Avaliação de mediadores inflamatórios e fatores de crescimento associados à disfunção endotelial nas manifestações clínicas da doença arterial obstrutiva periférica

Abstract

Peripheral arterial obstructive disease (PAD) is a manifestation of atherosclerosis and is more prevalent as of the sixth or seventh decade of life. It is a predictor of cardiovascular and cerebrovascular events and mortality. More severe cases require surgical intervention for revascularization. Some patients do not present a good response, in the medium term, resulting in revascularization or limb amputation. In any circumstance, DAOP has an impact on patients' quality of life. These events are mainly associated with endothelial dysfunction, and some inflammatory mediators and growth factors are involved. Therefore, the objective of this study was to evaluate serum levels of inflammatory mediators and growth factors in patients with peripheral obstructive vascular disease of the lower limbs. Fifty-one patients with lower limb PAOD with different clinical manifestations were enrolled at the Vascular and Endovascular Surgery Service of the Souza Aguiar Municipal Hospital (HMSA) in Rio de Janeiro and at the Vascular and Endovascular Surgery Service of the Federal Hospital of Andaraí (HFA) and 17 healthy individuals. Patients were separated into two groups according to Fontaine's classification of PAOD. Peripheral blood was collected and the samples were processed and stored for further detection of serum levels of Endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-β1), nitric oxide (NO) and platelet-derived growth factor (PDGF) by enzyme-linked immunosorbent assay (ELISA). Our results showed that the mediators that presented a significant statistical difference between the DAOP and control groups were ET-1, VEGF-A and PDGF-BB with p <0.0001, p = 0.0004, p = 0.0148, respectively. ET-1 showed elevated levels in different manifestations of the disease. The relationship between VEGF-A levels in Fontaine 4 patients was emphasized. We believe that a better understanding of the pathophysiology of PAOD may help in the identification of prognostic markers, as well as in the development of new therapeutic strategies adjuvant to clinical practice.