Autophagy and Venous Endothelial Function

Impact of Reactivation of Autophagy Through Spermidine on Venous Endothelial Function

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.

Study Overview

• Status: Active, not recruiting
• Conditions: Venous Disease

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

• Study Type: Observational
• Enrollment (Anticipated): 200

Contacts and Locations

Study Locations

• Italy
  • Isernia
    • Pozzilli, Isernia, Italy
      • IRCCS Neuromed

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• 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.

Description

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

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Group 1; Patients subjected to saphenectomy due to chronic venous insufficiency or varicose veins
Group 2; Patients with atherosclerotic obstructive disease of lower limbs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluation of endothelial function in venous samples from patients with venous insufficiency before and after treatment with autophagy enhancer spermidine	Ex vivo vascular reactivity experiments performed on isolated veins treated or not with spermidine ex vivo.	Immediately after the sampling

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Impact of autophagy on endothelial venous function	Quantification by immunoblot of markers of autophagy (LC3, p62, Beclin1, Atg5, Atg7, Ulk1) and its statistical correlation with venous endothelial function	6 months
Correlation between autophagy, oxidative stress and endothelial function	Quantification by immunoblot of markers of autophagy and oxidative stress and statistical correlation with venous endothelial function	6 months

Collaborators and Investigators

• Sponsor: Neuromed IRCCS
• Collaborators: Principal investigator: Giacomo Frati; Co-investigator: Francesco Pompeo

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 1, 2022
• Primary Completion (ACTUAL): December 1, 2022
• Study Completion (ANTICIPATED): April 1, 2023

Study Registration Dates

• First Submitted: October 22, 2019
• First Submitted That Met QC Criteria: October 22, 2019
• First Posted (ACTUAL): October 24, 2019

Study Record Updates

• Last Update Posted (ACTUAL): February 8, 2023
• Last Update Submitted That Met QC Criteria: February 4, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: autophagy; spermidine
• Other Study ID Numbers: 9-2019

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No