Perspective of SGLT2i in the Treatment of Abdominal Aortic Aneurysms

Pathophysiological mechanisms and benefits of SGLT?2 inhibitors in a patient with cerebral artery aneurysm: A case report

The present study described the case of a 50-year-old male patient. The patient had type 2 diabetes since the age of 38 years (in 2013) with an initial elevated glycated hemoglobin A1c of 7.2%, with a significant cardiovascular (CV) history consisting of an aneurysm of the anterior communicating artery that had been operated on in 1998 and a ruptured basilar artery tip aneurysm embolized with a stent in 2013; the case was also associated with bronchiectasis (since 2020), non-alcoholic fatty liver disease (since 2018), diabetic neuropathy (since 2023) and obesity with a body mass index of 31.72 kg/m2 (since 2010). Over the years the patient exhibited good metabolic control, initially treated with Metformin and managed through a change of diet. However, due to intolerance to Metformin, the patient stopped receiving treatments and only managed his diet. Since diabetes is by definition a condition that implies a high CV risk by itself, the primary focus with this patient was to provide additional CV protection, particularly secondary protection against any other potential future, and possibly fatal, CV events. After a brief introduction regarding the available therapeutic options, the case is presented along with the medical history, concomitant medications and evolution after 1 year. In the discussion section, similar documented cases in the literature were compared with the present case, and the potential effects of the therapeutic intervention in the present study were compared.

[Development, techniques, and utility of experimental animal models of thoracic and abdominal aortic aneurysms]

Aneurysms are clinical entities that can develop and affect human aorta; and although in most cases they have an asymptomatic course, these pathological dilatations can lead to a lethal outcome when rupture occurs, thus the establishment of predictors is crucial for death prevention. Essential events that take place in the vessel wall have been identified and described, such as inflammation, proteolysis, smooth muscle cell apoptosis, angiogenesis, and vascular remodeling. Porcine and ovine models have been useful for the development and evaluation of endovascular devices of the aorta. However, since the worldwide introduction and adoption of these minimally invasive techniques for aneurysm repair, there is lesser availability of diseased aortic tissue for molecular, cellular, and histopathological analysis, therefore over the last three decades it has been proposed various small species models that have allowed the focal induction of these lesions for the study of physiopathological mechanisms and possible useful biomarkers as diagnostic and therapeutic targets. The present review article presents and discusses the animal models available as their applications, characteristics, advantages, and limitations for the development of preclinical studies, and their importance in the comprehension of this pathology in humans.

Cellular, Molecular and Clinical Aspects of Aortic Aneurysm-Vascular Physiology and Pathophysiology

A disturbance of the structure of the aortic wall results in the formation of aortic aneurysm, which is characterized by a significant bulge on the vessel surface that may have consequences, such as distention and finally rupture. Abdominal aortic aneurysm (AAA) is a major pathological condition because it affects approximately 8% of elderly men and 1.5% of elderly women. The pathogenesis of AAA involves multiple interlocking mechanisms, including inflammation, immune cell activation, protein degradation and cellular malalignments. The expression of inflammatory factors, such as cytokines and chemokines, induce the infiltration of inflammatory cells into the wall of the aorta, including macrophages, natural killer cells (NK cells) and T and B lymphocytes. Protein degradation occurs with a high expression not only of matrix metalloproteinases (MMPs) but also of neutrophil gelatinase-associated lipocalin (NGAL), interferon gamma (IFN-γ) and chymases. The loss of extracellular matrix (ECM) due to cell apoptosis and phenotype switching reduces tissue density and may contribute to AAA. It is important to consider the key mechanisms of initiating and promoting AAA to achieve better preventative and therapeutic outcomes.