Relationships between activators and inhibitors of plasminogen, and the progression of small abdominal aortic aneurysms.
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.


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).


CONCLUSIONS
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.
Lindholt
J S
JS
Department of Vascular Surgery, Hospital of Viborg, Viborg, Denmark.
Jørgensen
B
B
Shi
G-P
GP
Henneberg
E W
EW
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D003367:Cotinine / Q000097:blood; D003718:Denmark; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007202:Indicators and Reagents; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood; D008297:Male; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010960:Plasminogen Activators / Q000097:blood; D015849:Plasminogen Inactivators / Q000097:blood; D011379:Prognosis; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016019:Survival Analysis; D010959:Tissue Plasminogen Activator / Q000097:blood; D016212:Transforming Growth Factor beta / Q000097:blood; D053773:Transforming Growth Factor beta1; D014568:Urokinase-Type Plasminogen Activator / Q000097:blood
D015415:Biomarkers; D007202:Indicators and Reagents; D008263:Macrophage Migration-Inhibitory Factors; D017395:Plasminogen Activator Inhibitor 1; D015849:Plasminogen Inactivators; C508960:TGFB1 protein, human; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D003367:Cotinine