Molekulare Therapieansätze beim AAA mit klinischem Potenzial

The treatment of abdominal aortic aneurysms (AAA) depends on the diameter and is primarily performed as surgical or endovascular repair. In recent years interventional studies on conservative stabilization of aneurysms failed to show a positive effect.

Based on a systematic presentation previous studies on the topic are discussed and potential limitations are shown. Based on a scoping review the authors present their own research approaches on the molecular pathogenesis of AAA.

Due to the heterogeneous pathobiology a patient-specific consideration is necessary. In the past the treatment with sartans, doxycycline, macrolides, propranolol, statins and angiotensin-converting enzyme (ACE) inhibitors did not lead to a relevant reduction in aneurysm growth; however, there is promising evidence from the use of metformin in diabetic patients with AAA. Furthermore, drugs with pleiotropic effects have shown promising results in small and large animal models as well as approaches for targeted inhibition of platelet function. Stabilization of the aneurysm by local treatment with non-coding RNA equivalents or an endovascular device in the aneurysm neck with a so-called circumferential aortic stiffening device (CASD) also showed a preclinical reduction of the increase in diameter.

Drug trials on controlling AAA progression must take patient-specific pathophysiological aspects, a sufficient number of patients and duration of follow-up into account. Several approaches for drug-based AAA treatment are currently being pursued with agents already in clinical use for other indications. Clinical trials on metformin in non-diabetic patients with AAA are the most advanced.