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Arteriosclerosis, Thrombosis, and... Mar 2019Aortic aneurysms in both abdominal and thoracic aortic regions have complex pathophysiological features. In recent years, a considerable increase in research on aneurysm... (Review)
Review
Aortic aneurysms in both abdominal and thoracic aortic regions have complex pathophysiological features. In recent years, a considerable increase in research on aneurysm pathogenesis has resulted in the discovery of novel mechanisms and implementation of clinical trials that seek to assess strategies for preventing aneurysm expansion. Despite progress on our understanding of aortic aneurysms, there are still many unanswered questions and conflicting findings requiring clarification. This uncertainty highlights the importance of continual cooperation between preclinical and clinical researchers in validating findings from preclinical studies to the human disease, in order to discover medical treatments that prevent or halt the progression of aortic aneurysmal disease. We hope that this brief review prompts interest in reading these highlighted articles and spurs further investigation into this complex and devastating disease.
Topics: Adaptor Proteins, Signal Transducing; Aged; Aged, 80 and over; Animals; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortitis; Cilostazol; Disease Models, Animal; Female; Genetic Predisposition to Disease; Humans; Macrophage Activation; Male; Mice; Risk Factors; Sex Factors; Transforming Growth Factor beta
PubMed: 30811252
DOI: 10.1161/ATVBAHA.119.312000 -
Heart (British Cardiac Society) Oct 2021Broadly defined, aortitis refers to inflammation of the aorta and incorporates both infectious and non-infectious aetiologies. As advanced imaging modalities are... (Review)
Review
Broadly defined, aortitis refers to inflammation of the aorta and incorporates both infectious and non-infectious aetiologies. As advanced imaging modalities are increasingly incorporated into clinical practice, the phenotypic spectrum associated with aortitis has widened. The primary large vessel vasculitides, giant cell arteritis and Takayasu arteritis, are the most common causes of non-infectious aortitis. Aortitis without systemic disease or involvement of other vascular territories is classified as clinically isolated aortitis. Periaortitis, where inflammation spreads beyond the aortic wall, is an important disease subset with a distinct group of aetiologies. Infectious aortitis can involve bacterial, viral or fungal pathogens and, while uncommon, can be devastating. Importantly, optimal management strategies and patient outcomes differ between aortitis subgroups highlighting the need for a thorough diagnostic workup. Monitoring disease activity over time is also challenging as normal inflammatory markers do not exclude significant vascular inflammation, particularly after starting treatment. Additional areas of unmet clinical need include clear disease classifications and improved short-term and long-term management strategies. Some of these calls are now being answered, particularly with regard to large vessel vasculitis where our understanding has advanced significantly in recent years. Work extrapolated from temporal artery histology has paved the way for targeted biological agents and, although glucocorticoids remain central to the management of non-infectious aortitis, these may allow reduced glucocorticoid reliance. Future work should seek to clarify disease definitions, improve diagnostic pathways and ultimately allow a more stratified approach to patient management.
Topics: Aorta; Aortitis; Humans; Tomography, X-Ray Computed
PubMed: 33593995
DOI: 10.1136/heartjnl-2020-318085 -
Journal of the American College of... Dec 2022The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and...
2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.
AIM
The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).
METHODS
A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.
STRUCTURE
Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Topics: United States; Humans; American Heart Association; Universities; Aortic Diseases
PubMed: 36334952
DOI: 10.1016/j.jacc.2022.08.004 -
European Journal of Case Reports in... 2018Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition characterized by tumefactive lesions that can affect multiple...
UNLABELLED
Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition characterized by tumefactive lesions that can affect multiple organs. Serum IgG4 levels may be elevated. Early recognition is sometimes difficult but is important to avoid irreversible organ damage. We describe the case of a 28-year-old male patient who presented with a 2-year history of recurrent low-grade fever, night sweats and non-specific manifestations. We eventually diagnosed IgG4-related aortitis by PET-CT scan. The patient was successfully treated with prednisolone and mycophenolate mofetil with complete clinical and radiological resolution.
LEARNING POINTS
IgG4-related disease is a systemic immune-mediated disease that can affect many organs and systems.Aortitis can be one of the differential diagnoses in patients with fever of unknown origin, back pain and other unspecific symptoms.Delayed diagnosis and treatment may cause major complications or irreversible damage, so timely diagnosis and appropriate treatment is very important.
PubMed: 30756063
DOI: 10.12890/2018_000881 -
Circulation Research Jan 2020Through localized delivery of rapamycin via a biomimetic drug delivery system, it is possible to reduce vascular inflammation and thus the progression of vascular...
RATIONALE
Through localized delivery of rapamycin via a biomimetic drug delivery system, it is possible to reduce vascular inflammation and thus the progression of vascular disease.
OBJECTIVE
Use biomimetic nanoparticles to deliver rapamycin to the vessel wall to reduce inflammation in an in vivo model of atherosclerosis after a short dosing schedule.
METHODS AND RESULTS
Biomimetic nanoparticles (leukosomes) were synthesized using membrane proteins purified from activated J774 macrophages. Rapamycin-loaded nanoparticles were characterized using dynamic light scattering and were found to have a diameter of 108±2.3 nm, a surface charge of -15.4±14.4 mV, and a polydispersity index of 0.11 +/ 0.2. For in vivo studies, ApoE mice were fed a high-fat diet for 12 weeks. Mice were injected with either PBS, free rapamycin (5 mg/kg), or rapamycin-loaded leukosomes (Leuko-Rapa; 5 mg/kg) once daily for 7 days. In mice treated with Leuko-Rapa, flow cytometry of disaggregated aortic tissue revealed fewer proliferating macrophages in the aorta (15.6±9.79 %) compared with untreated mice (30.2±13.34 %) and rapamycin alone (26.8±9.87 %). Decreased macrophage proliferation correlated with decreased levels of MCP (monocyte chemoattractant protein)-1 and IL (interleukin)-b1 in mice treated with Leuko-Rapa. Furthermore, Leuko-Rapa-treated mice also displayed significantly decreased MMP (matrix metalloproteinases) activity in the aorta (mean difference 2554±363.9, =9.95122×10). No significant changes in metabolic or inflammation markers observed in liver metabolic assays. Histological analysis showed improvements in lung morphology, with no alterations in heart, spleen, lung, or liver in Leuko-Rapa-treated mice.
CONCLUSIONS
We showed that our biomimetic nanoparticles showed a decrease in proliferating macrophage population that was accompanied by the reduction of key proinflammatory cytokines and changes in plaque morphology. This proof-of-concept showed that our platform was capable of suppressing macrophage proliferation within the aorta after a short dosing schedule (7 days) and with a favorable toxicity profile. This treatment could be a promising intervention for the acute stabilization of late-stage plaques.
Topics: 1,2-Dipalmitoylphosphatidylcholine; Animals; Aorta; Aortitis; Apolipoproteins E; Atherosclerosis; Biomimetics; C-Reactive Protein; Cryoelectron Microscopy; Cytokines; Drug Evaluation, Preclinical; Macrophage Activation; Macrophages; Mechanistic Target of Rapamycin Complex 1; Membrane Proteins; Mice; Mice, Inbred C57BL; Nanoparticles; Neovascularization, Pathologic; Organ Specificity; Phosphatidylcholines; Plaque, Atherosclerotic; Random Allocation; Sirolimus
PubMed: 31647755
DOI: 10.1161/CIRCRESAHA.119.315185 -
Annals of the Rheumatic Diseases Mar 2019IgG4-related disease (IgG4-RD) is a heterogeneous, multiorgan condition of unclear aetiology that can cause organ failure. Difficulty recognising IgG4-RD contributes to...
OBJECTIVE
IgG4-related disease (IgG4-RD) is a heterogeneous, multiorgan condition of unclear aetiology that can cause organ failure. Difficulty recognising IgG4-RD contributes to diagnostic delays. We sought to identify key IgG4-RD phenotypes.
METHODS
We used two cross-sectional studies assembled by an international, multispecialty network of IgG4-RD specialists who submitted 765 cases to derive and replicate phenotypic groups. Phenotype groups of disease manifestations and key covariate distributions across the identified groups were measured using latent class analysis.
RESULTS
In the derivation cohort (n=493), we identified four groups with distinct manifestations: Group 1 (31%), Pancreato-Hepato-Biliary disease; Group 2 (24%), Retroperitoneal Fibrosis and/or Aortitis; Group 3 (24%), Head and Neck-Limited disease and Group 4 (22%), classic Mikulicz syndrome with systemic involvement. We replicated the identification of four phenotype groups in the replication cohort. Compared with cases in Groups 1, 2 and 4, respectively, cases in Group 3 were more likely to be female (OR 11.60 (95% CI 5.39 to 24.98), 10.35 (95% CI 4.63 to 23.15) and 9.24 (95% CI 3.53 to 24.20)) and Asian (OR 6.68 (95% CI 2.82 to 15.79), 7.43 (95% CI 2.97 to 18.56) and 6.27 (95% CI 2.27 to 17.29)). Cases in Group 4 had a higher median serum IgG4 concentration (1170 mg/dL) compared with groups 1-3 (316, 178 and 445 mg/dL, respectively, p<0.001).
CONCLUSION
We identified four distinctive IgG4-RD phenotypes according to organ involvement. Being Asian or female may predispose individuals to head and neck-limited disease. These phenotypes serve as a framework for identifying IgG4-RD and studying its aetiology and optimal treatment.
Topics: Adult; Americas; Aortitis; Asia; Asian People; Cross-Sectional Studies; Digestive System Diseases; Europe; Female; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Male; Middle Aged; Mikulicz' Disease; Otorhinolaryngologic Diseases; Phenotype; Racial Groups; Retroperitoneal Fibrosis
PubMed: 30612117
DOI: 10.1136/annrheumdis-2018-214603 -
Ugeskrift For Laeger Aug 2023In this case report, we present a 70-year-old male who was brought to our hospital with signs of upper gastrointestinal bleeding. The patient was diagnosed with aortitis...
In this case report, we present a 70-year-old male who was brought to our hospital with signs of upper gastrointestinal bleeding. The patient was diagnosed with aortitis two and a half months prior. We suspected upper gastrointestinal bleeding, and the patient was taken to the operating room for an acute endoscopy, which showed blood in the oesophagus, ventricle, and duodenum, but no bleeding source. CT angiography showed erosion of aortic aneurism, at the site of known aortitis, with bleeding into the lung and pleura. The patient was transported to the nearest university hospital for thoracic endovascular repair and survived.
Topics: Male; Humans; Aged; Hematemesis; Hemoptysis; Aortitis; Gastrointestinal Hemorrhage; Aortic Aneurysm; Hospitals, University
PubMed: 37767877
DOI: No ID Found -
Trends in Cardiovascular Medicine Nov 2019Inflammation affects the aortic wall through complex pathways that alter its biomechanical structure and cellular composition. Inflammatory processes that predominantly... (Review)
Review
Inflammation affects the aortic wall through complex pathways that alter its biomechanical structure and cellular composition. Inflammatory processes that predominantly affect the intima cause occlusive disease whereas medial inflammation and degeneration cause aneurysm formation. Aortic inflammatory pathways share common metabolic features that can be localized by smart contrast agents and radiolabelled positron emission tomography (PET) tracers. F-Fluorodeoxyglucose (F-FDG) is a non-specific marker of metabolism and has been widely used to study aortic inflammation in various diseased aortic states. Although useful in detecting disease, F-FDG has yet to demonstrate a reliable link between vessel wall disease and clinical progression. F-Sodium fluoride (F-NaF) is a promising biological tracer that detects microcalcification related to active disease and cellular necrosis within the vessel wall. F-NaF shows a high affinity to bind to diseased arterial tissue irrespective of the underlying inflammatory process. In abdominal aortic aneurysms, F-NaF PET/CT predicts increased rates of growth and important clinical end-points, such as rupture or the requirement for repair. Much work remains to be done to bridge the gap between detecting aortic inflammation in at-risk individuals and predicting adverse clinical events. Novel radiotracers may hold the key to improve our understanding of vessel wall biology and how this relates to patients. Combined with established clinical and morphological assessment techniques, PET imaging promises to improve disease detection and clinical risk stratification.
Topics: Aortic Aneurysm; Aortitis; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Sodium Fluoride
PubMed: 30611605
DOI: 10.1016/j.tcm.2018.12.003 -
BMJ Case Reports Jan 2020A 72-year-old man was admitted with complaints of sudden-onset oppressive precordial pain radiating to the back for 1 hour. He had hypotension, peripheral cyanosis and...
A 72-year-old man was admitted with complaints of sudden-onset oppressive precordial pain radiating to the back for 1 hour. He had hypotension, peripheral cyanosis and cold extremities. An initial assessment was done and acute coronary syndrome was excluded. After the patient was admitted, he developed fever and increased levels of inflammatory markers. Data obtained from CT angiography and transoesophageal echocardiogram revealed diffuse parietal thickening of the arch and the descending thoracic aorta, as well as dilatation of the aortic root and the proximal ascending aorta. In addition, the test for was positive, and the patient was diagnosed with Lyme vasculitis of the thoracic aorta. He was treated with doxycycline for 3 weeks. Two months later, the patient exhibited a Stanford type A aortic dissection (clinically stable), which was treated by prosthesis replacement. The patient has remained asymptomatic for 1 year after the episode, performing his routine daily activities.
Topics: Aged; Aortic Dissection; Aortic Aneurysm, Thoracic; Aortitis; Blood Vessel Prosthesis Implantation; Borrelia burgdorferi; Diagnosis, Differential; Humans; Lyme Disease; Male
PubMed: 31941668
DOI: 10.1136/bcr-2019-231957