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Review
. 2024 Sep 7;5(9):e703.
doi: 10.1002/mco2.703. eCollection 2024 Sep.

Aortic aneurysm: pathophysiology and therapeutic options

Guang Yang  1   2   3   4 , Abbas Khan  5 , Wei Liang  1   4 , Zibo Xiong  1   4 , Johannes Stegbauer  6
Affiliations
Review

Aortic aneurysm: pathophysiology and therapeutic options

Guang Yang et al. MedComm (2020). .

Abstract

Aortic aneurysm (AA) is an aortic disease with a high mortality rate, and other than surgery no effective preventive or therapeutic treatment have been developed. The renin-angiotensin system (RAS) is an important endocrine system that regulates vascular health. The ACE2/Ang-(1-7)/MasR axis can antagonize the adverse effects of the activation of the ACE/Ang II/AT1R axis on vascular dysfunction, atherosclerosis, and the development of aneurysms, thus providing an important therapeutic target for the prevention and treatment of AA. However, products targeting the Ang-(1-7)/MasR pathway still lack clinical validation. This review will outline the epidemiology of AA, including thoracic, abdominal, and thoracoabdominal AA, as well as current diagnostic and treatment strategies. Due to the highest incidence and most extensive research on abdominal AA (AAA), we will focus on AAA to explain the role of the RAS in its development, the protective function of Ang-(1-7)/MasR, and the mechanisms involved. We will also describe the roles of agonists and antagonists, suggest improvements in engineering and drug delivery, and provide evidence for Ang-(1-7)/MasR's clinical potential, discussing risks and solutions for clinical use. This study will enhance our understanding of AA and offer new possibilities and promising targets for therapeutic intervention.

Keywords: aortic aneurysm; aortic lesion; inflammation; oxidative stress; renin–angiotensin system.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Screening, treatment, and prevention options for AA. The most common noninvasive diagnostic methods for AA are ultrasound, CT angiography (CTA), magnetic resonance angiography (MRA), and X‐ray. The most routine treatment methods are endovascular intervention and open surgery, and complex conditions may require a combination of both approaches. Prevention relies more on regular health check‐ups, lifestyle habit management, and medication to prevent further vascular injuries. However, no studies have proven that aneurysms can be reversed.
FIGURE 2
FIGURE 2
Schematic diagram of the causes of AA formation. Extrinsic and intrinsic risk factors can lead to physiological changes in blood vessels, including increased inflammation, changes in hemodynamics, accumulation of toxins, and endocrine disorders, causing vascular injuries. The continuous accumulation of these injuries can ultimately result in aortic pathologies, such as aneurysms. Created by Biorender software.
FIGURE 3
FIGURE 3
Illustration of the renin–angiotensin system, and its role in vascular pathophysiology. Ang‐(1–7) generation is dependent on ACE2 and NEP cleavage of upstream angiotensin proteins. ACE, angiotensin converting enzyme; ACE2, angiotensin converting enzyme 2; Mas, Ang‐(1−7) receptor; NEP, neprilysin; AT1R, Ang II type 1 receptor; AT2R, Ang II type 2 receptor; NO, nitric oxide; ECM, extracellular matrix. Picture adapted from Ref. .
FIGURE 4
FIGURE 4
Activation of the Ang‐(1–7)/MasR axis attenuates vascular injuries and related complications by decreasing inflammation, oxidative stress, and the expression of inflammatory cytokines, MMPs, and MAPKs, leading to a reduction in the formation of AA. MAPK, mitogen‐activated protein kinase.
See this image and copyright information in PMC

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