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Zong NC, Huang K, Yang X, Cai H. Expand the success of screening to reduce aortic aneurysm mortality: progress interpretation and new fronts. Trends Cardiovasc Med 2025; 35:221-229. [PMID: 39675687 DOI: 10.1016/j.tcm.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 12/04/2024] [Accepted: 12/04/2024] [Indexed: 12/17/2024]
Abstract
Aortic aneurysm is a leading cause of death across the world. Many victicms carry it without knowing. Ruputre of aortic aneurysms leads to devastating sudden death. This brings trauma to families and our society. Based upon sound results out of several cohort studies, US Preventive Services Task Force (USPST) crafted the 1st nationwide abdominal aorta aneurysm (AAA) screening program in 2005. It was renewed and expanded in subsequent revisions in 2014 and 2019. UK and Sweden estalished their own programs as well. Since then, a significant decline in AAA prevalence and mortality has been observed. Two decades into the practice, the state of the art on diagnostics, surgical approaches, and pharmacological options have drastically changed. Patients previously ineligible for treatment or inconclusive on diagnostics now have valid options. The screening program is on the verge for a bold expansion. In this review, we summarize the chroncles leading to the inception of the screening programs, progress in interpretation after implementation including gains, gaps and controversies, advents of new technologies and approaches, new fronts facing us, as well as priorities to be addressed in future phases. Particularly, screening asssys with a clinically tested biomarker, tetrahydrobiopterin (H4B), enables unpresended accessibility, consistency and throughput to accommodate the needs of a larger population. Furthermore, patients with AAAs at size below the eligibility threhold for surgical intervention (e.g., < 5.5 cm) can be treated with novel oral medications. Confronting factors such as changing demographics and COVID-19 aftermath are putting up new challenges. Nevertheless, running a program at national scale demands both unwavering commitment and agile fine-tuning. Technical innovation will be an indispensable chapter of its continued success. The burden of aortic aneurysm-led sudden death is too heavy for any family and the society to bear; it is time to step up our resolve with additional capacities as discussed in the present review.
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Affiliation(s)
- Nobel Chenggong Zong
- Division of Molecular Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Kai Huang
- Division of Molecular Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Xia Yang
- Department of Integrative Biology and Physiology, College of Life Science, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Hua Cai
- Division of Molecular Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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Nguyen TLL, Van Nguyen D, Jin Y, Kim L, Heo KS. Potential effects of a human milk oligosaccharide 6'-sialyllactose on angiotensin II-induced aortic aneurysm via p90RSK/TGF-β/SMAD2 signaling pathway. Arch Pharm Res 2024; 47:854-869. [PMID: 39463210 DOI: 10.1007/s12272-024-01515-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 10/15/2024] [Indexed: 10/29/2024]
Abstract
The aberrant phenotypic transformation of vascular smooth muscle cells (VSMCs) is a key factor in the formation of aortic aneurysm (AA). This study aimed to explore the effects of 6'-sialyllactose (6'-SL), a human milk oligosaccharide, on angiotensin II (Ang II)-induced VSMC dysfunction and AA formation both in vitro and in vivo. An AA model was established in male C57BL/6 mice challenged with Ang II via osmotic pumps and a lysyl oxidase inhibitor, β-aminopropionitrile (BAPN), in drinking water. The mice were administered with 6'-SL, FMK (a p90RSK inhibitor), or losartan (as a positive control). In vitro, VSMCs were pretreated with 6'-SL before Ang II stimulation. We found that p90RSK inhibition abolished Ang II/BAPN-induced thoracic AA and abdominal AA formation. Treatment with 100 mg/kg 6'-SL significantly attenuated Ang II/BAPN-induced aortic dilatation. 6'-SL attenuated Ang II-induced collagen deposition, calcification, and immune cell accumulation. Consistently, 6'-SL downregulated p-p90RSK, p90RSK, and p-SMAD2, and mitigated VSMC contractility loss, as indicated by α-SMA expression in vivo. Interestingly, Ang II-induced transforming growth factor-beta (TGF-β) signaling pathway was suppressed by p90RSK inhibition in VSMCs. 6'-SL treatment significantly reduced TGF-β/SMAD2 targets, including dedifferentiation markers such as osteopontin and vimentin, and elastin degradation factors MMP2 and MMP9. Overexpression of p90RSK in VSMCs enhanced TGF-β and abrogated the effects of 6'-SL. Furthermore, 6'-SL co-treatment abolished high phosphate-induced calcification in vitro via p90RSK/TGF-β signaling pathway. Altogether, our findings suggest that 6'-SL could be a potential therapeutic candidate for protecting against Ang II-induced AA formation by inhibiting the p90RSK/TGF-β/SMAD2 signaling pathway.
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MESH Headings
- Angiotensin II/pharmacology
- Animals
- Mice, Inbred C57BL
- Male
- Mice
- Aortic Aneurysm/chemically induced
- Aortic Aneurysm/metabolism
- Aortic Aneurysm/prevention & control
- Aortic Aneurysm/pathology
- Aortic Aneurysm/drug therapy
- Signal Transduction/drug effects
- Transforming Growth Factor beta/metabolism
- Humans
- Smad2 Protein/metabolism
- Ribosomal Protein S6 Kinases, 90-kDa/metabolism
- Ribosomal Protein S6 Kinases, 90-kDa/antagonists & inhibitors
- Oligosaccharides/pharmacology
- Cells, Cultured
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Disease Models, Animal
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Affiliation(s)
- Thuy Le Lam Nguyen
- College of Pharmacy, Chungnam National University, Daejeon, 34134, South Korea
| | - Dung Van Nguyen
- College of Pharmacy, Chungnam National University, Daejeon, 34134, South Korea
| | - Yujin Jin
- College of Pharmacy, Chungnam National University, Daejeon, 34134, South Korea
| | - Lila Kim
- NeuraGene Inc., 17 Techno 2-Ro, Yuseong-Gu, Daejeon, 34025, South Korea
| | - Kyung-Sun Heo
- College of Pharmacy, Chungnam National University, Daejeon, 34134, South Korea.
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Hultgren R, Sakalihasan N. Do we need new thresholds for surgical repair in patients with ascending thoracic aortic aneurysm disease? Eur Heart J 2023; 44:4589-4591. [PMID: 37042343 DOI: 10.1093/eurheartj/ehad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natzi Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, CHU Liège, University of Liège, Liège, Belgium
- Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium
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Kim M, Han JH, Kim DH, Yoon M, Jung HJ. Simultaneous Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm Combined with Saccular Thoracic Aortic Aneurysm. Vasc Specialist Int 2023; 39:29. [PMID: 37748931 PMCID: PMC10519935 DOI: 10.5758/vsi.230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
With the recent increase in imaging tests, coexisting abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) are being discovered accidentally. We report two cases of simultaneous endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) for AAA and TAA. Both 74-year-old and 79-year-old male with infrarenal AAA and saccular TAA were treated simultaneously with EVAR and TEVAR. Saccular TAAs were identified in the upper thoracic aorta during the evaluation of AAA. During endograft placement, carotid-subclavian bypass and cerebrospinal fluid (CSF) drainage were performed. Both patients were successfully discharged without spinal cord ischemia. Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. Moreover, CSF drainage may be necessary to protect the spinal cord.
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Affiliation(s)
- Minju Kim
- Department of Surgery, Biomedical Research Institue, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Hee Han
- Department of Surgery, Biomedical Research Institue, Pusan National University School of Medicine, Busan, Korea
| | - Dae Hwan Kim
- Department of Surgery, Biomedical Research Institue, Pusan National University School of Medicine, Busan, Korea
| | - Myunghee Yoon
- Department of Surgery, Biomedical Research Institue, Pusan National University School of Medicine, Busan, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Biomedical Research Institue, Pusan National University School of Medicine, Busan, Korea
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Li Y, Tao L, Xu Y, Guo R. Taxifolin ameliorates abdominal aortic aneurysm by preventing inflammation and apoptosis and extracellular matrix degradation via inactivating TLR4/NF-κB axis. Int Immunopharmacol 2023; 119:110197. [PMID: 37098322 DOI: 10.1016/j.intimp.2023.110197] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a serious aortic disease with high mortality. Vascular smooth muscle cells (VSMCs) loss is a prominent feature of AAA. Taxifolin (TXL) is a natural antioxidant polyphenol and possesses therapeutic functions in numerous human diseases. This study aimed to investigate TXL's impact on VSMC phenotype in AAA. METHODS In vitro and in vivo of VSMC injury model was induced by angiotensin II (Ang II). The potential function of TXL on AAA was determined using Cell Counting Kit-8, flow cytometry, Western blot, quantitative reverse transcription-PCR, and enzyme-linked immunosorbent assay. Meanwhile, TXL mechanism on AAA was checked by a series of molecular experiments. Also, TXL function on AAA in vivo was further evaluated using hematoxylin-eosin staining, TUNEL assay, Picric acid-Sirius red staining and immunofluorescence assay in C57BL/6 mice. RESULTS TXL alleviated Ang II-induced VSMC injury mainly by enhancing VSMC proliferation and weakening cell apoptosis, alleviating VSMC inflammation, and reducing extracellular matrix (ECM) degradation of VSMCs. Furthermore, mechanistic studies corroborated that TXL reversed the high levels of Toll-like receptor 4 (TLR4) and p-p65/p65 induced by Ang II. Also, TXL facilitated VSMC proliferation and reduced cell apoptosis, repressed inflammation, and ECM degradation of VSMCs, while these effects were reversed by TLR4 overexpression. In vivo studies further confirmed that TXL owned the function of alleviating AAA, such as alleviating collagen fiber hyperplasia and inflammatory cell infiltration in AAA mice, and repressing inflammation and ECM degradation. CONCLUSION TXL protected VSMCs against Ang II-induced injury through activating TLR4/noncanonical nuclear factor-kappaB(NF-κB).
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Affiliation(s)
- Yuanmin Li
- Department of Cardio-Thoracic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Lingyun Tao
- Shanghai Laboratory Animal Research Center, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China
| | - Rong Guo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China.
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Irtyuga O, Kopanitsa G, Kostareva A, Metsker O, Uspensky V, Mikhail G, Faggian G, Sefieva G, Derevitskii I, Malashicheva A, Shlyakhto E. Application of Machine Learning Methods to Analyze Occurrence and Clinical Features of Ascending Aortic Dilatation in Patients with and without Bicuspid Aortic Valve. J Pers Med 2022; 12:jpm12050794. [PMID: 35629216 PMCID: PMC9146498 DOI: 10.3390/jpm12050794] [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: 04/17/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023] Open
Abstract
Aortic aneurysm (AA) rapture is one of the leading causes of death worldwide. Unfortunately, the diagnosis of AA is often verified after the onset of complications, in most cases after aortic rupture. The aim of this study was to evaluate the frequency of ascending aortic aneurysm (AscAA) and aortic dilatation (AD) in patients with cardiovascular diseases undergoing echocardiography, and to identify the main risk factors depending on the morphology of the aortic valve. We processed 84,851 echocardiographic (ECHO) records of 13,050 patients with aortic dilatation (AD) in the Almazov National Medical Research Centre from 2010 to 2018, using machine learning methodologies. Despite a high prevalence of AD, the main reason for the performed ECHO was coronary artery disease (CAD) and hypertension (HP) in 33.5% and 14.2% of the patient groups, respectively. The prevalence of ascending AD (>40 mm) was 15.4% (13,050 patients; 78.3% (10,212 patients) in men and 21.7% (2838 patients) in women). Only 1.6% (n = 212) of the 13,050 patients with AD knew about AD before undergoing ECHO in our center. Among all the patients who underwent ECHO, we identified 1544 (1.8%) with bicuspid aortic valve (BAV) and 635 with BAV had AD (only 4.8% of all AD patients). According to the results of the random forest feature importance analysis, we identified the eight main factors of AD: age, male sex, vmax aortic valve (AV), aortic stenosis (AS), blood pressure, aortic regurgitation (AR), diabetes mellitus, and heart failure (HF). The known factors of AD-like HP, CAD, hyperlipidemia, BAV, and obesity, were also AD risk factors, but were not as important. Our study showed a high frequency of AscAA and dilation. Standard risk factors of AscAA such as HP, hyperlipidemia, or obesity are significantly more common in patients with AD, but the main factors in the formation of AD are age, male sex, vmax AV, blood pressure, AS, AR, HF, and diabetes mellitus. In males with BAV, AD incidence did not differ significantly, but the presence of congenital heart disease was one of the 12 main risk factors for the formation of AD and association with more significant aortic dilatation in AscAA groups.
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Affiliation(s)
- Olga Irtyuga
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
- Correspondence:
| | - Georgy Kopanitsa
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
- Department of Cardiac Surgery, Medical School, ITMO University, 49 Kronverskiy Prospect, 197101 Saint Petersburg, Russia;
| | - Anna Kostareva
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
| | - Oleg Metsker
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
| | - Vladimir Uspensky
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
| | - Gordeev Mikhail
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
| | - Giuseppe Faggian
- Department of Cardiac Surgery, Medical School, University of Verona, 37126 Verona, Italy;
| | - Giunai Sefieva
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
| | - Ilia Derevitskii
- Department of Cardiac Surgery, Medical School, ITMO University, 49 Kronverskiy Prospect, 197101 Saint Petersburg, Russia;
| | - Anna Malashicheva
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
| | - Evgeny Shlyakhto
- Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia; (G.K.); (A.K.); (O.M.); (V.U.); (G.M.); (G.S.); (A.M.); (E.S.)
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MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal. Tomography 2022; 8:200-228. [PMID: 35076599 PMCID: PMC8788571 DOI: 10.3390/tomography8010017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.
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