In the study of varicose vein pathophysiology, there has been much attention focussing on the venous epidemiology, symptoms and risk factors,
1
, 2
, 3
identification of histologic abnormalities in the venous wall,4
the structural changes that occur in collagen, elastin, laminin, fibronectin and tenascin,5
the differential expression of smooth muscle cell collagen I versus collagen III expression and the post-transcriptional modification of collagen by matrix metalloproteinases (MMPs) that take place affecting the production of collagen III,6
, 7
the presence of MMPs in varicose veins8
, 9
, 10
and how MMPs affect venous dilation and the mechanisms involving the endothelium and smooth muscle.11
, 12
, 13
What is unknown in the complex puzzle of varicose vein pathology, are the metabolic abnormalities that are critical to venous function. In this exciting new field of study called metabonomics (the study of metabolism in biologic systems in response to pathophysiologic responses), Anwar and colleagues use nuclear magnetic resonance spectroscopy, and determined that in patients with varicose veins there are significant differences in three important metabolic products involving creatine, lactate and myoinositol metabolites. The importance of this research is its ability to analyse cellular metabolism in varicose veins, with signature end products, that reflect the metabolism of the tissue and hold key information to the disease processes. Although it is not exactly clear what the function and role of these metabolites are in varicose veins, they do provide a ‘window’ into possible abnormal or compensatory metabolic pathways that have adapted due to the physiological stresses imposed by chronic venous disease. However, future research will need to define which cells (endothelial, smooth muscle and fibroblast) are involved in altered metabolism and how these metabolites are involved in the aetiology of varicose veins, to have the understanding in the disease pathway that will ultimately provide the best possible treatment to the involved cellular structures.References
- What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey.Br Med J. 1999; 318: 353-356
- Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France.J Vasc Surg. 2004; 40: 650-659
- Risk factors for chronic venous disease: the San Diego population study.J Vasc Surg. 2007; 46: 331-337
- Retinoblastoma protein: a molecular regulator of chronic venous insufficiency.J Surg Res. 1998; 76: 149-153
- Changes in the extracellular matrix of the vein wall–the cause of primary varicosis?.Vasa. 2000; 29: 173-177
- Imbalance in the synthesis of collagen type I and collagen type III in smooth muscle cells derived from human varicose veins.J Vasc Res. 2001; 38: 560-568
- Decreased production of collagen type III in cultured smooth muscle cells from varicose vein patients is due to a degradation by MMPs: possible implication of MMP-3.J Vasc Res. 2005; 42: 388-398
- Varicose veins possess greater quantities of MMP-1 than normal veins and demonstrate regional variation in MMP-1 and MMP-13.J Surg Res. 2002; 106: 233-238
- Morphologic characteristics of varicose veins: possible role of metalloproteinases.J Vasc Surg. 2003; 38: 162-169
- Comparison of extracellular matrix in skin and saphenous veins from patients with varicose veins: does the skin reflect venous matrix changes?.Clin Sci (Lond). 2007; 112: 229-239
- Matrix metalloproteinase 2-induced venous dilation via hyperpolarization and activation of K+ channels: relevance to varicose vein formation.J Vasc Surg. 2007; 45: 373-380
- Prolonged increases in vein wall tension increase matrix metalloproteinases and decrease constriction in rat vena cava: potential implications in varicose veins.J Vasc Surg. 2008; 48: 447-456
- Prolonged mechanical stretch is associated with upregulation of hypoxia-inducible factors and reduced contraction in rat inferior vena cava.J Vasc Surg. 2011; 53: 764-773
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Published online: July 27, 2012
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- In-vitro Identification of Distinctive Metabolic Signatures of Intact Varicose Vein Tissue via Magic Angle Spinning Nuclear Magnetic Resonance SpectroscopyEuropean Journal of Vascular and Endovascular SurgeryVol. 44Issue 4
- PreviewNuclear magnetic resonance (NMR) spectroscopy is an established tool for metabolic profiling of tissues or biofluids with utility in identifying disease biomarkers and changes in enzymatic or gene expression. This pilot study aims to compare the metabolic profiles of intact varicose and non-varicose vein tissue via magic angle spinning (MAS) NMR spectroscopy with a view to promoting the understanding of the pathogenesis of varicose vein formation.
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