1
|
Panthofer AM, Olson SL, Rademacher BL, Kraiss LW, Blackwelder WC, Baxter BT, MacTaggart JN, Katzen BT, Berman SS, Matsumura JS. Effect of Two Years of Doxycycline Treatment on Infrarenal Aortic Neck Diameter. EJVES Vasc Forum 2023; 59:43-48. [PMID: 37408850 PMCID: PMC10319163 DOI: 10.1016/j.ejvsvf.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Endovascular aneurysm repair (EVAR) is a widely used option for patients with suitable vascular anatomy who have a large infrarenal abdominal aortic aneurysm (AAA). Neck diameter is the primary anatomical determinant of EVAR eligibility and device durability. Doxycycline has been proposed to stabilise the proximal neck after EVAR. This study explored doxycycline mediated aortic neck stabilisation in patients with small AAA, monitored by computed tomography over two years. Methods This was a multicentre prospective randomised clinical trial. Subjects from the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA3CT, NCT01756833) were included in this secondary a priori analysis. Female baseline AAA maximum transverse diameter was between 3.5 and 4.5 cm, and male was between 3.5 and 5.0 cm. Subjects were included if they completed pre-enrolment and two year follow up computed tomography (CT) imaging. Proximal aortic neck diameter was measured at the lowest renal artery, and 5, 10, and 15 mm caudal to this point; mean neck diameter was calculated from these values. Unpaired, two tailed parametric t test analysis with post hoc Bonferroni correction was used to detect differences between neck diameters in subjects treated with placebo vs. doxycycline at baseline and two years. Results One hundred and ninety-seven subjects (171 male, 26 female) were included in the analysis. All patients, regardless of treatment arm, demonstrated larger neck diameter caudally, a slight increase in diameter at all anatomical levels over time, and greater growth caudally. There was no statistically significant difference in infrarenal neck diameter between treatment arms at any anatomical level at any time point, nor mean change in neck diameter over two years. Conclusion Doxycycline does not demonstrate infrarenal aortic neck growth stabilisation in small AAA followed for two years by thin cut CT imaging using a standardised acquisition protocol and cannot be recommended for mitigation of growth of the aortic neck in patients with untreated small abdominal aortic aneurysms.
Collapse
Affiliation(s)
- Annalise M. Panthofer
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sydney L. Olson
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Brooks L. Rademacher
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Larry W. Kraiss
- Department of Surgery, Division of Vascular Surgery, University of Utah, Salt Lake City, UT, USA
| | - William C. Blackwelder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - B. Timothy Baxter
- Department of Surgery, Division of Vascular Surgery, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Jason N. MacTaggart
- Department of Surgery, Division of Vascular Surgery, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Barry T. Katzen
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Jon S. Matsumura
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | |
Collapse
|
2
|
Salhi L, Rijkschroeff P, Van Hede D, Laine ML, Teughels W, Sakalihasan N, Lambert F. Blood Biomarkers and Serologic Immunological Profiles Related to Periodontitis in Abdominal Aortic Aneurysm Patients. Front Cell Infect Microbiol 2022; 11:766462. [PMID: 35096635 PMCID: PMC8798408 DOI: 10.3389/fcimb.2021.766462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Periodontitis is a chronic inflammatory gum disease associated with systemic diseases such as cardiovascular diseases. Aim To investigate the association of systemic blood biomarkers, C-reactive protein (CRP), levels of lipopolysaccharide (LPS), and IgG levels against periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) with the stability, based on the aortic diameter, the growth rate and the eligibility for surgical intervention, of patients with abdominal aortic aneurysm (AAA). Methods Patients with stable AAA (n = 30) and unstable AAA (n = 31) were recruited. The anti-A. actinomycetemcomitans and anti-P. gingivalis IgG levels were analyzed by ELISA, the LPS analysis was performed by using the limulus amebocyte lysate (LAL) test, and plasma levels of CRP were determined using an immune turbidimetric method. The association between these blood systemic biomarkers, AAA features, periodontal clinical parameters and oral microbial profiles were explored. Regression models were used to test the relationship between variables. Results The presence of antibodies against Pg and Aa, LPS and high CRP concentrations were found in all AAA patients. The IgG levels were similar in patients with stable and unstable AAA (both for Aa and Pg). Among investigated blood biomarkers, only CRP was associated with AAA stability. The amount of LPS in saliva, supra, and subgingival plaque were significantly associated with the systemic LPS (p <0.05). Conclusions This post-hoc study emphasizes the presence of antibodies against Pg and Aa, LPS and high CRP concentrations in all AAA patients. The presence of Pg in saliva and subgingival plaque was significantly associated with the blood LPS levels. For further studies investigating periodontitis and systemic diseases, specific predictive blood biomarkers should be considered instead of the use of antibodies alone.
Collapse
Affiliation(s)
- Leila Salhi
- Department of Periodontology, Buccal Surgery and Implantology, Faculty of Medicine, Liège, Belgium
- *Correspondence: Leila Salhi, ; orcid.org/0000-0003-3529-8452
| | - Patrick Rijkschroeff
- Department of Periodontology , Academic Centre for Dentistry Amsterdam, Vrije Universiteit (VU) Amsterdam, Amsterdam, Netherlands
| | - Dorien Van Hede
- Department of Periodontology, Buccal Surgery and Implantology, Faculty of Medicine, Liège, Belgium
| | - Marja L. Laine
- Department of Periodontology , Academic Centre for Dentistry Amsterdam, Vrije Universiteit (VU) Amsterdam, Amsterdam, Netherlands
| | - Wim Teughels
- Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Natzi Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Liège, Belgium
| | - France Lambert
- Department of Periodontology, Buccal Surgery and Implantology, Faculty of Medicine, Liège, Belgium
| |
Collapse
|
3
|
Abstract
OBJECTIVE There is no medical treatment proven to limit abdominal aortic aneurysm (AAA) progression. This systematic review aimed to summarise available trial evidence on the efficacy of pharmacotherapy in limiting AAA growth and AAA-related events. METHODS A systematic literature search was performed to examine the efficacy of pharmacotherapy in reducing AAA growth and AAA-related events. Pubmed, Embase (Excerpta Medica Database), and the Cochrane library were searched from March, 1999 to March 29, 2022. AAA growth (mm/year) in the intervention and control groups was expressed as mean and standard deviation (SD). The results of AAA growth were expressed as mean difference (MD) and its 95% confidence interval (95% CI). Odds ratios (ORs) were calculated for the AAA-related events.Heterogeneity was quantified using the I2 statistic. Forest plots were created to show the pooled results of each outcome. OUTCOMES A total of 1373 articles were found in different databases according to the search strategy, and 10 articles were identified by hand searching. A total of 26 articles were included in our systematic review after the screening. For the studies of metformin, the meta-analysis demonstrated that metformin use was associated with a lower AAA growth rate (MD: -0.81 mm/y, 95% CI: -1.19 to -0.42, P < 0.0001, I2 = 87%), Metformin use also was related to the lower rates of AAA-related events (OR: 0.53, 95% CI: 0.36 to 0.76, P = 0.0007, I2 = 60%). The hypotensive drugs of the studies mainly included angiotensin-converting enzyme inhibitors (ACEI), angiotensin II type 1 receptor blockers (ARB), and propranolol. The overall meta-analysis of blood pressure-lowering drugs reported no significant effect in limiting the AAA growth (MD: 0.31mm/year, 95%CI: -0.03 to 0.65, P = 0.07, I2 = 66%) and AAA-related events (OR: 1.33, 95%CI: 0.76 to 2.32, P = 0.32, I2 = 98%), In the subgroup analysis of the hypotensive drugs, the ACEI/ARB and propranolol also showed no significant in reducing the AAA growth and AAA-related events. The meta-analysis of the antibiotics demonstrated that the antibiotics were not associated with a lower AAA growth rate (MD: -0.27 mm/y, 95% CI: -0.88 to 0.34, P = 0.39, I2 = 77%) and AAA-related events (OR: 0.94, 95%CI: 0.65 to 1.35, P = 0.72, I2 = 0%). The results of statins also showed no significant effect in limiting AAA growth (MD: -1.11mm/year, 95%CI: -2.38 to 0.16, P = 0.09, I2 = 96%) and AAA-related events (OR: 0.53, 95%CI: 0.26 to 1.06, P = 0.07, I2 = 92%). CONCLUSION In conclusion, effective pharmacotherapy for AAA was still lacking. Although the meta-analysis showed that metformin use was associated with lower AAA growth and AAA-related events, all of the included studies about metformin were cohort studies or case-control studies. More randomized controlled trials (RCTs) are needed for further verification.
Collapse
Affiliation(s)
- Zhixiang Su
- Vascular Surgery Department, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Vascular Surgery Department, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Vascular Surgery Department, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Paghdar S, Khan TM, Patel NP, Chandrasekaran S, De Sousa JFM, Tsouklidis N. Doxycycline Therapy for Abdominal Aortic Aneurysm: Inhibitory Effect on Matrix Metalloproteinases. Cureus 2021; 13:e14966. [PMID: 34123662 PMCID: PMC8191685 DOI: 10.7759/cureus.14966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a life-threatening condition associated with smoking, aging, atherosclerosis, and destruction of the connective tissue in the abdominal aortic wall. Disturbances in the synthesis and degradation of matrix metalloproteinase (MMP) have been known to contribute to the development of AAAs. The only available treatment of AAA is surgical repair. Doxycycline, a tetracycline analog, is thought to have an inhibitory effect on MMPs. Knowing the effect of doxycycline, there may be some favorable effects of the drug to reduce the growth of small AAAs and avoid the need for invasive treatment. This article aims to determine the relationship between doxycycline and the MMPs to prevent the growth of small AAAs. We conducted our review using online resources such as PubMed, Google Scholar, The Journal of Vascular Surgery, and ResearchGate. The result of our study supports the effect of doxycycline in preventing the growth of small AAAs. We conclude that therapeutic treatment with doxycycline in patients with small AAAs can prevent the growth of aneurysms, life-threatening aneurysm rupture, and reduce the need for expensive, invasive treatment.
Collapse
Affiliation(s)
- Smit Paghdar
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, IND
| | - Taheseen M Khan
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nishant P Patel
- Internal Medicine, Government Medical College, Surat, Surat, IND.,Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Savitri Chandrasekaran
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Joaquim Francisco Maria De Sousa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Surgery, S.S. Institute of Medical Sciences and Research Centre, Davangere, IND.,Emergency Medicine, Healthway Hospital, Panaji, IND
| | - Nicholas Tsouklidis
- Health Care Administration, University of Cincinnati Health, Cincinnati, USA.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Atlantic University School of Medicine, Gros Islet, LCA
| |
Collapse
|
5
|
Salhi L, Sakalihasan N, Okroglic AG, Labropoulos N, Seidel L, Albert A, Teughels W, Defraigne JO, Lambert F. Further evidence on the relationship between abdominal aortic aneurysm and periodontitis: A cross-sectional study. J Periodontol 2020; 91:1453-1464. [PMID: 32329066 DOI: 10.1002/jper.19-0671] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Periodontitis is a chronic inflammatory disease characterized by Gram-negative bacteria responsible for the degradation of tissues surrounding tooth. Moreover, periopathogens can invade the bloodstream, disseminate and promote cardiovascular disease, such as the link between Porphyromonas gingivalis and atherosclerosis. The aim of this study was to explore the relationship between the severity of periodontitis and of abdominal aortic aneurysm (AAA). METHODS This cross-sectional study compared patients with stable AAA (n = 30) and patients with unstable AAA (n = 31) based on aortic diameter, growth rate, and eligibility for surgical intervention. Periodontal clinical parameters were recorded as well as the Periodontal Inflamed Surface Area and the Periodontal Index for Risk of Infectiousness (PIRI). Microbiological analyses were performed on saliva and supragingival and subgingival plaque. Quantification of Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) was done by quantitative polymerase chain reaction. RESULTS The two AAA groups were homogeneous for age, sex, and most risk factors except hypertension and chronic obstructive pulmonary disease. Periodontal parameters were comparable but the proportion of patients with high PIRI scores was greater in those with unstable AAA (51.6% versus 23.3%). The probing depth (PD) and the proportion of PD >6 mm were positively correlated with AAA size and thrombus volume. Several associations were found between periopathogens such as Pg and AAA diameters and volumes, but no difference could be evidenced between stable and unstable AAA groups. CONCLUSIONS Periodontitis was highly prevalent in both stable and unstable AAA patients. Severe and progressive periodontitis (stage IV and grade C) tended to be more frequent in the group of patients with unstable AAA. Moreover, Pg was observed in all the samples (saliva, supragingival, and subgingival plaque) and was correlated with AAA diameters and volumes. The study evidenced potential relationships between periodontitis severity and size of AAA.
Collapse
Affiliation(s)
- Leila Salhi
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Natzi Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Ambre Gau Okroglic
- Department of Medical Imagery, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University School of Medicine, Stony Brook, USA
| | - Laurence Seidel
- Department of Biostatistics, University of Liège, Liège, Belgium
| | - Adelin Albert
- Department of Public Health Sciences, University of Liège, Liège, Belgium
| | - Wim Teughels
- Department of Periodontology, Research Group for Microbial Adhesion, Catholic University Leuven, Leuven, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
| | - France Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
| |
Collapse
|
6
|
Salhi L, Rompen E, Sakalihasan N, Laleman I, Teughels W, Michel JB, Lambert F. Can Periodontitis Influence the Progression of Abdominal Aortic Aneurysm? A Systematic Review. Angiology 2018; 70:479-491. [DOI: 10.1177/0003319718821243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Leila Salhi
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Eric Rompen
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Natzi Sakalihasan
- Department of Cardiovascular and Thoracic Surgery, Surgical Research Centre, GIGA-Cardiovascular Science Unit, University of Liège, Liège, Belgium
| | - Isabelle Laleman
- Department of Oral Health Sciences, KU Leuven & Dentistry University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Periodontology, Research Group for Microbial Adhesion, Catholic University Leuven, Leuven, Belgium
| | - Jean-Baptiste Michel
- DRE Laboratory for Translational Vascular Science, Inserm Denis Diderot University, Paris, France
| | - France Lambert
- Dental Biomaterials Research Unit, Head of Clinic, Department of Periodontology and Oral Surgery, University of Liège, Liège, Belgium
| |
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: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
|
Abstract
The purpose of this study was to determine the effect of low-dose doxycycline on matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP)-1 expression in the wall of abdominal aortic aneurysms. A double-blind, randomized study was conducted of patients treated with doxycycline (100 mg/d orally) or placebo for 1 month prior to surgery. MMP-2, -3, and -9 (zymogen and activity); MMP-1, -2, -3, -7, -9, -11, -12, and -14; and TIMP-1 (messenger ribonucleic acid [mRNA]) were measured in the aneurysm wall. No differences were found between the treatment and placebo groups in zymogen levels of MMP-2, -3, or -9 or in the free or total activities of MMP-2 and -9. Treatment with doxycycline also had no effect on the concentration of any mRNA measured. No relationship was found between the number of tablets taken and MMP or TIMP protein, mRNA, or activity levels in the aneurysm wall. Low-dose doxycycline treatment does not alter the expression or activity of metalloproteinases or their inhibitor, TIMP-1, in the aneurysm wall.
Collapse
Affiliation(s)
- Ren Ding
- Academic Department of Surgery, King's College, St Thomas' Campus, London, UK
| | | | | | | | | |
Collapse
|
9
|
Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. Clin Investig Arterioscler 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
| | | |
Collapse
|
10
|
Sharif MA, McDowell DA, Badger SA. Chlamydia pneumoniae antibodies and C-reactive protein levels in patients with abdominal aortic aneurysms. ScientificWorldJournal 2013; 2013:212450. [PMID: 24459421 DOI: 10.1155/2013/212450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/19/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The study aim was to assess the relationship between the presence of antibodies to Chlamydia pneumoniae and abdominal aortic aneurysm (AAA) incidence. PATIENTS AND METHODS Consecutive AAA patients and AAA-free controls were recruited prospectively. Serum samples from both groups were examined to determine Immunoglobulin (Ig) A and IgG titres against Chlamydia pneumoniae by ELISA and C-reactive protein (CRP) concentrations. Results were expressed as mean (SD) or median (IQR) and compared using χ (2) and Mann-Whitney U tests. A P value of <0.05 was considered statistically significant. RESULTS Each study group (AAA/nAAA) comprised 250 patients. 196 (78.7%) AAA patients had positive IgA antichlamydial antibody titres, compared to 181 (72.4%) in the control group (P = 0.008, OR 2.0, 95% CI 1.2-3.5). However, positive IgG antibody titres were similar (191 versus 203; P = 0.222, OR 0.7, 95% CI 0.4-1.3). Average CRP concentrations were higher in AAA individuals. IgA or IgG antibody titres were not related to CRP concentrations. CONCLUSIONS These results demonstrated that the frequent incidence of Chlamydia pneumoniae antibodies within the general population makes it difficult to relate its presence to AAA development, despite the high IgA antibody titres. In addition, raised CRP concentrations in AAA patients are not related to the presence of antichlamydial antibodies.
Collapse
|
11
|
Abstract
Multiple medical therapies have been proposed to prevent abdominal aortic aneurysm expansion. Use of these medications, hormones, vitamins, and dietary products is based on their ability to alter the pathophysiology of continued aortic wall growth. In this review, the explanation of how these medications can achieve suppression of abdominal aortic aneurysm is explained in relation to their effect on the various aspects of aortic wall inflammation. Despite the large number of animal and observational studies, there remain very few randomized clinical trials to support use of any of these agents. However, there may be sufficient evidence to suggest that statins, doxycycline, vitamin E, cyclooxygenase-2 inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers can prove beneficial in some individuals.
Collapse
Affiliation(s)
- Russell Samson
- Mote Vascular Foundation, Inc., Florida State University Medical School, Sarasota, FL 34232, USA.
| |
Collapse
|
12
|
Hinterseher I, Gäbel G, Corvinus F, Lück C, Saeger HD, Bergert H, Tromp G, Kuivaniemi H. Presence of Borrelia burgdorferi sensu lato antibodies in the serum of patients with abdominal aortic aneurysms. Eur J Clin Microbiol Infect Dis 2012; 31:781-9. [PMID: 21842293 PMCID: PMC3319877 DOI: 10.1007/s10096-011-1375-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/28/2011] [Indexed: 01/13/2023]
Abstract
Infectious agents are likely to play a role in the pathogenesis of chronic inflammatory diseases, including abdominal aortic aneurysms (AAAs). The goal of this study was to determine if Borrelia burgdorferi sensu lato (sl), a microorganism responsible for Lyme disease, is involved in the etiology of AAAs. The presence of serum antibodies against B. burgdorferi sl was measured with enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blotting in 96 AAA and 108 peripheral artery disease (PAD) patients. Polymerase chain reaction (PCR) was used for the detection of Borrelia-specific DNA in the aneurysm wall. Among AAA patients 34% and among PAD patients 16% were seropositive for B. burgdorferi sl antibodies (Fisher's exact test, p = 0.003; odds ratio [OR] 2.79; 95% confidence interval [CI] 1.37-5.85). In the German general population, 3-17% are seropositive for Borrelia antibodies. No Borrelia DNA was detected in the aneurysm wall. Our findings suggest a relationship between AAAs and B. burgdorferi sl. We hypothesize that the underlying mechanism for B. burgdorferi sl in AAA formation is similar to that by the spirochete Treponema pallidum; alternatively, AAAs could develop due to induced autoimmunity via molecular mimicry due to similarities between some of the B. burgdorferi sl proteins and aortic proteins.
Collapse
Affiliation(s)
- I Hinterseher
- Department of Visceral, Thoracic, and Vascular Surgery, Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJE, van Keulen JW, Rantner B, Schlösser FJV, Setacci F, Ricco JB. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41 Suppl 1:S1-S58. [PMID: 21215940 DOI: 10.1016/j.ejvs.2010.09.011] [Citation(s) in RCA: 986] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/12/2010] [Indexed: 12/11/2022]
Affiliation(s)
- F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Høgh A, Vammen S, Ostergaard L, Joensen JB, Henneberg EW, Lindholt JS. Intermittent Roxithromycin for Preventing Progression of Small Abdominal Aortic Aneurysms: Long-Term Results of a Small Clinical Trial. Vasc Endovascular Surg 2009; 43:452-6. [DOI: 10.1177/1538574409335037] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Antibodies against Chlamydia pneumoniae are associated with an increased rate of expansion of small abdominal aortic aneurysms (AAAs). Short-term follow-up trials have shown a transient reduction AAA growth rate, in macrolide treated compared with placebo. Therefore we analysed the influence of intermittent, long-term roxithromycin treatment on AAA expansion and referral for surgery. Methods: Eighty-four patients with small AAAs were randomized to either an annual 4 weeks’ treatment with roxithromycin or placebo, and followed prospectively. Results: Intermittent, long-term Roxithromycin-treatment reduced mean annual growth rate by 36% compared with placebo after adjustment for potential confounders. Long-term roxithromycin-treated patients had a 29% lower risk of being referred for surgical evaluation, increasing to 57% after adjusting for potential confounders. Conclusion: Annual 4 week treatment with 300 mg roxithromycin daily may reduce the progression of small AAAs, and later need for surgical repair. However, more robust studies are needed for confirmation.
Collapse
Affiliation(s)
- Annette Høgh
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark,
| | - Steen Vammen
- Department of Vascular Surgery, , Skejby Sygehus, University hospital of Aarhus, Denmark
| | - Lars Ostergaard
- 2 Department of Infectious Diseases, Skejby Sygehus, University hospital of Aarhus, Denmark
| | | | - Esklid W. Henneberg
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark
| | - Jes S. Lindholt
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark
| |
Collapse
|
15
|
Abstract
Abdominal aortic aneurysm (AAA) is a common degenerative condition with high mortality in older men. Elective surgical or endovascular repair is performed to prevent rupture of large AAAs. In contrast, despite gradual expansion, small AAAs have a low risk of rupture, and there is currently no well-defined treatment strategy for them. Therefore, a pharmacological approach for AAA is expected in the clinical setting. Indeed, several therapeutic effects of pharmacological agents have been reported in experimental models, and some agents have undergone clinical trials. Treatment with statins, angiotensin-converting enzyme-inhibitors, antibiotics, and anti-inflammatory agents appears to inhibit the growth rate of AAA in humans. However, as the sample size and follow-up period were limited in these studies, a large randomized study with long-term follow-up of small AAA should be performed to clarify the effect of these agents. Recently, the regression of AAA using molecular pharmacological approaches was reported in experimental studies. The characteristics of these strategies are the regulation of multiple molecular mediators and the signalling networks associated with AAA formation. On the basis of the results of these investigations, it may be possible to repair the injured aortic wall and obtain the remission of AAA using pharmacological therapy.
Collapse
Affiliation(s)
- Takashi Miyake
- Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | | |
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
Schlösser FJV, Tangelder MJD, Verhagen HJM, van der Heijden GJMG, Muhs BE, van der Graaf Y, Moll FL. Growth predictors and prognosis of small abdominal aortic aneurysms. J Vasc Surg 2008; 47:1127-33. [PMID: 18440183 DOI: 10.1016/j.jvs.2008.01.041] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/13/2008] [Accepted: 01/13/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evidence regarding the influence of cardiovascular risk factors, comorbidities, and patient characteristics on the growth of small abdominal aortic aneurysms (AAA) is limited. We assessed, in an observational cohort study, rupture rates, risks of mortality, and the effects of cardiovascular risk factors and patient demographics on growth rates of small AAAs. METHODS Between September 1996 and January 2005, 5057 patients with manifest arterial vascular disease or cardiovascular risk factors were included in the Second Manifestation of ARTerial disease (SMART) study. Measurements of the abdominal aortic diameter were performed in all patients. All patients with an initial AAA diameter between 30 and 55 mm were selected for this study. All AAA measurements during follow-up until August 2007 were collected. Multivariate regression analysis was performed to calculate the effects of demographic patient characteristics, initial AAA diameter, and cardiovascular risk factors on AAA growth. RESULTS Included were 230 patients, with a mean age of 66 years and 90% were male. Seven AAA ruptures (six fatal) occurred in 755 patient years of follow-up (rupture rate 0.9% per patient-year). In 147 patients, AAA measurements were performed for a period of more than 6 months. The median follow-up time was 3.3 years (mean 4.0, range 0.5 to 11.1 years, standard deviation (SD) 2.5). Mean AAA diameter was 38.8 mm (SD 6.8) and mean expansion rate 2.5 mm/y. Patients using lipid-lowering drugs had a 1.2 mm/y (95% confidence interval [CI] -2.34 to -0.060 mm/y) lower AAA growth rate compared to nonusers of these drugs. Initial AAA diameter was associated with a 0.09 mm/y (95% CI 0.01 to 0.18 mm/y) higher growth rate per millimetre increase of the diameter. No other factors, including blood lipid values, were independently associated with AAA growth. CONCLUSIONS Lipid-lowering drug treatment and initial AAA diameter appear to be independently associated with lower AAA growth rates. The risk of rupture of these small abdominal aortic aneurysms was low, which pleads for watchful waiting.
Collapse
Affiliation(s)
- Felix J V Schlösser
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Falkensammer B, Duftner C, Seiler R, Pavlic M, Walder G, Wilflingseder D, Stoiber H, Klein-Weigel P, Dierich M, Fraedrich G, Würzner R, Schirmer M. Lack of microbial DNA in tissue specimens of patients with abdominal aortic aneurysms and positive Chlamydiales serology. Eur J Clin Microbiol Infect Dis 2007; 26:141-5. [PMID: 17216421 DOI: 10.1007/s10096-006-0245-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a case-control study that included a total of 98 patients and 83 controls, the possible link between various pathogens and abdominal aortic aneurysms was investigated. For 68 patients with abdominal aortic aneurysm and age-matched controls, no differences were detected in the levels of immunoglobulin (Ig)A and IgG Chlamydiaceae and Chlamydophila pneumoniae antibodies. Patients with IgA titers positive for Chlamydophila pneumoniae showed progressive disease (defined as an annual increase of the aneurysm diameter of > or = 0.5 cm) more frequently than patients with negative IgA titers (p = 0.046). Polymerase chain reactions performed to detect DNA for Chlamydophila pneumoniae, Chlamydia trachomatis, Chlamydophila psittaci, human cytomegalovirus, Borrelia burgdorferi and Helicobacter pylori in tissue specimens of 30 patients and 15 controls were negative. In summary, Chlamydophila pneumoniae may contribute to aortic aneurysm disease progression, but DNA of this and other pathogens was not found in patients' specimens.
Collapse
Affiliation(s)
- B Falkensammer
- Department of Hygiene, Microbiology and Social Medicine, Innsbruck Medical University, Fritz-Pregl-Strasse 3, 6020, Innsbruck, Austria
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
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.
Collapse
Affiliation(s)
- Jes S Lindholt
- Department of Vascular Surgery, Viborg Hospital, Denmark.
| |
Collapse
|
20
|
Abstract
Abdominal aortic aneurysm (AAA) affects approximately 5% of elderly men and is responsible for a significant number of deaths in Western Countries. At present surgery by open or endovascular means is the only widely used therapy for this condition. In this review we examine the risk factors, serum, and genetic associations of AAA. Epidemiology studies suggest that smoking cessation and control of cholesterol and blood pressure should reduce the number of patients developing AAA. Natural history studies suggest that smoking cessation should reduce the rate of progression of AAA. Clear level 1 evidence for drug treatments of AAA are presently lacking; however, animal and human in vitro studies suggest that medication targeted at reducing inflammation and proteolysis are most likely to be beneficial, with limited data to support the use of statins, Angiotensin II inhibitors, and macrolides. Work has commenced in understanding which patients, identified by clinical, serum, and genotype, are more at risk of AAA progression and thus should be selected out for aggressive treatment. Well designed large multicenter randomized controlled trials are required to examine the medical treatment of AAA.
Collapse
Affiliation(s)
- Jonathan Golledge
- The Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Queensland 4811, Australia.
| | | | | | | |
Collapse
|
21
|
Lindholt JS, Shi GP. Chronic Inflammation, Immune Response, and Infection in Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2006; 31:453-63. [PMID: 16414293 DOI: 10.1016/j.ejvs.2005.10.030] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 10/24/2005] [Indexed: 11/29/2022]
Abstract
Abdominal aortic aneurysms (AAA) are associated with atherosclerosis, transmural degenerative processes, neovascularization, decrease in content of vascular smooth muscle cells, and a chronic infiltration, mainly located in the outer aortic wall. The chronic infiltration consists mainly of macrophages, lymphocytes, and plasma cells. The dominant cells are Th2 restricted CD3+ lymphocytes expressing interleukine 4, 5, 8, and 10, and tumor necrosis factor-alpha for regulation of the local immune response. They also produce interferon-gamma and CD40 ligand to stimulate surrounding cells to produce matrix metalloproteases and cysteine proteases for aortic matrix remodeling. The lymphocyte activation may be mediated by microorganisms as well as autoantigens generated from vascular structural proteins, perhaps through molecular mimicry. As in autoimmune diseases, the risk of AAA is increased by certain genotypes concerning human leucocyte antigen class II. These types are also associated with increased aneurysmal inflammation indicating a genetic susceptibility to aortic inflammation. Chlamydia pneumoniae is often detected in AAA but the validity of the methods can be questioned, and two small antibiotic trials have been disappointing. However, serum antibodies against C. pneumoniae have been associated with AAA growth and cross-react with AAA wall proteins. Thus, immune responses mediated by microorganisms and autoantigens may play a pivotal role in AAA pathogenesis.
Collapse
Affiliation(s)
- J S Lindholt
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark.
| | | |
Collapse
|
22
|
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysms (IAAA) are a variant of aortic aneurysm characterised by extensive peri-aneurysmal fibrosis, thickened walls and dense adhesions and represent between 3 and 10% of all abdominal aortic aneurysms (AAA). Surgery is technically challenging and is still associated with an increased morbidity and mortality. Controversy exists about aetiology and pathogenesis. METHODS We review the literature on the current theories, the available imaging modalities and the current thinking on management of IAAA. A Medline database search was performed. Articles were cross-referenced. RESULTS AND CONCLUSIONS Aneurysm development is multifactorial with important genetic and environmental factors. The literature supports the theory that IAAA arise from the same antigenic stimulus that is responsible for the non-IAAA, representing one extreme of an inflammatory spectrum. The results after open repair have improved and there is now little difference in the mortality between non-IAAA and IAAA repair. However, there is likely to be a role for endovascular stenting in IAAA management and this requires further study. It is clear that closer follow-up of patients after IAAA repair with either technique is necessary to monitor the inflammatory process. No evidence-based follow-up protocol exists but three to six-monthly monitoring of renal function and erythrocyte sedimentation rate (ESR) for 24 months post-repair would seem a reasonable regime.
Collapse
Affiliation(s)
- T Tang
- Regional Vascular Unit, Addenbrooke's NHS Trust, University of Cambridge, Cambridge, UK
| | | | | | | |
Collapse
|
23
|
Sodeck G, Domanovits H, Khanakah G, Schillinger M, Thalmann M, Bayegan K, Schoder M, Grabenwoeger M, Hoelzenbein T, Boehmig G, Laggner AN, Stanek G. The Role of Chlamydia Pneumoniae in Human Aortic Disease—A Hypothesis Revisited. Eur J Vasc Endovasc Surg 2004; 28:547-52. [PMID: 15465378 DOI: 10.1016/j.ejvs.2004.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The role of Chlamydia pneumoniae in the pathogenesis of aortic aneurysm is controversial. We investigated the presence of C. pneumoniae in tissue samples excised from patients and controls. METHODS Aortic wall specimens were obtained from 17 patients with acute Stanford type A aortic dissection, 25 patients with thoracic aortic aneurysms (TAA) and 23 patients with abdominal aortic aneurysms (AAA). Eighty-three tissue samples of 73 control patients free of aortic disease were obtained either at surgery or autopsy. The presence of Chlamydia subspecies DNA (sequences specific for all known Chlamydiaceae) and DNA of C. pneumoniae, C. trachomatis and C. psittaci were assessed by a validated highly sensitive and specific real time polymerase chain reaction (PCR) analysis. Atherosclerotic risk factors were assessed in all patients. RESULTS We failed to detect C. pneumoniae and C. psittaci-DNA in any of the 148 vessel specimens. C. trachomatis-DNA was detected in 1/65 patients and in none of 83 controls (P=0.43). Chlamydia subspecies DNA was found in samples of eight cases and in one control (P=0.01), however, no significant differences were found between the subgroups aortic dissection (P=0.09), TAA (P=0.99) and AAA (P=0.15) and respective controls. CONCLUSIONS C. pneumoniae does not play a clinically relevant role in acute and chronic aortic disease. The impact of other organisms of the family Chlamydiaceae needs further evaluation.
Collapse
Affiliation(s)
- G Sodeck
- Department of Emergency Medicine, Medical University of Vienna, General Hospital Vienna, Austria, Europe
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pupka A, Skóra J, Kałuza G, Szyber P. The detection of Chlamydia pneumoniae in aneurysm of abdominal aorta and in normal aortic wall of organ donors. Folia Microbiol (Praha) 2004; 49:79-82. [PMID: 15114871 DOI: 10.1007/bf02931651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sixty patients underwent surgery due to abdominal aortic aneurysms; the group included 30 patients with asymptomatic aneurysm and 30 with ruptured aneurysm. A control group comprised 30 organ donors. Surgical specimens derived from aneurysm or aorta fragments were investigated for Chlamydia pneumoniae DNA using PCR. In asymptomatic aneurysms, DNA was found in 9 cases (29%), and in ruptured aneurysms in 14 cases (49%). In the control group, C. pneumoniae DNA was not detected in an aortic wall. These results suggest that healthy aortic wall is not susceptible to chlamydial infection. A large number of aneurysm infections implies C. pneumoniae role in proteolysis and degradation of the aneurysm wall. The biological effect of this process may cause an enlargement of the aneurysm.
Collapse
Affiliation(s)
- A Pupka
- Department of Vascular, General and Transplantation Surgery, Wrocław Medical University, Wrocław, Poland.
| | | | | | | |
Collapse
|
25
|
Lindholt JS, Støvring J, Østergaard L, Urbonavicius S, Henneberg EW, Honoré B, Vorum H. Serum antibodies against Chlamydia pneumoniae outer membrane protein cross-react with the heavy chain of immunoglobulin in the wall of abdominal aortic aneurysms. Circulation 2004; 109:2097-102. [PMID: 15117850 DOI: 10.1161/01.cir.0000127772.58427.7e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chlamydia pneumoniae (Cp) has been demonstrated in arteries and abdominal aortic aneurysms (AAAs). However, the validity of the methods used is questioned, and antibiotic treatment trials have thus far shown disappointing results. Nevertheless, antibodies against the Cp outer membrane proteins (OMPs) have been associated with progression of atherosclerosis and AAAs. The aim of this study was to detect Cp OMPs in the wall of AAA patients by use of purified serum antibodies directed against Cp OMP and to assess potential cross-reacting proteins in AAA walls. METHODS AND RESULTS Seventeen patients undergoing infrarenal AAA repair were studied. Full AAA thickness tissue was collected from the anterior wall of the aneurysm. Anti-OMP was extracted from seropositive AAA patients by use of an ELISA kit (Labsystems). Analysis was performed by use of 2D polyacrylamide gel electrophoresis, immunoblotting, and mass spectrometric protein identification. OMP antigens were not detected in 16 of 17 AAA walls. However, 3 major AAA proteins cross-reacted with anti-OMP. The proteins were all identified as heavy chains of human immunoglobulin. CONCLUSIONS We could not find evidence of Cp OMP in 16 of 17 AAA walls, but instead, all samples showed a strong cross-reaction between Cp OMP antibodies and human immunoglobulin. This might indicate that AAA is an autoimmune disease, perhaps triggered by an initial Cp infection.
Collapse
Affiliation(s)
- Jes S Lindholt
- Department of Vascular Surgery, Viborg Hospital, Postbox 130, 8800 Viborg, Denmark.
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Prompt recognition of actual or impending aortic emergencies is essential to the effective practice of emergency medicine. Understanding the pathophysiologic principles and awareness of the potential subtleties in the clinical presentations of aortic dissection, aneurysm, and occlusive disease are prerequisites to this task. Knowledge of current diagnostic modalities is also important if these entities are to be identified rapidly and managed efficiently to maximize the potential for a good patient outcome. Awareness of the potential complications of these conditions and the necessary interventional and resuscitative measures that might be called for in the appropriate clinical setting are likewise essential requirements for the EP. Appropriate surgical consultation and mobilization of operative resources form the backbone of appropriate management in the patient who has an aortic emergency.
Collapse
Affiliation(s)
- Andrew L Knaut
- Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, MC 0108, Denver, CO 80204, USA.
| | | |
Collapse
|
27
|
Lindholt JS, Jørgensen B, Shi GP, Henneberg EW. Relationships between activators and inhibitors of plasminogen, and the progression of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2003; 25:546-51. [PMID: 12787697 DOI: 10.1053/ejvs.2002.1872] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE plasmin is a common activator of the known proteolytic systems involved in the aneurysmal degradation, and is reported to be associated with the expansion of abdominal aortic aneurysms (AAA). The aim of this study was to study the activating pathways of plasminogen as predictors of the progression of AAA. MATERIALS AND METHODS one hundred and twelve of 122 male patients with a small AAA (def.: +3cm) were interviewed, examined, had blood samples taken at diagnosis, and scanned annually for 1-5 years (mean 3.5 years), and referred for surgery if the AAA exceeded 5cm in diameter.A random sample of 70 of the 112 cases had plasma levels of urokinase-like-plasminogen activator (uPA), tissue-type-plasminogen activator (tPA), plasminogen-activator-inhibitor-1 (PAI-1), macrophage inhibiting factor (MIF), tumour-growth-factor-beta1 (TGF-beta1), homocysteine, and serum levels of IgA-antibodies against Chlamydia pneumoniae (IgA-CP) and Cotinine (a nicotine metabolite) measured. Spearmans correlation analysis was used for statistics. RESULTS the annual expansion rate correlated positively with tPA, IgA-CP and S-Cotinine; r =0.37 (p=0.002), 0.29 (p=0.006) and 0.24 (p=0.038), while PAI1, uPA, TGF-beta1, homocysteine, and MIF did not. S-Cotinine did also correlate positively with tPA, r=0.24 (p=0.049). CONCLUSION the aortic matrix degradation in AAA may be partly caused by an activation of plasminogen by tPA, but apparently not by uPA, which usually dominates matrix degradation. Smoking seems to be a factor for this pathway, while the pathways of IgA-CP and MIF, a new marker of aneurysmal progression, seem different. The latter observations suggest that other proteolytic pathways are involved in the aortic wall degradation in AAA.
Collapse
Affiliation(s)
- J S Lindholt
- Department of Vascular Surgery, Hospital of Viborg, Viborg, Denmark
| | | | | | | |
Collapse
|
28
|
Abstract
Abdominal aortic aneurysms (AAAs) are a chronic degenerative disease with life-threatening implications. While AAAs are thought to arise through a localized form of arterial wall injury superimposed on various predisposing factors, their natural history is one of progressive structural deterioration, gradual expansion, and eventual rupture. Pathologic processes contributing to the changes observed in AAAs include chronic inflammation, destructive remodeling of the extracellular matrix, and depletion of vascular smooth muscle cells. These changes result in progressive aortic dilatation accompanied by alterations in vessel geometry, redistribution of hemodynamic wall stresses, and diminished tensile strength. As outlined in this review, better understanding of the biological mechanisms underlying these changes will allow design of novel therapeutic strategies to suppress the process of aneurysmal degeneration.
Collapse
Affiliation(s)
- Eric F Steinmetz
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | | | | |
Collapse
|
29
|
Karlsson L, Gnarpe J, Olsson G, Gnarpe H. A family with abdominal aortic aneurysms. Angiology 2003; 54:177-80. [PMID: 12678192 DOI: 10.1177/000331970305400206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This investigation focused on 7 siblings to 2 brothers with abdominal aortic aneurysm (AAA), with respect to AAA, Chlamydia pneumoniae (CP) serology, serum cholesterol, and smoking habits. Five male and 4 female siblings were included. All siblings underwent ultrasonography, and surgical specimens from the aorta were prepared for immunohistochemical (IHC) analysis. Blood was obtained from all living siblings and serum cholesterol level was analyzed. Serologic analysis was done by microimmunofluorescence (MIF). Smoking habits were recorded. In addition to the 2 known siblings with AAA, 2 other brothers with AAA were found. Four of 8 siblings had IgG 1/512 or greater and 7 of 8 had IgA 1/64 or greater. Two of 3 were positive for CP in IHC obtained from aortic specimens. Two of 8 had hypercholesterolemia; 7 of 9 were smokers. C. pneumoniae as well as smoking seems to be important in the pathogenesis of AAA in this small cohort; however, larger patient cohorts are needed.
Collapse
Affiliation(s)
- Lars Karlsson
- Department of Surgery, University Hospital Uppsala, Uppsala, Sweden
| | | | | | | |
Collapse
|
30
|
Vammen S, Vorum H, Ostergaard L, Henneberg EW, Lindholt JS. Immunoblotting analysis of abdominal aortic aneurysms using antibodies against Chlamydia pneumoniae recombinant MOMP. Eur J Vasc Endovasc Surg 2002; 24:81-5. [PMID: 12127853 DOI: 10.1053/ejvs.2002.1658] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES antibodies against Chlamydia pneumoniae have been associated with atherosclerosis and with expansion of abdominal aortic aneurysms (AAA). C. pneumoniae has been demonstrated in coronary arteries, AAA and the carotid arteries by use of polymerase chain reactions (PCR), immunohistochemical procedures and electron microscopy. However, the correlation between demonstrating C. pneumoniae DNA or antigen in tissue from plaque material or aneurysms and the antibody titres in serum is controversial. The specificity of immunohistochemical procedures is unknown. The aim of this study was to assess the possibility of potential non-specific findings for methods based on immunostaining. MATERIALS AND METHODS twenty patients undergoing infrarenal AAA repair were studied. Full AAA thickness tissue was collected from the anterior wall of the aneurysm. Analysis was performed using polyacrylamide gelelectrophoresis, immunoblotting and mass spectrometric protein identification. RESULTS C. pneumoniae antigen was not demonstrated in any of the AAA samples, whereas a major cross-reacting protein was present in all AAA samples. The protein was identified as the human haemoglobin beta chain. CONCLUSION we were not able to find C. pneumoniae antigens reacting with an anti C. pneumoniae major outer membrane protein (MOMP). Direct detection of C. pneumoniae by immunohistostaining procedures should be interpreted with caution due to potential crossreaction with non chlamydial proteins.
Collapse
Affiliation(s)
- S Vammen
- Department of Vascular Surgery, Viborg Hospital, Denmark
| | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- Robert W Thompson
- Department of Surgery (Section of Vascular Surgery), Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | |
Collapse
|
32
|
Abstract
OBJECTIVES to investigate whether Chlamydia pneumoniae (C. pneumoniae) may increase elastin degradation in the aortic wall. MATERIALS AND METHODS eighteen full thickness aortic wall samples from non-aneurysmal infrarenal abdominal aortas were collected from autopsies. Two adjacent and equally large pieces were cut out of each aortic sample. From each sample, one piece was incubated in a HEp-2 cell culture infected with C. pneumoniae and the other piece was incubated in an uninfected HEp-2 cell culture. The incubation time was one week at 35 degrees C. The concentration of elastin-derived peptides (EDP) (ng/ml) in the medium of each cell culture was measured in duplicate. For each paired sample, delta-EDP (EDP in HEp-2 cell culture infected with C. pneumoniae- EDP in uninfected HEp-2 cell culture) was calculated. RESULT there was a significantly increased degradation of aortic elastin, estimated by EDP concentrations in cell culture conditioned medium, when aortic wall samples were incubated in C. pneumoniae cultures compared with uninfected cultures (p=0.025, Wilcoxon signed ranks test). CONCLUSION these results indicate that there is a relationship between the presence of C. pneumoniae and increased elastin degradation in the aortic wall in vitro. This suggests C. pneumoniae in the aortic wall directly or indirectly leads to the degradation of aortic elastin.
Collapse
Affiliation(s)
- E Petersen
- Department of Surgery, University Hospital, S-90185 Umeå, Sweden
| | | | | | | | | |
Collapse
|
33
|
Mosorin M, Juvonen J, Biancari F, Satta J, Surcel HM, Leinonen M, Saikku P, Juvonen T. Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study. J Vasc Surg 2001; 34:606-10. [PMID: 11668312 DOI: 10.1067/mva.2001.117891] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Eradication of Chlamydia pneumoniae infection and inhibition of elastolytic matrix metalloproteinases with doxycycline have been suggested to reduce the growth rates of small abdominal aortic aneurysms (AAA). We designed a study to investigate the efficacy of doxycycline in reducing the expansion of small AAAs. SUBJECTS AND METHODS This was a prospective, double-blind, randomized, placebo-controlled study that was set in a university referral hospital. The study group consisted of 32 of 34 initially eligible patients who had an AAA diameter perpendicular to the aortic axis of 30 mm or more in size or a ratio of infrarenal to suprarenal aortic diameter of 1.2 or more and a diameter less than 55 mm. Patients were randomly assigned to receive either doxycycline (150 mg daily) or placebo during a 3-month period and underwent ultrasound surveillance during an 18-month period. Outcome measures included aneurysm expansion rates, the number of patients who had AAA rupture or repair, C pneumoniae antibody titers, and serum concentrations of C-reactive protein. RESULTS The aneurysm expansion rate in the doxycycline group was significantly lower than that in the placebo group during the 6- to 12-month (P = .01) and the 12- to 18-month periods (P =.01). Five patients (41%) in the placebo group and 1 patient (7%) in the doxycycline group had an overall expansion of the aneurysm of 5 mm or more during the 18-month follow-up. Among the placebo group patients, a higher expansion rate was observed in those with enhanced C pneumoniae immunoglobulin G antibody titers (> 128) than in those with lower titers (P = .03). Doxycycline treatment had no clear effect on antibody titers. However, at 6-month follow-up, C-reactive protein levels in the doxycycline group were significantly lower than the baseline levels (P = .01). CONCLUSIONS The results of this small pilot study suggest that doxycycline may favorably alter the outcome of patients with small AAA. However, because of the small size of this randomized study and of the potentially confounding effect of pretreatment risk factors, doxycycline-based treatment cannot be justified only on the ground of the current results. Because of the high prevalence of this disorder and its clinical, social, and economic relevance, a multicenter study should be performed to further investigate whether there is any place for medical treatment of small AAAs.
Collapse
Affiliation(s)
- M Mosorin
- Department of Surgery, University of Oulu, Finland
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Lindholt JS, Jørgensen B, Fasting H, Henneberg EW. Plasma levels of plasmin-antiplasmin-complexes are predictive for small abdominal aortic aneurysms expanding to operation-recommendable sizes. J Vasc Surg 2001; 34:611-5. [PMID: 11668313 DOI: 10.1067/mva.2001.119040] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Three proteolytic systems seem involved in the aneurysmal degradation of the aortic wall. Plasmin is a common activator of the systems and could thus be predictive for the progression of abdominal aortic aneurysms (AAAs). METHODS AND MATERIALS In 1994, 112 of 141 male patients with AAA diagnosed through population screening (defined as 3 cm or more) were interviewed and examined and had blood samples taken. One hundred twelve cases were scanned annually for 1 to 5 years (mean, 2.5 years) and referred for surgery if the AAA exceeded 5 cm in diameter. A random sample of 70 of the 112 cases had P-plasmin-antiplasmin-complexes (PAPs), P-plasminogen, and S-elastin-peptides (SEPs). RESULTS PAP was positively correlated with annual expansion rate (r = 0.39, 0.16-0.56), persisting after adjustment for initial AAA size, SEP, age, and smoking. However, PAP levels did not correlate with the initial AAA size or SEP. Furthermore, PAP levels were significantly predictive for cases expanding to operation-recommendable AAA sizes. Combined with the initial AAA size, both optimal sensitivity and specificity were 82%, increasing to 95% and 96%, respectively, excluding those lost to follow-up and accepting 2 mm of interobserver variation. CONCLUSION The progression of AAA is correlated with the PAP level, which seems to have a predictive value similar to the best serologic predictor known, serum-elastin-peptides.
Collapse
Affiliation(s)
- J S Lindholt
- Department of Vascular Surgery, Hospital of Viborg, Denmark
| | | | | | | |
Collapse
|
35
|
Abstract
PURPOSE Chlamydia Pneumoniae has been shown to be associated with atherosclerosis, myocardial infarction, and abdominal aortic aneurysms (AAAs). The possible association between AAA expansion and C pneumoniae infection was therefore assessed. METHODS Blood samples were taken from patients with an AAA that was considered for surgical repair after having been diagnosed by means of the Chichester aneurysm screening program (UK) as having an initially infrarenal aortic diameter of 3.0 to 5.9 cm. The patients were examined prospectively for as long as 11.5 years (mean, 4.1 years) with ultrasound scanning. Of 110 patients considered for surgery, 90 men and 10 women had blood samples taken. Their IgG and IgA antibodies against C pneumoniae were measured by means of a microimmunofluorescence test. Unpaired t tests, multiple linear regression analyses, and logistic regression analyses were used for statistical analysis. RESULTS A total of 44% (95% CI, 31%-55%) of the men with an AAA had an IgA titer of 64 or more, an IgG titer of 128 or more, or both, compared with 10% of the women with an AAA (OR = 7.2; 95% CI, 1.05-160.8). A titer of IgG of 128 or more was significantly associated with higher expansion (5.3 vs 2.6 mm per year), even after adjustment for initial AAA size and age. A significant positive correlation between both IgA and IgG titers and mean annual expansion was observed (r = 0.28; 95% CI, 0.05-0.49; and r = 0.45; 95% CI, 0.24-0.62, respectively), persisting after adjusting for initial AAA size and age. An IgG titer of 128 or more was present significantly more often in cases with an expansion greater than 1 cm annually (adjusted OR = 12.6; 95% CI, 1.37-293). CONCLUSION A high proportion of men with an AAA has signs of infection with C pneumoniae. The progression of their AAAs was positively correlated with the presence of indicators of C pneumoniae infection.
Collapse
Affiliation(s)
- J S Lindholt
- Department of Vascular Surgery, Hospital of Viborg, Denmark
| | | | | |
Collapse
|
36
|
Vammen S, Lindholt JS, Ostergaard L, Fasting H, Henneberg EW. Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion. Br J Surg 2001; 88:1066-72. [PMID: 11488791 DOI: 10.1046/j.0007-1323.2001.01845.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Macrolide treatment has been reported to lower the risk of recurrent ischaemic heart disease. The influence of macrolides on the expansion rate of abdominal aortic aneurysms (AAAs) remains unknown. The aim was to investigate the effect of roxithromycin on the expansion rate of small AAAs. METHODS A total of 92 subjects with a small AAA were recruited from two populations. One population consisted of 6339 men aged 65-73 years who were offered a hospital-based mass screening programme for AAA. From this population 66 subjects were recruited. The remaining 26 men were recruited from among 49 subjects diagnosed at interval screening for an initial aortic diameter between 25 and 29 mm. Subjects were randomized to receive either oral roxithromycin 300 mg once daily for 28 days or matching placebo, and followed for a mean of 1.5 years. RESULTS During the first year the mean annual expansion rate of AAAs was reduced by 44 [corrected] per cent in the intervention group (1.56 mm per year), compared with 2.80 mm per year following placebo (P = 0.02). During the second year the difference was only 5 per cent [corrected]. Multiple linear regression analysis showed that roxithromycin treatment and initial AAA size were significantly related to AAA expansion when adjusted for smoking, diastolic blood pressure and immunoglobulin A level of 20 or more [corrected]. Logistic regression analysis confirmed a significant difference in expansion rates above 2 mm annually between the intervention and placebo groups: odds ratio = 0.09 (95 per cent confidence interval 0.01-0.83) [corrected]. CONCLUSION In comparison to placebo, roxithromycin 300 mg daily for 4 weeks reduced the expansion rate of AAAs.
Collapse
Affiliation(s)
- S Vammen
- Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark.
| | | | | | | | | |
Collapse
|
37
|
Vammen S, Lindholt JS, Andersen PL, Henneberg EW, Østergaard L. Antibodies against Chlamydia pneumoniae predict the need for elective surgical intervention on small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2001; 22:165-8. [PMID: 11472052 DOI: 10.1053/ejvs.2001.1414] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to compare the ability of two independent Chlamydia pneumoniae antibody tests to predict need for small abdominal aortic aneurysm (AAA) repair. PATIENTS AND METHODS annual scans were offered to 149 screening diagnosed small AAA (<5 cm). Serum samples were collected for measuring IgA and IgG-antibodies to C. pneumoniae by microimmunofluorescence (MIF) test and the new ELISA (Labsystems). RESULTS a significant concordance was found between MIF and ELISA titres with Kappa values of 0.29 for S-IgA and 0.42 for S-IgG. IgG antibodies measured by ELISA were most predictive for cases expanding operation recommendable sizes with a sensitivity and specificity of 80% and 66%, respectively. CONCLUSION the simpler EIA has a high correlation with the MIF test and both were predictive for the natural history of AAA. Chlamydia antibody test may be used to identify individuals who might benefit from follow-up and anti-chlamydia treatment.
Collapse
Affiliation(s)
- S Vammen
- Department of Vascular Surgery, Viborg Hospital, Denmark
| | | | | | | | | |
Collapse
|