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Comparison of Clinical and Hematologic Factors Associated with Stenosis and Aneurysm Development in Patients with Atherosclerotic Arterial Disease. Ann Vasc Surg 2019; 60:165-170. [PMID: 31195106 DOI: 10.1016/j.avsg.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/24/2019] [Accepted: 03/12/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Atherosclerosis is known to result in individuals with arterial stenosis or occlusion. Alternatively, certain atherosclerotic arteries develop aneurysms. However, there has been no clear explanation regarding the mechanism associated with this alternate clinical presentation. This study aimed to investigate the clinical and hematologic factors that could lead to the development of the different clinical outcomes of stenosis and aneurysm in atherosclerotic arterial disease. METHODS From March 2016 to January 2018, 219 consecutive atherosclerotic patients, of whom 195 (171 men, 24 women) had stenosis or occlusion and 24 (19 men, 5 women) had aneurysm, were investigated. All patients underwent vascular procedures. Continuous variables studied were age, body mass index, smoking status (pack-years), frequency of alcohol consumption (days), levels of natural anticoagulants (protein C, protein S, and antithrombin III), coagulation-enhancing factors (factor VIII, fibrinogen, and homocysteine), antiphospholipid antibodies (lupus anticoagulant, immunoglobulin [Ig] G/IgM anticardiolipin antibody, and IgG/IgM anti-beta 2 glycoprotein I [anti-β2GPI]), lipids (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride), and hemoglobin A1c. The investigated nominal variables were sex, diabetes mellitus, and hypertension. RESULTS A logistic regression analysis of all nominal and continuous variables as independent variables revealed that IgM anticardiolipin antibody was a significant independent factor associated with aneurysm formation in atherosclerotic arterial disease (P = 0.042). CONCLUSIONS A higher IgM anticardiolipin antibody level may be one of the causative factors behind aneurysm development and may have the clinical potential to be used as a biomarker to predict the development of aneurysms in atherosclerotic arterial disease.
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Pierce DM, Maier F, Weisbecker H, Viertler C, Verbrugghe P, Famaey N, Fourneau I, Herijgers P, Holzapfel GA. Human thoracic and abdominal aortic aneurysmal tissues: Damage experiments, statistical analysis and constitutive modeling. J Mech Behav Biomed Mater 2014; 41:92-107. [PMID: 25460406 DOI: 10.1016/j.jmbbm.2014.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/26/2014] [Accepted: 10/06/2014] [Indexed: 12/31/2022]
Abstract
Development of aortic aneurysms includes significant morphological changes within the tissue: collagen content increases, elastin content reduces and smooth muscle cells degenerate. We seek to quantify the impact of these changes on the passive mechanical response of aneurysms in the supra-physiological loading range via mechanical testing and constitutive modeling. We perform uniaxial extension tests on circumferentially and axially oriented strips from five thoracic (65.6 years ± 13.4, mean ± SD) and eight abdominal (63.9 years ± 11.4) aortic fusiform aneurysms to investigate both continuous and discontinuous softening during supra-physiological loading. We determine the significance of the differences between the fitted model parameters: diseased thoracic versus abdominal tissues, and healthy (Weisbecker et al., J. Mech. Behav. Biomed. Mater. 12, 93-106, 2012) versus diseased tissues. We also test correlations among these parameters and age, Body Mass Index (BMI) and preoperative aneurysm diameter, and investigate histological cuts. Tissue response is anisotropic for all tests and the anisotropic pseudo-elastic damage model fits the data well for both primary loading and discontinuous softening which we interpret as damage. We found statistically relevant differences between model parameters fitted to diseased thoracic versus abdominal tissues, as well as between those fitted to healthy versus diseased tissues. Only BMI correlated with fitted model parameters in abdominal aortic aneurysmal tissues.
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Affiliation(s)
- David M Pierce
- Departments of Mechanical Engineering, Biomedical Engineering and Mathematics, University of Connecticut, CT, USA
| | - Franz Maier
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | - Hannah Weisbecker
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | | | - Peter Verbrugghe
- Experimental Cardiac Surgery, Faculty of Medicine, UZ Leuven, Leuven, Belgium
| | - Nele Famaey
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Vascular Surgery, Faculty of Medicine, UZ Leuven, Leuven, Belgium
| | - Paul Herijgers
- Experimental Cardiac Surgery, Faculty of Medicine, UZ Leuven, Leuven, Belgium
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Recent advances in pharmacotherapy development for abdominal aortic aneurysm. Int J Vasc Med 2012; 2012:648167. [PMID: 22957259 PMCID: PMC3432368 DOI: 10.1155/2012/648167] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/25/2012] [Indexed: 12/16/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a common disease causing segmental expansion and rupture of the aorta with a high mortality rate. The lack of nonsurgical treatment represents a large and unmet need in terms of pharmacotherapy. Advances in AAA research revealed that activation of inflammatory signaling pathways through proinflammatory mediators shifts the balance of extracellular matrix (ECM) metabolism toward tissue degradation. This idea is supported by experimental evidence in animal models that pharmacologic intervention at each pathological step can prevent AAA development. Previously, we identified c-Jun N-terminal kinase (JNK), a pro-inflammatory signaling molecule, as a therapeutic target for AAA. Abnormal activation of JNK in AAA tissue regulates multiple pathological processes in a coordinated manner. Pharmacologic inhibition of JNK tips the ECM balance back towards repair rather than degradation. Interventions targeting signaling molecules such as JNK in order to manipulate multiple pathological processes may be an ideal therapeutic strategy for AAA. Furthermore, the development of biomarkers as well as appropriate drug delivery systems is essential to produce clinically practical pharmacotherapy for AAA.
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Humphrey JD, Holzapfel GA. Mechanics, mechanobiology, and modeling of human abdominal aorta and aneurysms. J Biomech 2012; 45:805-14. [PMID: 22189249 PMCID: PMC3294195 DOI: 10.1016/j.jbiomech.2011.11.021] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2011] [Indexed: 12/25/2022]
Abstract
Biomechanical factors play fundamental roles in the natural history of abdominal aortic aneurysms (AAAs) and their responses to treatment. Advances during the past two decades have increased our understanding of the mechanics and biology of the human abdominal aorta and AAAs, yet there remains a pressing need for considerable new data and resulting patient-specific computational models that can better describe the current status of a lesion and better predict the evolution of lesion geometry, composition, and material properties and thereby improve interventional planning. In this paper, we briefly review data on the structure and function of the human abdominal aorta and aneurysmal wall, past models of the mechanics, and recent growth and remodeling models. We conclude by identifying open problems that we hope will motivate studies to improve our computational modeling and thus general understanding of AAAs.
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Affiliation(s)
- J D Humphrey
- Department of Biomedical Engineering and Vascular Biology and Therapeutics Program, Malone Engineering Center, Yale University, New Haven, CT 06520-8260, USA.
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Tedesco MM, Terashima M, Blankenberg FG, Levashova Z, Spin JM, Backer MV, Backer JM, Sho M, Sho E, McConnell MV, Dalman RL. Analysis of in situ and ex vivo vascular endothelial growth factor receptor expression during experimental aortic aneurysm progression. Arterioscler Thromb Vasc Biol 2009; 29:1452-7. [PMID: 19574559 DOI: 10.1161/atvbaha.109.187757] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Mural inflammation and neovascularization are characteristic pathological features of abdominal aortic aneurysm (AAA) disease. Vascular endothelial growth factor receptor (VEGFR) expression may also mediate AAA growth and rupture. We examined VEGFR expression as a function of AAA disease progression in the Apolipoprotein E-deficient (Apo E(-/-)) murine AAA model. METHODS AND RESULTS Apo E(-/-) mice maintained on a high-fat diet underwent continuous infusion with angiotensin II at 1000 ng/kg/min (Ang II) or vehicle (Control) via subcutaneous osmotic pump. Serial transabdominal ultrasound measurements of abdominal aortic diameter were recorded (n=16 mice, 3 to 4 time points per mouse) for up to 28 days. Near-infrared receptor fluorescent (NIRF) imaging was performed on Ang II mice (n=9) and Controls (n=5) with scVEGF/Cy, a single-chain VEGF homo-dimer labeled with Cy 5.5 fluorescent tracer (7 to 18 microg/mouse IV). NIRF with inactivated single chain VEGF/Cy tracer (scVEGF/In, 18 microg/mouse IV) was performed on 2 additional Ang II mice to control for nonreceptor-mediated tracer binding and uptake. After image acquisition and sacrifice, aortae were harvested for analysis. An additional AAA mouse cohort received either an oral angiogenesis inhibitor or suitable negative or positive controls to clarify the significance of angiogenesis in experimental aneurysm progression. Aneurysms developed in the suprarenal aortic segment of all Ang II mice. Significantly greater fluorescent signal was obtained from aneurysmal aorta as compared to remote, uninvolved aortic segments in Ang II scVEGF/Cy mice or AAA in scVEGF/In mice or suprarenal aortic segments in Control mice. Signal intensity increased in a diameter-dependent fashion in aneurysmal segments. Immunostaining confirmed mural VEGFR-2 expression in medial smooth muscle cells. Treatment with an angiogenesis inhibitor attenuated AAA formation while decreasing mural macrophage infiltration and CD-31(+) cell density. CONCLUSIONS Mural VEGFR expression, as determined by scVEGF/Cy fluorescent imaging and VEGFR-2 immunostaining, increases in experimental AAAs in a diameter-dependent fashion. Angiogenesis inhibition limits AAA progression. Clinical VEGFR expression imaging strategies, if feasible, may improve real-time monitoring of AAA disease progression and response to suppressive strategies.
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Affiliation(s)
- Maureen M Tedesco
- Division of Vascular Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642, USA
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Deguchi JO, Huang H, Libby P, Aikawa E, Whittaker P, Sylvan J, Lee RT, Aikawa M. Genetically engineered resistance for MMP collagenases promotes abdominal aortic aneurysm formation in mice infused with angiotensin II. J Transl Med 2009; 89:315-26. [PMID: 19153555 PMCID: PMC2932654 DOI: 10.1038/labinvest.2008.167] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Clinical evidence links increased aortic collagen content and stiffness to abdominal aortic aneurysm (AAA) formation. However, the possibility that excess collagen contributes to AAA formation remains untested. We investigated the hypothesis that augmented collagen promotes AAA formation, and employed apoE-null mice expressing collagenase-resistant mutant collagen (Col(R/R)/apoE(-/-)), heterozygote (Col(R/+)/apoE(-/-)), or wild-type collagen (Col(+/+)/apoE(-/-)) infused with angiotensin II to induce AAA. As expected, the aortas of Col(R/R)/apoE(-/-) mice contained more interstitial collagen than those from the other groups. Angiotensin II treatment elicited more AAA formation in Col(R/R)/apoE(-/-) mice than Col(R/+)/apoE(-/-) or Col(+/+)/apoE(-/-) mice. Aortic circumferences correlated positively with collagen content, determined by picrosirius red and Masson trichrome staining. Mechanical testing of aortas of Col(R/R)/apoE(-/-) mice showed increased stiffness and susceptibility to mechanical failure compared to those of Col(+/+)/apoE(-/-) mice. Optical analysis further indicated altered collagen fiber orientation in the adventitia of Col(R/R)/apoE(-/-) mice. These results demonstrate that collagen content regulates aortic biomechanical properties and influences AAA formation.
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Affiliation(s)
- Jun-o Deguchi
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hayden Huang
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Peter Libby
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Elena Aikawa
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA
| | - Peter Whittaker
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Jeremy Sylvan
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Richard T. Lee
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Masanori Aikawa
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Humphrey J, Taylor C. Intracranial and abdominal aortic aneurysms: similarities, differences, and need for a new class of computational models. Annu Rev Biomed Eng 2008; 10:221-46. [PMID: 18647115 PMCID: PMC2742216 DOI: 10.1146/annurev.bioeng.10.061807.160439] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Intracranial saccular and abdominal aortic aneurysms (ISAs and AAAs, respectively) result from different underlying disease processes and exhibit different rupture potentials, yet they share many histopathological and biomechanical characteristics. Moreover, as in other vascular diseases, hemodynamics and wall mechanics play important roles in the natural history and possible treatment of these two types of lesions. The goals of this review are twofold: first, to contrast the biology and mechanics of intracranial and abdominal aortic aneurysms to emphasize that separate advances in our understanding of each disease can aid in our understanding of the other disease, and second, to suggest that research on the biomechanics of aneurysms must embrace a new paradigm for analysis. That is, past biomechanical studies have provided tremendous insight but have progressed along separate lines, focusing on either the hemodynamics or the wall mechanics. We submit that there is a pressing need to couple in a new way the separate advances in vascular biology, medical imaging, and computational biofluid and biosolid mechanics to understand better the mechanobiology, pathophysiology, and treatment of these lesions, which continue to be responsible for significant morbidity and mortality. We refer to this needed new class of computational tools as fluid-solid-growth (FSG) models.
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Affiliation(s)
- J.D. Humphrey
- Department of Biomedical Engineering and M.E. DeBakey Institute Texas A&M University, College Station, TX, USA
| | - C.A. Taylor
- Departments of Bioengineering and Surgery Stanford University, Stanford, CA, USA
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Goldberg A, Pakkiri P, Dai E, Lucas A, Fenster A. Measurements of aneurysm morphology determined by 3-d micro-ultrasound imaging as potential quantitative biomarkers in a mouse aneurysm model. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1552-60. [PMID: 17602826 DOI: 10.1016/j.ultrasmedbio.2007.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Revised: 02/18/2007] [Accepted: 04/10/2007] [Indexed: 05/16/2023]
Abstract
Aneurysms remain a significant medical problem and our current understanding of aneurysm formation and developmental stages remains incomplete. Noninvasive 3-D micro-ultrasound (3-D micro-US) imaging technologies designed for noninvasive evaluation of small laboratory animals diminish risks associated with invasive examination and provide in-situ (live) analysis of vascular morphological changes, which enables quantitative measurements of live biological specimens. We demonstrate here that aneurysm morphology can be quantified using 3-D micro-US, and we validate this methodology through comparison of geometric measures with those obtained from 3-D serial histologic records in a mouse model of accelerated aneurysm formation. Aneurysms were induced in Balb/C mice after C57Bl/6 mouse aortic transplant with injections of a pro-inflammatory viral serpin with a mutated reactive site. Aortic transplant segments were imaged 28 days after transplant using 3-D micro-US. Upon sacrifice, the aortas were excised and histology sections (5-microm thick) were digitized, co-registered using mutual information and stacked to form 3-D images. Surfaces of the mouse aorta and aneurysm were manually segmented from the 3-D micro-US and histology images. Comparisons with 3-D histology images demonstrated that 3-D micro-US allowed in-vivo analysis of aneurysm morphology, including total aneurysm area, plaque growth and lumen size. Linear regression of 3-D US-derived aneurysm and plaque volumes vs. 3-D histology-derived volumes resulted in slopes of 1.30 (R(2) = 0.96) and 1.20 (R(2) = 0.98), respectively, demonstrating that 3-D micro-US measurements can be used to track aneurysm growth in a mouse aortic transplant model.
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MESH Headings
- Animals
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/transplantation
- Aortic Aneurysm/diagnostic imaging
- Aortic Aneurysm/pathology
- Atherosclerosis/diagnostic imaging
- Atherosclerosis/pathology
- Imaging, Three-Dimensional
- Membrane Proteins/genetics
- Membrane Proteins/pharmacology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Transgenic
- Models, Animal
- Mutation
- Plasminogen Activator Inhibitor 1/genetics
- Staining and Labeling
- Transplantation, Homologous
- Ultrasonography, Doppler
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Bogoyevitch MA. The isoform-specific functions of the c-Jun N-terminal Kinases (JNKs): differences revealed by gene targeting. Bioessays 2007; 28:923-34. [PMID: 16937364 DOI: 10.1002/bies.20458] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The c-Jun N-terminal kinases (JNKs) are members of the mitogen-activated protein kinase (MAPK) family. In mammalian genomes, three genes encode the JNK family. To evaluate JNK function, mice have been created with deletions in one or more of three Jnk genes. Initial studies on jnk1(-/-) or jnk2(-/-) mice have shown roles for these JNKs in the immune system whereas studies on jnk3(-/-) mice have highlighted roles for JNK3 in the nervous system. Further studies have highlighted the contributions of JNK1 and/or JNK2 to a range of biological and pathological processes. These include bone remodelling and joint disease, inflammatory and autoimmune diseases, obesity, diabetes, cardiovascular disease, liver disease and tumorigenesis in addition to effects in neurons. These results emphasise the differences in the roles played by JNK isoforms in vivo and suggest that the design of JNK inhibitors for subsequent therapeutic uses may benefit from selective inhibition of individual JNK isoforms.
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Affiliation(s)
- Marie A Bogoyevitch
- Cell Signalling Laboratory, Biochemistry and Molecular Biology (M310), School of Biomedical, Biomolecular and Chemical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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10
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Baxter BT. Abdominal aortic aneurysm regression by medical treatment: possibility or pipe dream? J Vasc Surg 2006; 43:1068-9. [PMID: 16678709 DOI: 10.1016/j.jvs.2006.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 01/11/2006] [Indexed: 11/21/2022]
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