BACKGROUND: Aortic aneurysms represent a serious and common condition. Current therapies are based on mechanical treatment. With increased knowledge of the biochemical mechanisms responsible for aneurysm expansion, it may be possible to prevent the growth of small aneurysms. METHODS: A series of experiments performed in the investigator's laboratory during the past decade is outlined to show the evolution of our concepts of the processes underlying aneurysm formation and progression. RESULTS: Our understanding of aortic aneurysms has changed dramatically. Once thought to represent a simple degenerative process, aneurysm tissue is highly active metabolically with ongoing synthesis and degradation of matrix proteins. Several members of a family of matrix-degrading enzymes play an important role in this process. These enzymes can be inhibited by the antibiotic doxycycline. CONCLUSIONS: With a better understanding of aneurysm pathology, it may be possible in the future to inhibit the growth of small aortic aneurysms before they reach a size at which the risk of rupture is significant.
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