Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp bdominal aortic aneurysm (AAA) is a common condition of increasing prevalence, particularly among older men. 1,2 Aneurysm-related mortality is responsible for approximately 15,000 deaths in 2010 in the USA. 1, 3 Although there are approximately 55,000 patients who undergo AAA repairs annually, the overall incidence of AAA is probably estimated to be higher. 4 AAA occurs in 4-9% of the population over the age of 65 years according to the screening studies, and affects approximately 1.7 million individuals 5-8 in the USA.Many groups have researched the pathophysiology of AAA with the intent to discover an effective medical treatment through a biological or molecular approach. 9-15 Matrix metalloproteinase (MMP) is a key proteinase mechanism in the development and growth of AAA. Effective medical treatment for AAA has not been established yet; however, it would be beneficial to avoid the invasive interventions and it would be expected to reduce the medical cost. 1, 16 We reviewed the current treatment options and potential medical treatment for AAA.
Etiology and Pathogenesis of AAAAAA is hypothesized to be caused by multifunctional degenerative processes, including extracellular matrix remodeling, vascular smooth muscle cell apoptosis/necrosis, oxidative stress and infiltration of inflammatory cells. Genetic disorder, inflammation, infection and connective tissue disease are also causal underlying factors of destructive degeneration of the aortic wall. 17-21 While the precise etiology of AAA hasn't been fully understood yet, it is certain that the progression of aneurysmal degeneration involves destructive remodeling of the aneurysmal wall.Elastin is the one of the key structural proteins of extracellular matrix in the aortic wall and maintains the integrity of the wall. Numerous studies suggest that proteolytic degradation of elastin in the medial layer leads to weakening and dilatation of the aortic wall while collagen degradation accounts for the rupture of the aneurysm. 22-25 The elastin and collagen degradation in the aneurysm wall is contributed by the matrix metalloproteinase (MMP) family such as collagenase-1 (MMP-1), stromelysin-1 (MMP-3), the 72-kDa gelatinase (MMP-2) and the 92-kDa gelatinase (MMP-9), macrophage elastase (MMP-12) and collagenase-3 (MMP13). 22,23,26-29MMPs are structurally related metalloendopeptidases that can degrade the extracellular matrix and play important roles in normal tissue development and remodeling. Abnormal expression of MMPs is associated with various pathological processes such as osteoarthritis, rheumatoid arthritis, tumor invasion and metastasis, pulmonary emphysema and atherosclerosis. 30-34 Regulation of MMP activities has been attempted (to prevent the tissue degradation) by controlling them at different levels of the activation processes. The tissue inhibitor of metalloproteinases (TIMPs) are physiological inhibitors of MMP activity. Several studies suggested that aneury...