortic aneurysm and dissection. Br J Pharmacol 2021; 179:1287-1303. [PMID: 34599830 DOI: 10.1111/bph.15694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/20/2022] Open
Abstract
Recent studies have shown that NO is a central mediator in diseases associated with thoracic aortic aneurysm, such as Marfan syndrome. The progressive dilation of the aorta in thoracic aortic aneurysm ultimately leads to aortic dissection. Unfortunately, current medical treatments have neither halt aortic enlargement nor prevented rupture, leaving surgical repair as the only effective treatment. There is therefore a pressing need for effective therapies to delay or even avoid the need for surgical repair in thoracic aortic aneurysm patients. Here, we summarize the mechanisms through which NO signalling dysregulation causes thoracic aortic aneurysm, particularly in Marfan syndrome. We discuss recent advances based on the identification of new Marfan syndrome mediators related to pathway overactivation that represent potential disease biomarkers. Likewise, we propose iNOS, sGC and PRKG1, whose pharmacological inhibition reverses aortopathy in Marfan syndrome mice, as targets for therapeutic intervention in thoracic aortic aneurysm and are candidates for clinical trials.
Collapse
Affiliation(s)
- Marta Toral
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andrea de la Fuente-Alonso
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel R Campanero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas-Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan Miguel Redondo
- Gene Regulation in Cardiovascular Remodeling and Inflammation Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| |
Collapse
|
21
|
Socha K, Karwowska A, Kurianiuk A, Markiewicz-Żukowska R, Guzowski A, Gacko M, Hirnle T, Borawska MH. Estimation of Selected Minerals in Aortic Aneurysms-Impaired Ratio of Zinc to Lead May Predispose? Biol Trace Elem Res 2021; 199:2811-2818. [PMID: 33006035 PMCID: PMC8222018 DOI: 10.1007/s12011-020-02410-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/23/2020] [Indexed: 12/04/2022]
Abstract
The objective of this study was to estimate the content of copper, zinc, selenium, cadmium, and lead in the tissue of patients with aortic aneurysms. Molar ratio of Cu/Zn and antioxidant micronutrients to toxic elements was also calculated. A total of 108 patients: 47 with abdominal aortic aneurysm (AAA), 61 patients with thoracic aortic aneurysm (TAA), and a control group of 20 abdominal aortic (AA) and 20 thoracic aortic (TA) wall samples from the deceased were studied. The concentrations of mineral components in the tissue samples were determined by the AAS method. The average concentration of Cu in the aortic wall of patients with TAA was significantly lower than in the aortic wall samples of healthy people. The mean concentration of Zn in the aortic wall of patients with AAA and TAA was significantly lower than in the control group samples. Cu/Zn ratio was significantly higher in AAA patients than in control group which indicates a greater role of oxidative stress and inflammatory process in this type of aneurysm. The concentration of Se was significantly decreased in TAA patients compared with the control group; in turn, the concentration of Pb was increased in this group of patients. We observed significantly lower Cu/Pb ratio in TAA patients than in control group, whereas Zn/Pb ratio was significantly lower comparing with control samples in both types of aneurysms. In the examined aneurysms, we have shown the differences in concentrations of mineral components compared with the control tissues. The Zn concentration was decreased in both AAA and TAA samples. Impaired ratio of Zn to Pb may predispose to aortic aneurysms.
Collapse
Affiliation(s)
- Katarzyna Socha
- Department of Bromatology, Medical University of Bialystok, Bialystok, Poland.
| | - Alicja Karwowska
- Department of Hygiene, Epidemiology and Metabolic Disorders, Medical University of Bialystok, Bialystok, Poland
| | - Adam Kurianiuk
- Department of Hygiene, Epidemiology and Metabolic Disorders, Medical University of Bialystok, Bialystok, Poland
| | | | - Andrzej Guzowski
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, Bialystok, Poland
| | - Marek Gacko
- Department of Vascular Surgery and Transplantation, Medical University of Bialystok, Bialystok, Poland
| | - Tomasz Hirnle
- Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland
| | - Maria H Borawska
- Department of Bromatology, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
22
|
Nuotio K, Koskinen SM, Mäkitie L, Tuimala J, Ijäs P, Heikkilä HM, Saksi J, Vikatmaa P, Sorto P, Kasari S, Paakkari I, Silvennoinen H, Valanne L, Mäyränpää MI, Soinne L, Kovanen PT, Lindsberg PJ. Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification. Front Neurol 2021; 12:696244. [PMID: 34322086 PMCID: PMC8311519 DOI: 10.3389/fneur.2021.696244] [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] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries. Methods: Overall, 500 consecutive patients underwent carotid endarterectomy, 82 of whom had received long-term warfarin therapy. The extent of calcification was assessed with preoperative computed tomography angiography, and both macroscopic morphological grading and microscopic histological examination of each excised carotid plaque were performed after carotid endarterectomy. Results: Compared with non-users, warfarin users had significantly more computed tomography angiography-detectable vascular calcification in the common carotid arteries (odds ratio 2.64, 95% confidence interval 1.51–4.63, P < 0.001) and even more calcification in the internal carotid arteries near the bifurcation (odds ratio 18.27, 95% confidence interval 2.53–2323, P < 0.001). Histological analysis revealed that the intramural calcified area in plaques from warfarin users was significantly larger than in plaques from non-users (95% confidence interval 3.36–13.56, P = 0.0018). Conclusions: Long-lasting warfarin anticoagulation associated with increased calcification of carotid atherosclerotic plaques, particularly in locations known to be the predilection sites of stroke-causing plaques. The clinical significance of this novel finding warrants further investigations.
Collapse
Affiliation(s)
- Krista Nuotio
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Suvi M Koskinen
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.,Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Mäkitie
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | | | - Petra Ijäs
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Hanna M Heikkilä
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Jani Saksi
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Pirkka Vikatmaa
- Abdominal Center, Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Pia Sorto
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Sonja Kasari
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Ilari Paakkari
- Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heli Silvennoinen
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Valanne
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko I Mäyränpää
- Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Soinne
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Petri T Kovanen
- Wihuri Research Institute, Biomedicum Helsinki 1, Helsinki, Finland
| | - Perttu J Lindsberg
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| |
Collapse
|
23
|
Stejskal V, Karalko M, Šteiner I. Ascending aorta dissection in a new classification system: Clinicopathological features of 62 cases. Pathol Res Pract 2021; 224:153542. [PMID: 34246045 DOI: 10.1016/j.prp.2021.153542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
Herein we present a single institution 5-year experience with ascending aorta dissection biopsies depicting the clinicopathological features of 62 cases. To detect microscopic abnormalities in the aortic wall beside the dissection itself, we applied a new histopathological classification scheme from the consensus documents issued by The Society for Cardiovascular Pathology and The Association for the European Cardiovascular Pathology in 2015 and 2016. The most common finding was medial degeneration (MD) - 61 cases (98.4%); atherosclerosis (AS) was found in 19 aortae (30.6%), and chronic aortitis- giant cell pattern described in one aorta (1.6%). The medial degeneration constituents included mucoid matrix accumulation, smooth muscle cells and elastic fibers abnormalities, and medial fibrosis. The consensus document application led to increased MD reporting compared to older studies and to our previous experience, probably due to assessing more subtle and focal changes such as intralamellar fibrosis, intralamellar mucoid matrix accumulation, and loss of smooth muscle cell nuclei- these changes being also the most common MD abnormalities we are reporting. We have compared the results in patients with bicuspid (n = 7; 11.3%) versus tricuspid (n = 55; 88.7%) aortic valve, suggesting no significant differences except for translamellar fibrosis, which appeared to be more severe in the bicuspid valve group (p = 0.0397). The results might imply similar histopathological findings regardless of the aortic valve cuspidity in aortic dissection. These findings are in contrast to ascending aorta dilation (aneurysm), where more severe medial degeneration changes have been described in patients with the tricuspid aortic valve.
Collapse
Affiliation(s)
- Václav Stejskal
- The Fingerland Department of Pathology, University Hospital Hradec Králové and Faculty of Medicine in Hradec Králové, Charles University, Czech Republic.
| | - Mikita Karalko
- The Department of Cardiosurgery, University Hospital Hradec Králové and Faculty of Medicine in Hradec Králové, Charles University, Czech Republic
| | - Ivo Šteiner
- The Fingerland Department of Pathology, University Hospital Hradec Králové and Faculty of Medicine in Hradec Králové, Charles University, Czech Republic
| |
Collapse
|
24
|
Ferfar Y, Morinet S, Espitia O, Agard C, Vautier M, Comarmond C, Desbois AC, Domont F, Resche-Rigon M, Cacoub P, Biard L, Saadoun D. Spectrum and Outcome of Noninfectious Aortitis. J Rheumatol 2021; 48:1583-1588. [PMID: 34210830 DOI: 10.3899/jrheum.201274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the spectrum and long-term outcome of patients with noninfectious aortitis. METHODS We performed a retrospective multicenter study of 353 patients (median age at diagnosis was 62 [IQR 46-71] yrs and 242 [68.6%] patients were women) with noninfectious aortitis. Factors associated with vascular complications were assessed in multivariate analysis. RESULTS We included 136 patients with giant cell arteritis (GCA), 96 with Takayasu arteritis (TA), 73 with clinically isolated aortitis (CIA), and 48 with aortitis secondary to inflammatory diseases (including Behçet disease, relapsing polychondritis, IgG4-related disease, Cogan syndrome, ankylosing spondylitis). After a median follow-up of 52 months, vascular complications were observed in 32.3%, revascularizations in 30% of patients, and death in 7.6%. The 5-year cumulative incidence of vascular complications was 58% (95% CI 41-71), 20% (95% CI 13-29), and 19% (95% CI 11-28) in CIA, GCA, and TA, respectively. In multivariate analysis, male sex (HR 2.10, 95% CI 1.45-3.05, P < 0.0001) and CIA (HR 1.76, 95% CI 1.11-2.81, P = 0.02) were independently associated with vascular complications. CONCLUSION Noninfectious aortitis accounts for significant morbidity and mortality. CIA seems to carry the highest rate of vascular complications.
Collapse
Affiliation(s)
- Yasmina Ferfar
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Sarah Morinet
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Olivier Espitia
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Christian Agard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Mathieu Vautier
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Cloé Comarmond
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Anne Claire Desbois
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Fanny Domont
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Matthieu Resche-Rigon
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Patrice Cacoub
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | - Lucie Biard
- Y. Ferfar, MD, M. Vautier, MD, C. Comarmond, MD, PhD, A.C. Desbois, MD, PhD, F. Domont, MD, P. Cacoub, MD, D. Saadoun, MD, PhD, Sorbonne Universités, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris; S. Morinet, MD, M. Resche-Rigon, MD, PhD, L. Biard, MD, PhD, AP-HP Department of Biostatistics and Medical Information, Hôpital Saint-Louis; ECSTRRA Team, CRESS UMR 1153, INSERM, University of Paris, Paris; 3O. Espitia, MD, PhD, C. Agard, MD, PhD, Department of Internal Medicine, CHU Nantes, Nantes, France. S. Morinet and O. Espitia contributed equally to this work. DS has received consulting and lecturing fees from Medimmune, AbbVie, Bristol Myers Squibb, Amgen, Celgene, Sanofi-Genzyme, Roche-Chugai, Servier, Gilead, AstraZeneca, and GlaxoSmithKline. PC has received consulting and lecturing fees from AbbVie, AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Janssen, MSD, Roche, Servier, and Vifor. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. D. Saadoun, Département de Médecine Interne et d'Immunologie Clinique, Hôpital Pitié-Salpêtrière, 83 boulevard de l'hôpital, 75013 Paris, France. . Accepted for publication April 12, 2021
| | | | | |
Collapse
|
25
|
Quimson L, Mayer A, Capponi S, Rea B, Rhee RL. Comparison of Aortitis Versus Noninflammatory Aortic Aneurysms Among Patients Who Undergo Open Aortic Aneurysm Repair. Arthritis Rheumatol 2020; 72:1154-1159. [PMID: 32067388 DOI: 10.1002/art.41233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Distinguishing aortitis-induced aneurysms from noninflammatory aortic aneurysms is difficult and often incidentally diagnosed on histologic examination after surgical repair. This study was undertaken to examine surgically diagnosed aortitis and identify patient characteristics and imaging findings associated with the disease. METHODS In this case-control study, cases had newly diagnosed, biopsy-proven noninfectious aortitis after open thoracic aortic aneurysm surgical repair. Five controls were matched with cases for year of surgery and lacked significant inflammation on surgical pathology analysis. Data on comorbidities, demographic characteristics, and laboratory and imaging abnormalities prior to surgery were collected. Associations between exposures and outcomes were evaluated using conditional logistic regression. Backward stepwise logistic regression was used to determine factors independently associated with aortitis. Odds ratios (ORs) with 95%confidence intervals (95%CIs) were calculated. RESULTS The study included 262 patients (43 patients with aortitis and 219 controls). Patients with aortitis were older at the time of surgery, predominantly female, and less likely to have a history of coronary artery disease (CAD). Multivariable analysis revealed that aortitis was independently associated with an older age at the time of surgery (OR 1.08 [95%CI 1.03-1.13], P < 0.01), female sex (OR 2.36 [95%CI 1.01-5.51], P = 0.04), absence of CAD (OR 6.92 [95%CI 2.14-22.34], P = 0.04), a larger aneurysm diameter (OR 1.74 [95%CI 1.02-2.98], P = 0.04), and arterial wall thickening on imaging (OR 56.93 [95%CI 4.31-752.33], P < 0.01). CONCLUSION Among patients who undergo open surgical repair of an aortic aneurysm, elderly women with no history of CAD who have evidence of other aortic or arterial wall thickening on imaging are more likely to have histologic evidence of aortitis. Patients with these characteristics may benefit from further rheumatologic evaluation.
Collapse
Affiliation(s)
- Laarni Quimson
- Hospital of the University of Pennsylvania, Philadelphia
| | - Adam Mayer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sarah Capponi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Bryan Rea
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rennie L Rhee
- Hospital of the University of Pennsylvania, Philadelphia
| |
Collapse
|
26
|
Chen PY, Qin L, Li G, Malagon-Lopez J, Wang Z, Bergaya S, Gujja S, Caulk AW, Murtada SI, Zhang X, Zhuang ZW, Rao DA, Wang G, Tobiasova Z, Jiang B, Montgomery RR, Sun L, Sun H, Fisher EA, Gulcher JR, Fernandez-Hernando C, Humphrey JD, Tellides G, Chittenden TW, Simons M. Smooth Muscle Cell Reprogramming in Aortic Aneurysms. Cell Stem Cell 2020; 26:542-557.e11. [PMID: 32243809 PMCID: PMC7182079 DOI: 10.1016/j.stem.2020.02.013] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/27/2019] [Accepted: 02/21/2020] [Indexed: 11/29/2022]
Abstract
The etiology of aortic aneurysms is poorly understood, but it is associated with atherosclerosis, hypercholesterolemia, and abnormal transforming growth factor β (TGF-β) signaling in smooth muscle. Here, we investigated the interactions between these different factors in aortic aneurysm development and identified a key role for smooth muscle cell (SMC) reprogramming into a mesenchymal stem cell (MSC)-like state. SMC-specific ablation of TGF-β signaling in Apoe-/- mice on a hypercholesterolemic diet led to development of aortic aneurysms exhibiting all the features of human disease, which was associated with transdifferentiation of a subset of contractile SMCs into an MSC-like intermediate state that generated osteoblasts, chondrocytes, adipocytes, and macrophages. This combination of medial SMC loss with marked increases in non-SMC aortic cell mass induced exuberant growth and dilation of the aorta, calcification and ossification of the aortic wall, and inflammation, resulting in aneurysm development.
Collapse
Affiliation(s)
- Pei-Yu Chen
- Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lingfeng Qin
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Guangxin Li
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong Province, China
| | - Jose Malagon-Lopez
- Computational Statistics and Bioinformatics Group, Advanced Artificial Intelligence Research Laboratory, WuXiNextCODE, Cambridge, MA, USA; Complex Biological Systems Alliance, Medford, MA, USA
| | - Zheng Wang
- School of Basic Medicine, Qingdao University, Shandong, China
| | - Sonia Bergaya
- Department of Medicine (Cardiology), the Marc and Ruti Bell Program in Vascular Biology and the Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY, USA
| | - Sharvari Gujja
- Computational Statistics and Bioinformatics Group, Advanced Artificial Intelligence Research Laboratory, WuXiNextCODE, Cambridge, MA, USA; Complex Biological Systems Alliance, Medford, MA, USA
| | - Alexander W Caulk
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Sae-Il Murtada
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Xinbo Zhang
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT, USA; Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine, and Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Zhen W Zhuang
- Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Deepak A Rao
- Division of Rheumatology, Inflammation, Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Guilin Wang
- Department of Molecular Biophysics and Biochemistry, Yale University School of Medicine, New Haven, CT, USA
| | - Zuzana Tobiasova
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Bo Jiang
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lele Sun
- Genomics Laboratory, WuXiNextCODE, Shanghai, China
| | - Hongye Sun
- Genomics Laboratory, WuXiNextCODE, Shanghai, China
| | - Edward A Fisher
- Department of Medicine (Cardiology), the Marc and Ruti Bell Program in Vascular Biology and the Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY, USA
| | | | - Carlos Fernandez-Hernando
- Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT, USA; Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine, and Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - George Tellides
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Thomas W Chittenden
- Computational Statistics and Bioinformatics Group, Advanced Artificial Intelligence Research Laboratory, WuXiNextCODE, Cambridge, MA, USA; Complex Biological Systems Alliance, Medford, MA, USA; Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael Simons
- Yale Cardiovascular Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Cell Biology, Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
27
|
Milewicz DM, Ramirez F. Therapies for Thoracic Aortic Aneurysms and Acute Aortic Dissections. Arterioscler Thromb Vasc Biol 2019; 39:126-136. [PMID: 30651002 DOI: 10.1161/atvbaha.118.310956] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thoracic aortic aneurysms that progress to acute aortic dissections are often fatal. Thoracic aneurysms have been managed with treatment with β-adrenergic blocking agents (β-blockers) and routine surveillance imaging, followed by surgical repair of the aneurysm when the risk of dissection exceeds the risk for repair. Thus, there is a window to initiate therapies to slow aortic enlargement and delay or ideally negate the need for surgical repair of the aneurysm to prevent a dissection. Mouse models of Marfan syndrome-a monogenic disorder predisposing to thoracic aortic disease-have been used extensively to identify such therapies. The initial finding that TGFβ (transformation growth factor-β) signaling was increased in the aortic media of a Marfan syndrome mouse model and that its inhibition via TGFβ neutralization or At1r (Ang II [angiotensin II] type I receptor) antagonism prevented aneurysm development was generally viewed as a groundbreaking discovery that could be translated into the first cure of thoracic aortic disease. However, several large randomized trials of pediatric and adult patients with Marfan syndrome have subsequently yielded no evidence that At1r antagonism by losartan slows aortic enlargement more effectively than conventional treatment with β-blockers. Subsequent studies in mouse models have begun to resolve the complex molecular pathophysiology underlying onset and progression of aortic disease and have emphasized the need to preserve TGFβ signaling to prevent aneurysm formation. This review describes critical experiments that have influenced the evolution of our understanding of thoracic aortic disease, in addition to discussing old controversies and identifying new therapeutic opportunities.
Collapse
Affiliation(s)
- Dianna M Milewicz
- From the Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.)
| | - Francesco Ramirez
- Department of Pharmacological Sciences, Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York (F.R.)
| |
Collapse
|
28
|
Smeeton B, Mustaev M, Sabetai M. A Large Ascending Aortic Aneurysm Secondary to Idiopathic Necrotizing Aortitis-A Rare but Important Cause of Thoracic Aortic Disease. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:125-128. [PMID: 31756735 PMCID: PMC6914356 DOI: 10.1055/s-0039-1693986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Idiopathic necrotizing aortitis is characterized by lymphoplasmacytic or giant cell-associated inflammation of the aorta, with no specific identifiable cause. We present the case of a 79-year-old man who sought medical attention from his primary care physician because of worsening shortness of breath. The patient underwent an elective ascending aorta, hemiarch, and aortic valve replacement. Histological examination of the aortic specimen demonstrated an unusually thin aorta with features consistent with necrotizing aortitis with giant cell infiltration.
Collapse
Affiliation(s)
- Benjamin Smeeton
- Department of Plastic & Reconstructive Surgery, St. George's NHS Foundation Trust, London, United Kingdom
| | - Muslim Mustaev
- Department of Cardiac Surgery, Guys' and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Sabetai
- Department of Cardiac Surgery, Guys' and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
29
|
Benhuri B, ELJack A, Kahaleh B, Chakravarti R. Mechanism and biomarkers in aortitis--a review. J Mol Med (Berl) 2019; 98:11-23. [PMID: 31664480 DOI: 10.1007/s00109-019-01838-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/11/2019] [Accepted: 09/22/2019] [Indexed: 12/26/2022]
Abstract
Aortitis can be the manifestation of an underlying infectious or noninfectious disease process. An autoimmune cause is suggested in a large proportion of noninfectious causes. Similar to other autoimmune diseases, the pathophysiology of aortitis has been investigated in detail, but the etiology remains unknown. Most cases of aortitis often go undetected for a long time and are often identified at late stages of the disease. Recent advances in imaging techniques have significantly improved the diagnosis of aortitis. However, significant challenges associated with the imaging techniques limit their use. Several routine inflammation-based markers, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and inflammatory cytokines, are nonspecific and, therefore, have limited use in the diagnosis of aortitis. The search for more specific serum biomarkers, which can facilitate detection and progression is under progress. Several autoantibodies have been identified, but assigning their role in the pathogenesis as well as their specificity remains a challenge. The current review addresses some of these issues in detail. KEY MESSAGES: • Noninfectious aortitis is an autoimmune disease. • Several biomarkers, including cytokines and autoantibodies, are increased in aortitis. • Imaging techniques, commonly used to detect aortitis, are associated with the high cost and technical challenges. • There is a need to develop low-cost biomarker-based detection tools. • The knowledge of biomarkers in aortitis detection is discussed.
Collapse
Affiliation(s)
- Benjamin Benhuri
- Department of Physiology & Pharmacology, College of Medical & Life Sciences, University of Toledo College of Medicine, 3000 Arlington Ave, Toledo, OH, 43614, USA.,Department of Internal Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ammar ELJack
- Department of Physiology & Pharmacology, College of Medical & Life Sciences, University of Toledo College of Medicine, 3000 Arlington Ave, Toledo, OH, 43614, USA.,Depatment of Intenal Medicine, Beaumont Hospital, Dearborn, MI, 48124, USA
| | - Bashar Kahaleh
- Division of Rheumatology, University of Toledo College of Medicine, 3000 Arlington Ave, Toledo, OH, 43614, USA
| | - Ritu Chakravarti
- Department of Physiology & Pharmacology, College of Medical & Life Sciences, University of Toledo College of Medicine, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| |
Collapse
|
30
|
Chhibber AV, Muttaiyah S, Hill AA, Roberts SA. Aerococcus urinae Aortitis: A Case Report. Open Forum Infect Dis 2019; 6:ofz453. [PMID: 31850388 PMCID: PMC6910077 DOI: 10.1093/ofid/ofz453] [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] [Received: 08/19/2019] [Accepted: 10/21/2019] [Indexed: 11/12/2022] Open
Abstract
Background Aerococcus urinae is a Gram-positive coccus that is increasingly recognized as a urinary pathogen since the introduction of mass spectrometry for identification of bacteria. We report a case of abdominal aortitis (with aneurysm) caused by A urinae in a male with recurrent urinary tract infections and recently treated A urinae bacteremia. A 63-year-old gentleman with a history of A urinae urosepsis 7 weeks prior, presented to the Emergency Department with thoracolumbar back pain radiating bilaterally into the groin. Radiological and surgical findings were consistent with infective infrarenal aortitis with aneurysm. Methods The patient successfully underwent open surgical debridement and reconstruction of the infrarenal aorta with autologous vein graft. Results Aerococcus urinae was isolated from excised tissue. The patient completed a 4-week course of intravenous antimicrobial therapy. Conclusions Aurinae is a urinary pathogen with the ability to cause severe invasive disease including endovascular infections.
Collapse
Affiliation(s)
- Aakash Varun Chhibber
- Department of Microbiology, LabPLUS, Auckland District Health Board, Auckland, New Zealand
| | - Sharmini Muttaiyah
- Department of Microbiology, LabPLUS, Auckland District Health Board, Auckland, New Zealand
| | - Andrew A Hill
- Department of Vascular Surgery, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Sally A Roberts
- Department of Microbiology, LabPLUS, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
31
|
Wiskott K, Genet P, Lobrinus JA, Fracasso T, Lardi C. Intimomedial mucoid arterial degeneration, a rare arterial disorder of forensic significance. Forensic Sci Med Pathol 2019; 15:591-594. [PMID: 31446611 DOI: 10.1007/s12024-019-00154-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] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
Abstract
The body of a 43-year-old African woman with a history of aortic aneurysm and hypertension was forensically investigated after her sudden death. The cause of death was related to a cardiac tamponade due to a ruptured aneurysm of the ascending aorta. Post-mortem gross examination showed an abnormal whitish discoloration of the intima with fibrous thickening of the aortic wall. Several arteries (left main and circumflex coronaries, carotid, renal and iliac arteries) showed similar features. Upon histological examination, the aortic aneurysm as well as the other arteries sampled showed mucoid degeneration, excess mucopolysaccharides and pools of mucin inside the intima and the media associated with collagen and elastic fiber destruction and loss of smooth muscle cells. This pattern strongly suggested the diagnosis of intimomedial mucoid degeneration (IMMD), a rare arterial disorder consisting of a progressive deposition of mucin into the intima and media, with a strong prevalence in middle-aged black African females with high blood pressure. In addition to the typical features of IMMD, histological examination of the ascending aorta showed a thickening of the adventita with sparse mixed inflammatory infiltrates and fibrosis, suggesting an additional chronic infectious aortitis. No infectious agent was detected. The body of literature on IMMD is reviewed and the origin of death is discussed in this case report.
Collapse
Affiliation(s)
- Kim Wiskott
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland.
| | - Pia Genet
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| | - Johannes A Lobrinus
- Clinical Pathology Division, Geneva University Hospitals, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| | - Tony Fracasso
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| | - Christelle Lardi
- University Center of Legal Medicine, Rue Michel-Servet 1, 1205, Geneva, Switzerland
| |
Collapse
|
32
|
Yuan L, Wang M, Liu T, Lei Y, Miao Q, Li Q, Wang H, Zhang G, Hou Y, Chang X. Carbonic Anhydrase 1-Mediated Calcification Is Associated With Atherosclerosis, and Methazolamide Alleviates Its Pathogenesis. Front Pharmacol 2019; 10:766. [PMID: 31354482 PMCID: PMC6635697 DOI: 10.3389/fphar.2019.00766] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/13/2019] [Indexed: 12/27/2022] Open
Abstract
Vascular calcification is an important pathogenic process in atherosclerosis (AS); however, its immediate cause is unknown. Our previous study demonstrated that carbonic anhydrase 1 (CA1) stimulates ossification and calcification in ankylosing spondylitis and breast cancer. The current study investigated whether CA1 plays an important role in AS calcification and whether the CA inhibitor methazolamide (MTZ) has a therapeutic effect on AS. We successfully established an AS model by administration of a high-fat diet to apolipoprotein E (ApoE−/−) mice. The treated animals had significantly increased serum levels of high-density lipoprotein cholesterol (HDL-c) and nitric oxide (NO) and decreased serum concentrations of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), interleukin (IL-6), interferon (IFN)-γ, granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor-α (TNF-α), chemokine (C-X-C motif) ligand 1/keratinocyte-derived chemokine (CXCL1/KC), and C-C motif chemokine ligand 2 (CCL2)/monocyte chemoattractant protein 1 (MCP-1). The treated mice also had reduced AS plaque areas and fat accumulation, with no clear calcium deposition in the intima of the blood vessels. CA1 expression was significantly increased in the aortic lesions, particularly in calcified regions, but the expression was dramatically lower in the mice that received MTZ treatment or MTZ preventive treatment. CA1 was also highly expressed in human AS tissues and in rat vascular smooth muscle cells (VSMCs) with β-glycerophosphate (㒐β-GP)-induced calcification. Acetazolamide (AZ), a CA inhibitor with a chemical structure similar to MTZ, markedly suppressed calcification and reduced CA1, IL-6, IFN-γ, GM-CSF, and TNF-α expression in cultured VSMCs. Anti-CA1 small interfering ribonucleic acid (siRNA) significantly suppressed calcification, cell proliferation, and migration, promoted apoptosis, and reduced IL-6, IFN-γ, GM-CSF, and TNF-α secretion in cultured VSMCs. These results demonstrated that CA1 expression and CA1-mediated calcification are significantly associated with AS progression. MTZ significantly alleviated AS and suppressed CA1 expression and proinflammatory cytokine secretion, indicating the potential use of this drug for AS treatment.
Collapse
Affiliation(s)
- Lin Yuan
- Medical Research Center of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Minghua Wang
- Cardiac Surgery Department of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Tianqi Liu
- Cardiac Surgery Department of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Yinsheng Lei
- Cardiac Surgery Department of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Qiang Miao
- Cardiac Surgery Department of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Quan Li
- Cardiac Surgery Department of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Hongxing Wang
- Medical Research Center of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Guoqing Zhang
- Medical Research Center of the Hospital Affiliated with Qingdao University, Qingdao, China
| | - Yinglong Hou
- Cardiology Department of Qianfoshan Hospital Affiliated with Shandong University, Jinan, China
| | - Xiaotian Chang
- Medical Research Center of the Hospital Affiliated with Qingdao University, Qingdao, China
| |
Collapse
|
33
|
Buja LM, Ottaviani G, Mitchell RN. Pathobiology of cardiovascular diseases: an update. Cardiovasc Pathol 2019; 42:44-53. [PMID: 31255975 DOI: 10.1016/j.carpath.2019.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023] Open
Abstract
This article introduces the Second Special Issue of Cardiovascular Pathology (CVP), the official journal of the Society for Cardiovascular Pathology (SCVP). This CVP Special Issue showcases a series of commemorative review articles in celebration of the 25th anniversary of CVP originally published in 2016 and now compiled into a virtual collection with online access for the cardiovascular pathology community. This overview also provides updates on the major categories of cardiovascular diseases from the perspective of cardiovascular pathologists, highlighting publications from CVP, as well as additional important review articles and clinicopathologic references.
Collapse
Affiliation(s)
- L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA.
| | - Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and sudden infant death syndrome, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
34
|
Foulex A, Coen M, Cherkaoui A, Lazarevic V, Gaïa N, Leo S, Girard M, Mugnai D, Schrenzel J. Listeria monocytogenes infectious periaortitis: a case report from the infectious disease standpoint. BMC Infect Dis 2019; 19:326. [PMID: 30991963 PMCID: PMC6469050 DOI: 10.1186/s12879-019-3953-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/04/2019] [Indexed: 12/30/2022] Open
Abstract
Background Endograft infection is a rare but extremely dangerous complication of aortic repair (25–100% of mortality). We describe here the first case of Listeria monocytogenes abdominal periaortitis associated with a vascular graft. We also discuss the differential diagnosis of periaortitis and provide a literature review of L. monocytogenes infectious aortitis. Case presentation Nine months after endovascular treatment of an abdominal aortic aneurysm (abdominal stent graft), a 76-year-old man was admitted for severe abdominal pain radiating to the back. Laboratory tests were normal apart from elevated C-reactive protein (CRP). Injected abdominal computed tomography (CT) showed infiltration of the fat tissues around the aortic endoprosthesis and aneurysmal sac expansion; positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) showed a hypermetabolic mass in contact with the endoprosthesis. Blood cultures were negative. At surgical revision, an infra-renal peri-aortic abscess was evident; post-operative antibiotic therapy with ciprofloxacin and doxycycline was started. Cultures of intraoperative samples were positive for L. monocytogenes. Results were further confirmed by a broad-range polymerase chain reaction (PCR) and next-generation sequencing. Antibiotic treatment was switched to intravenous amoxicillin for 6 weeks. Evolution was uneventful with decrease of inflammatory parameters and regression of the abscess. Conclusion An etiologic bacterial diagnosis before starting antibiotic therapy is paramount; nevertheless, culture-independent methods may provide a microbiological diagnosis in those cases where antimicrobials are empirically used and when cultures remain negative.
Collapse
Affiliation(s)
- Aurélie Foulex
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. .,Department of Pathology and Immunology, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
| | - Abdessalam Cherkaoui
- Bacteriology Laboratory, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Department of Medical Specialties, Geneva University Hospitals and University of Geneva, CMU-C09.2141, rue Michel Servet 1, 1211, Geneva 4, Switzerland
| | - Nadia Gaïa
- Genomic Research Laboratory, Department of Medical Specialties, Geneva University Hospitals and University of Geneva, CMU-C09.2141, rue Michel Servet 1, 1211, Geneva 4, Switzerland.,Genomic Research Laboratory, CMU-C09.2138, rue Michel Servet 1, 1211, Geneva 4, Switzerland
| | - Stefano Leo
- Genomic Research Laboratory, Department of Medical Specialties, Geneva University Hospitals and University of Geneva, CMU-C09.2141, rue Michel Servet 1, 1211, Geneva 4, Switzerland
| | - Myriam Girard
- Genomic Research Laboratory, Department of Medical Specialties, Geneva University Hospitals and University of Geneva, CMU-C09.2141, rue Michel Servet 1, 1211, Geneva 4, Switzerland
| | - Damiano Mugnai
- Service of Cardiac and Vascular Surgery, Department of Surgery, Geneva University Hospitals, rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Genomic Research Laboratory, Department of Medical Specialties, Geneva University Hospitals and University of Geneva, CMU-C09.2141, rue Michel Servet 1, 1211, Geneva 4, Switzerland.,Service of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland.,Bacteriology Laboratory and Service of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals, rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
| |
Collapse
|
35
|
Yao Y, Yao J, Boström KI. SOX Transcription Factors in Endothelial Differentiation and Endothelial-Mesenchymal Transitions. Front Cardiovasc Med 2019; 6:30. [PMID: 30984768 PMCID: PMC6447608 DOI: 10.3389/fcvm.2019.00030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
The SRY (Sex Determining Region Y)-related HMG box of DNA binding proteins, referred to as SOX transcription factors, were first identified as critical regulators of male sex determination but are now known to play an important role in vascular development and disease. SOX7, 17, and 18 are essential in endothelial differentiation and SOX2 has emerged as an essential mediator of endothelial-mesenchymal transitions (EndMTs), a mechanism that enables the endothelium to contribute cells with abnormal cell differentiation to vascular disease such as calcific vasculopathy. In the following paper, we review published information on the SOX transcription factors in endothelial differentiation and hypothesize that SOX2 acts as a mediator of EndMTs that contribute to vascular calcification.
Collapse
Affiliation(s)
- Yucheng Yao
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jiayi Yao
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kristina I Boström
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Molecular Biology Institute, UCLA, Los Angeles, CA, United States
| |
Collapse
|
36
|
Syed MBJ, Fletcher AJ, Dweck MR, Forsythe R, Newby DE. Imaging aortic wall inflammation. Trends Cardiovasc Med 2018; 29:440-448. [PMID: 30611605 PMCID: PMC6853180 DOI: 10.1016/j.tcm.2018.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/10/2018] [Accepted: 12/22/2018] [Indexed: 12/17/2022]
Abstract
Inflammation affects the aortic wall through complex pathways that alter its biomechanical structure and cellular composition. Inflammatory processes that predominantly affect the intima cause occlusive disease whereas medial inflammation and degeneration cause aneurysm formation. Aortic inflammatory pathways share common metabolic features that can be localized by smart contrast agents and radiolabelled positron emission tomography (PET) tracers. 18F-Fluorodeoxyglucose (18F-FDG) is a non-specific marker of metabolism and has been widely used to study aortic inflammation in various diseased aortic states. Although useful in detecting disease, 18F-FDG has yet to demonstrate a reliable link between vessel wall disease and clinical progression. 18F-Sodium fluoride (18F-NaF) is a promising biological tracer that detects microcalcification related to active disease and cellular necrosis within the vessel wall. 18F-NaF shows a high affinity to bind to diseased arterial tissue irrespective of the underlying inflammatory process. In abdominal aortic aneurysms, 18F-NaF PET/CT predicts increased rates of growth and important clinical end-points, such as rupture or the requirement for repair. Much work remains to be done to bridge the gap between detecting aortic inflammation in at-risk individuals and predicting adverse clinical events. Novel radiotracers may hold the key to improve our understanding of vessel wall biology and how this relates to patients. Combined with established clinical and morphological assessment techniques, PET imaging promises to improve disease detection and clinical risk stratification.
Collapse
Affiliation(s)
- Maaz B J Syed
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom.
| | - Alexander J Fletcher
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Marc R Dweck
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Rachael Forsythe
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - David E Newby
- Department of Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| |
Collapse
|
37
|
Rimac G, Lafleur A. Acute infectious aortitis presenting as pyelonephritis. Am J Emerg Med 2018; 36:1722.e5-1722.e7. [DOI: 10.1016/j.ajem.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022] Open
|
38
|
Selvaraj A, Francis N, Harky A, Goli G, Bashir M. Imaging modalities in the management of aortitis. Indian J Thorac Cardiovasc Surg 2018; 35:67-71. [PMID: 33061068 DOI: 10.1007/s12055-018-0710-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
Aortitis is a pathological term that refers to the inflammation of one or more layers of the aortic wall. It is associated with a wide spectrum of inflammatory diseases of infectious and non-infectious origins, and often present with vague clinical findings and non-specific laboratory results that can model other entities. As a result, aortitis may not form part of the initial workup and appropriate treatment can be delayed or missed. Therefore, imaging modalities are required to assess for inflammation and structural changes in the aorta to support or exclude the diagnosis of aortitis. This review presents current literature on the imaging modalities utilized in the diagnosis and management of aortitis, which surgeons and physicians should be familiar with for providing optimal patient care.
Collapse
Affiliation(s)
- Andrew Selvaraj
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Niroshan Francis
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Amer Harky
- Department of Vascular Surgery, Countess of Chester Hospital, Chester, CH2 1UL UK
| | - Giridhara Goli
- Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, EC1A 7BE UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, M13 9WL UK
| |
Collapse
|
39
|
Pokhrel R, Gerstman BS, Hutcheson JD, Chapagain PP. In Silico Investigations of Calcium Phosphate Mineralization in Extracellular Vesicles. J Phys Chem B 2018. [PMID: 29519123 DOI: 10.1021/acs.jpcb.8b00169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Calcification in bone, cartilage, and cardiovascular tissues involves the release of specialized extracellular vesicles (EVs) that promote mineral nucleation. The small size of the EVs, however, makes molecular level studies difficult, and consequently uncertainty exists on the role and function of these structures in directing mineralization. The lack of mechanistic understanding associated with the initiators of ectopic mineral deposition has severely hindered the development of potential therapeutic options. Here, we used multiscale molecular dynamics simulations to investigate the calcification within the EVs. Results show that Ca2+-HPO42- and phosphatidylserine complexes facilitate the early nucleation. Use of coarse-grained simulations allows investigations of Ca2+-PO43- nucleation and crystallization in the EVs. Systematic variation in the ion-to-water ratio shows that the crystallization and growth strongly depend on the enrichment of the ions and dehydration inside the EVs. Our investigations provide insights into the role of EVs on calcium phosphate mineral nucleation and growth in both physiological and pathological mineralization.
Collapse
|
40
|
Wanga S, Hibender S, Ridwan Y, van Roomen C, Vos M, van der Made I, van Vliet N, Franken R, van Riel LA, Groenink M, Zwinderman AH, Mulder BJ, de Vries CJ, Essers J, de Waard V. Aortic microcalcification is associated with elastin fragmentation in Marfan syndrome. J Pathol 2017; 243:294-306. [PMID: 28727149 DOI: 10.1002/path.4949] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 12/20/2022]
Abstract
Marfan syndrome (MFS) is a connective tissue disorder in which aortic rupture is the major cause of death. MFS patients with an aortic diameter below the advised limit for prophylactic surgery (<5 cm) may unexpectedly experience an aortic dissection or rupture, despite yearly monitoring. Hence, there is a clear need for improved prognostic markers to predict such aortic events. We hypothesize that elastin fragments play a causal role in aortic calcification in MFS, and that microcalcification serves as a marker for aortic disease severity. To address this hypothesis, we analysed MFS patient and mouse aortas. MFS patient aortic tissue showed enhanced microcalcification in areas with extensive elastic lamina fragmentation in the media. A causal relationship between medial injury and microcalcification was revealed by studies in vascular smooth muscle cells (SMCs); elastin peptides were shown to increase the activity of the calcification marker alkaline phosphatase (ALP) and reduce the expression of the calcification inhibitor matrix GLA protein in human SMCs. In murine Fbn1C1039G/+ MFS aortic SMCs, Alpl mRNA and activity were upregulated as compared with wild-type SMCs. The elastin peptide-induced ALP activity was prevented by incubation with lactose or a neuraminidase inhibitor, which inhibit the elastin receptor complex, and a mitogen-activated protein kinase kinase-1/2 inhibitor, indicating downstream involvement of extracellular signal-regulated kinase-1/2 (ERK1/2) phosphorylation. Histological analyses in MFS mice revealed macrocalcification in the aortic root, whereas the ascending aorta contained microcalcification, as identified with the near-infrared fluorescent bisphosphonate probe OsteoSense-800. Significantly, microcalcification correlated strongly with aortic diameter, distensibility, elastin breaks, and phosphorylated ERK1/2. In conclusion, microcalcification co-localizes with aortic elastin degradation in MFS aortas of humans and mice, where elastin-derived peptides induce a calcification process in SMCs via the elastin receptor complex and ERK1/2 activation. We propose microcalcification as a novel imaging marker to monitor local elastin degradation and thus predict aortic events in MFS patients. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Shaynah Wanga
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Stijntje Hibender
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Yanto Ridwan
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Cindy van Roomen
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Mariska Vos
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ingeborg van der Made
- Department of Experimental Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Nicole van Vliet
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Romy Franken
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Luigi Amjg van Riel
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Barbara Jm Mulder
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Carlie Jm de Vries
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Essers
- Department of Molecular Genetics, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiation Oncology, Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
41
|
Antunes ML, Cabral G, Tavares R, Noronha C, Araújo J. Going Round in Circles with a Multisystemic Disease: A Unique Case of Parasitic Aortitis. Eur J Case Rep Intern Med 2017; 4:000601. [PMID: 30755949 PMCID: PMC6346790 DOI: 10.12890/2017_000601] [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: 02/16/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022] Open
Abstract
Aortitis results from aortic inflammation, frequent causes being infections and rheumatological disorders. The authors report the case of a 33-year-old black male with recent arterial hypertension, who presented with recurrent abdominal pain, jaundice, anorexia, weight loss and diarrhoea. Laboratory work-up was compatible with inflammatory anaemia and obstructive jaundice, while abdominal imaging revealed a dilated biliary tract, no visible gallstones, cephalic pancreatic globosity and aortic thickening. Pancreatic aspirate was negative for malignant cells, bacteria and Mycobacterium tuberculosis. The jaundice spontaneously subsided and the pancreatic globosity improved over time. Following positive PPD and IGRA, isoniazid was started. However, follow-up investigations revealed a severe bulbar stenosis with intense eosinophilic infiltrate, multiple non-necrotizing granulomas, and thoracic and abdominal aortitis not previously recognized. Immunological profile (ECA, ANCA and IgG4), eggs and parasites in stool samples were negative. The multisystemic disease, with an insidious and migrating behaviour, gastrointestinal and vascular involvement, granulomatous inflammatory response and tissue eosinophilia, raised the suspicion of a parasitic infestation (despite negative screening) or vasculitis. After 7 days of empirical treatment with albendazole and ivermectin, the patient passed a specimen of Ascaris lumbricoides in the stool and improved clinically.
Collapse
Affiliation(s)
- Maria Lobo Antunes
- Autoimmune Diseases Unit, Hospital Beatriz Ângelo, Loures, Portugal.,Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gonçalo Cabral
- Vascular Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Tavares
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carla Noronha
- Autoimmune Diseases Unit, Hospital Beatriz Ângelo, Loures, Portugal.,Internal Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - José Araújo
- Autoimmune Diseases Unit, Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
42
|
Cinar I, Wang H, Stone JR. Clinically isolated aortitis: pitfalls, progress, and possibilities. Cardiovasc Pathol 2017; 29:23-32. [PMID: 28500877 DOI: 10.1016/j.carpath.2017.04.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 12/12/2022] Open
Abstract
Non-infectious aortitis may be caused by several distinct systemic rheumatologic diseases. In some patients, aortitis is identified either pathologically or radiologically in the absence of clinical evidence of a systemic vasculitis. By consensus nomenclature, such cases are referred to as clinically isolated aortitis (CIA). Some systemic disorders may initially present as CIA including giant cell arteritis (GCA), IgG4-related disease, infectious aortitis, and granulomatosis with polyangiitis. CIA most commonly occurs in women of European descent over the age of 50 and, thus, mirrors the gender, age, and geographic distribution of GCA. CIA most often demonstrates a granulomatous/giant cell pattern of inflammation (GPI), and CIA-GPI is pathologically indistinguishable from aortitis due to GCA. In many cases, CIA may be a manifestation of extracranial GCA. CIA is being identified both pathologically in resected aortic tissue and radiologically by computed tomography scanning, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. However, there appears to be significant differences between pathologically defined CIA and radiologically defined CIA. Multiple studies have shown that patients with CIA are at increased risk for subsequent aortic events (new aneurysms or dissections) and thus it is recommended to monitor these patients with periodic aortic imaging. While the data is currently limited, there is increasing evidence that at least some patients with CIA may benefit from immunosuppressive therapy.
Collapse
Affiliation(s)
- Ilkay Cinar
- Department of Pathology, Prof. Dr. A. Ilhan Ozdemir Research Hospital, Giresun University, Giresun, Turkey
| | - He Wang
- Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
43
|
Al Hariri M, Zibara K, Farhat W, Hashem Y, Soudani N, Al Ibrahim F, Hamade E, Zeidan A, Husari A, Kobeissy F. Cigarette Smoking-Induced Cardiac Hypertrophy, Vascular Inflammation and Injury Are Attenuated by Antioxidant Supplementation in an Animal Model. Front Pharmacol 2016; 7:397. [PMID: 27881962 PMCID: PMC5101594 DOI: 10.3389/fphar.2016.00397] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/07/2016] [Indexed: 01/05/2023] Open
Abstract
Background: Cardiovascular diseases are the leading causes of morbidity and mortality worldwide. Cigarette smoking remains a global health epidemic with associated detrimental effects on the cardiovascular system. In this work, we investigated the effects of cigarette smoke exposure on cardiovascular system in an animal model. The study then evaluated the effects of antioxidants (AO), represented by pomegranate juice, on cigarette smoke induced cardiovascular injury. This study aims at evaluating the effect of pomegranate juice supplementation on the cardiovascular system of an experimental rat model of smoke exposure. Methods: Adult rats were divided into four different groups: Control, Cigarette smoking (CS), AO, and CS + AO. Cigarette smoke exposure was for 4 weeks (5 days of exposure/week) and AO group received pomegranate juice while other groups received placebo. Assessment of cardiovascular injury was documented by assessing different parameters of cardiovascular injury mediators including: (1) cardiac hypertrophy, (2) oxidative stress, (3) expression of inflammatory markers, (4) expression of Bradykinin receptor 1 (Bdkrb1), Bradykinin receptor 2 (Bdkrb2), and (5) altered expression of fibrotic/atherogenic markers [(Fibronectin (Fn1) and leptin receptor (ObR))]. Results: Data from this work demonstrated that cigarette smoke exposure induced cardiac hypertrophy, which was reduced upon administration of pomegranate in CS + AO group. Cigarette smoke exposure was associated with elevation in oxidative stress, significant increase in the expression of IL-1β, TNFα, Fn1, and ObR in rat's aorta. In addition, an increase in aortic calcification was observed after 1 month of cigarette smoke exposure. Furthermore, cigarette smoke induced a significant up regulation in Bdkrb1 expression level. Finally, pomegranate supplementation exhibited cardiovascular protection assessed by the above findings and partly contributed to ameliorating cardiac hypertrophy in cigarette smoke exposed animals. Conclusion: Findings from this work showed that cigarette smoking exposure is associated with significant cardiovascular pathology such as cardiac hypertrophy, inflammation, pro-fibrotic, and atherogenic markers and aortic calcification in an animal model as assessed 1 month post exposure. Antioxidant supplementation prevented cardiac hypertrophy and attenuated indicators of atherosclerosis markers associated with cigarette smoke exposure.
Collapse
Affiliation(s)
- Moustafa Al Hariri
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Kazem Zibara
- ER045, PRASE, DSST, Lebanese UniversityBeirut, Lebanon; Laboratory of Cardiovascular Diseases and Stem Cells, Biochemistry Department, Faculty of Sciences-1, EDST, Lebanese UniversityBeirut, Lebanon
| | - Wissam Farhat
- ER045, PRASE, DSST, Lebanese University Beirut, Lebanon
| | - Yasmine Hashem
- Department of Physiology, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Nadia Soudani
- Department of Physiology, Faculty of Medicine, American University of BeirutBeirut, Lebanon; Department of Biology, Faculty of Sciences, EDST, Lebanese UniversityHadath, Lebanon
| | - Farah Al Ibrahim
- Laboratory of Cardiovascular Diseases and Stem Cells, Biochemistry Department, Faculty of Sciences-1, EDST, Lebanese University Beirut, Lebanon
| | - Eva Hamade
- ER045, PRASE, DSST, Lebanese UniversityBeirut, Lebanon; Laboratory of Cardiovascular Diseases and Stem Cells, Biochemistry Department, Faculty of Sciences-1, EDST, Lebanese UniversityBeirut, Lebanon
| | - Asad Zeidan
- Department of Physiology, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| | - Ahmad Husari
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, American University of Beirut Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut Beirut, Lebanon
| |
Collapse
|