3011
Cat: Miscellaneous
WHAT DIABETES MELLITUS HAS TAUGHT US ABOUT POTENTIAL
TREATMENTS FOR SMALL ABDOMINAL AORTIC ANEURYSMS
S.D. Gertz1, L. Gavish1, Y. Mintz2, R. Beeri3, C. Rubinstein4, L.Y. Gavish1,
Y. Berlatzky4, L. Appelbaum5, D. Gilon3
1. Institute for Medical Research (IMRIC), The Hebrew University--Hadassah Medical
School, Jerusalem, Israel
2. Department of Surgery, Hadassah University Hospital, Jerusalem, Israel
3. Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel
4. Department of Vascular Surgery, Hadassah University Hospital, Jerusalem, Israel
5. Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
Increased detection of abdominal aortic aneurysm (AAA) at early stages of growth (more
than 80% of those diagnosed now are less than 3.5 cm maximum diameter), and the high
rate of severe complications of urgent, open abdomen or endovascular surgical treatment
have emphasized the need for less invasive strategies that target the pathogenetic
mechanisms of progression and rupture. In sharp contrast to hypercholesterolemia,
diabetes mellitus (DM) is negatively associated with AAA in experimental animal
models and in epidemiological studies in humans. Whereas hypercholesterolemia favors
an increased proteolytic state in the arterial wall, diabetes, through increased glycation of
protein precursors and increased advanced glycation end products, facilitates matrix
protein synthesis and increases covalent bonding of matrix proteins, rendering the wall
less prone to proteolysis, decreasing the likelihood of aneurysmal dilatation and rupture.
Recent studies from our laboratory have shown that Low Level laser (LLL)
photobiomodulation, in the visible to near infrared range [780 nm] of the electromagnetic
spectrum, used widely clinically for reducing pain and increasing wound healing, inhibits
the development and progression of AAA in the angiotensin-II-infused, apolipoprotein-Edeficient mouse. The mechanism for this effect involves upregulation of collagen-rich
fibrous matrix repair of transmedial defects in the aortic wall in the vicinity of aortic
branch orifices. Reinforcement of the extracellular matrix in the aortic wall also explains
the negative association between DM and AAA even though the underlying cellular
mechanisms are different. In this talk, we discuss the use of minimally invasive
photobiomodulation, and other options, for mechanism-based targeting and management
of small, progressing aneurysms that are refractory to risk factor modification and
pharmacological therapy in order to save the patient from the frequently severe
consequences of urgent, obligatory, surgical or endovascular intervention.