Local and Systemic Endothelial Damage in Patients with CEAP C2 Chronic Venous Insufficiency: Role of Mesoglycan

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Abstract
Chronic venous disease (CVD) involves complex pathophysiological processes where the imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) contributes to venous remodelling and varicosities. Elevated levels of MMP-2 and MMP-9 are notably observed in tissues affected by venous ulcers. Local inflammation is a key feature in CVD, with increased concentrations of pro-inflammatory markers in varicose veins compared to healthy veins. Syndecans, components of the endothelial glycocalyx, play critical roles in inflammation. Recent studies have shown that alterations in glycocalyx structure are indicative of vascular damage in both venous and arterial diseases. This study aims to explore the inflammatory alterations in CVD patients, focusing on glycocalyx damage and the potential therapeutic effects of mesoglycan, a compound used in CVD treatment. A prospective, monocentric study was conducted with 23 patients diagnosed with CVD of CEAP class C2. Serum samples were analyzed at baseline and after mesoglycan treatment. Results showed significantly higher levels of VCAM-1, MMP-2, MMP-9, SDC-1, IL-6, and IL-8 in blood from varicose veins compared to systemic circulation. After treatment with mesoglycan, there was a notable reduction in these inflammatory markers, indicating a positive therapeutic effect. These findings support the hypothesis that mesoglycan may help reduce local and systemic inflammation in CVD. This study contributes to a better understanding of the inflammatory mechanisms in CVD and the role of mesoglycan in modulating these processes, offering insights into potential therapeutic strategies for managing CVD.

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