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Yuwen L, Ciqiu Y, Yi S, Ruilei L, Yuanhui L, Bo L, Songqi L, Weiming L, Jie L. A Pilot Study of Protein Microarray for Simultaneous Analysis of 274 Cytokines Between Abdominal Aortic Aneurysm and Normal Aorta. Angiology 2019; 70:830-837. [PMID: 31018647 DOI: 10.1177/0003319719844678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cytokines play an important role in the pathogenesis of abdominal aortic aneurysm (AAA). We evaluated the cytokine expression profile of large AAA walls using a 274-cytokine protein array. We hypothesized that AAAs are characterized by an inflammatory, chemotactic cytokine profile. We investigated the cytokine expression profile of 12 patients with AAA and 6 nonaneurysmal controls using an antibody-based protein array. The array generated antibodies against homogenized human aortic tissues to validate the cytokines differentially expressed in AAAs and normal aortas. Data were quantified using fluorescent signal intensities and statistically analyzed by the t test. Fifty-nine cytokines were differentially expressed between the AAA and control samples. Of the 35 selected cytokines that had relative expression >1000, 29 were significantly higher and 6 were lower in AAA samples than in controls. They respectively belonged to CC chemokines, CXC chemokines, pro-inflammatory cytokines, growth factors, proteolytic proteins and inhibitors, and cell adhesion cytokines. Our results show that distinct cytokines are involved in AAAs and suggest that the pathways involving these cytokines may be associated with the pathogenesis and development of AAAs. These findings, if confirmed by larger studies, may suggest treatment targets.
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Affiliation(s)
- Li Yuwen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yang Ciqiu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People’s Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Shi Yi
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Liu Ruilei
- Department of Breast and Thyroid Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lai Yuanhui
- Division of Vascular Surgery, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lin Bo
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Li Songqi
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lv Weiming
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Li Jie
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Abstract
Abdominal aortic aneurysm (AAA) is a local dilatation of the abdominal aortic vessel wall and is among the most challenging cardiovascular diseases as without urgent surgical intervention, ruptured AAA has a mortality rate of >80%. Most patients present acutely after aneurysm rupture or dissection from a previously asymptomatic condition and are managed by either surgery or endovascular repair. Patients usually are old and have other concurrent diseases and conditions, such as diabetes mellitus, obesity, and hypercholesterolemia making surgical intervention more difficult. Collectively, these issues have driven the search for alternative methods of diagnosing, monitoring, and treating AAA using therapeutics and less invasive approaches. Noncoding RNAs-short noncoding RNAs (microRNAs) and long-noncoding RNAs-are emerging as new fundamental regulators of gene expression. Researchers and clinicians are aiming at targeting these microRNAs and long noncoding RNAs and exploit their potential as clinical biomarkers and new therapeutic targets for AAAs. While the role of miRNAs in AAA is established, studies on long-noncoding RNAs are only beginning to emerge, suggesting their important yet unexplored role in vascular physiology and disease. Here, we review the role of noncoding RNAs and their target genes focusing on their role in AAA. We also discuss the animal models used for mechanistic understanding of AAA. Furthermore, we discuss the potential role of microRNAs and long noncoding RNAs as clinical biomarkers and therapeutics.
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Affiliation(s)
- Sandeep Kumar
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Reinier A. Boon
- Institute for Cardiovascular Regeneration, Center of
Molecular Medicine, Goethe University, Frankfurt, Germany
- Department of Physiology, Amsterdam Cardiovascular
Sciences, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The
Netherlands
- German Center of Cardiovascular Research DZHK, Frankfurt,
Germany
| | - Lars Maegdefessel
- Department of Medicine, Karolinska Institute, Stockholm,
Sweden
- Department of Vascular and Endovascular Surgery, Technical
University Munich, Munich, Germany
- German Center for Cardiovascular Research DZHK, Munich,
Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Center of
Molecular Medicine, Goethe University, Frankfurt, Germany
- German Center of Cardiovascular Research DZHK, Frankfurt,
Germany
- Corresponding authors: Hanjoong Jo, PhD, John and Jan Portman
Professor, Wallace H. Coulter Department of Biomedical Engineering, Emory
University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, GA
30322, , Stefanie Dimmeler, PhD, Institute for
Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany,
| | - Hanjoong Jo
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Institute of Technology, Atlanta, GA, USA
- Division of Cardiology, Emory University, Atlanta, GA,
USA
- Corresponding authors: Hanjoong Jo, PhD, John and Jan Portman
Professor, Wallace H. Coulter Department of Biomedical Engineering, Emory
University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, GA
30322, , Stefanie Dimmeler, PhD, Institute for
Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany,
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Siennicka A, Zuchowski M, Kaczmarczyk M, Cnotliwy M, Clark JS, Jastrzębska M. Tissue factor levels and the fibrinolytic system in thin and thick intraluminal thrombus and underlying walls of abdominal aortic aneurysms. J Vasc Surg 2018; 68:30S-37S. [PMID: 29571624 DOI: 10.1016/j.jvs.2017.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/08/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND The hemostatic system cooperates with proteolytic degradation in processes allowing abdominal aortic aneurysm (AAA) formation. In previous studies, it has been suggested that aneurysm rupture depends on intraluminal thrombus (ILT) thickness, which varies across each individual aneurysm. We hypothesized that hemostatic components differentially accumulate in AAA tissue in relation to ILT thickness. Thick (A1) and thin (B1) segments of ILTs and aneurysm wall sections A (adjacent to A1) and B (adjacent to B1) from one aneurysm sac were taken from 35 patients undergoing elective repair. METHODS Factor levels were measured using enzyme-linked immunosorbent assay of protein extract. RESULTS Tissue factor (TF) activities were significantly higher in thinner segments of AAA (B1 vs A1, P = .003; B vs A, P < .001; B vs A1, P < .001; B vs B1, P = .001). Significantly higher tissue plasminogen activator was found in thick thrombus-covered wall segments (A) than in B, A1, and B1 (P = .015, P < .001, and P < .001, respectively). Plasminogen concentrations were highest in ILT. Concentrations of α2-antiplasmin in thin ILT adjacent walls (B) were higher compared with wall (A) adjacent to thick ILT (P = .021) and thick ILT (A1; P < .001). Significant correlations between levels of different factors were mostly found in thick ILT (A1). However, no correlations were found at B sites, except for a correlation between plasmin and TF activities (r = 0.55; P = .004). CONCLUSIONS These results suggest that higher TF activities are present in thinner AAA regions. These parameters and local fibrinolysis may be part of the processes leading to destruction of the aneurysm wall.
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Affiliation(s)
- Aldona Siennicka
- Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland.
| | - Marta Zuchowski
- Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Miłosław Cnotliwy
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Jeremy Simon Clark
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Maria Jastrzębska
- Department of Laboratory Diagnostics, Pomeranian Medical University, Szczecin, Poland
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Ruddy JM, Akerman AW, Kimbrough D, Nadeau EK, Stroud RE, Mukherjee R, Ikonomidis JS, Jones JA. Differential hypertensive protease expression in the thoracic versus abdominal aorta. J Vasc Surg 2016; 66:1543-1552. [PMID: 28034583 DOI: 10.1016/j.jvs.2016.07.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypertension (HTN), which is a major risk factor for cardiovascular morbidity and mortality, can drive pathologic remodeling of the macro- and microcirculation. Patterns of aortic pathology differ, however, suggesting regional heterogeneity of the pressure-sensitive protease systems triggering extracellular matrix remodeling in the thoracic (TA) and abdominal aortas (AA). This study tested the hypothesis that the expression of two major protease systems (matrix metalloproteinases [MMPs] and cathepsins) in the TA and AA would be differentially affected with HTN. METHODS Normotensive (BPN3) mice at 14-16 weeks of age underwent implantation of osmotic infusion pumps for 28-day angiotensin II (AngII) delivery (1.46 mg/kg/day; BPN3+AngII; n = 8) to induce HTN. The TA and AA were harvested to determine levels of MMP-2, MMP-9, and membrane type 1-MMP, and cathepsins S, K, and L were evaluated in age-matched BPN3 (n = 8) control and BPH2 spontaneously hypertensive mice (non-AngII pathway; n = 7). Blood pressure was monitored via CODA tail cuff plethysmography (Kent Scientific Corporation, Torrington, Conn). Quantitative real-time polymerase chain reaction and immunoblotting/zymography were used to measure MMP and cathepsin messenger RNA expression and protein abundance, respectively. Target protease values were compared within each aortic region via analysis of variance. RESULTS Following 28 days infusion, the BPN3+AngII mice had a 17% increase in systolic blood pressure, matching that of the BPH2 spontaneously hypertensive mice (both P < .05 vs BPN3). MMP-2 gene expression demonstrated an AngII-dependent increase in the TA (P < .05), but MMP-9 was not altered with HTN. Expression of tissue inhibitor of metalloproteinases-1 was markedly increased in TA of BPN3+AngII mice, but tissue inhibitor of metalloproteinases-2 demonstrated decreased expression in the AA of both hypertensive groups (P < .05). Only cathepsin K responded to AngII-induced HTN with significant elevation in the TA of those mice, but expression of cathepsin L and cystatin C was inhibited in AA of both hypertensive groups (P < .05). Apoptotic markers were not significantly elevated in any experimental group. CONCLUSIONS By using two different models of HTN, this study has identified pressure-dependent as well as AngII-dependent regional alterations in aortic gene expression of MMPs and cathepsins that may lead to differential remodeling responses in each of the aortic regions. Further studies will delineate mechanisms and may provide targeted therapies to attenuate down-stream aortic pathology based on demonstrated regional heterogeneity.
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Affiliation(s)
- Jean Marie Ruddy
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC; Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC.
| | - Adam W Akerman
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Denise Kimbrough
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Elizabeth K Nadeau
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Robert E Stroud
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Rupak Mukherjee
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - John S Ikonomidis
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC; Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Jeffrey A Jones
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
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Rouchaud A, Johnson C, Thielen E, Schroeder D, Ding YH, Dai D, Brinjikji W, Cebral J, Kallmes DF, Kadirvel R. Differential Gene Expression in Coiled versus Flow-Diverter-Treated Aneurysms: RNA Sequencing Analysis in a Rabbit Aneurysm Model. AJNR Am J Neuroradiol 2015; 37:1114-21. [PMID: 26721773 DOI: 10.3174/ajnr.a4648] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/10/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE The biologic mechanisms leading to aneurysm healing or rare complications such as delayed aneurysm ruptures after flow-diverter placement remain poorly understood. We used RNA sequencing following implantation of coils or flow diverters in elastase aneurysms in rabbits to identify genes and pathways of potential interest. MATERIALS AND METHODS Aneurysms were treated with coils (n = 5) or flow diverters (n = 4) or were left untreated for controls (n = 6). Messenger RNA was isolated from the aneurysms at 4 weeks following treatment. RNA samples were processed by using RNA-sequencing technology and were analyzed by using the Ingenuity Pathway Analysis tool. RESULTS With RNA sequencing for coiled versus untreated aneurysms, 464/9990 genes (4.6%) were differentially expressed (58 down-regulated, 406 up-regulated). When we compared flow-diverter versus untreated aneurysms, 177/10,041 (1.8%) genes were differentially expressed (8 down-regulated, 169 up-regulated). When we compared flow-diverter versus coiled aneurysms, 13/9982 (0.13%) genes were differentially expressed (8 down-regulated, 5 up-regulated). Keratin 8 was overexpressed in flow diverters versus coils. This molecule may potentially play a critical role in delayed ruptures due to plasmin production. We identified overregulation of apelin in flow diverters, supporting the preponderance of endothelialization, whereas we found overexpression of molecules implicated in wound healing (dectin 1 and hedgehog interacting protein) for coiled aneurysms. Furthermore, we identified metallopeptidases 1, 12, and 13 as overexpressed in coiled versus untreated aneurysms. CONCLUSIONS We observed different physiopathologic responses after endovascular treatment with various devices. Flow diverters promote endothelialization but express molecules that could potentially explain the rare delayed ruptures. Coils promote wound healing and express genes potentially implicated in the recurrence of coiled aneurysms.
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Affiliation(s)
- A Rouchaud
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
| | - C Johnson
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
| | - E Thielen
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
| | - D Schroeder
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
| | - Y-H Ding
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
| | - D Dai
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
| | - W Brinjikji
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.) Department of Radiology (W.B., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - J Cebral
- Department of Bioengineering (J.C.), George Mason University, Fairfax, Virginia
| | - D F Kallmes
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.) Department of Radiology (W.B., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Applied Neuroradiology Laboratory (A.R., C.J., E.T., D.S., Y.-H.D., D.D., W.B., D.F.K., R.K.)
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Sultan S, Hynes N, Kavanagh EP, Diethrich EB. How does the multilayer flow modulator work? The science behind the technical innovation. J Endovasc Ther 2015; 21:814-21. [PMID: 25453884 DOI: 10.1583/14-4858.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sherif Sultan
- 1 Western Vascular Institute and the Department of Vascular and Endovascular Surgery, University College Hospital Galway, Ireland
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Kawano T, Kajimoto K, Higashi M, Minatoya K, Toyoda K, Nagatsuka K. Aortic transgraft hemorrhage after intravenous tissue plasminogen activator therapy in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:2145-2150. [PMID: 25088170 DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/02/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The safety of intravenous recombinant tissue plasminogen activator (IV tPA) therapy for patients with an aortic aneurysm or undergoing aortic graft replacement has not been established. We evaluated the incidence, bleeding site, coagulation factors, and clinical outcomes of patients treated with IV tPA for acute stroke. METHODS Between October 2005 and May 2013, 394 ischemic stroke patients were treated in our stroke center with IV tPA. Among these patients, we investigated those who had a history of aortic aneurysm with or without aortic graft replacement before IV tPA therapy and underwent computed tomography imaging. We compared the levels of D-dimer and hemoglobin (Hb) around IV tPA therapy between the patients with and without tPA-associated periaortic bleeding. RESULTS Seven patients with a history of aortic aneurysm (3 men; mean age: 80.4 years) were examined; 3 had undergone aortic graft replacement, and 2 had experienced tPA-associated bleeding around vascular grafts. The serum D-dimer levels in those with bleeding were only slightly higher before tPA than in those without (median: 10.5 vs. 1.5 μg/mL) but were elevated 1 day after tPA (107.4 vs. 8.6 μg/mL). The Hb levels 2 days after tPA were comparable with those before tPA (11.9 vs. 11.8 g/dL) but were lower in the patients with bleeding than in those without (8.5 vs. 11.7 g/dL). Surgical intervention was not required, although 1 patient required blood transfusion. CONCLUSIONS Our analysis provides reassurance regarding the risk of IV tPA therapy in patients undergoing aortic graft replacement.
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Affiliation(s)
- Tomohiro Kawano
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Katsufumi Kajimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masahiro Higashi
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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Qian HS, Gu JM, Liu P, Kauser K, Halks-Miller M, Vergona R, Sullivan ME, Dole WP, Deng GG. Overexpression of PAI-1 prevents the development of abdominal aortic aneurysm in mice. Gene Ther 2007; 15:224-32. [DOI: 10.1038/sj.gt.3303069] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lindholt JS. Activators of Plasminogen and the Progression of Small Abdominal Aortic Aneurysms. Ann N Y Acad Sci 2006; 1085:139-50. [PMID: 17182930 DOI: 10.1196/annals.1383.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to examine the role of activating pathways of plasminogen in the natural history of abdominal aortic aneurysms (AAA). To fulfill this objective 70 male patients with small AAA (> 3 cm) were interviewed and examined. Their blood samples were taken at diagnosis. The patients were scanned annually for a minimum period of 1 year and a maximum of 5 years (mean 2.5 years), and referred for surgery if the AAA exceeded 5 cm in diameter. Plasma levels of urokinase-like plasminogen activator (uPA), tissue-type plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage-inhibiting factor (MIF), transforming-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and cotinine (a nicotine metabolite) were measured. The annual expansion rate correlated positively with tPA, IgA-CP, and S-cotinine; rho = 0.37 (P = 0.004), 0.28 (P = 0.01), and 0.24 (P = 0.04), while PAI-1, uPA, TGF-beta1, homocysteine, and MIF did not. S-cotinine and PAI-1 also correlated positively with tPA, rho = 0.24 (P = 0.04), and 0.33 (P = 0.005). IgA-CP did not correlate with tPA. By receiver operating characteristics (ROC) curve analysis, tPA showed to be predictive of cases expanding to above 5 cm within the first 5 years with an optimal sensitivity and specificity of 0.73 and 0.71, respectively (P = 0.015). The aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but not by uPA, which usually dominates matrix degradation. Smoking seems to be an important factor for this pathway, while the pathway of IgA-CP seems different.
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Affiliation(s)
- Jes S Lindholt
- Department of Vascular Surgery, Viborg Hospital, Denmark.
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Abstract
Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell infiltrate, neovascularisation, and production and activation of various proteases and cytokines contribute to the development of this disorder, although the underlying mechanisms are unknown. In this Seminar, we aim to provide an updated review of the pathophysiology, current and new diagnostic procedures, assessment, and treatment of abdominal aortic aneurysm to provide family practitioners with a working knowledge of this disorder.
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Affiliation(s)
- N Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, University of Liège, Sart-Tilman 4000 Liège, Belgium
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Deng GG, Martin-McNulty B, Sukovich DA, Freay A, Halks-Miller M, Thinnes T, Loskutoff DJ, Carmeliet P, Dole WP, Wang YX. Urokinase-type plasminogen activator plays a critical role in angiotensin II-induced abdominal aortic aneurysm. Circ Res 2003; 92:510-7. [PMID: 12600880 DOI: 10.1161/01.res.0000061571.49375.e1] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have previously demonstrated that urokinase-type plasminogen activator (uPA) is highly expressed in the aneurysmal segment of the abdominal aorta (AAA) in apolipoprotein E-deficient (apoE-/-) mice treated with angiotensin II (Ang II). In the present study, we tested the hypothesis that uPA is essential for AAA formation in this model. An osmotic minipump containing Ang II (1.44 mg/kg per day) was implanted subcutaneously into 7- to 11-month-old male mice for 1 month. Ang II induced AAA in 9 (90%) of 10 hyperlipidemic mice deficient in apoE (apoE-/-/uPA+/+ mice) but in only 2 (22%) of 9 mice deficient in both apoE and uPA (apoE-/-/uPA-/- mice) (P<0.05). Although the expansion of the suprarenal aorta was significantly less in apoE-/-/uPA-/- mice than in apoE-/-/uPA+/+ mice, the aortic diameters of the aorta immediately above or below the suprarenal aorta were similar between the 2 groups. Ang II induced AAA in 7 (39%) of 18 strain-matched wild-type C57 black/6J control mice. The incidence was significantly higher in atherosclerotic apoE-deficient (apoE-/-) mice, in which 8 (100%) of 8 mice developed AAA. Only 1 (4%) of 27 uPA-/- mice developed AAA after Ang II treatment. We conclude the following: (1) uPA plays an essential role in Ang II-induced AAA in mice with or without preexisting hyperlipidemia and atherosclerosis; (2) uPA deficiency does not affect the diameter of the nonaneurysmal portion of the aorta; and (3) atherosclerosis and/or hyperlipidemia promotes but is not essential for Ang II-induced AAA formation in this model.
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Affiliation(s)
- Gary G Deng
- Berlex Biosciences, Department of Pharmacology and Cardiovascular Research, PO Box 4099, 2600 Hilltop Dr, Richmond, Calif 94804-0099, USA. j
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12
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Wielockx B, Libert C. Serine proteases of the fibrinolysis pathway are not involved in lethal hepatitis and fibrinogen breakdown induced by tumor necrosis factor. Cytokine 2003; 21:281-5. [PMID: 12824001 DOI: 10.1016/s1043-4666(03)00104-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tumor necrosis factor (TNF) plays a key role in several types of fulminant and acute hepatitis, and induces massive apoptosis and necrosis of hepatocytes. Our previous studies described the central role played by several matrix metalloproteinases (MMPs) and one or more unknown serine proteases. The aim of this study was to investigate the involvement of serine proteases of the fibrinolytic pathway, known to be activators of several MMPs, in TNF-induced hepatitis and fibrinogen (FG) breakdown. Experiments were performed in a model of TNF-induced hepatitis, consisting of administration of TNF in combination with D-(+)-galactosamine (GalN) to mice deficient in urokinase-type plasminogen (PG) activator (u-PA), tissue-type PG activator (t-PA) or PG. Lethality, transaminase release, increased plasma clotting time and FG levels were measured. In PA- and PG-deficient mice, TNF/GalN still induced hepatitis, as well as increased clotting time and FG breakdown. MMP-9 activation still occurred in the liver despite the lack of plasmin. The data suggest that the serine proteases involved in TNF-induced lethal hepatitis are no constituents of the fibrinolytic cascade.
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Affiliation(s)
- B Wielockx
- Department for Molecular Biomedical Research, Flanders Interuniversity Institute for Biotechnology and Ghent University, K L Ledeganckstraat 35, 9000 Ghent, Belgium
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Wang YX, Martin-McNulty B, Freay AD, Sukovich DA, Halks-Miller M, Li WW, Vergona R, Sullivan ME, Morser J, Dole WP, Deng GG. Angiotensin II increases urokinase-type plasminogen activator expression and induces aneurysm in the abdominal aorta of apolipoprotein E-deficient mice. THE AMERICAN JOURNAL OF PATHOLOGY 2001; 159:1455-64. [PMID: 11583973 PMCID: PMC1850514 DOI: 10.1016/s0002-9440(10)62532-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Urokinase-type plasminogen activator (uPA) is increased in human abdominal aortic aneurysm (AAA). Chronic infusion of angiotensin II (Ang II) results in AAA in apolipoprotein E-deficient mice. We tested the hypothesis that Ang II infusion results in an elevation of uPA expression contributing to aneurysm formation. Ang II or vehicle was infused by osmotic pumps into apoE-KO mice. All mice treated with Ang II developed a localized expansion of the suprarenal aorta (75% increase in outer diameter), accompanied by an elevation of blood pressure (22 mmHg), compared to the vehicle-treated group. Histological examination of the dilated aortic segment revealed similarities to human AAA including focal elastin fragmentation, macrophage infiltration, and intravascular hemorrhage. Ang II treatment resulted in a 13-fold increase in the expression of uPA mRNA in the AAA segment in contrast to a twofold increase in the atherosclerotic aortic arch. Increased uPA protein was detected in the abdominal aorta as early as 10 days after Ang II infusion before significant aorta expansion. Thus, Ang II infusion results in macrophage infiltration, increased uPA activity, and aneurysm formation in the abdominal aorta of apoE-KO mice. These data are consistent with a causal role for uPA in the pathogenesis of AAA.
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Midttun M, Sejrsen P, Paaske WP. Is non-specific aneurysmal disease of the infrarenal aorta also a peripheral microvascular disease? Eur J Vasc Endovasc Surg 2000; 19:625-9. [PMID: 10873731 DOI: 10.1053/ejvs.1999.1044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to examine whether aneurysmal disease of the aorta has a functional component in the peripheral microIvasculature. MATERIALS ten normal persons; and 15 patients who had been operated on for ruptured non-specific infrarenal aortic aneurysm months to years previously were studied. METHODS blood flow rates were measured: (a) in the subcutaneous adipose tissue of the forefoot by the(133)xenon local washout method (perfusion through nutritive capillaries supplied by arterioles with elastin in the tunica media); and (b) in the arteriovenous anastomoses of the pulp of the first toe as measured by the heat washout method (perfusion predominantly through thick-walled tubes without elastin). Perfusion rates were measured in supine subjects at heart level, at 30 cm above and at 30 cm below heart level. RESULTS in subcutaneous adipose tissue, the capillary blood flow rate was four times higher in patients with aneurysmal disease than in normal subjects. Both groups exhibited autoregulation of blood flow and a normal veno-arteriolar sympathetic axon reflex. Blood flow rates in the arteriovenous anastomoses of the pulp did not differ between aneurysm patients and normal subjects. Autoregulation and the axon reflex were absent in the arteriovenous anastomoses of normal subjects as well as in aneurysm patients. CONCLUSIONS non-specific aneurysmal disease of the infrarenal aorta has a peripheral functional component affecting arterioles but not arteriovenous anastomoses.
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Affiliation(s)
- M Midttun
- Department of Medical Physiology, University of Copenhagen, Denmark
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