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Lu S, White JV, Nwaneshiudu I, Nwaneshiudu A, Monos DS, Solomides CC, Oleszak EL, Platsoucas CD. Human abdominal aortic aneurysm (AAA): Evidence for an autoimmune antigen-driven disease. Clin Exp Rheumatol 2022; 21:103164. [PMID: 35926768 DOI: 10.1016/j.autrev.2022.103164] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/02/2022]
Abstract
Abdominal aortic aneurism (AAA) is a complex immunological disease with a strong genetic component, and one of the ten leading causes of death of individuals 55-74 years old worldwide. Strong evidence has been accumulated suggesting that AAA is an autoimmune specific antigen-driven disease. Mononuclear cells infiltrating AAA lesions comprised of T and B lymphocytes and other cells expressing early-, intermediate- and late-activation antigens, and the presence of antigen-presenting cells have been documented, demonstrating an ongoing immune response. The three components of the trimolecular complex, T-cell receptor (TCR)/peptide (antigen)/HLA have been identified in AAA, and specifically: (i) clonal expansions of T-cell clones in AAA lesions; (ii) the association of AAA with particular HLA Class I and Class II; and (iii) self or nonself putative AAA-associated antigens. IgG autoantibodies recognizing proteins present in normal aortic tissue have been reported in patients with AAA. Molecular mimicry, defined as the sharing of antigenic epitopes between microorganisms (bacteria, viruses) and self antigens, maybe is responsible for T-cell responses and antibody production in AAA. Also, the frequency and the suppressor activity of CD4 + CD25 + FOXP3+ Tregs and the expression of FOXP3 transcripts and protein have been reported to be significantly impaired in AAA patients vs normal donors.
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Affiliation(s)
- Song Lu
- Mon Health Medical Center, Department of Pathology, Morgantown, WV, USA
| | - John V White
- Department of Surgery, Advocate Lutheran General Hospital & University of Illinois School of Medicine, Park Ridge, IL, USA
| | - Ifeyinwa Nwaneshiudu
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adaobi Nwaneshiudu
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA, USA; Cutis Wellness Dermatology and Dermatopathology PLLC, Laredo, TX, USA
| | - Dimitri S Monos
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Charalambos C Solomides
- Department of Pathology & Laboratory Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Emilia L Oleszak
- Department of Biological Sciences and Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA
| | - Chris D Platsoucas
- Department of Biological Sciences and Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA.
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Anaya-Ayala JE, Escamilla-Tilch M, Granados J, Hernandez-Dono S, Hernandez-Sotelo K, Lozano-Corona R, Ruiz-Gomez D, Garcia-Toca M, Hinojosa CA. Investigation of an Immunogenetic Profile in Patients with Abdominal Aortic Aneurysms and Possible Applications in Screening and Surveillance. Ann Vasc Surg 2019; 62:57-62. [PMID: 31201975 DOI: 10.1016/j.avsg.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/20/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The pathogenesis of atherosclerotic abdominal aortic aneurysms (AAAs) remains not fully understood. Histological analyses confirm chronic adventitial and medial inflammatory cell infiltration, and its pathophysiology involves the upregulation of proteolytic pathways; added to this, genetic factors have been suggested to favor the susceptibility for AAA. The aim of the present study was to analyze the association between genetic polymorphism of the class II human leukocyte antigens (HLAs, HLA-DRB1) with the susceptibility to develop AAA in Mexican patients and to initiate a pilot study of single-nucleotide polymorphisms (SNPs) rs1024611 in the monocyte chemoattractant protein-1 (MCP-1/CCL2) gene to investigate a possible role in the AAA pathogenesis. METHODS In a cohort of patients with AAA, HLA molecular typing was completed for DRB1 loci with LABType SSO-One Lambda kit in 39 patients (69% men with a mean age of 72 years) and compared with 99 without the disease (60% men, mean age 65 years) (control group). Genotyping of rs1024611 in the MCP-1 gene was performed using TaqMan predesigned SNP genotyping assays in 27 patients with AAA (63% men, mean age of 71). Gene frequencies (gfs) and genotype frequencies (Gfs) were determined; categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), and odds ratios (ORs) were calculated using the STATA v14 software and StatCalc software Epi Info™ 7.2.2.2. RESULTS Seventy-eight HLA-DRB1 alleles of patients with AAA and 198 from the control group were studied. We observed that the gf of HLA-DRB1*01 was 0.128 in the AAA group compared with 0.05 in the control group (P = 0.03, OR: 2.6, 95% confidence interval [CI]: 1.04-6.5); the gf of HLA-DRB1*16 was 0.115 in the AAA and 0.025 in control group (P = 0.002, OR: 5, 95% CI: 1.6-16.9). The Gf for SNP rs1024611 were 0.51 in the GA genotype, 0.30 in AA, and 0.19 of GG. Four patients with the proinflammatory homozygous genotype GG (80%) were women and younger than patients with other genotypes, and only one had a history of dyslipidemia. CONCLUSIONS The dissection and interpretation of an immunogenetic profile in patients with AAA is an active and complex field of research that might assist in a more precise identification of those patients at genetic risk. Our study demonstrated increased frequencies of HLA-DRB1*01 and HLA-DRB1*16 alleles in Mexican patients with AAA compared with an ethnically matched control group.
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Affiliation(s)
- Javier E Anaya-Ayala
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico; Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico
| | | | - Julio Granados
- Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico; Division of Immunogenetics, Department of Transplant Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Susana Hernandez-Dono
- Division of Immunogenetics, Department of Transplant Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Kemberly Hernandez-Sotelo
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico
| | - Rodrigo Lozano-Corona
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico; Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico
| | - Daniela Ruiz-Gomez
- Division of Immunogenetics, Department of Transplant Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos A Hinojosa
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Section of Vascular Surgery and Endovascular Therapy, Mexico City, Mexico; Division for Postgraduate studies, Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Master and Doctoral degree program, Mexico City, Mexico.
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Anaya-Ayala JE, Hernandez-Doño S, Escamilla-Tilch M, Marquez-Garcia J, Hernandez-Sotelo K, Lozano-Corona R, Ruiz-Gomez D, Granados J, Hinojosa CA. Genetic polymorphism of HLA-DRB1 alleles in Mexican mestizo patients with abdominal aortic aneurysms. BMC MEDICAL GENETICS 2019; 20:102. [PMID: 31174489 PMCID: PMC6555914 DOI: 10.1186/s12881-019-0833-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multiple factors are implicated in the etiology and pathogenesis of Abdominal Aortic Aneurysms (AAA). Available literature of genetic studies has previously suggested the possible roles of autoimmunity, genetic predisposition and ethnic susceptibility. Due to the association with autoimmune diseases and proven application in population genetics, we aimed to investigate alleles of the Class II Human Leukocyte Antigens (HLA-DRB1) in the Mexican Mestizo population with aortic aneurysms and determine possible associations with susceptibility. METHODS We performed a case Control Study; the HLA molecular typing was completed for DRB1 loci by LabType Sequence-Specific Oligonucleotide (SSO) SSO-OneLambda kit (Applied Biosystems; Thermo Fisher Scientific. Inc.) in the studied individuals. Allele frequencies (af) were determined, associations were assessed by chi square or fisher exact tests at significance level (< 0.05), and Odds Ratios (OR) were calculated using the STATA software version 14. RESULTS The genetic polymorphism of HLA-DRB1 of fifty one patients (70% males with a mean age of 71 years) with atherosclerotic or also known as degenerative AAA were compared with 99 unrelated patients (60% males, mean age 65 years) without the disease [Control group (CG)] from the same ethnic group. We examined a total of 102 Class II HLA-DRB1 alleles of AAA patients and 198 from CG. When comparing af, we observed the HLA-DRB1*01 af of 0.139 in the AAA compared to 0.05 in the CG [p = 0.015, OR 3, 95% confidence interval (CI) 1.29-7.08], the HLA-DRB1*16 af were 0.109 in the AAA and 0.025 in CG (p = 0.006, OR 4.7, 95% CI 1.59-13.98). CONCLUSIONS Our study confirmed increased frequencies of the alleles HLA-DRB1*01 and HLA-DRB1*16 and their association to the development of AAA in Mexican Mestizo patients. The utility of genetic testing may assist in identifying individuals at genetic risk for the development of this disease in different ethnic groups, who might benefit from earlier ultrasound screening and closer imaging surveillance.
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Affiliation(s)
- Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico
| | - Susana Hernandez-Doño
- Department of Transplant Surgery, Division of Immunogenetics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | | | - Jose Marquez-Garcia
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Biochemistry Unit, Mexico City, Mexico
| | - Kemberly Hernandez-Sotelo
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico
| | - Rodrigo Lozano-Corona
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico
| | - Daniela Ruiz-Gomez
- Department of Transplant Surgery, Division of Immunogenetics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Julio Granados
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico
- Department of Transplant Surgery, Division of Immunogenetics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Vasco De Quiroga 15, Tlalpan, Sección XVI, 14080, México City, Mexico.
- Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Division for Postgraduate Studies, Master and Doctoral Degree Program, Mexico City, Mexico.
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Tilson MD. Autoimmunity in the Abdominal Aortic Aneurysm and its Association with Smoking. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2018; 5:159-167. [PMID: 29766007 DOI: 10.12945/j.aorta.2017.17.693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022]
Abstract
Smoking increases the risk of abdominal aortic aneurysm (AAA) in both humans and mice, although the underlying mechanisms are not completely understood. An adventitial aortic antigen, AAAP-40, has been partially sequenced. It has motifs with similarities to all three fibrinogen chains and appears to be connected in evolution to a large family of proteins called fibrinogen-related proteins. Fibrinogen may undergo non-enzymatic nitration, which may result from exposure to nitric oxide in cigarette smoke. Nitration of proteins renders them more immunogenic. It has recently been reported that anti-fibrinogen antibody promotes AAA development in mice. Also, anti-fibrinogen antibodies are present in patients with AAA. These matters are reviewed in the overall context of autoimmunity in AAA. The evidence suggests that smoking amplifies an auto-immune reaction that is critical to the pathogenesis of AAA.
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Affiliation(s)
- M David Tilson
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Chang TW, Gracon ASA, Murphy MP, Wilkes DS. Exploring autoimmunity in the pathogenesis of abdominal aortic aneurysms. Am J Physiol Heart Circ Physiol 2015; 309:H719-27. [DOI: 10.1152/ajpheart.00273.2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
Abstract
The abdominal aortic aneurysm (AAA) is a disease process that carries significant morbidity and mortality in the absence of early identification and treatment. While current management includes surveillance and surgical treatment of low- and high-risk aneurysms, respectively, our narrow understanding of the pathophysiology of AAAs limits our ability to more effectively manage and perhaps even prevent the occurrence of this highly morbid disease. Over the past couple of decades, there has been considerable interest in exploring the role of autoimmunity as an etiological component of AAA. This review covers the current literature pertaining to this immunological process, focusing on research that highlights the local and systemic immune components found in both human patients and murine models. A better understanding of the autoimmune mechanisms in the pathogenesis of AAAs can pave the way to novel and improved treatment strategies in this patient population.
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Affiliation(s)
- Tiffany W. Chang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Adam S. A. Gracon
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Michael P. Murphy
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - David S. Wilkes
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since the first candidate gene studies were published 20 years ago, approximately 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. These studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, only when appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called contactin-3, which is located on chromosome 3p12.3. However, two follow-up studies could not replicate this association. Two other SNPs, which are located on chromosome 9p21 and 9q33, were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense ribonucleic acid that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute toward AAA pathogenesis.
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Saratzis A, Abbas AA, Kiskinis D, Melas N, Saratzis N, Kitas GD. Abdominal aortic aneurysm: a review of the genetic basis. Angiology 2010; 62:18-32. [PMID: 20566578 DOI: 10.1177/0003319710373092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a complex disease with a largely unknown pathophysiological background and a strong genetic component. Various studies have tried to link specific genetic variants with AAA. METHODS Systematic review of the literature (1947-2009). RESULTS A total of 249 studies were identified, 89 of which were eventually deemed relevant to this review. Genetic variants (polymorphisms) in a wide variety of genes, most of which encode proteolytic enzymes and inflammatory molecules, have been associated with AAA development and progression. CONCLUSION The genetic basis of AAA remains unknown, and most results from ''candidate-gene'' association studies are contradictory. Further analyses in appropriately powered studies in large, phenotypically well-characterized populations, including genome-wide association studies, are necessary to elucidate the exact genetic contribution to the pathophysiology of AAA.
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Affiliation(s)
- Athanasios Saratzis
- Russell's Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, West Midlands, UK.
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Jagadesham VP, Scott DJA, Carding SR. Abdominal aortic aneurysms: an autoimmune disease? Trends Mol Med 2008; 14:522-9. [PMID: 18980864 DOI: 10.1016/j.molmed.2008.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 09/29/2008] [Accepted: 09/29/2008] [Indexed: 11/26/2022]
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Kuivaniemi H, Platsoucas CD, Tilson MD. Aortic aneurysms: an immune disease with a strong genetic component. Circulation 2008; 117:242-52. [PMID: 18195185 DOI: 10.1161/circulationaha.107.690982] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Helena Kuivaniemi
- Center for Molecular Medicine and Genetics and Department of Surgery, Wayne State University School of Medicine, 540 E Canfield Ave, Detroit, MI 48201, USA.
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Sandford RM, Bown MJ, London NJ, Sayers RD. The Genetic Basis of Abdominal Aortic Aneurysms: A Review. Eur J Vasc Endovasc Surg 2007; 33:381-90. [PMID: 17276705 DOI: 10.1016/j.ejvs.2006.10.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 10/25/2006] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The pathogenesis of abdominal aortic aneurysm (AAA) remains poorly understood, however significant evidence has emerged in recent years to suggest a chronic inflammatory process. Observational studies have highlighted a familial trend towards AAA development among relatives of affected individuals and it is thought that inflammatory genes may influence an individual's susceptibility. Conflicting reports exist over single gene versus multiple gene inheritance patterns in addition to a collection of studies examining individual inflammatory genes. This paper reviews the evidence for a genetic predisposition to aneurysm formation including familial and segregation studies in addition to experimental evidence investigating specific candidate genes. METHOD Medline and Pubmed database searches were conducted using the search terms abdominal aortic aneurysm and gene. Papers were reviewed and references manually searched for further relevant publications which were added to the data. Papers were categorised under the headings familial, segregation and candidate gene studies. RESULTS A review of 58 papers is presented under sub-headings as above. In the case of the candidate gene section, a brief report of the functional relevance of each gene is included. CONCLUSION A summary of the evidence presented is given and the direction of future work in this field is briefly considered.
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Affiliation(s)
- R M Sandford
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Leicester, UK.
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Badger SA, Soong CV, O'Donnell ME, Middleton D. The role of human leukocyte antigen genes in the formation of abdominal aortic aneurysms. J Vasc Surg 2007; 45:475-80. [PMID: 17321339 DOI: 10.1016/j.jvs.2006.09.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 09/19/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing evidence suggests an autoimmune component to abdominal aortic aneurysm (AAA) formation. This study was conducted to determine if a difference exists in human leukocyte antigen (HLA) allele distribution between patients with AAA and population controls, and between patients with small and large AAA. METHODS Patients with known AAA attending the vascular unit were consented for recruitment. HLA-A, HLA-B and HLA-DR was determined by polymerase chain reaction and sequence-specific oligonucleotide probes. The distribution of these alleles in the Northern Ireland general population was obtained from the histocompatibility and immunogenetics database. The chi(2) test was used for statistical analysis with Bonferroni correction. RESULTS A total of 241 AAA patients were recruited, with a wide range of aneurysm size. In class I, the most frequent allele families were HLA-A*02 and *01 and HLA-B*07, *08, and *44. In class II, HLA-DRB1*03, *04, *07, and *15 were the most frequent. HLA-A*11 was lower in AAA cases (10.4% vs 15.0%; P = .08), whereas HLA-B*08 was lower in the controls (29.8% vs 36.5%; P = .05) and HLA-DRB1*11 was lower in cases (4.2% vs 8.1%; P = .05). After Bonferroni correction, however, the proportion of allele families was not significantly different in AAA patients compared with the proportion seen in controls. HLA-DRB1*11 and *14 had a lower prevalence in large AAAs (0.9% vs 6.7% [P = .05]; 0.0% vs 5.9% [P = .03]). HLA-A*68 was also lower in large AAA (1.9% vs 11.9%; P = .0075). After Bonferroni correction, however, no difference was demonstrated between small and large aneurysms. CONCLUSION This study provides more definitive results on this important subject and has failed to demonstrate the risk association between AAA and these alleles as reported by others. Therefore, the role of these particular genes and the autoimmune component in AAA etiology does not appear to be as crucial as previously proposed.
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Affiliation(s)
- Stephen A Badger
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, United Kingdom.
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Platsoucas CD, Lu S, Nwaneshiudu I, Solomides C, Agelan A, Ntaoula N, Purev E, Li LP, Kratsios P, Mylonas E, Jung WJ, Evans K, Roberts S, Lu Y, Layvi R, Lin WL, Zhang X, Gaughan J, Monos DS, Oleszak EL, White JV. Abdominal aortic aneurysm is a specific antigen-driven T cell disease. Ann N Y Acad Sci 2007; 1085:224-35. [PMID: 17182939 DOI: 10.1196/annals.1383.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine whether monoclonal/oligoclonal T cells are present in abdominal aortic aneurysm (AAA) lesions, we amplified beta-chain T cell receptor (TCR) transcripts from these lesions by the nonpalindromic adaptor (NPA)-polymerase chain reaction (PCR)/V-beta-specific PCR followed by cloning and sequencing. Sequence analysis revealed the presence of substantial proportions of identical beta-chain TCR transcripts in AAA lesions in 9 of 10 patients examined, strongly suggesting the presence of oligoclonal populations of alphabeta TCR+ T cells. We have also shown the presence of oligoclonal populations of gammadelta TCR+ T cells in AAA lesions. Sequence analysis after appropriate PCR amplification and cloning revealed the presence of substantial proportions of identical VgammaI and VgammaII TCR transcripts in 15 of 15 patients examined, and of Vdelta1 and Vdelta2 TCR transcripts in 12 of 12 patients. These clonal expansions were very strong. All these clonal expansions were statistically significant by the binomial distribution. In other studies, we determined that mononuclear cells infiltrating AAA lesions express early- (CD69), intermediate- (CD25, CD38), and late- (CD45RO, HLA class II) activation antigens. These findings suggest that active ongoing inflammation is present in the aortic wall of patients with AAA. These results demonstrate that oligoclonal alphabeta TCR+ and gammadelta TCR+T cells are present in AAA lesions. These oligoclonal T cells have been clonally expanded in vivo in response to yet unidentified antigens. Although the antigenic specificity of these T cells remains to be determined, these T cells may play a significant role in the initiation and/or the propagation of the AAA. It appears that AAA is a specific antigen-driven T cell disease.
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Affiliation(s)
- Chris D Platsoucas
- Department of Microbiology, Temple University School of Medicine, 3400 North Broad Street, Philadelphia, PA 19140, USA.
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Tilson MD, Ro CY. The candidate gene approach to susceptibility for abdominal aortic aneurysm: TIMP1, HLA-DR-15, ferritin light chain, and collagen XI-Alpha-1. Ann N Y Acad Sci 2007; 1085:282-90. [PMID: 17182944 DOI: 10.1196/annals.1383.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
There are two approaches to gene discovery for diseases when genetic susceptibility has been implicated by clinical genetic or case-control studies: (1) genome-wide screening and (2) evaluation of candidate genes. Each has specific advantages and disadvantages. The principal advantage of genome-wide screening is that it is impeccably objective in as much as it proceeds without any presuppositions regarding the importance of specific pathobiological features of the disease process. The principal disadvantage is that such a study is expensive and resource intensive. A large population of enrolled patients and multidisciplinary teams of investigators cooperating from several institutions are usually required. The alternative approach of evaluating candidate genes can be pursued by a small independent laboratory with limited funding and resources, a small collection of clinical specimens, and a small number of team players. The disadvantage is that it is by necessity highly subjective in the process of selecting specific candidates among many reasonable possibilities. There is no a priori assurance that effort will not be expended on one or more candidates that turn out in the end to be failures. This report reviews efforts in our laboratory to evaluate four genes as candidates. One of these tissue inhibitor of metalloprotease 1(TIMP1) led to the description of a polymorphism, but not a conclusive mutation. The other three (HLA-DR-15, ferritin light chain (FTL), and collagen XI-alpha-1 (COL11A1) are subjects of continuing interest.
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Affiliation(s)
- M David Tilson
- Department of Surgery, St. Luke's-Roosevelt Hospital Center, Continuum Health Partners, New York, New York 10019, USA.
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Duftner C, Seiler R, Dejaco C, Fraedrich G, Schirmer M. Increasing evidence for immune-mediated processes and new therapeutic approaches in abdominal aortic aneurysms--a review. Ann N Y Acad Sci 2007; 1085:331-8. [PMID: 17182953 DOI: 10.1196/annals.1383.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Animal models for abdominal aortic aneurysms (AAAs), immunogenetical and pathophysiological studies support the importance of immune-mediated processes in the pathogenesis of AAA disease. Neutrophils, natural killer (NK) cells, monocytes/macrophages, and proinflammatory cytokines are involved in the complex and dynamic tissue remodeling of the AAA vessel wall. Our group showed an increased prevalence of circulating interferon-gamma (IFN-gamma) producing CD28(-) T cells especially in smaller AAAs, thus supporting the concept of a T cell-mediated pathophysiology of AAAs, especially during the early development of AAAs. Further research should now assess the possible benefit of anti-inflammatory therapeutic approaches in AAA patients, especially with small AAAs.
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Affiliation(s)
- Christina Duftner
- Department of Internal Medicine, Clinical Division of General Internal Medicine, Innsbruck Medical University, Innsbruck, Austria
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Frösen J, Pitkäniemi J, Tulamo R, Marjamaa J, Isoniemi H, Niemelä M, Jääskeläinen J, Lokki ML, Matinlauri I. Association of fatal aneurysmal subarachnoid hemorrhage with human leukocyte antigens in the Finnish population. Hum Immunol 2006; 68:100-5. [PMID: 17321899 DOI: 10.1016/j.humimm.2006.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022]
Abstract
Human leukocyte antigens (HLA) have been reported to associate with the risk of aneurysmal subarachnoid hemorrhage (SAH) and poor outcome after SAH. Our aim was to identify HLA antigens that associate with the risk of fatal SAH in the Finnish population. Medical records of 600 cadaveric organ donors were reviewed to find organ donors that succumbed to SAH (n = 232) or brain trauma (n = 151). HLA antigen frequencies in these groups were compared with HLA frequencies in a reference population of 10,000 bone marrow donors. Chi-Square test with Bonferroni correction and multiplicative logistic regression models were used and false positive result probabilities (FPRP) were calculated. Alpha-level was 0.01. HLA-A3 associated with fatal SAH (p = 0.0014, OR 1.3 and 95%CI 1.1-1.6) and HLA-DR7 inversely associated with fatal SAH (p = 0.0040, OR 0.3 and 95%CI 0.2-0.6). HLA-A3 but not HLA-DR7 showed also a positive trend in donors with brain trauma. FPRP was below 0.5 for HLA-A3, but clearly above 0.5 for HLA-DR7. HLA-A3 seems to associate with fatal SAH in the Finnish population. Further studies are needed to reveal the pathobiologic mechanisms for how HLA-A3 associates with the risk of fatal SAH in Finns.
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Affiliation(s)
- Juhana Frösen
- Neurosurgery Research Group, Biomedicum Helsinki, Helsinki, Finland.
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Pearce WH, Shively VP. Abdominal Aortic Aneurysm as a Complex Multifactorial Disease: Interactions of Polymorphisms of Inflammatory Genes, Features of Autoimmunity, and Current Status of MMPs. Ann N Y Acad Sci 2006; 1085:117-32. [PMID: 17182928 DOI: 10.1196/annals.1383.025] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The role of matrix metalloproteinases (MMPs) in the pathogenesis of abdominal aortic aneurysm (AAA) has focused on the degradation of the extracellular matrix (ECM). The new frontier of MMP biology involves the role of MMPs in releasing cryptic fragments and neoepitopes from the ECM and the impact of MMPs on the regulation of the inflammatory response. The ECM is a complex structure, much more important than an inert scaffold. Both MMP-2 and MMP-9 expose a cryptic epitope that controls angiogenesis. MMPs inhibit angiogenesis through the release of endostatin, endorepellin, arresten, canstatin, and tumstatin. Other breakdown products of the ECM include fragments of fragmin and elastin degradation products (EDPs). In addition, the ECM contains embedded vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-beta). Inflammation is a complex, highly regulated system that involves the identification of injury or infection, response to the injury or infection, repair and healing, and return to normal homeostasis. In some instances, the inflammatory process leads to a pathologic process that is damaging to the host. MMPs play an important role in the control of the inflammatory response through the modification of proinflammatory cytokines, chemokines, and shedding of membrane receptors. Genetic association studies have been performed to help determine the genetic risk associated with certain single nucleotide polymorphisms (SNPs) However, because of the variability in the patient populations and the size of the population, it is difficult to draw any conclusions from these studies. While the etiology of AAA remains unknown, understanding of the inflammatory process and its regulatory points will develop new strategies for the treatment of AAA. Perhaps one difficulty with understanding the pathogenesis of AAA is the lack of precise definition of the phenotype.
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Affiliation(s)
- William H Pearce
- Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Wang JF, Zhang D, Zhao JZ, Jia BX, Bi RM. A study on the relationship between HLA-DR, DQ antigen, and intracranial aneurysm in the Han nationality. ACTA ACUST UNITED AC 2006; 66 Suppl 1:S25-8; discussion S28-9. [PMID: 16904993 DOI: 10.1016/j.surneu.2006.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND To investigate the relationship between HLA-DR, DQ antigen, and intracranial aneurysm in the Han nationality. METHODS We compared the occurrence of HLA-DR and HLA-DQ antigens in patients with intracranial saccular aneurysm and in the control group by PCR and agarose gel electrophoresis. RESULTS No statistically significant correlation between HLA-DR, HLA-DQ antigen frequency, and the pathogenesis and clinical characteristics of intracranial aneurysm has been found. CONCLUSIONS We have not found any relationship between HLA-DR and HLA-DQ antigen frequency, haplotype frequency, and pathogenesis and clinical characteristics of intracranial aneurysm, but the patients who presented with HLA-DR53, DR52, DQ7(3), and DQ5(1) seem to be more likely to bear multiple intracranial aneurysms.
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Affiliation(s)
- Jiang-Fei Wang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital University of Medical Sciences, Beijing 100050, China.
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Ogata T, Gregoire L, Goddard KAB, Skunca M, Tromp G, Lancaster WD, Parrado AR, Lu Q, Shibamura H, Sakalihasan N, Limet R, MacKean GL, Arthur C, Sueda T, Kuivaniemi H. Evidence for association between the HLA-DQA locus and abdominal aortic aneurysms in the Belgian population: a case control study. BMC MEDICAL GENETICS 2006; 7:67. [PMID: 16879749 PMCID: PMC1559600 DOI: 10.1186/1471-2350-7-67] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 07/31/2006] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic inflammation and autoimmunity likely contribute to the pathogenesis of abdominal aortic aneurysms (AAAs). The aim of this study was to investigate the role of autoimmunity in the etiology of AAAs using a genetic association study approach with HLA polymorphisms. METHODS HLA-DQA1, -DQB1, -DRB1 and -DRB3-5 alleles were determined in 387 AAA cases (180 Belgian and 207 Canadian) and 426 controls (269 Belgian and 157 Canadian) by a PCR and single-strand oligonucleotide probe hybridization assay. RESULTS We observed a potential association with the HLA-DQA1 locus among Belgian males (empirical p = 0.027, asymptotic p = 0.071). Specifically, there was a significant difference in the HLA-DQA1*0102 allele frequencies between AAA cases (67/322 alleles, 20.8%) and controls (44/356 alleles, 12.4%) in Belgian males (empirical p = 0.019, asymptotic p = 0.003). In haplotype analyses, marginally significant association was found between AAA and haplotype HLA-DQA1-DRB1 (p = 0.049 with global score statistics and p = 0.002 with haplotype-specific score statistics). CONCLUSION This study showed potential evidence that the HLA-DQA1 locus harbors a genetic risk factor for AAAs suggesting that autoimmunity plays a role in the pathogenesis of AAAs.
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Affiliation(s)
- Toru Ogata
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lucie Gregoire
- Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Katrina AB Goddard
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Magdalena Skunca
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gerard Tromp
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Wayne D Lancaster
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Antonio R Parrado
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Qing Lu
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hidenori Shibamura
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Natzi Sakalihasan
- Department of Cardiovascular Surgery, University of Liège, Liège, Belgium
| | - Raymond Limet
- Department of Cardiovascular Surgery, University of Liège, Liège, Belgium
| | | | | | - Taijiro Sueda
- Department of Surgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
| | - Helena Kuivaniemi
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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Hemminki K, Li X, Johansson SE, Sundquist K, Sundquist J. Familial risks of aortic aneurysms among siblings in a nationwide Swedish study. Genet Med 2006; 8:43-9. [PMID: 16418598 DOI: 10.1097/01.gim.0000195973.60136.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Aortic aneurysms have a high fatality rate that could be reduced with control of risk factors and use of available screening methods for detection of early changes in aortic walls. The available data on familial risks, a potential indication for screening, are mainly limited to abdominal aortic aneurysms. METHODS A nationwide Swedish cohort was constructed by linking the Multigeneration Register on 0- to 69-year-old siblings to the Hospital Discharge Register and the Cause of Death Register for data on aortic aneurysms from years 1987 to 2001. Standardized incidence ratios (SIRs) were calculated for affected siblings by comparing with those whose siblings had no aneurysm. RESULTS A total of 71 affected siblings were identified with a familial SIR of 8.71; when one sibling was diagnosed before age 50 years, the SIR was 19.69. For concordant thoracic or concordant abdominal aneurysms, the SIRs were 21.68 and 13.06, respectively. For brothers, the risk of abdominal aneurysms was 14.63, and 49.50 for diagnosis before age 50 years. Familial risks and the effects of early diagnostic age were shared by the anatomic subtypes of aneurysms. Within limits of the sample size, no gender differences could be observed. Affected siblings constituted 2.2% of all diagnosed patients. CONCLUSIONS A family history of any aortic aneurysms and age groups younger than 50 years should be considered in recommendations for screening. The high familial risks are likely to be the result of heritable genes, the identification of which would allow gene testing and preventive counseling.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
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Papel de los polimorfismos del promotor del gen de la interleucina-10 en la génesis de los aneurismas de la aorta abdominal. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)74982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Zhang B, Fugleholm K, Day LB, Ye S, Weller RO, Day INM. Molecular pathogenesis of subarachnoid haemorrhage. Int J Biochem Cell Biol 2003; 35:1341-60. [PMID: 12798348 DOI: 10.1016/s1357-2725(03)00043-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Subarachnoid haemorrhage (SAH) results from leakage of blood into the subarachnoid space and carries high morbidity and mortality. However, there is limited understanding to date, of the risk factors, cellular, intermediate biochemical and genetic traits predisposing to SAH. Nevertheless, in conjunction with improved methods of diagnostic imaging and less invasive approaches to preventing aneurysmal rupture, there may be utility in gaining a better understanding of the pathogenesis and in identifying pre-disease markers. Additionally, it is not impossible that drugs of value (e.g. matrix or endothelial modifiers) could become available. Several different clinical subtypes can be recognised, distinguished by arterial or venous involvement, presence of unruptured arterial aneurysms, and apparently "sporadic" and "familial" occurrences. Epidemiological risk factors include alcohol consumption and smoking: hypertension is a risk factor for rupture. About 10% seem to reflect strong family history and this subset may be particularly illuminating with respect to the molecular pathogenesis. Haemodynamic stress and poor vascular structure may be the main mechanisms of pathogenesis. The epidemiological and statistical evidence for familial megaphenic genes and modifier genes is reviewed. This review focuses on the pathogenesis, as opposed to inflammatory response to SAH. It sets in context the roles of specific genes and their protein products, such as polycystin (PKD1), fibrillin (FBN1), collagen III (COL3A1), elastin (ELN), collagen IV, protease inhibitor or alpha1-antitrypsin (PI) and proteases. These considerations illustrate the shortfalls in current knowledge, the needs of future biochemical and cellular research and their potential implications for future prevention of this often fatal condition.
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Affiliation(s)
- Baiping Zhang
- Human Genetics Division, School of Medicine, Southampton University Hospital NHS Trust, Duthie Building (Mailpoint 808), Tremona Road, Southampton SO16 6YD, UK
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Moñux G, Serrano FJ, Vigil P, De la Concha EG. Role of HLA-DR in the pathogenesis of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2003; 26:211-4. [PMID: 12917840 DOI: 10.1053/ejvs.2002.1897] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to establish a possible role for autoimmunity in the aetiology of abdominal aortic aneurysm (AAA) by examining human leukocyte antigen class II (HLA-II) immune response genes. MATERIALS AND METHODS HLA-II typing was performed in a series of 72 AAA patients and a control group of 380 healthy subjects. RESULTS a higher incidence of the allele subtype HLA-DR B1*0401 was detected in the AAA group with respect to the control group (12.5 vs 5.2%; p = 0.02, OR 2.59). In contrast, the HLA-DR B1*01 allele tended to behave as a protective factor for AAA (12.5% AAA vs 21.3% controls; p = 0.09, OR 0.5). CONCLUSIONS the association observed here between HLA-DR B1*0401 and HLA-DR B1*01 and unspecific AAA is similar to that reported in several autoimmune diseases. This similarity suggests an essential role for autoimmune factors in the formation of the AAA.
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Affiliation(s)
- G Moñux
- Department of Angiology and Vascular Surgery, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040 Madrid, Spain
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Sugimoto T, Sada M, Miyamoto T, Yao H. Genetic analysis on HLA loci in Japanese patients with abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2003; 26:215-8. [PMID: 12917841 DOI: 10.1053/ejvs.2002.1912] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE autoimmunity has been proposed as one of the pathogenesis of abdominal aortic aneurysm (AAA). There is also a likelihood that when aorto-iliac occlusive disease (AIOD) coexists with AAA, some other occlusive atherosclerotic diseases, such as ischemic heart disease and cerebrovascular disease, may develop, leading to a very poor long-term prognosis. Previous studies using serological HLA typing showed that HLA-DR15 was a risk factor for AAA. In this study, we performed HLA-DNA typing by PCR to clarify the relationship between AAA and HLA genotypes in Japanese patients with AAA. In addition, we analyzed whether HLA genotypes are involved in the pathogenesis of AIOD. RESULTS we examined 78 HLA genotypes of class I (HLA-A and -B) and class II (HLA-DR) and found that 60.4 and 30.4% of 49 AAA patients had HLA-A2 and HLA-B61, respectively. These frequencies were significantly higher than those in control individuals (HLA-A2, p < 0.05; HLA-B61, p < 0.005). We also found that 55.6% of nine AAA patients with AIOD had both HLA-B52 and HLA-DR B1*1502. In contrast, only 10.0% each of 40 AAA patients without AIOD showed HLA-B53 or HLA-DR B1*1502. CONCLUSIONS this study showed that HLA A-2 and HLA B-61, but not HLA DR-15, were important genetic risk factors for the development of AAA among the Japanese population. We also found high frequencies of HLA-B52 and HLA-DR B1*1502 in the AAA patients with AIOD than in those without, although this must be confirmed using a larger number of AAA patients with AIOD.
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Affiliation(s)
- T Sugimoto
- National Cardiovascular Center, Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan
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van Vlijmen-van Keulen CJ, Pals G, Rauwerda JA. Familial abdominal aortic aneurysm: a systematic review of a genetic background. Eur J Vasc Endovasc Surg 2002; 24:105-16. [PMID: 12389231 DOI: 10.1053/ejvs.2002.1692] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Familial clustering of the abdominal aortic aneurysm (AAA) is clear, 12-19% of AAA patients have one or more first-degree relatives with an aneurysm and 4-19% is detected with ultrasound screening. OBJECTIVES To review the genetic background of AAA. DESIGN, METHODS AND MATERIALS: Computer searches of the MEDLINE, EMBASE, SUMsearch database and the Cochrane Library and searched reference lists of English language articles concerning the genetics of AAA, candidate gene approach and linkage analysis. RESULTS Brothers of AAA patients are at high risk to develop an AAA. The candidate gene approach was performed to detect defects in one of the components of the connective tissue, i.e. type I and III collagen, elastin and fibrillin, the inflammatory cell-derived matrix metalloproteinase, there inhibitors, auto-immune components and components related to atherosclerosis. CONCLUSION These studies give us insight in the pathology but do not lead to the specific genetic factor(s) responsible for (familial) AAA. Considering the supposed autosomal dominant inheritance, a gene mutation in one of the structural proteins of the connective tissue is expected. In the future, linkage analysis may resolve the genetic background of AAA.
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Rasmussen TE, Hallett JW, Tazelaar HD, Miller VM, Schulte S, O'Fallon WM, Weyand CM. Human leukocyte antigen class II immune response genes, female gender, and cigarette smoking as risk and modulating factors in abdominal aortic aneurysms. J Vasc Surg 2002; 35:988-93. [PMID: 12021716 DOI: 10.1067/mva.2002.121753] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Aortic inflammation and the genes that regulate the immune response play an important role in abdominal aortic aneurysm pathogenesis. However, the modulating effects of such genetic and other environmental factors on the severity on aneurysm inflammation is not known. The objective of this study was to determine the influence of the human leukocyte antigen (HLA) class II genes, gender, and environmental factors on degree of abdominal aortic aneurysm tissue inflammation. METHODS Aneurysm specimens were obtained at the time of operation from 96 consecutive patients who underwent abdominal aortic aneurysm repair and were graded for degree of histologic inflammation. Multivariate analysis was used to determine the association of genetic and environmental factors with degree of inflammation and to determine the HLA-associated disease risk for aneurysm. RESULTS Active cigarette smoking and female gender were independently associated with high-grade tissue inflammation identified histologically (odds ratio [OR], confidence interval [CI]: 5.6, 1.6 to 19.3; and 6.0, 1.4 to 26.2, respectively), and a specific HLA allele (DR B1(*)01) was inversely associated with inflammation (OR, CI: 0.2, 0.04 to 0.7). Overall, the HLA-DR B1(*)02 and B1(*)04 alleles were significantly associated with disease risk, more than doubling risk for abdominal aortic aneurysm (OR, CI: 2.5, 1.4 to 4.3; and 2.1, 1.2 to 3.7, respectively). CONCLUSION Active cigarette smoking and female gender are significant disease-modulating factors associated with increased abdominal aortic aneurysm inflammation. In addition, the HLA class II immune response genes possess both disease modulating and disease risk properties, which may be useful in early aneurysm detection and surveillance.
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Affiliation(s)
- Todd E Rasmussen
- Department of Surgery, Uniformed Services University of Health Sciences, Malcolm Grow USAF Medical Center, Andrews Air Force Base, MD 20762, USA
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Thompson RW, Geraghty PJ, Lee JK. Abdominal aortic aneurysms: basic mechanisms and clinical implications. Curr Probl Surg 2002; 39:110-230. [PMID: 11884965 DOI: 10.1067/msg.2002.121421] [Citation(s) in RCA: 204] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Robert W Thompson
- Department of Surgery (Section of Vascular Surgery), Washington University School of Medicine, St. Louis, Missouri, USA
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Papel del HLA en la patogenia de los aneurismas de aorta abdominal. ANGIOLOGIA 2002. [DOI: 10.1016/s0003-3170(02)74732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Abstract
The pathogenesis of abdominal aortic aneurysms (AAAs) is unknown. We hypothesize that the autoimmune disease process plays a key role in the development of AAAs. Both cellular and humoral immunity is involved in the pathogenesis of AAAs. Triggers of autoimmunity are multifactorial. Certain HLA typing is closely related to AAAs, and a certain viral infection may have a potential role in the etiology of AAA via a molecular mimicry mechanism. The autoantigen is located in the microfibrillar compartment of the aortic wall as a normal structure. Patients with AAA are immunoreactive with this novel structural protein. If in the future the autoantigen is fully elucidated, serum testing to detect antibody against the autoantigen can be performed.
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Affiliation(s)
- H Hirose
- Department of Cardiovascular Surgery, Kobari General Hospital, Noda City, Chiba, Japan.
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31
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Wassef M, Baxter BT, Chisholm RL, Dalman RL, Fillinger MF, Heinecke J, Humphrey JD, Kuivaniemi H, Parks WC, Pearce WH, Platsoucas CD, Sukhova GK, Thompson RW, Tilson MD, Zarins CK. Pathogenesis of abdominal aortic aneurysms: a multidisciplinary research program supported by the National Heart, Lung, and Blood Institute. J Vasc Surg 2001; 34:730-8. [PMID: 11668331 DOI: 10.1067/mva.2001.116966] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Wassef
- Vascular Biology Research Program, Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-7956, USA.
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Rasmussen TE, Hallett JW, Schulte S, Harmsen WS, O'Fallon WM, Weyand CM. Genetic similarity in inflammatory and degenerative abdominal aortic aneurysms: a study of human leukocyte antigen class II disease risk genes. J Vasc Surg 2001; 34:84-9. [PMID: 11436079 DOI: 10.1067/mva.2001.115603] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Clinically, abdominal aortic aneurysms (AAAs) display a spectrum of inflammation that extends from apparently noninflamed (degenerative) AAAs to the classic inflammatory variant. Genes encoded in the human leukocyte antigen (HLA) region are important in the development of both variants of AAA; however, their role in progression to the inflammatory variant is unknown. The purpose of this study was to compare HLA class II genes in patients with degenerative versus classic inflammatory AAAs and to quantify their impact as disease risk factors. METHODS Genotypes of the 12 major alleles of the HLA-DR B1 locus were determined in patients with degenerative (102) and inflammatory (40) AAAs who were compared with controls (118). Univariate and multivariate logistic regression analyses were used to determine allele distributions and to quantify disease risk. RESULTS Distribution of the HLA-DR B1 alleles was nonrandom and similar in both degenerative and inflammatory AAA groups compared with controls. The B1*02 and B1*04 alleles were enhanced in both degenerative (39.2% vs. 25.4%, P =.03; and 35.3% vs. 24.6%, P =.08 respectively) and inflammatory (47.5% vs. 25.4%, P =.01; and 32.5% vs. 24.6%, P =.09, respectively) AAAs compared with controls. The B1*02 and B1*04 alleles were associated with risk for both degenerative (odds ratio [OR] 2.2; 95% CI, 1.2-4.0; and OR 2.0; 95% CI, 1.1-3.7, respectively) and inflammatory AAAs (OR 3.7; 95% CI, 1.8-8.6; and OR 2.5; 95% CI, 1.1-6.1). CONCLUSION This study demonstrates that identical HLA alleles function as genetic risk factors for both inflammatory and degenerative AAAs. These results support the concept of a common, immune-mediated pathogenesis for AAAs that may be modulated by HLA-independent factors.
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Affiliation(s)
- T E Rasmussen
- Division of Vascular Surgery, Mayo Clinic and Mayo Medical School, Rochester, MN 55905, USA
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Karlsson L, Gnarpe J, Nääs J, Olsson G, Lindholm J, Steen B, Gnarpe H. Detection of viable Chlamydia pneumoniae in abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2000; 19:630-5. [PMID: 10873732 DOI: 10.1053/ejvs.1999.1057] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to investigate the presence of Chlamydia pneumoniae in the wall of abdominal aortic aneurysms (AAAs) and in the aortas of patients without a history of cardiovascular disease. DESIGN case-control study. MATERIALS twenty-six consecutive patients operated for AAA were compared to 17 controls. METHODS aorta was obtained at surgery or autopsy (controls) and prepared for immunohistochemical (IHC) analysis and culture for C. pneumoniae. Throat swabs from 14/26 patients were analysed by PCR for C. pneumoniae. Blood was obtained from 24/26 patients and from 178 70-year-old males. RESULTS C. pneumoniae was detected in the aortic aneurysms of 20/26 patients by IHC. C. pneumoniae was cultured from 10 of the 20 IHC-positive patients. Only 1/17 controls was positive for C. pneumoniae by IHC (p=0.0001). PCR was positive for C. pneumoniae in 5/14 patients. Serological analysis by microimmunofluoresence (MIF) showed significantly more high titres of the specific antibodies to C. pneumoniae in patients than in age-matched male controls. CONCLUSIONS we conclude that C. pneumoniae is often present in AAAs in a viable form and that C. pneumoniae is linked to the pathogenesis of AAA.
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Affiliation(s)
- L Karlsson
- Gävle-Sandviken Central Hospital, Gävle, Sweden
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34
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Hirose H, Tilson MD. Negative genetic risk factor for abdominal aortic aneurysm: HLA-DQ3, a Japanese study. J Vasc Surg 1999; 30:959-60. [PMID: 10550198 DOI: 10.1016/s0741-5214(99)70025-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Stanley JC. Vascular surgery. J Am Coll Surg 1999; 188:202-14. [PMID: 10024166 DOI: 10.1016/s1072-7515(98)00311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J C Stanley
- Department of Surgery, University of Michigan Medical School, Ann Arbor, USA
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