Molecular targets in aortic aneurysm for establishing novel management paradigms

Abstract

Aortic aneurysm (AA) is a lethal disease and presents a large challenge for surgeons in the clinic. Although surgical management remains the major choice of AA, operative mortality remains high. With advances in understanding of the mechanisms of AAs, molecular targets, such as matrix metalloproteinases (MMPs), D-dimer, and inflammation markers, including C-reactive protein, interleukins and phagocytes, are important in the pathology of development of AA. These markers may become important for improving the diagnostic quality and provide more therapeutic choices for treatment of AA. Although these new markers require long-term trials before they can be translated into the clinic, they can still be helpful in determining new directions. The main aim of this review is to discuss the current findings of molecular targets in progression of AA and discuss the potential application of these new targets for managing this disease.

Keywords: Aortic aneurysm (AA); inflammation; molecular targets; nanomedicine; remodeling.

Figure 1

Schema showing the inflammation process in AA (10). AA, aortic aneurysm.

Figure 2

MMP-9 levels are increased in TAA compared with controls (21). TAA, thoracic aortic aneurysm.

Figure 3

MMP-2 levels are not significantly different between TAA and controls (21). MMP, matrix metalloproteinase; TAA, thoracic aortic aneurysm.

Figure 4

TIMP-1 and TIMP-2 are significantly decreased in TAA compared with controls (21). TIMP, tissue inhibitors of metalloproteinase; TAA, thoracic aortic aneurysm.

Figure 5

¹⁸F-FDG uptake to predict short and mid-term prognosis in medically controlled patients with AA dissection by comparing uptake of ¹⁸F-FDG in controls and in patients with AAD. (A) ¹⁸F-FDG SUV_max and SUV_mean were on 50-minute images (middle) and 100-minute images (right) on patients with favorable outcome; (B) ¹⁸F-FDG SUV_max and SUV_mean were on 50-minute images (middle) and on 100-minute images (right) on patients with unfavorable outcome (68). F-FDG, F-fluorodeoxy glucose; SUV, standardized uptake value; AA, aortic aneurysm; AAD, acute aortic dissection.

Figure 6

Ex vivo images of AAAs of mice with (A) USPIO administration and (B) without USPIO administration. A macrophage-rich area has decreased signal intensity in USPIO administered mice (83). AAA, abdominal aortic aneurysm; USPIO, ultrasmall super-paramagnetic iron oxide.