Therapies for Thoracic Aortic Aneurysms and Acute Aortic Dissections.

Therapies for Thoracic Aortic Aneurysms and Acute Aortic Dissections.
Arterioscler Thromb Vasc Biol. 2019 Jan 17;:ATVBAHA118310956
Authors: Milewicz DM, Ramirez F
Abstract
Thoracic aortic aneurysms that progress to acute aortic dissections are often fatal. Thoracic aneurysms have been managed with treatment with β-adrenergic blocking agents (β-blockers) and routine surveillance imaging, followed by surgical repair of the aneurysm when the risk of dissection exceeds the risk for repair. Thus, there is a window to initiate therapies to slow aortic enlargement and delay or ideally negate the need for surgical repair of the aneurysm to prevent a dissection. Mouse models of Marfan syndrome-a monogenic disorder predisposing to thoracic aortic disease-have been used extensively to identify such therapies. The initial finding that TGFβ (transformation growth factor-β) signaling was increased in the aortic media of a Marfan syndrome mouse model and that its inhibition via TGFβ neutralization or At1r (Ang II [angiotensin II] type I receptor) antagonism prevented aneurysm development was generally viewed as a groundbreaking discovery that could be translated into the first cure of thoracic aortic disease. However, several large randomized trials of pediatric and adult patients with Marfan syndrome have subsequently yielded no evidence that At1r antagonism by losartan slows aortic enlargement more effectively than conventional treatment wit...

Source: Arteriosclerosis, Thrombosis and Vascular Biology - January 17, 2019 Category: Cardiology Authors: Milewicz DM, Ramirez F Tags: Arterioscler Thromb Vasc Biol Source Type: research