Analysis of Calcifications in Patients with Coral Reef Aorta

作者：Schlieper Georg^*; Grotemeyer Dirk; Aretz Anke; Schurgers Leon J; Krueger Thilo; Rehbein Hermann; Weirich Thomas E; Westenfeld Ralf; Brandenburg Vincent M; Eitner Frank; Mayer Joachim; Floege Juergen; Sandmann Wilhelm; Ketteler Markus

来源：Annals of Vascular Surgery, 2010, 24(3): 408-414.

DOI：10.1016/j.avsg.2009.11.006

Background: Coral reef aorta is a rare vascular disease with intraluminal calcifications of the dorsal part of the visceral aorta. The pathogenesis of this disease with its topographic and morphologic characteristics is unknown. The aim of our study was to investigate calcification inhibitors and the ultrastructure of calcifications in patients with coral reef aorta.
Methods: Ten patients with coral reef aorta were examined. Calcified specimens were investigated by immunohistochemical techniques for the expression of the calcification inhibitors matrix gla protein (MGP) and fetuin-A. Vessel walls were also assessed by electron microscopic techniques including electron energy-lost spectroscopy, electron dispersive spectroscopy, and electron diffraction. Sera of patients were analyzed for fetuin-A, uncarboxylated MGP (ucMGP), and osteoprotegerin.
Results: As assessed by immunohistochemistry, most MGP was detected in the vicinity of calcified regions. Serum levels of the calcification inhibitors ucMGP, fetuin-A, and osteoprotegerin were 370 +/- 107 nmol/L, 0.57 +/- 0.03 g/L, and 5.64 +/- 0.79 pmol/L, respectively. Ultrastructural analysis of calcified specimens showed a core-shell structure with multiple calcification nuclei. calcifications displayed a. ne-crystalline character, and elemental analysis revealed hydroxyl apatite as the chemical compound.
Conclusion: The coral reef aorta represents an extreme exophytic growth of vascular calcification with multiple nuclei which resemble typical media calcification. Positive vascular immunostaining and low serum levels of both fetuin-A and ucMGP suggest a pathophysiologic role of these calcification inhibitors in the development of coral reef aorta.

• 出版日期2010-4