Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 131; no. 3; pp. 671 - 678.e2
• Main Authors: He, Rumin, Guo, Dong-Chuan, Estrera, Anthony L., Safi, Hazim J., Huynh, Tam T., Yin, Zhengnan, Cao, Shi-Nian, Lin, Jing, Kurian, Thomas, Buja, L. Maximillian, Geng, Yong-Jian, Milewicz, Dianna M.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.03.2006; AATS/WTSA; Elsevier
• Subjects: Aneurysm, Dissecting - immunology; Aneurysm, Dissecting - pathology; Antigens, CD - immunology; Antigens, Differentiation, Myelomonocytic - immunology; Aortic Aneurysm, Thoracic - immunology; Aortic Aneurysm, Thoracic - pathology; Apoptosis; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; CD3 Complex - immunology; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Inflammation - pathology; Male; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; SMC; AAA; TUNEL; 26; TAA; TAD; Ascending aorta; Heart; Human; Cardiovascular disease; Patient; Thorax; Aortic aneurysm; Arterial disease; Vascular disease; Thoracic aorta; Characterization; Treatment; Surgery; Aortic dissection; Inflammatory cell; Aortic disease; Apoptosis
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2005.09.018

The histopathologic abnormality underlying ascending aortic aneurysm and dissection is medial degeneration, a lesion that is described as the noninflammatory loss of smooth muscle cells and elastic fibers. This study sought to determine whether inflammatory cells are present in medial degeneration and assess any possible contribution of these cells to apoptosis of smooth muscle cells. Aortic specimens were obtained from patients undergoing prophylactic surgical repair of an ascending aortic aneurysm (n = 9) and type A dissection (n = 7), along with control patients dying of causes unrelated to aortic disease (n = 5). Immunohistochemical staining was performed to evaluate the presence of lymphocytes and macrophages, and markers of apoptosis were assessed in the aortas of patients with ascending aortic aneurysm and dissection. Immunohistochemical study indicated significantly more CD3 + cells in the aortas of patients with aneurysms or dissections than in control aortas ( P = .020 and P = .0022, respectively). In addition, aortas of patients with aneurysms or dissections had more CD68 + cells ( P = .01 and P = .005, respectively). CD3 + cells were localized in the media and surrounding the vasa vasorum in the adventitia. Cells yielding a positive result on in situ terminal transferase–mediated deoxyuridine triphosphate nick end-labeling were found in increased numbers in the aortas of patients with aneurysms or dissections relative to control aortas ( P = .005 and P = .002, respectively). Furthermore, Fas and FasL were increased in the aortic samples from patients with aneurysms and dissections relative to control aortas. The coexistence of inflammatory cells with markers of apoptotic vascular cell death in the media of ascending aortas with aneurysms and type A dissections raises the possibility that activated T cells and macrophages may contribute to the elimination of smooth muscle cells and degradation of the matrix associated with thoracic aortic aneurysms and dissections.