Clinical trial NCT04138134: Autophagy and Venous Endothelial Function
Official title: Impact of Reactivation of Autophagy Through Spermidine on Venous Endothelial Function
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Venous Disease
Keywords: autophagy
spermidine
Lead sponsor: Neuromed IRCCS
Sponsor class: OTHER
Collaborators: name: Principal investigator: Giacomo Frati
name: Co-investigator: Francesco Pompeo
First posted: 2019-10-24
Enrollment: 200
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: PROBABILITY_SAMPLE
Study population: * Subjects affected by chronic venous insufficiency or varicose veins undergoing surgical procedure of saphenectomy.
* Patients with atherosclerotic obstructive disease of the lower limbs subjected revascularization through implantation of venous by-pass.

Brief summary: The molecular mechanisms involved in venous endothelial dysfunction are largely unknowns. Autophagy is an intracellular mechanism devoted to the removal of damaged cytoplasmic elements. Previous evidence demonstrated that activation of autophagy exerts beneficial effects in the cardiovascular system, reducing cardiac damage and improving cardiac function in response to stress. However, the association between venous endothelial dysfunction and autophagy remains to be characterized. In this study the investigators will test whether reactivation of autophagy through a natural compound (spermidine) is able to improve vascular function in saphenous veins derived from patients subjected to saphenectomy. The same outcome will be evaluated in saphenous veins isolated from patients with atherosclerotic obstructive disease of the lower limbs subjected revascularization through implantation of venous by-pass.

Detailed description: Endothelial dysfunction contributes to different cardiovascular diseases, such as atherosclerosis, myocardial infarction, stroke and peripheral artery diseases. Recent evidence also demonstrated that endothelial dysfunction is associated with vascular venous diseases. In this regard, venous endothelial dysfunction contributes to the development of varicose veins and deep vein thrombosis. Disequilibrium in endothelial function is also present in venous traits derived from saphenous veins which are routinely used as aortocoronary by-pass. The molecular mechanisms involved in venous diseases require further investigations. Autophagy, the intracellular mechanism devoted to the removal of dysfunctional or senescent cytoplasmic elements may represent a new therapeutic target for the treatment of vascular diseases. In this regard, it has been demonstrated that the enhancement of autophagy limits cardiac injury in pre-clinical models of cardiovascular diseases. However, the association between autophagy and vascular disease is still unknown in humans. Spermidine is a natural activator of autophagy which has been demonstrated to extend lifespan in mice and to reduce cardiac dysfunction through autophagy-dependent mechanisms. The objectives of this study will be the following: 1) to test whether spermidine is able to improve vascular function and to reduce oxidative stress in saphenous veins obtained from patients subjected to saphenectomy due to chronic venous insufficiency or varicose veins; 2) to test whether spermidine is able to improve vascular function in saphenous veins derived from patients with atherosclerotic obstructive disease of lower limbs subjected to revascularization through implantation of arteriosus by-pass. In a different set of experiments, the investigators will also test whether vein portions incubated with spermidine show increased autophagy and decreased markers of oxidative stress with respect to controls. The investigators expect that venous segments treated with spermidine will show an amelioration of endothelial function

Eligibility criteria: Inclusion Criteria:

* Eligible subjects undergoing saphenectomy
* Patients with chronic venous insufficiency
* Patients with varicose veins
* Eligible subjects undergoing peripheral artery revascularization through implantation of venous by-pass derived from saphenous vein
* Acceptance and signature of the informed consent

Exclusion Criteria:

* Chronic and acute Inflammatory diseases
* Immunological and rheumatic diseases
* Pre-existing or ongoing neoplasms
* Infectious diseases
* Previous organ transplantation
* Treatment with pharmacological therapies able to modulate autophagy, i. e. rapamycin and derivative compounds (rapalogues).
* Antioxidant therapies in the last three months
* Patients with surgical technical complications

Primary outcomes:
measure: Evaluation of endothelial function in venous samples from patients with venous insufficiency before and after treatment with autophagy enhancer spermidine
timeFrame: Immediately after the sampling
Secondary outcomes:
measure: Impact of autophagy on endothelial venous function
timeFrame: 6 months
measure: Correlation between autophagy, oxidative stress and endothelial function
timeFrame: 6 months
Other outcomes:
Locations:
city: Pozzilli
country: Italy
facility: IRCCS Neuromed
state: Isernia
Study officials:
References: