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 therapy.

Abstract

OBJECTIVE:

We 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).

METHODS:

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

RESULTS:

As 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.

CONCLUSION:

The 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.

• Authors: Jiunn-Jye Sheu, Pao-Yuan Lin, Pei-Hsun Sung, Yi-Ching Chen, Steve Leu, Yung-Lung Chen, Tzu-Hsien Tsai, Han-Tan Chai, Sarah Chua, Hsueh-Wen Chang, Sheng-Ying Chung, Chih-Hung Chen, Sheung-Fat Ko, Hon-Kan Yip
• Journal: Journal of translational medicine (J Transl Med) Vol. 12 Pg. 101 (Apr 17 2014) ISSN: 1479-5876 [Electronic] England
• PMID: 24742198 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• DNA Primers
• Galectin 3
• Platelet Aggregation Inhibitors
• Tetrazoles
• Clopidogrel
• rho-Associated Kinases
• 1-Alkyl-2-acetylglycerophosphocholine Esterase
• Cilostazol
• Ticlopidine

Topics

• 1-Alkyl-2-acetylglycerophosphocholine Esterase (metabolism)
• Aged
• Base Sequence
• Cilostazol
• Clopidogrel
• DNA Primers
• Drug Therapy, Combination
• Endothelial Progenitor Cells (cytology)
• Extremities (blood supply)
• Female
• Galectin 3 (metabolism)
• Humans
• Ischemia (drug therapy)
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Reverse Transcriptase Polymerase Chain Reaction
• Tetrazoles (administration & dosage, therapeutic use)
• Ticlopidine (administration & dosage, analogs & derivatives, therapeutic use)
• rho-Associated Kinases (metabolism)