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[Preprint]. 2023 Jun 29:rs.3.rs-3054767. [Version 1] doi: 10.21203/rs.3.rs-3054767/v1

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(A) Animals underwent exposure to PPE to develop AAAs and were also treated with BAPN to promote AAA rupture. Following AAA induction, animals received a ketogenic ‘treatment’ via an oral diet (KDt) or exogenous supplement (EKB). (B) Ketosis (βHB whole blood levels > 0.5 mM/L) in SD, KDt, and EKB animals at week 1 (0.2±0.1, 1.8±0.9 and 1±0.02, respectively; p < 0.05) and at week 2 (0.2±0.1, 2.7±1.1, and 1±0.02 respectively; p < 0.01) analyzed using two-way ANOVA. (C) Percent body weight difference for SD, KDt, and EKB animals at week 1 (11±4, 2.5±1.4, and 2.4±1.3, respectively; p < 0.01) and at week 2 (31±6, 6±3.5, and 5±3.6, respectively; p < 0.01) analyzed using two-way ANOVA. (D) AAA rupture event rate in SD, KDt and EKB animals (p<0.05 between SD and KDt) using survival analysis. (E) Kaplan-Meier curve demonstrating survival following BAPN administration. 67% (8/12) of SD animals, 22% (2/9) of KDt animals (p=0.03), and 40% (4/10) of EKB animals (p = ns) developed AAA rupture by week 2. (F) Percent aortic diameter at week 1 in SD vs KDt animals (270±94 and 155±73; p = 0.06), and SD vs EKB animals (148±94; p = 0.04). At week 2, in SD vs KDt animals (485±153 and 234±151; p < 0.01), and SD vs EKB animals (227±147; p < 0.01 analyzed using two-way ANOVA. (G-J) Trichrome staining of AAA tissue at 5x and 10x magnifications to demonstrate collagen deposition in SD vs KDt animals (26±3 and 34±8; p = ns), and SD vs EKB animals (37±5; p = 0.02) analyzed using one-way ANOVA. (K) CCR2 ELISA content in AAA tissue of SD vs KDt animals (5.7±4 and 4.6±3; p = ns), and SD vs EKB animals (4.7±3; p = ns). (L-N) Immunofluorescent staining of AAA tissue at 5x and 10x magnifications to demonstrate CD68, CCR2, and DAPI positive cells. (O) Immunofluoresecent intensity of CD68 was analyzed using one-way ANOVA between SD, KDt, and EKB groups. (P) Pro MMP9 levels for SD vs KDt animals (1.2±0.5 ×10³ and 2.1±1.7 ×10³; p = ns), and SD vs EKB animals (1.6±0.12 ×10³; p = ns). (Q) Active MMP9 levels for SD vs KDt (5.8±2.4 ×10² and 2±1.4 ×10²; p = 0.02), and SD vs EKB animals (0.7±0.2 ×10²; p = 0.005). (R) Total MMP-2 levels for SD vs KDt animals (10.8±1.1 ×10³ and 2.1±0.7 ×10³; p < 0.001), and SD vs EKB animals (11.5±1.7 ×10³; p = ns). Pro and active MMP9 and total MMP2 levels were measured by integrated optical density (IOD) in AAA tissue, and analyzed using one-way ANOVA. (S) Representative separate zymogram gels of AAA tissue homogenates at week 2, demonstrating pro and active MMP-9 and total MMP-2 levels in animals fed SD, KDt, and EKB. Data presented as mean ± standard deviation. ns > 0.05, *p < 0.05, **p < 0.01, ***p < 0.001 using one-way ANOVA, or two-way ANOVA with multiple comparison.