- 1. Zhejiang University School of Medicine, Hangzhou, 310058, P. R. China;
- 2. Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310058, P. R. China;
- 3. National Key Laboratory of Vascular Implantation Devices, Hangzhou, 310058, P. R. China;
SU Sheng'an,
Email: chearbear@zju.edu.cn
Thoracic aortic dissection (TAD) is a highly lethal cardiovascular emergency in clinical practice. Its annual incidence stands at approximately 3-4 per 100 000 individuals and is on the rise. This condition confers an extremely poor prognosis. In patients who fail to receive timely treatment, the mortality rate reaches 1%-2% per hour on the first day, rising to 50% within one week, with a recurrence rate of approximately 8.0%, significantly increasing the burden on clinical diagnosis and treatment. In-depth exploration of the pathological mechanisms underlying TAD holds significant research value for elucidating the disease's essence and optimising diagnostic and therapeutic strategies. The pathogenesis and progression of TAD involve multidimensional aetiological factors. This review focuses on the core pathological mechanisms underpinning TAD development, summarising current research advances from multiple perspectives: the biomechanical properties of the aortic wall, smooth muscle cell phenotypic switching and imbalanced extracellular matrix degradation, endothelial dysfunction, inflammatory and immune responses, and genetic susceptibility. It aims to provide a reference framework for both fundamental research and clinical management of TAD.
Copyright ? the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
| 1. | Stombaugh DK, Mangunta VR. Aortic dissection. Anesthesiol Clin, 2022, 40(4): 685-703. |
| 2. | Rylski B, Schilling O, Czerny M. Acute aortic dissection: evidence, uncertainties, and future therapies. Eur Heart J, 2023, 44(10): 813-821. |
| 3. | Reed MJ. Diagnosis and management of acute aortic dissection in the emergency department. Br J Hosp Med (Lond), 2024, 85(4): 1-9. |
| 4. | Ogami T, Arnaoutakis GJ, Isselbacher EM, et al. Long-term outcomes after recurrent acute thoracic aortic dissection: insights from the international registry of aortic dissection. J Thorac Cardiovasc Surg, 2025, 169(1): 1-10. |
| 5. | Laloo R, Bailey M. The protective role of periaortic lymphatic vessels in thoracic aortic dissection. Cardiovasc Res, 2025, 121(16): 2457-2458. |
| 6. | Salmasi MY, Sasidharan S, Frattolin J, et al. Regional variation in biomechanical properties of ascending thoracic aortic aneurysms. Eur J Cardiothorac Surg, 2022, 62(3): ezac392. |
| 7. | Qiao X, Wang D, Zhu H, et al. SIRT3-activating, biodegradable poly-honokiol with high drug loading for thoracic aortic dissection therapy. J Adv Res, 2025. Epub ahead of print. PMID: 41242496. |
| 8. | Davis MJ, Earley S, Li YS, Chien S. Vascular mechanotransduction. Physiol Rev, 2023, 103(2): 1247-1421. |
| 9. | Zhang C, Li Y, Chakraborty A, et al. Aortic stress activates an adaptive program in thoracic aortic smooth muscle cells that maintains aortic strength and protects against aneurysm and dissection in mice. Arterioscler Thromb Vasc Biol, 2023, 43(2): 234-252. |
| 10. | Park WY, Lee SY, Seo J. Hemodynamic analysis in aortic dilatation after arterial switch operation for patients with transposition of great arteries using computational fluid dynamics. J Cardiovasc Transl Res, 2025, 18(1): 79-90. |
| 11. | De Moudt S, Leloup A, Fransen P. Aortic stiffness hysteresis in isolated mouse aortic segments is intensified by contractile stimuli, attenuated by age, and reversed by elastin degradation. Front Physiol, 2021, 12: 723972. |
| 12. | Taguchi E, Nishigami K, Miyamoto S, et al. Impact of shear stress and atherosclerosis on entrance-tear formation in patients with acute aortic syndromes. Heart Vessels, 2014, 29(1): 78-82. |
| 13. | Liu S, Cai J, Chen Z. Vascular mechanical forces and vascular diseases. J Adv Res, 2025. Epub ahead of print. PMID: 40975125. |
| 14. | Gao J, Chen Y, Wang H, et al. Gasdermin D deficiency in vascular smooth muscle cells ameliorates abdominal aortic aneurysm through reducing putrescine synthesis. Adv Sci (Weinh), 2023, 10(5): e2204038. |
| 15. | Su Z, Lu W, Cao J, et al. Endoplasmic reticulum stress in abdominal aortic aneurysm. Int J Cardiol Heart Vasc, 2024, 54: 101500. |
| 16. | Pan L, Bai P, Weng X, et al. Legumain is an endogenous modulator of integrin αvβ3 triggering vascular degeneration, dissection, and rupture. Circulation, 2022, 145(9): 659-674. |
| 17. | Elmarasi M, Elmakaty I, Elsayed B, et al. Phenotypic switching of vascular smooth muscle cells in atherosclerosis, hypertension, and aortic dissection. J Cell Physiol, 2024, 239(4): e31200. |
| 18. | Lu H, Chen Y, Chen Y, et al. C/EBPα-mediated transcriptional activation of PIK3C2A regulates autophagy, matrix metalloproteinase expression, and phenotypic of vascular smooth muscle cells in aortic dissection. J Immunol Res, 2022, 2022: 7465353. |
| 19. | Almendra-Pegueros R, Rodriguez C, Camacho M, et al. Identification of endoplasmic reticulum stress-associated lncRNAs influencing inflammation and VSMC function in abdominal aortic aneurysm. Clin Sci (Lond), 2025, 139(6): 357-372. |
| 20. | Rombouts KB, van Merrienboer TAR, Ket JCF, et al. The role of vascular smooth muscle cells in the development of aortic aneurysms and dissections. Eur J Clin Invest, 2022, 52(4): e13697. |
| 21. | Ye Z, Zhu S, Li G, et al. Early matrix softening contributes to vascular smooth muscle cell phenotype switching and aortic dissection through down-regulation of microRNA-143/145. J Mol Cell Cardiol, 2024, 192: 1-12. |
| 22. | Li M, Li R, Zheng Z, et al. LncRNA LINC01605 regulates smooth muscle cell functions and participates in the development of aortic dissection through regulating SGK1. J Cell Mol Med, 2025, 29(22): e70963. |
| 23. | Poetsch F, Henze LA, Estepa M, et al. Role of SGK1 in the osteogenic transdifferentiation and calcification of vascular smooth muscle cells promoted by hyperglycemic conditions. Int J Mol Sci, 2020, 21(19): 7207. |
| 24. | Lou Y, Hu M, Mao L, et al. Involvement of serum glucocorticoid-regulated kinase 1 in reproductive success. FASEB J, 2017, 31(2): 447-456. |
| 25. | Leng S, Li H, Zhang P, et al. SGK1-mediated vascular smooth muscle cell phenotypic transformation promotes thoracic aortic dissection progression. Arterioscler Thromb Vasc Biol, 2025, 45(2): 238-259. |
| 26. | Chen PY, Qin L, Li G, et al. Smooth muscle cell reprogramming in aortic aneurysms. Cell Stem Cell, 2020, 26(4): 542-557. |
| 27. | Chen Y, Zhang T, Yao F, et al. Dysregulation of interaction between LOXhigh fibroblast and smooth muscle cells contributes to the pathogenesis of aortic dissection. Theranostics, 2022, 12(2): 910-928. |
| 28. | Alves RD, Eijken M, van de Peppel J, et al. Calcifying vascular smooth muscle cells and osteoblasts: independent cell types exhibiting extracellular matrix and biomineralization-related mimicries. BMC Genomics, 2014, 15(1): 965. |
| 29. | Maguire EM, Pearce SWA, Xiao R, et al. Matrix metalloproteinase in abdominal aortic aneurysm and aortic dissection. Pharmaceuticals (Basel), 2019, 12(3): 118. |
| 30. | Shen YH, LeMaire SA, Webb NR, et al. Aortic aneurysms and dissections series. Arterioscler Thromb Vasc Biol, 2020, 40(3): e37-e46. |
| 31. | Zhou S, Ma B, Luo M. Matrix metalloproteinases in aortic dissection. Vascul Pharmacol, 2024, 156: 107420. |
| 32. | Chen SW, Chou SH, Tung YC, et al. Expression and role of lumican in acute aortic dissection: a human and mouse study. PLoS One, 2021, 16(7): e0255238. |
| 33. | Gong Z, Huang J, Wang D, et al. ADAMTS-7 deficiency attenuates thoracic aortic aneurysm and dissection in mice. J Mol Med (Berl), 2023, 101(3): 237-248. |
| 34. | Ren P, Hughes M, Krishnamoorthy S, et al. Critical role of ADAMTS-4 in the development of sporadic aortic aneurysm and dissection in mice. Sci Rep, 2017, 7(1): 12351. |
| 35. | El-Mahdy MA, Abdelghany TM, Hemann C, et al. Chronic cigarette smoke exposure triggers a vicious cycle of leukocyte and endothelial-mediated oxidant stress that results in vascular dysfunction. Am J Physiol Heart Circ Physiol, 2020, 319(1): H51-H65. |
| 36. | Yang X, Xu C, Yao F, et al. Targeting endothelial tight junctions to predict and protect thoracic aortic aneurysm and dissection. Eur Heart J, 2023, 44(14): 1248-1261. |
| 37. | Iida Y, Hachiya T, Asano R, et al. Extended thoracic endovascular aortic repair for residual aortic dissection after type A aortic dissection repair. Vascular, 2021, 29(6): 826-831. |
| 38. | Wei JQ, Yang Y, Zhai WH, et al. Deficiency of NPR-C triggers high salt-induced thoracic aortic dissection by impairing mitochondrial homeostasis. Cardiovasc Res, 2025, 121(7): 1121-1134. |
| 39. | Song J, Peng H, Lai M, et al. Relationship between inflammatory-related cytokines with aortic dissection. Int Immunopharmacol, 2023, 122: 110618. |
| 40. | He YB, Jin HZ, Zhao JL, et al. Single-cell transcriptomic analysis reveals differential cell subpopulations and distinct phenotype transition in normal and dissected ascending aorta. Mol Med, 2022, 28(1): 158. |
| 41. | Guo LL, Wu MT, Zhang LW, et al. Blocking interleukin-1 beta reduces the evolution of thoracic aortic dissection in a rodent model. Eur J Vasc Endovasc Surg, 2020, 60(6): 916-924. |
| 42. | Terriaca S, Scioli MG, Bertoldo F, et al. miRNA-driven regulation of endothelial-to-mesenchymal transition differs among thoracic aortic aneurysms. Cells, 2024, 13(15): 1252. |
| 43. | Maleki S, Poujade FA, Bergman O, et al. Endothelial/epithelial mesenchymal transition in ascending aortas of patients with bicuspid aortic valve. Front Cardiovasc Med, 2019, 6: 182. |
| 44. | An Z, Qiao F, Lu Q, et al. Interleukin-6 downregulated vascular smooth muscle cell contractile proteins via ATG4B-mediated autophagy in thoracic aortic dissection. Heart Vessels, 2017, 32(12): 1523-1535. |
| 45. | Xu Y, Ye J, Wang M, et al. Increased interleukin-11 levels in thoracic aorta and plasma from patients with acute thoracic aortic dissection. Clin Chim Acta, 2018, 481: 193-199. |
| 46. | Ye J, Wang M, Jiang H, et al. Increased levels of interleukin-22 in thoracic aorta and plasma from patients with acute thoracic aortic dissection. Clin Chim Acta, 2018, 486: 395-401. |
| 47. | Adam M, Kooreman NG, Jagger A, et al. Systemic upregulation of IL-10 (interleukin-10) using a nonimmunogenic vector reduces growth and rate of dissecting abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol, 2018, 38(8): 1796-1805. |
| 48. | Lian G, Li X, Zhang L, et al. Macrophage metabolic reprogramming aggravates aortic dissection through the HIF1α-ADAM17 pathway. EBioMedicine, 2019, 49: 291-304. |
| 49. | Pei Y, Lin W, Zhang T, et al. Periaortic lymphatic vessels protect against thoracic aortic dissection through mobilizing immune response. Cardiovasc Res, 2025, 121(16): 2594-2609. |
| 50. | Zhang Y, Zhang H, Zhao S, et al. S-nitrosylation of septin2 exacerbates aortic aneurysm and dissection by coupling the TIAM1-RAC1 axis in macrophages. Circulation, 2024, 149(24): 1903-1920. |
| 51. | Shen M, Quertermous T, Fischbein MP, et al. Generation of vascular smooth muscle cells from induced pluripotent stem cells: methods, applications, and considerations. Circ Res, 2021, 128(5): 670-686. |
| 52. | Deleeuw V, Carlson E, Renard M, et al. Unraveling the role of TGFβ signaling in thoracic aortic aneurysm and dissection using Fbn1 mutant mouse models. Matrix Biol, 2023, 123: 17-33. |
| 53. | Morales S, Monzo M, Navarro A. Epigenetic regulation mechanisms of microRNA expression. Biomol Concepts, 2017, 8(5-6): 203-212. |
| 54. | Yi YS. MicroRNA-mediated epigenetic regulation of inflammasomes in inflammatory responses and immunopathologies. Semin Cell Dev Biol, 2024, 154(Pt C): 227-238. |
| 55. | Gao Q, Bao M, Tan J, et al. Copy number loss of APP cause thoracic aortic dissection. Hypertens Res, 2025, 48(10): 2641-2653. |
| 56. | Murdock DR, Guo DC, DePaolo JS, et al. Non-canonical splice variants in thoracic aortic dissection cases and Marfan syndrome with negative genetic testing. NPJ Genom Med, 2025, 10(1): 25. |
| 57. | Yang K, Ren J, Li X, et al. Prevention of aortic dissection and aneurysm via an ALDH2-mediated switch in vascular smooth muscle cell phenotype. Eur Heart J, 2020, 41(26): 2442-2453. |
| 58. | An Z, Sun Y, Yang X, et al. Enhanced expression of miR-20a driven by nanog exacerbated the degradation of extracellular matrix in thoracic aortic dissection. Noncoding RNA Res, 2024, 9(4): 1040-1049. |
| 59. | Zhou M, Shi Z, Li X, et al. Prediction of distal aortic enlargement after proximal repair of aortic dissection using machine learning. Ann Vasc Surg, 2021, 75: 332-340. |
| 60. | Messou JCE, Yeung K, Sudbrook E, et al. Investigating the role of thrombosis and false lumen orbital orientation in the hemodynamics of type B aortic dissection. Sci Rep, 2024, 14(1): 27379. |
| 61. | Teng X, Wang Y, Huang H, et al. Calpain-2-mediated endothelial focal adhesion disruption in thoracic aortic dissection. Adv Sci (Weinh), 2025, 12(25): e2501112. |
| 62. | Zhu L, An P, Zhao W, et al. Low zinc alleviates the progression of thoracic aortic dissection by inhibiting inflammation. Nutrients, 2023, 15(7): 1640. |
| 63. | Wang X, Ghayesh MH, Kotousov A, et al. Fluid-structure interaction study for biomechanics and risk factors in Stanford type A aortic dissection. Int J Numer Method Biomed Eng, 2023, 39(8): e3736. |
| 64. | Teng P, Chen ZH, Ma L. Mechanosensitive ion channel Piezo1 regulates tight junctions between endothelium and mediates the occurrence of aortic dissection. Eur Heart J, 2024, 45(Suppl 1): ehae666.2243. |
| 65. | Yin ZQ, Wen T, Cao XL, et al. The transcription factor RBPJ is required for inflammatory macrophage activation in thoracic aortic dissection by mediating mechanotransduction-induced glycolysis. Cell Mol Life Sci, 2025, 82(1): 370. |
| 66. | Kose T, Antal A, Gunel T. Expression of MMP2, MMP9, TIMP2 and TIMP3 genes in aortic dissection. Exp Ther Med, 2024, 28(3): 360. |
| 67. | Wu A, Wu Y, Song M, et al. Protective effects of liraglutide on hypercholesterolemia-associated atherosclerosis involve attenuation of endothelial-monocyte adhesion through down-regulating the LOX-1/NF-κB signaling pathway. Sci Rep, 2025, 15(1): 27429. |
| 68. | Del Río-Solá MAL, Laura SV, Daniel GV. The association between plasma proinflammatory cytokine concentrations and endoleak after endovascular aortic aneurysm repair. Ann Vasc Surg, 2025, 110(Pt A): 244-254. |
| 69. | Kimura S, Sato H, Shimajiri S, et al. An acute aortic dissection prognostic score for predicting early in-hospital mortality in acute thoracic aortic dissection. Am Heart J Plus, 2025, 52: 100521. |
- 1. Stombaugh DK, Mangunta VR. Aortic dissection. Anesthesiol Clin, 2022, 40(4): 685-703.
- 2. Rylski B, Schilling O, Czerny M. Acute aortic dissection: evidence, uncertainties, and future therapies. Eur Heart J, 2023, 44(10): 813-821.
- 3. Reed MJ. Diagnosis and management of acute aortic dissection in the emergency department. Br J Hosp Med (Lond), 2024, 85(4): 1-9.
- 4. Ogami T, Arnaoutakis GJ, Isselbacher EM, et al. Long-term outcomes after recurrent acute thoracic aortic dissection: insights from the international registry of aortic dissection. J Thorac Cardiovasc Surg, 2025, 169(1): 1-10.
- 5. Laloo R, Bailey M. The protective role of periaortic lymphatic vessels in thoracic aortic dissection. Cardiovasc Res, 2025, 121(16): 2457-2458.
- 6. Salmasi MY, Sasidharan S, Frattolin J, et al. Regional variation in biomechanical properties of ascending thoracic aortic aneurysms. Eur J Cardiothorac Surg, 2022, 62(3): ezac392.
- 7. Qiao X, Wang D, Zhu H, et al. SIRT3-activating, biodegradable poly-honokiol with high drug loading for thoracic aortic dissection therapy. J Adv Res, 2025. Epub ahead of print. PMID: 41242496.
- 8. Davis MJ, Earley S, Li YS, Chien S. Vascular mechanotransduction. Physiol Rev, 2023, 103(2): 1247-1421.
- 9. Zhang C, Li Y, Chakraborty A, et al. Aortic stress activates an adaptive program in thoracic aortic smooth muscle cells that maintains aortic strength and protects against aneurysm and dissection in mice. Arterioscler Thromb Vasc Biol, 2023, 43(2): 234-252.
- 10. Park WY, Lee SY, Seo J. Hemodynamic analysis in aortic dilatation after arterial switch operation for patients with transposition of great arteries using computational fluid dynamics. J Cardiovasc Transl Res, 2025, 18(1): 79-90.
- 11. De Moudt S, Leloup A, Fransen P. Aortic stiffness hysteresis in isolated mouse aortic segments is intensified by contractile stimuli, attenuated by age, and reversed by elastin degradation. Front Physiol, 2021, 12: 723972.
- 12. Taguchi E, Nishigami K, Miyamoto S, et al. Impact of shear stress and atherosclerosis on entrance-tear formation in patients with acute aortic syndromes. Heart Vessels, 2014, 29(1): 78-82.
- 13. Liu S, Cai J, Chen Z. Vascular mechanical forces and vascular diseases. J Adv Res, 2025. Epub ahead of print. PMID: 40975125.
- 14. Gao J, Chen Y, Wang H, et al. Gasdermin D deficiency in vascular smooth muscle cells ameliorates abdominal aortic aneurysm through reducing putrescine synthesis. Adv Sci (Weinh), 2023, 10(5): e2204038.
- 15. Su Z, Lu W, Cao J, et al. Endoplasmic reticulum stress in abdominal aortic aneurysm. Int J Cardiol Heart Vasc, 2024, 54: 101500.
- 16. Pan L, Bai P, Weng X, et al. Legumain is an endogenous modulator of integrin αvβ3 triggering vascular degeneration, dissection, and rupture. Circulation, 2022, 145(9): 659-674.
- 17. Elmarasi M, Elmakaty I, Elsayed B, et al. Phenotypic switching of vascular smooth muscle cells in atherosclerosis, hypertension, and aortic dissection. J Cell Physiol, 2024, 239(4): e31200.
- 18. Lu H, Chen Y, Chen Y, et al. C/EBPα-mediated transcriptional activation of PIK3C2A regulates autophagy, matrix metalloproteinase expression, and phenotypic of vascular smooth muscle cells in aortic dissection. J Immunol Res, 2022, 2022: 7465353.
- 19. Almendra-Pegueros R, Rodriguez C, Camacho M, et al. Identification of endoplasmic reticulum stress-associated lncRNAs influencing inflammation and VSMC function in abdominal aortic aneurysm. Clin Sci (Lond), 2025, 139(6): 357-372.
- 20. Rombouts KB, van Merrienboer TAR, Ket JCF, et al. The role of vascular smooth muscle cells in the development of aortic aneurysms and dissections. Eur J Clin Invest, 2022, 52(4): e13697.
- 21. Ye Z, Zhu S, Li G, et al. Early matrix softening contributes to vascular smooth muscle cell phenotype switching and aortic dissection through down-regulation of microRNA-143/145. J Mol Cell Cardiol, 2024, 192: 1-12.
- 22. Li M, Li R, Zheng Z, et al. LncRNA LINC01605 regulates smooth muscle cell functions and participates in the development of aortic dissection through regulating SGK1. J Cell Mol Med, 2025, 29(22): e70963.
- 23. Poetsch F, Henze LA, Estepa M, et al. Role of SGK1 in the osteogenic transdifferentiation and calcification of vascular smooth muscle cells promoted by hyperglycemic conditions. Int J Mol Sci, 2020, 21(19): 7207.
- 24. Lou Y, Hu M, Mao L, et al. Involvement of serum glucocorticoid-regulated kinase 1 in reproductive success. FASEB J, 2017, 31(2): 447-456.
- 25. Leng S, Li H, Zhang P, et al. SGK1-mediated vascular smooth muscle cell phenotypic transformation promotes thoracic aortic dissection progression. Arterioscler Thromb Vasc Biol, 2025, 45(2): 238-259.
- 26. Chen PY, Qin L, Li G, et al. Smooth muscle cell reprogramming in aortic aneurysms. Cell Stem Cell, 2020, 26(4): 542-557.
- 27. Chen Y, Zhang T, Yao F, et al. Dysregulation of interaction between LOXhigh fibroblast and smooth muscle cells contributes to the pathogenesis of aortic dissection. Theranostics, 2022, 12(2): 910-928.
- 28. Alves RD, Eijken M, van de Peppel J, et al. Calcifying vascular smooth muscle cells and osteoblasts: independent cell types exhibiting extracellular matrix and biomineralization-related mimicries. BMC Genomics, 2014, 15(1): 965.
- 29. Maguire EM, Pearce SWA, Xiao R, et al. Matrix metalloproteinase in abdominal aortic aneurysm and aortic dissection. Pharmaceuticals (Basel), 2019, 12(3): 118.
- 30. Shen YH, LeMaire SA, Webb NR, et al. Aortic aneurysms and dissections series. Arterioscler Thromb Vasc Biol, 2020, 40(3): e37-e46.
- 31. Zhou S, Ma B, Luo M. Matrix metalloproteinases in aortic dissection. Vascul Pharmacol, 2024, 156: 107420.
- 32. Chen SW, Chou SH, Tung YC, et al. Expression and role of lumican in acute aortic dissection: a human and mouse study. PLoS One, 2021, 16(7): e0255238.
- 33. Gong Z, Huang J, Wang D, et al. ADAMTS-7 deficiency attenuates thoracic aortic aneurysm and dissection in mice. J Mol Med (Berl), 2023, 101(3): 237-248.
- 34. Ren P, Hughes M, Krishnamoorthy S, et al. Critical role of ADAMTS-4 in the development of sporadic aortic aneurysm and dissection in mice. Sci Rep, 2017, 7(1): 12351.
- 35. El-Mahdy MA, Abdelghany TM, Hemann C, et al. Chronic cigarette smoke exposure triggers a vicious cycle of leukocyte and endothelial-mediated oxidant stress that results in vascular dysfunction. Am J Physiol Heart Circ Physiol, 2020, 319(1): H51-H65.
- 36. Yang X, Xu C, Yao F, et al. Targeting endothelial tight junctions to predict and protect thoracic aortic aneurysm and dissection. Eur Heart J, 2023, 44(14): 1248-1261.
- 37. Iida Y, Hachiya T, Asano R, et al. Extended thoracic endovascular aortic repair for residual aortic dissection after type A aortic dissection repair. Vascular, 2021, 29(6): 826-831.
- 38. Wei JQ, Yang Y, Zhai WH, et al. Deficiency of NPR-C triggers high salt-induced thoracic aortic dissection by impairing mitochondrial homeostasis. Cardiovasc Res, 2025, 121(7): 1121-1134.
- 39. Song J, Peng H, Lai M, et al. Relationship between inflammatory-related cytokines with aortic dissection. Int Immunopharmacol, 2023, 122: 110618.
- 40. He YB, Jin HZ, Zhao JL, et al. Single-cell transcriptomic analysis reveals differential cell subpopulations and distinct phenotype transition in normal and dissected ascending aorta. Mol Med, 2022, 28(1): 158.
- 41. Guo LL, Wu MT, Zhang LW, et al. Blocking interleukin-1 beta reduces the evolution of thoracic aortic dissection in a rodent model. Eur J Vasc Endovasc Surg, 2020, 60(6): 916-924.
- 42. Terriaca S, Scioli MG, Bertoldo F, et al. miRNA-driven regulation of endothelial-to-mesenchymal transition differs among thoracic aortic aneurysms. Cells, 2024, 13(15): 1252.
- 43. Maleki S, Poujade FA, Bergman O, et al. Endothelial/epithelial mesenchymal transition in ascending aortas of patients with bicuspid aortic valve. Front Cardiovasc Med, 2019, 6: 182.
- 44. An Z, Qiao F, Lu Q, et al. Interleukin-6 downregulated vascular smooth muscle cell contractile proteins via ATG4B-mediated autophagy in thoracic aortic dissection. Heart Vessels, 2017, 32(12): 1523-1535.
- 45. Xu Y, Ye J, Wang M, et al. Increased interleukin-11 levels in thoracic aorta and plasma from patients with acute thoracic aortic dissection. Clin Chim Acta, 2018, 481: 193-199.
- 46. Ye J, Wang M, Jiang H, et al. Increased levels of interleukin-22 in thoracic aorta and plasma from patients with acute thoracic aortic dissection. Clin Chim Acta, 2018, 486: 395-401.
- 47. Adam M, Kooreman NG, Jagger A, et al. Systemic upregulation of IL-10 (interleukin-10) using a nonimmunogenic vector reduces growth and rate of dissecting abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol, 2018, 38(8): 1796-1805.
- 48. Lian G, Li X, Zhang L, et al. Macrophage metabolic reprogramming aggravates aortic dissection through the HIF1α-ADAM17 pathway. EBioMedicine, 2019, 49: 291-304.
- 49. Pei Y, Lin W, Zhang T, et al. Periaortic lymphatic vessels protect against thoracic aortic dissection through mobilizing immune response. Cardiovasc Res, 2025, 121(16): 2594-2609.
- 50. Zhang Y, Zhang H, Zhao S, et al. S-nitrosylation of septin2 exacerbates aortic aneurysm and dissection by coupling the TIAM1-RAC1 axis in macrophages. Circulation, 2024, 149(24): 1903-1920.
- 51. Shen M, Quertermous T, Fischbein MP, et al. Generation of vascular smooth muscle cells from induced pluripotent stem cells: methods, applications, and considerations. Circ Res, 2021, 128(5): 670-686.
- 52. Deleeuw V, Carlson E, Renard M, et al. Unraveling the role of TGFβ signaling in thoracic aortic aneurysm and dissection using Fbn1 mutant mouse models. Matrix Biol, 2023, 123: 17-33.
- 53. Morales S, Monzo M, Navarro A. Epigenetic regulation mechanisms of microRNA expression. Biomol Concepts, 2017, 8(5-6): 203-212.
- 54. Yi YS. MicroRNA-mediated epigenetic regulation of inflammasomes in inflammatory responses and immunopathologies. Semin Cell Dev Biol, 2024, 154(Pt C): 227-238.
- 55. Gao Q, Bao M, Tan J, et al. Copy number loss of APP cause thoracic aortic dissection. Hypertens Res, 2025, 48(10): 2641-2653.
- 56. Murdock DR, Guo DC, DePaolo JS, et al. Non-canonical splice variants in thoracic aortic dissection cases and Marfan syndrome with negative genetic testing. NPJ Genom Med, 2025, 10(1): 25.
- 57. Yang K, Ren J, Li X, et al. Prevention of aortic dissection and aneurysm via an ALDH2-mediated switch in vascular smooth muscle cell phenotype. Eur Heart J, 2020, 41(26): 2442-2453.
- 58. An Z, Sun Y, Yang X, et al. Enhanced expression of miR-20a driven by nanog exacerbated the degradation of extracellular matrix in thoracic aortic dissection. Noncoding RNA Res, 2024, 9(4): 1040-1049.
- 59. Zhou M, Shi Z, Li X, et al. Prediction of distal aortic enlargement after proximal repair of aortic dissection using machine learning. Ann Vasc Surg, 2021, 75: 332-340.
- 60. Messou JCE, Yeung K, Sudbrook E, et al. Investigating the role of thrombosis and false lumen orbital orientation in the hemodynamics of type B aortic dissection. Sci Rep, 2024, 14(1): 27379.
- 61. Teng X, Wang Y, Huang H, et al. Calpain-2-mediated endothelial focal adhesion disruption in thoracic aortic dissection. Adv Sci (Weinh), 2025, 12(25): e2501112.
- 62. Zhu L, An P, Zhao W, et al. Low zinc alleviates the progression of thoracic aortic dissection by inhibiting inflammation. Nutrients, 2023, 15(7): 1640.
- 63. Wang X, Ghayesh MH, Kotousov A, et al. Fluid-structure interaction study for biomechanics and risk factors in Stanford type A aortic dissection. Int J Numer Method Biomed Eng, 2023, 39(8): e3736.
- 64. Teng P, Chen ZH, Ma L. Mechanosensitive ion channel Piezo1 regulates tight junctions between endothelium and mediates the occurrence of aortic dissection. Eur Heart J, 2024, 45(Suppl 1): ehae666.2243.
- 65. Yin ZQ, Wen T, Cao XL, et al. The transcription factor RBPJ is required for inflammatory macrophage activation in thoracic aortic dissection by mediating mechanotransduction-induced glycolysis. Cell Mol Life Sci, 2025, 82(1): 370.
- 66. Kose T, Antal A, Gunel T. Expression of MMP2, MMP9, TIMP2 and TIMP3 genes in aortic dissection. Exp Ther Med, 2024, 28(3): 360.
- 67. Wu A, Wu Y, Song M, et al. Protective effects of liraglutide on hypercholesterolemia-associated atherosclerosis involve attenuation of endothelial-monocyte adhesion through down-regulating the LOX-1/NF-κB signaling pathway. Sci Rep, 2025, 15(1): 27429.
- 68. Del Río-Solá MAL, Laura SV, Daniel GV. The association between plasma proinflammatory cytokine concentrations and endoleak after endovascular aortic aneurysm repair. Ann Vasc Surg, 2025, 110(Pt A): 244-254.
- 69. Kimura S, Sato H, Shimajiri S, et al. An acute aortic dissection prognostic score for predicting early in-hospital mortality in acute thoracic aortic dissection. Am Heart J Plus, 2025, 52: 100521.