Illustration of ruptured aneurysm via Shutterstock.com.
Israel’s beloved singer Arik Einstein died on November 26, at age 74, from a ruptured aortic aneurysm. This condition is an abnormal ballooning of the body’s main artery that can lead to fatal internal bleeding.
Abdominal aortic aneurysm (AAA) is the 13th leading cause of death in most Western countries, and more than 200,000 new cases are diagnosed annually in the US alone.
If aneurysms could be treated early to prevent worsening, the incidence of rupture and death would fall dramatically. And that is the aim of a patented technology from Israel.
“Our purpose is to intervene at a stage where the aneurysm is not at the point where an emergency procedure is necessary,” says Dr. S. David Gertz, the Brandman Foundation Professor of Cardiac and Pulmonary Diseases at the Institute for Medical Research of The Hebrew University—Hadassah Medical School.
Current forms of treatment focus primarily on advanced stages of AAA and are associated with potentially life-threatening complications, explains Gertz, who heads the research project with Dr. Lilach Gavish.
When Gavish applied to do her doctorate in Gertz’s lab several years ago, she explained that for her master’s degree she had identified a molecular mechanism by which low-level laser (LLL) reduces inflammation and promotes wound healing.
“I didn’t know much at all about low-level laser at the time. However, having developed the first physiological model of arterial aneurysm in the late 1980s, we quickly realized the potential importance of this technology for this extremely common disease,” Gertz tells ISRAEL21c.
“An aneurysm is an inflammation-driven process, and that process causes major weakening in the structural integrity of the arterial wall. So we realized this may be ideal as a treatment approach.”
LLL for AAA
Using laboratory mice prone to developing aortic aneurysms after injection with a hormone that increases blood pressure, the Israeli scientists proved that LLL inhibits the development and progression of AAA by enhancing fibrous tissue reinforcement at the spots where the artery is weakened.
Through Yissum, Hebrew University’s technology transfer company, the investigators have submitted patent applications for a device that can be implanted temporarily into the abdomen, using laparoscopic surgery, to deliver LLL to the developing aneurysm.
Their first studies showed that low-level laser successfully prevented aneurysms from forming. Then, they did an additional series of experiments on those mice that had developed aneurysms, which showed that LLL also prevented existing aneurysms from progressing.
A poster on these findings presented at the annual American College of Cardiology meeting in 2012, won first prize in the vascular heart disease section. Five scientific papers have so far been published on the results of this multidisciplinary project.
“Now we are in the process of developing a large animal model so we’ll be able to show additional relevance for the human interventional setting,” says Gertz. “Hopefully, we will be able to identify the appropriate the strategic partner to develop this device.”
Early detection, early treatment
This approach makes sense in light of improved methods of early detection of AAA, says Gertz, a Baltimore native who moved to Israel 37 years ago.
“Since 2005, the US Preventive Services Task Force has recommended that all males between the ages of 65 and 74 who ever smoked should have a one-time ultrasound screening for abdominal aortic aneurysms,” he explains.
The reason for the guideline is that smokers and men are at greatest risk for this condition. Cigarette smoking heightens the risk of AAA seven-fold.
Because of increased screening, “we’re seeing many more small aneurysms than before. The target population for our intervention would be those in whom a relatively small aneurysm has been identified but, after repeat examination and failure of medication, are predicted to most likely reach the stage of needing either open-abdomen surgical graft repair or stent implantation within two to three years,” says Gertz.
“To avoid those patients reaching the stage of needing serious procedures, this technology based on LLL could slow or inhibit the progression.”
Gertz stresses that it could take some years until the implant is on the market.
“We’re pretty far along experimentally, but there’s still quite a way to go for it to be applicable to the human interventional setting,” he cautions.
“Nonetheless, this technology offers a minimally invasive approach that has the potential for preventing patients from having to undergo surgical procedures … known to be associated with a high percentage of significant consequences. That would be a major contribution.”
The research is funded by the Israel Science Foundation, the Saul Brandman Research Foundation, The Rosetrees Trust Fund (UK), and the Prof. Eliyahu Kelman Fund. In addition to Gavish, team members also include Prof. Ronen Beeri, Prof. Dan Gilon, Prof. Yoav Mintz, Dr. Chen Rubinstein, Dr. Leah Y. Gavish, Prof. Yacov Berlatzky, Dr. Liat Appelbaum, Dr. Atilla Bulut, Prof. Petachia Reissman, and Dr. Mickey Harlev.