Intraluminal thrombus enhances proteolysis in abdominal aortic aneurysms

This study examined whether intraluminal thrombus in abdominal aortic aneurysms (AAAs) is a source of fibrinolytic activity and proteolysis that could weaken the aneurysm wall. Plasmin, tissue plasminogen activator (tPA), and urokinase plasminogen activator (uPA) activity plasminogen activator inhibitor 1 (PAI-1), and alpha(2)-antiplasmin (alpha 2AP) antigen were measured in the AAA wall and juxtamural and luminal aspects of intraluminal thrombus in 18 patients. The aneurysm wall contained 100-fold higher tPA activity (1.06 +/- 0.34 [standard error of measurement] U/mg soluble protein) compared with juxtamural thrombus (JMT) (0.011 +/- 0.001) and luminal thrombus (LT) (0.01 0.001) (p <.00001) and over 6-fold higher uPA activity (29.3 +/- 3.4 IU/mg) compared with the JMT (4.3 +/- 2.4, p =.00024) and LT (7.9 +/- 1.76, p =.0005). The LT had significantly lower levels of PAI-1 (1.26 +/- 0.34 ng/mg) than the AAA wall (2.08 +/- 0.51, p =.04) and the JMT (3.94 +/- 0.85, p =.007). The levels of alpha 2AP in the wall (19.4 +/- 3.1 ng/mg) were lower than in the JMT or LT (43.0 +/- 7.9 ng/mg, p =.013, and 47.6 +/- 6.0 ng/mg, p =.002, respectively). There was no significant difference, however, in plasmin activity among the AAA wall, JMT, and LT. There were significant amounts of latent gelatinase B (matrix metalloproteinase [MMP]-9) in the AAA, JMT, and LT. Mean levels of activated MMP-9 activity were similar in the AAA, JMT, and LT. Plasmin activation of MMPs at the interface between intraluminal thrombus and the aneurysm wall may enhance proteolysis and accelerate aneurysm expansion.