Male-female Differences in Immunohistological and Biomechanical Properties of the Thoracic Aorta

Thoracic aortic aneurysms (TAA) result from progressive dilatation of the thoracic aorta and confer a risk for aortic dissection or rupture, which is associated with significant morbidity and mortality. In the Netherlands there are an estimated 200.000 adults with TAA, and annually 600 deaths after aortic dissection or rupture. There are clear differences in the incidence of TAA between men and women, with a higher incidence in men. Little is known on possible differences in outcome between male and female patients with Thoracic Aortic Aneurysm (TAA). Aortic disease is thought to affect men more frequently than women, and aortic growth is different between men and women. Current data suggest that women are at an increased risk of both dying from aortic dissection and having aorta-related complications compared to men (1). The mechanisms for these male-female difference in TAA outcome remain, however, unclear. The timing of preventive surgery is now not different for men and women, but gender-based cut-off values for maximal aortic diameter based on differences in vessel wall composition might be needed.

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Key information

Conditions

Thoracic Aortic Aneurysm Aneurysm Aortic Aneurysm Aortic Aneurysm, Thoracic Aortic Diseases Cardiovascular Diseases Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

Erasmus MC

Rotterdam, 3000 CA, Netherlands

About this study

Thoracic aortic aneurysms (TAA) result from progressive dilatation of the thoracic aorta and confer a risk for aortic dissection or rupture, which is associated with significant morbidity and mortality. In the Netherlands there are an estimated 200.000 adults with TAA, and annually 600 deaths after aortic dissection or rupture. There are clear differences in the incidence of TAA between men and women, with a higher incidence in men. Little is known on possible differences in outcome between male and female patients with Thoracic Aortic Aneurysm (TAA). Aortic disease is thought to affect men more frequently than women, and aortic growth is different between men and women. Current data suggest that women are at an increased risk of both dying from aortic dissection and having aorta-related complications compared to men(1). However, the mechanisms for these male-female differences in TAA outcome remain unclear. The timing of preventive surgery is not different for men and women, but gender-based cut-off values for maximal aortic diameter based on differences in vessel wall composition might be beneficial for outcome.

The current research project aims to implement male-female specific insights into aortic root and ascending aorta characteristics into clinical practice, allowing better identification of high risk Thoracic Aortic Aneurysm (TAA) patients and better timing of intervention. With this study the investigators aim to obtain insight into male-female differences in the immunohistological and biomechanical properties of the thoracic aortic wall. In order to reveal possible mechanisms for male-female differences in TAA.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Adult patients (≥ 18 years old) who have a thoracic aortic aneurysm and are scheduled for elective thoracic aortic surgery in the Erasmus MC or the LUMC.

Exclusion criteria

Patients with a known connective tissue disease (e.g. Marfan Syndrome and Ehlers-Danlos syndromes).
Connective tissue disease,

Treatment and study plan

Primary outcomes

Male-female differences in immunohistochemical and mass spectrometry-based estrogen and testosterone receptor expression levels (and density) in the proximal aortic wall

Time frame: 1 year

To investigate male-female differences in estrogen receptor (ESR-alpha and ESRbeta) and testosterone receptor (AR) tissue expression in the wall of the aortic root and ascending aorta by immunohistochemical techniques and mass spectometry. Comparisons will be made using a students t-test.

Secondary outcomes

Male-female differences in immunohistochemical or mass spectrometry-based sex hormone receptor expression levels (and density) in the proximal aortic wall.

Time frame: 1 year

To perform an explorative analysis of differences in sex hormone receptor expression in the relation to 1) the immunohistological properties of the aortic wall structure (smooth muscle cell differentiation, presence of macrophages, endothelial cell activation and extracellular matrix, through the following markers: alpha smooth muscle actin, sex hormone receptors (ESR1, RAGE, MMP 2, 3 and 9 and aromatase expression as marker for estrogen synthesis in SMC in both male and female), presence of macrophages (CD68 and MAC2) and endothelial cell activation (NOS3, TGF-β signaling) and extracellular matrix (a.o. fibrillin 1, elastin, collagen and crosslinking)) and to (1) sex hormone (androstenedione, DHEA, testosterone and SHBG in nmol/L, LH and FSH in IU/L, DHEA-S in micromole/L, AMH in micrograms/L, estradiol in picomol/L) and sRAGE (picograms/L) levels in blood, (2) aortic diameter (in millimeters) and (3) age (in years) using linear regression models.

Sponsors and collaborators

Lead sponsor

Hanneke Takkenberg

Other

Registry information

Acronym: MAFATS

Important dates

Study start: 2021
Primary completion: 2022
Study completion: 2022
First posted: Dec 14, 2022
Registry last updated: Sep 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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Completed