1
|
Buksh MM, Nuzhath S, Heslop J, Moawad M. A systematic review and case presentation: Giant abdominal aortic aneurysm. Vascular 2024; 32:521-532. [PMID: 36598291 DOI: 10.1177/17085381221140166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE An abdominal aortic aneurysm is considered giant when its transverse diameter is greater than 10-13 cm in diameter. A giant abdominal aortic aneurysm is rare but with a significant risk of rupture if it is not diagnosed or left untreated. METHOD The authors have performed a systematic review of the evidence that has looked into the clinical presentations, and management methods employed and have presented a 14 cm giant abdominal aortic aneurysm patient. RESULTS The systematic review has been based on level-IV evidence due to the rarity of the condition. The final analysis included 61 relevant reported cases. The mean age was 72.4 years, the male to female ratio was 52: 8, and the average size of a giant abdominal aortic aneurysm was 14.7 cm. These were mostly infra renal (72.58%). Rupture of these aneurysms was found in 23 (37.1%) patients, and was treated by laparotomy in 51 (82.25%) cases. There were 11 (17.74%) mortalities. CONCLUSION The size of an abdominal aortic aneurysm is known to be the biggest factor in the rupture of an aneurysm. The reason abdominal aortic aneurysms can reach such size without rupturing is unclear but needs further exploring. Early diagnosis with effective screening programmes is essential to diagnose in a timely manner to avoid life-threatening consequences.
Collapse
Affiliation(s)
- Md Mahfooz Buksh
- General Surgery, Ashford and St Peters Hospital NHS, Chertsey, UK
| | | | | | | |
Collapse
|
2
|
Plasma complement component C2: a potential biomarker for predicting abdominal aortic aneurysm related complications. Sci Rep 2022; 12:21252. [PMID: 36482198 PMCID: PMC9732295 DOI: 10.1038/s41598-022-24698-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Blood-based adjunctive measures that can reliably predict abdominal aortic aneurysm (AAA)-related complications hold promise for mitigating the AAA disease burden. In this pilot study, we sought to evaluate the prognostic performance of complement factors in predicting AAA-related clinical outcomes. We recruited consecutive AAA patients (n = 75) and non-AAA patients (n = 75) presenting to St. Michael's Hospital. Plasma levels of complement proteins were assessed at baseline, as well as prospectively measured regularly over a period of 2 years. The primary outcome was the incidence of rapidly progressing AAA (i.e. aortic expansion), defined as change in AAA diameter by either 0.5 cm in 6 months, or 1 cm in 12 months. Secondary outcomes included incidence of major adverse aortic events (MAAE) and major adverse cardiovascular events (MACE). All study outcomes (AAA diameter, MACE and MAAE) were obtained during follow-up. Multivariable adjusted Cox regression analyses were performed to assess the prognostic value of plasma C2 levels in patients with AAA regarding rapid aortic expansion and MAAE and MACE. Event-free survival rates of both groups were also compared. Compared to non-AAA patients, patients with AAA demonstrated significantly higher plasma concentrations of C1q, C4, Factor B, Factor H and Factor D, and significantly lower plasma concentrations of C2, C3, and C4b (p = 0.001). After a median of 24 months from initial baseline measurements, C2 was determined as the strongest predictor of rapid aortic expansion (HR 0.10, p = 0.040), MAAE (HR 0.09, p = 0.001) and MACE (HR 0.14, p = 0.011). Based on the data from the survival analysis, higher levels of C2 at admission in patients with AAA predicted greater risk for rapid aortic expansion and MAAE (not MACE). Plasma C2 has the potential to be a biomarker for predicting rapid aortic expansion, MAAE, and the eventual need for an aortic intervention in AAA patients.
Collapse
|
3
|
Open surgical repair of a giant abdominal aortic aneurysm. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:144-146. [PMID: 31708991 PMCID: PMC6836629 DOI: 10.5114/kitp.2019.88607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022]
|
4
|
Mordi IR, Forsythe RO, Gellatly C, Iskandar Z, McBride OM, Saratzis A, Chalmers R, Chin C, Bown MJ, Newby DE, Lang CC, Huang JTJ, Choy AM. Plasma Desmosine and Abdominal Aortic Aneurysm Disease. J Am Heart Assoc 2019; 8:e013743. [PMID: 31595818 PMCID: PMC6818029 DOI: 10.1161/jaha.119.013743] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background It is recognized that factors beyond aortic size are important in predicting outcome in abdominal aortic aneurysm (AAA) disease. AAA is characterized by the breakdown of elastin within the aortic tunica media, leading to aortic dilatation and rupture. The aim of this study was to investigate the association of plasma desmosine (pDES), an elastin‐specific degradation product, with disease severity and clinical outcome in patients with AAA. Methods and Results We measured pDES and serum biomarker concentrations in 507 patients with AAAs (94% men; mean age, 72.4±6.1 years; mean AAA diameter, 48±8 mm) and 162 control subjects (100% men; mean age, 71.5±4.4 years) from 2 observational cohort studies. In the longitudinal cohort study (n=239), we explored the incremental prognostic value of pDES on AAA events. pDES was higher in patients with AAA compared with control subjects (mean±SD: 0.46±0.22 versus 0.33±0.16 ng/mL; P<0.001) and had the strongest correlation with AAA diameter (r=0.39; P<0.0001) of any serum biomarker. After adjustment for baseline AAA diameter, pDES was associated with an AAA event (hazard ratio, 2.03 per SD increase [95% CI, 1.02–4.02]; P=0.044). In addition to AAA diameter, pDES provided incremental improvement in risk stratification (continuous net reclassification improvement, 34.4% [95% CI, −10.8% to 57.5%; P=0.09]; integrated discrimination improvement, 0.04 [95% CI, 0.00–0.15; P=0.050]). Conclusions pDES concentrations predict disease severity and clinical outcomes in patients with AAA. Clinical Trial Registration http://www.isrctn.com. Unique identifier: ISRCTN76413758.
Collapse
Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| | - Rachael O Forsythe
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Corry Gellatly
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre University of Leicester Glenfield Hospital Leicester United Kingdom
| | - Zaid Iskandar
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| | - Olivia M McBride
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre University of Leicester Glenfield Hospital Leicester United Kingdom
| | - Rod Chalmers
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Calvin Chin
- Department of Cardiovascular Science National Heart Center Singapore
| | - Matthew J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre University of Leicester Glenfield Hospital Leicester United Kingdom
| | - David E Newby
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science Edinburgh United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| | - Jeffrey T J Huang
- Division of Systems Medicine University of Dundee Dundee United Kingdom
| | - Anna-Maria Choy
- Division of Molecular and Clinical Medicine University of Dundee Dundee United Kingdom
| |
Collapse
|
5
|
Rønnow SR, Langholm LL, Sand JMB, Thorlacius-Ussing J, Leeming DJ, Manon-Jensen T, Tal-Singer R, Miller BE, Karsdal MA, Vestbo J. Specific elastin degradation products are associated with poor outcome in the ECLIPSE COPD cohort. Sci Rep 2019; 9:4064. [PMID: 30858579 PMCID: PMC6412140 DOI: 10.1038/s41598-019-40785-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by a slow heterogeneous progression. Therefore, improved biomarkers that can accurately identify patients with the highest likelihood of progression and therefore the ability to benefit from a given treatment, are needed. Elastin is an essential structural protein of the lungs. In this study, we investigated whether elastin degradation products generated by the enzymes proteinase 3, cathepsin G, neutrophil elastase, MMP7 or MMP9/12 were prognostic biomarkers for COPD-related outcomes. The elastin degradome was assessed in a subpopulation (n = 1307) of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) cohort with 3 years of clinical follow-up. Elastin degraded by proteinase 3 could distinguish between COPD participants and non-smoking controls (p = 0.0006). A total of 30 participants (3%) died over the 3 years of observation. After adjusting for confounders, plasma levels of elastin degraded by proteinase 3 and cathepsin G were independently associated with mortality outcome with a hazard ratio per 1 SD of 1.49 (95%CI 1.24-1.80, p < 0.0001) and 1.31 (95%CI 1.10-1.57, p = 0.0029), respectively. Assessing the elastin degradome demonstrated that specific elastin degradation fragments have potential utility as biomarkers identifying subtypes of COPD patients at risk of poor prognosis and supports further exploration in confirmatory studies.
Collapse
Affiliation(s)
- Sarah Rank Rønnow
- Nordic Bioscience A/S, Herlev, Denmark. .,University of Southern Denmark, The Faculty of Health Science, Odense, Denmark.
| | - Lasse Løcke Langholm
- Nordic Bioscience A/S, Herlev, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | - Jørgen Vestbo
- Division of Infection Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, England
| |
Collapse
|
6
|
Gudmann NS, Manon-Jensen T, Sand JMB, Diefenbach C, Sun S, Danielsen A, Karsdal MA, Leeming DJ. Lung tissue destruction by proteinase 3 and cathepsin G mediated elastin degradation is elevated in chronic obstructive pulmonary disease. Biochem Biophys Res Commun 2018; 503:1284-1290. [PMID: 30017196 DOI: 10.1016/j.bbrc.2018.07.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by high levels of protease activity leading to degradation of elastin followed by loss of elasticity of the lung and the development of emphysema. Elastin is an essential structural component of the lung parenchyma to support the expansion and recoil of the alveoli during breathing. The lung extracellular matrix is vulnerable to pathological structural changes upon upregulation of serine proteases, including cathepsin G (CG) and proteinase 3 (PR3). In this study, we explored the diagnostic features of elastin neo-epitopes generated by CG and PR3. Two novel competitive enzyme-linked immunosorbent assays (ELISA) measuring CG and PR3 generated elastin fragments (EL-CG and ELP-3 respectively) were developed for assessment in serum. Both assays were technically robust and biologically validated in serum from patients with COPD. Serological levels of both elastin fragments were significantly elevated in patients with COPD compared to healthy controls. These data suggest that EL-CG and ELP-3 may serve as plausible biologic markers of destructive changes in COPD.
Collapse
Affiliation(s)
| | | | | | | | - Shu Sun
- Nordic Bioscience, Herlev, Denmark
| | | | | | | |
Collapse
|
7
|
Groeneveld ME, Meekel JP, Rubinstein SM, Merkestein LR, Tangelder GJ, Wisselink W, Truijers M, Yeung KK. Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture. J Am Heart Assoc 2018; 7:JAHA.117.007791. [PMID: 29960996 PMCID: PMC6064909 DOI: 10.1161/jaha.117.007791] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture. METHODS AND RESULTS Potential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty-two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S-elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta-analysis was conducted because of clinical and methodological heterogeneity. CONCLUSIONS We identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.
Collapse
Affiliation(s)
- Menno E Groeneveld
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Jorn P Meekel
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Sidney M Rubinstein
- Department of Health Sciences and Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
| | - Lisanne R Merkestein
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Geert Jan Tangelder
- Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Maarten Truijers
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands .,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| |
Collapse
|
8
|
Hu C, Zhu K, Li J, Wang C, Lai L. Molecular targets in aortic aneurysm for establishing novel management paradigms. J Thorac Dis 2017; 9:4708-4722. [PMID: 29268541 DOI: 10.21037/jtd.2017.10.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortic aneurysm (AA) is a lethal disease and presents a large challenge for surgeons in the clinic. Although surgical management remains the major choice of AA, operative mortality remains high. With advances in understanding of the mechanisms of AAs, molecular targets, such as matrix metalloproteinases (MMPs), D-dimer, and inflammation markers, including C-reactive protein, interleukins and phagocytes, are important in the pathology of development of AA. These markers may become important for improving the diagnostic quality and provide more therapeutic choices for treatment of AA. Although these new markers require long-term trials before they can be translated into the clinic, they can still be helpful in determining new directions. The main aim of this review is to discuss the current findings of molecular targets in progression of AA and discuss the potential application of these new targets for managing this disease.
Collapse
Affiliation(s)
- Chengkai Hu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Kai Zhu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Lao Lai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| |
Collapse
|
9
|
Deeg MA, Meijer CA, Chan LS, Shen L, Lindeman JHN. Prognostic and predictive biomarkers of abdominal aortic aneurysm growth rate. Curr Med Res Opin 2016; 32:509-17. [PMID: 26636178 DOI: 10.1185/03007995.2015.1128406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To test the utility of clinical and circulating biomarkers to predict abdominal aortic aneurysm (AAA) growth rate and response to doxycycline therapy. METHODS Plasma samples were obtained in the Pharmaceutical Aneurysm Stabilization Trial that tested the effect of doxycycline (n = 44) vs. placebo (n = 49) in patients with a 35-50 mm AAA. Approximately 200 biomarkers were evaluated in a candidate approach that included markers of matrix turnover and cathepsin S activity and a broad-based approach of predominantly inflammation-related and clinical biomarkers. RESULTS In a recursive partitioning based analysis, total cholesterol, baseline AAA size, and apolipoprotein B were prognostic of AAA growth in the placebo group whereas elastin and biglycan degradation products were predictive of AAA growth with doxycycline treatment. Univariate analysis of these biomarkers showed that baseline total cholesterol (r = 0.38, unadjusted P = 0.011), apolipoprotein B (r = 0.41, unadjusted P = 0.005), and baseline AAA size (r = 0.35, unadjusted P = 0.013) correlated with AAA growth in the placebo but not the doxycycline group. Elastin fragments were associated with 18 month AAA growth (r = 0.33, unadjusted P = 0.031) in the doxycycline group. LIMITATIONS Limitations of this study include small sample size, a retrospective growth analysis, and translatability of the method used to measure the analytes. CONCLUSIONS This study implies that total cholesterol, baseline AAA size, and apolipoprotein B are predictors of AAA growth. Levels of elastin and biglycan fragments are predictive of doxycycline effects on AAA growth and provide a clue towards this unexpected negative effect.
Collapse
Affiliation(s)
- Mark A Deeg
- a a Lilly Research Laboratories, Eli Lilly & Co. , Indianapolis , IN , USA
| | - C Arnoud Meijer
- b b Department of Vascular Surgery , Leiden University Medical Center , Leiden , The Netherlands
| | - Lai Shan Chan
- a a Lilly Research Laboratories, Eli Lilly & Co. , Indianapolis , IN , USA
| | - Lei Shen
- a a Lilly Research Laboratories, Eli Lilly & Co. , Indianapolis , IN , USA
| | - Jan H N Lindeman
- b b Department of Vascular Surgery , Leiden University Medical Center , Leiden , The Netherlands
| |
Collapse
|
10
|
Nielsen MJ, Lehmann J, Leeming DJ, Schierwagen R, Klein S, Jansen C, Strassburg CP, Bendtsen F, Møller S, Sauerbruch T, Karsdal MA, Krag A, Trebicka J. Circulating Elastin Fragments Are Not Affected by Hepatic, Renal and Hemodynamic Changes, But Reflect Survival in Cirrhosis with TIPS. Dig Dis Sci 2015; 60:3456-64. [PMID: 26138655 DOI: 10.1007/s10620-015-3783-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Progressive fibrosis increases hepatic resistance and causes portal hypertension with complications. During progressive fibrosis remodeling and deposition of collagens and elastin occur. Elastin remodeling is crucially involved in fibrosis progression in animal models and human data. This study investigated the association of circulating elastin with the clinical outcome in cirrhotic patients with severe portal hypertension receiving transjugular intrahepatic porto-systemic shunt (TIPS). METHODS We analyzed portal and hepatic venous samples of 110 cirrhotic patients obtained at TIPS insertion and 2 weeks later. The circulating levels of elastin fragments (ELM) were determined using specific monoclonal ELISA. The relationship of ELM with clinical short-time follow-up and long-term outcome was investigated. RESULTS Circulating levels of ELM showed a gradient across the liver before TIPS with higher levels in the hepatic vein. Interestingly, the circulating ELM levels remained unchanged after TIPS. The circulating levels of ELM in portal and hepatic veins correlated with platelet counts and inversely with serum sodium. Hepatic venous levels of ELM were higher in CHILD C compared to CHILD A and B and were associated with the presence of ascites. Patients with high levels of ELM in the hepatic veins before TIPS showed poorer survival. In multivariate analysis ELM levels in the hepatic veins and MELD were independent predictors of mortality in these patients. CONCLUSION This study demonstrated that circulating levels of ELM are not associated with hemodynamic changes, but might reflect fibrosis remodeling and predict survival in patients with severe portal hypertension receiving TIPS independently of MELD.
Collapse
Affiliation(s)
- M J Nielsen
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark.,Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark
| | - J Lehmann
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D J Leeming
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
| | - R Schierwagen
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - S Klein
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C Jansen
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Bendtsen
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - S Møller
- Department of Clinical Physiology and Nuclear Medicine, 239 Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Sauerbruch
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M A Karsdal
- Nordic Bioscience, Fibrosis Biology and Biomarkers, Herlev, Denmark
| | - A Krag
- Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark
| | - J Trebicka
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| |
Collapse
|
11
|
Skjøt-Arkil H, Clausen RE, Rasmussen LM, Wang W, Wang Y, Zheng Q, Mickley H, Saaby L, Diederichsen ACP, Lambrechtsen J, Martinez FJ, Hogaboam CM, Han M, Larsen MR, Nawrocki A, Vainer B, Krustrup D, Bjørling-Poulsen M, Karsdal MA, Leeming DJ. Acute Myocardial Infarction and Pulmonary Diseases Result in Two Different Degradation Profiles of Elastin as Quantified by Two Novel ELISAs. PLoS One 2013; 8:e60936. [PMID: 23805173 PMCID: PMC3689773 DOI: 10.1371/journal.pone.0060936] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/04/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Elastin is a signature protein of the arteries and lungs, thus it was hypothesized that elastin is subject to enzymatic degradation during cardiovascular and pulmonary diseases. The aim was to investigate if different fragments of the same protein entail different information associated to two different diseases and if these fragments have the potential of being diagnostic biomarkers. METHODS Monoclonal antibodies were raised against an identified fragment (the ELM-2 neoepitope) generated at the amino acid position '552 in elastin by matrix metalloproteinase (MMP) -9/-12. A newly identified ELM neoepitope was generated by the same proteases but at amino acid position '441. The distribution of ELM-2 and ELM, in human arterial plaques and fibrotic lung tissues were investigated by immunohistochemistry. A competitive ELISA for ELM-2 was developed. The clinical relevance of the ELM and ELM-2 ELISAs was evaluated in patients with acute myocardial infarction (AMI), no AMI, high coronary calcium, or low coronary calcium. The serological release of ELM-2 in patients with chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF) was compared to controls. RESULTS ELM and ELM-2 neoepitopes were both localized in diseased carotid arteries and fibrotic lungs. In the cardiovascular cohort, ELM-2 levels were 66% higher in serum from AMI patients compared to patients with no AMI (p<0.01). Levels of ELM were not significantly increased in these patients and no correlation was observed between ELM-2 and ELM. ELM-2 was not elevated in the COPD and IPF patients and was not correlated to ELM. ELM was shown to be correlated with smoking habits (p<0.01). CONCLUSIONS The ELM-2 neoepitope was related to AMI whereas the ELM neoepitope was related to pulmonary diseases. These results indicate that elastin neoepitopes generated by the same proteases but at different amino acid sites provide different tissue-related information depending on the disease in question.
Collapse
Affiliation(s)
- Helene Skjøt-Arkil
- Nordic Bioscience A/S, Herlev, Denmark
- School of Endocrinology, University of Southern Denmark, Odense, Denmark
| | | | - Lars M. Rasmussen
- Institute of Clinical Research, Odense University Hospital, Odense, Denmark
| | | | - Yaguo Wang
- Nordic Bioscience Beijing, Beijing, China
| | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine and Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Cory M. Hogaboam
- Division of Pulmonary and Critical Care Medicine and Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - MeiLan Han
- Division of Pulmonary and Critical Care Medicine and Department of Pathology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Martin R. Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Arkadiusz Nawrocki
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Ben Vainer
- Department of Pathology, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dorrit Krustrup
- Department of Pathology, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | |
Collapse
|
12
|
Suzuki T, Bossone E, Sawaki D, Jánosi RA, Erbel R, Eagle K, Nagai R. Biomarkers of aortic diseases. Am Heart J 2013; 165:15-25. [PMID: 23237129 DOI: 10.1016/j.ahj.2012.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
Abstract
The development of diagnostic biomarkers of acute cardiovascular disease remains an important topic of interest given potential use to aid in early diagnosis. Cardiac biomarkers of ischemia and heart failure have already proven to be clinically useful. Biomarkers of aortic diseases are also needed, especially for life-threatening conditions such as aortic dissection. In this review, we discuss the present status of the development of biomarkers of aortic diseases. Although aortic dissection has been most vigorously pursued, there has also been notable recent progress in biomarkers of aneurysms and inflammatory aortic disease.
Collapse
|
13
|
Karsdal MA, Nielsen MJ, Sand JM, Henriksen K, Genovese F, Bay-Jensen AC, Smith V, Adamkewicz JI, Christiansen C, Leeming DJ. Extracellular matrix remodeling: the common denominator in connective tissue diseases. Possibilities for evaluation and current understanding of the matrix as more than a passive architecture, but a key player in tissue failure. Assay Drug Dev Technol 2012; 11:70-92. [PMID: 23046407 DOI: 10.1089/adt.2012.474] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Increased attention is paid to the structural components of tissues. These components are mostly collagens and various proteoglycans. Emerging evidence suggests that altered components and noncoded modifications of the matrix may be both initiators and drivers of disease, exemplified by excessive tissue remodeling leading to tissue stiffness, as well as by changes in the signaling potential of both intact matrix and fragments thereof. Although tissue structure until recently was viewed as a simple architecture anchoring cells and proteins, this complex grid may contain essential information enabling the maintenance of the structure and normal functioning of tissue. The aims of this review are to (1) discuss the structural components of the matrix and the relevance of their mutations to the pathology of diseases such as fibrosis and cancer, (2) introduce the possibility that post-translational modifications (PTMs), such as protease cleavage, citrullination, cross-linking, nitrosylation, glycosylation, and isomerization, generated during pathology, may be unique, disease-specific biochemical markers, (3) list and review the range of simple enzyme-linked immunosorbent assays (ELISAs) that have been developed for assessing the extracellular matrix (ECM) and detecting abnormal ECM remodeling, and (4) discuss whether some PTMs are the cause or consequence of disease. New evidence clearly suggests that the ECM at some point in the pathogenesis becomes a driver of disease. These pathological modified ECM proteins may allow insights into complicated pathologies in which the end stage is excessive tissue remodeling, and provide unique and more pathology-specific biochemical markers.
Collapse
|
14
|
Measurement of MMP-9 and -12 degraded elastin (ELM) provides unique information on lung tissue degradation. BMC Pulm Med 2012; 12:34. [PMID: 22818364 PMCID: PMC3515477 DOI: 10.1186/1471-2466-12-34] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 07/03/2012] [Indexed: 01/13/2023] Open
Abstract
Background Elastin is an essential component of selected connective tissues that provides a unique physiological elasticity. Elastin may be considered a signature protein of lungs where matrix metalloprotease (MMP) -9-and -12, may be considered the signature proteases of the macrophages, which in part are responsible for tissue damage during disease progression. Thus, we hypothesized that a MMP-9/-12 generated fragment of elastin may be a relevant biochemical maker for lung diseases. Methods Elastin fragments were identified by mass-spectrometry and one sequence, generated by MMP-9 and -12 (ELN-441), was selected for monoclonal antibody generation and used in the development of an ELISA. Soluble and insoluble elastin from lung was cleaved in vitro and the time-dependent release of fragments was assessed in the ELN-441 assay. The release of ELN-441 in human serum from patients with chronic obstructive pulmonary disease (COPD) (n = 10) and idiopathic pulmonary fibrosis (IPF) (n = 29) were compared to healthy matched controls (n = 11). Results The sequence ELN-441 was exclusively generated by MMP-9 and -12 and was time-dependently released from soluble lung elastin. ELN-441 levels were 287% higher in patients diagnosed with COPD (p < 0.001) and 124% higher in IPF patients (p < 0.0001) compared with controls. ELN-441 had better diagnostic value in COPD patients (AUC 97%, p = 0.001) than in IPF patients (AUC 90%, p = 0.0001). The odds ratios for differentiating controls from COPD or IPF were 24 [2.06–280] for COPD and 50 [2.64–934] for IPF. Conclusions MMP-9 and -12 time-dependently released the ELN-441 epitope from elastin. This fragment was elevated in serum from patients with the lung diseases IPF and COPD, however these data needs to be validated in larger clinical settings.
Collapse
|
15
|
Shan M, Cheng HF, Song LZ, Roberts L, Green L, Hacken-Bitar J, Huh J, Bakaeen F, Coxson HO, Storness-Bliss C, Ramchandani M, Lee SH, Corry DB, Kheradmand F. Lung myeloid dendritic cells coordinately induce TH1 and TH17 responses in human emphysema. Sci Transl Med 2010; 1:4ra10. [PMID: 20368170 DOI: 10.1126/scitranlsmed.3000154] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Exposure to tobacco smoke activates innate and adaptive immune responses that in long-term smokers have been linked to diseases of the lungs, cardiovascular system, joints, and other organs. The destruction of lung tissue that underlies smoking-induced emphysema has been associated with T helper 1 cells that recognize the matrix protein elastin. Factors that result in the development of such autoreactive T cells in smokers remain unknown but are crucial for further understanding the pathogenesis of systemic inflammatory diseases in smokers. Here, we show that lung myeloid dendritic cells were sufficient to induce T helper 1 and T helper 17 responses in CD4 T cells. T helper 1 and 17 cells are invariably present in lungs from patients with emphysema but not in lungs from normal individuals. Interleukin-17A, a canonical T helper 17 cytokine, enhanced secretion of CCL20, a chemoattractant for dendritic cells, and matrix metalloproteinase 12, a potent elastolytic proteinase, from lung macrophages. Thus, although diverse lung factors potentially contribute to T helper effector differentiation in vivo, lung myeloid dendritic cells direct the generation of pathogenic T cells and support a feedback mechanism that sustains both inflammatory cell recruitment and lung destruction. This mechanism may underlie disease in other elastin-rich organs and tissues.
Collapse
Affiliation(s)
- Ming Shan
- Department of Medicine, Section of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Urbonavicius S, Urbonaviciene G, Honoré B, Henneberg EW, Vorum H, Lindholt JS. Potential circulating biomarkers for abdominal aortic aneurysm expansion and rupture--a systematic review. Eur J Vasc Endovasc Surg 2008; 36:273-80; discussion 281-2. [PMID: 18639476 DOI: 10.1016/j.ejvs.2008.05.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 05/14/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND The maximal diameter of abdominal aortic aneurysms (AAAs) is the dominating indication for repair. However half of the AAAs repaired would never have ruptured if left unrepaired, although small AAAs occasionally rupture. Earlier surgery may be associated with a lower mortality. More precise indicators for surgery are warranted. This systematic review identifies potential systemic biomarkers for AAA rupture or expansion. METHODS MEDLINE/PubMed and EMBASE (from 1985 trough May 2007) were searched with the medical subject heading abdominal aortic aneurysm and keywords "size", "progression" or "growth" or "expansion rate" or "rupture" on the basis of MESH tree and as a text search restricted to English, German, French and Italian. In addition, reference lists were studied and manual searches performed. Observational studies investigating the association of circulating biomarkers with AAA rupture, expansion or size were selected. DATA EXTRACTION Two reviewers (SU and GU) independently extracted the following data: year of publication, study characteristics, duration of follow-up, circulating biomarker, AAA expansion rate or size or rupture. RESULTS 699 papers were identified. After exclusion of thoracic aneurysms and cardiac studies (n=118), surgical or medical treatment studies (n=179), case reports and animal studies (n=87), as well as reviews or letters (n=66), 249 articles were selected. Also excluded were 230 papers that did not report AAA size, expansion rate or rupture. 39 papers were included. Several potential biomarkers were identified. The strongest association with AAA was obtained with serum elastin peptides (SEP) and plasmin-antiplasmin (PAP) complexes. Matrix-degrading metalloproteinase 9 (MMP9) and interferon-gamma (IFN-gamma) could have clinical potential while many putative biomarkers showed poor association. CONCLUSIONS Several circulating agents in peripheral blood may predict AAA size, expansion rate or rupture. Few of them have clinical potential for future use. Confirmative studies and development of multivariate models are needed, together with continuing search for new biomarkers using the discovery based sciences within proteomics and/or genomics.
Collapse
Affiliation(s)
- S Urbonavicius
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark.
| | | | | | | | | | | |
Collapse
|
17
|
Petersen E, Wågberg F, Angquist KA. Does Lipoprotein(a) Inhibit Elastolysis in Abdominal Aortic Aneurysms? Eur J Vasc Endovasc Surg 2003; 26:423-8. [PMID: 14512007 DOI: 10.1016/s1078-5884(03)00178-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE to test the hypothesis that there is a negative association between serum levels of lipoprotein(a) (Lp(a)) and elastin-derived peptides (EDP) as well as matrix metalloproteinase (MMP)-9 activation in the aneurysm wall in patients with asymptomatic abdominal aortic aneurysms (AAA). MATERIAL AND METHODS from 30 patients operated for asymptomatic AAAs, preoperative serum samples and AAA biopsies were collected. Lp(a) (mg/L) and EDP (ng/ml) in serum were measured by enzyme linked immunosorbent assays. MMP-9 activity (arbitrary units) in the AAA wall was measured by gelatin zymography and the ratio: active MMP-9/total MMP-9 were calculated. RESULTS there was a significant negative correlation (Spearman's rho) between serum levels of Lp(a) and EDP (r= -0.707, p<0.001), as well as the share of activated MMP-9 (r= -0.461, p=0.01) in the AAA wall. CONCLUSION this preliminary study indicate that Lp(a) inhibit elastolysis in asymptomatic AAA.
Collapse
Affiliation(s)
- E Petersen
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | | | | |
Collapse
|
18
|
Petersen E, Wågberg F, Angquist KA. Serum concentrations of elastin-derived peptides in patients with specific manifestations of atherosclerotic disease. Eur J Vasc Endovasc Surg 2002; 24:440-4. [PMID: 12435345 DOI: 10.1053/ejvs.2002.1750] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To measure serum concentrations of elastin-derived peptides (S-EDP) in patients with aneurysmal, occlusive and ulcerative manifestations of atherosclerotic disease. MATERIALS AND METHODS S-EDP concentrations were measured by a competitive enzyme-linked immunosorbent assay in 10 patients with infrarenal aneurysms 5cm in diameter (AAA), 10 patients with distal aortic occlusive disease (AOD), 10 patients with symptomatic carotid stenosis (>or=70%) and plaque ulceration (SCS) and a control group of 10 patients with no similar specific manifestations of atherosclerotic disease (NAM). RESULTS S-EDP concentrations (median, range) were significantly higher in patients with AAA (42ng/ml, 35-52, p<0.001) and SCS (49ng/ml, 37-60, p<0.001) but not AOD (28ng/ml, 22-38, p=0.240) compared to NAM (26ng/ml, 19-36) patients. CONCLUSION Increased concentrations of S-EDP were associated with aneurysmal and ulcerative, but not occlusive, manifestations of atherosclerosis.
Collapse
Affiliation(s)
- E Petersen
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | | | | |
Collapse
|
19
|
Lindholt JS, Ashton HA, Heickendorff L, Scott RA. Serum elastin peptides in the preoperative evaluation of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2001; 22:546-50. [PMID: 11735205 DOI: 10.1053/ejvs.2001.1516] [Citation(s) in RCA: 23] [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 Serum elastin peptides (SEP) have been reported to be associated with the expansion of small abdominal aortic aneurysms (AAA). Consequently, SEP-measurements may predict future rupture, and allow further selection for surgery in cases referred for surgery due to size. MATERIAL AND METHODS SEP was measured in 90 men and 10 women with AAA, who were considered for surgery as part of the Chichester aneurysm screening programme. Sixty-one patients were electively operated and four because of symptoms. The rest were followed up further. Twelve of these experienced ruptured AAA later. RESULTS No correlation between last measured AAA-diameter, annual expansion rate and SEP was noticed. However, SEP levels were significantly higher in cases rupturing later, persisting after adjustment for age, sex, and last measured AAA-size. ROC curve analysis concerning SEP as a predictor of rupture later showed an optimal sensitivity and specificity of 67% and 60%, respectively, similar with last measured AAA-size. By combining AAA-size and SEP, the optimal sensitivity and specificity reached 83% and 66%, respectively. CONCLUSION One sampling of SEP combined with AAA-size in patients referred for AAA surgery may be a clinical useful indicator of high rupture risk.
Collapse
Affiliation(s)
- J S Lindholt
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | | |
Collapse
|