Levels and values of lipoprotein-associated phospholipase A2, galectin-3, RhoA-ROCK, and endothelial progenitor cells in critical limb ischemia: pharmaco-therapeutic role of cilostazol and clopidogrel combination therapyReportar como inadecuado




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Journal of Translational Medicine

, 12:101

Cardiovascular, Metabolic and Lipoprotein Translation

Abstract

ObjectiveWe tested the hypothesis that clopidogrel and cilostazol combination therapy could effectively attenuate systemic inflammatory reaction, facilitate proliferation of circulating endothelial progenitor cell EPC, and improve the clinical outcomes of critical limb ischemia CLI in patients unsuitable for surgical revascularization or percutaneous transluminal angioplasty PTA.

MethodsA total 55 patients mean age, 72 years; 56% female were consecutively enrolled. Clopidogrel and cilostazol combination therapy was administered throughout the study period.

ResultsAs compared with the baseline, circulating endothelial progenitor cell level as shown by flow cytometry was significantly increased p < 0.003, whereas the CLI-related ulcers and painfulness were significantly improved all p < 0.01 by day 90 after treatment. On the other hand, after clopidogrel and cilostazol combination therapy, galectin-3 level, lipoprotein-associated phospholipase A2 gene expression, and RhoA-ROCK-related protein expression in peripheral blood mononuclear cells were significantly suppressed all p < 0.01. Eventually, by day 90, 5 patients 9.1% died of other etiologies, 3 5.5% withdrew from the study, 6 10.9% required amputation, and the remaining 41 had satisfactory clinical improvement with complete wound healing in 9 16.4% patients.

ConclusionThe results of the present study highlight that clopidogrel and cilostazol combination therapy may be considered to be an alternative method for treating patients with CLI unsuitable for surgical revascularization or PTA.

KeywordsCritical limb ischemia Endothelial progenitor cells Inflammation Clopidogrel Cilostazol therapy Electronic supplementary materialThe online version of this article doi:10.1186-1479-5876-12-101 contains supplementary material, which is available to authorized users.

Jiunn-Jye Sheu, Pao-Yuan Lin contributed equally to this work.

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Autor: Jiunn-Jye Sheu - Pao-Yuan Lin - Pei-Hsun Sung - Yi-Ching Chen - Steve Leu - Yung-Lung Chen - Tzu-Hsien Tsai - Han-Tan Chai

Fuente: https://link.springer.com/







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