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Published on: May 12, 2020
Association between Oxidative Burden and Restenosis: A Case-Control Study
Shiva Ganjali1, Atena Mansouri2,3, Mitra Abbasifard4,5
1Department of Medical Biotechnology and Nanotechnology, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
In-stent restenosis (ISR) risk can be predicted by measuring oxidative stress markers. Elevated pro-oxidant-antioxidant balance (PAB) and superoxide dismutase (SOD) activity are associated with increased ISR risk.
Area of Science:
- Biochemistry
- Cardiovascular Medicine
- Oxidative Stress Research
Background:
- In-stent restenosis (ISR) is a significant complication following stent implantation, with current treatments like drug-eluting stents and medications offering incomplete protection.
- Identifying patients at high risk for ISR and understanding its biochemical markers are crucial for effective management.
- Oxidative stress (OS) is a key factor implicated in the development and progression of ISR.
Purpose of the Study:
- To investigate the association between various oxidative and anti-oxidative markers and the risk of in-stent restenosis (ISR).
- To identify potential biochemical predictors for ISR risk stratification.
- To explore the role of oxidative burden in the pathophysiology of ISR.
Main Methods:
- A case-control study was conducted with 21 ISR patients, 26 non-ISR patients, and 20 healthy controls.
- Serum levels of malondialdehyde (MDA), thiol groups (GSH), total antioxidant capacity (TAC), glutathione peroxidase (GPx), and superoxide dismutase (SOD) were measured.
- The pro-oxidant-antioxidant balance (PAB) assay was used to assess the overall oxidative burden.
Main Results:
- Malondialdehyde (MDA) levels were significantly higher in the ISR group compared to healthy subjects (P=0.004).
- The pro-oxidant-antioxidant balance (PAB) was significantly elevated in both ISR (P<0.001) and non-ISR (P<0.001) groups versus healthy controls.
- After adjusting for confounders, elevated PAB (OR: 1.866) and SOD activity (OR: 0.0) were significantly associated with ISR risk, while increased TAC (OR: 0.990) was associated with decreased risk.
Conclusions:
- Serum markers of oxidative stress, specifically the pro-oxidant-antioxidant balance (PAB) and superoxide dismutase (SOD) activity, show potential for predicting ISR risk.
- These findings suggest that oxidative stress plays a significant role in the development of ISR.
- Further research into these markers could lead to improved diagnostic and therapeutic strategies for ISR.
Background:
In-stent restenosis (ISR) is an important clinical complication that occurs following stent implantation. The application of drug-eluting stents (DES) and even consumption of drugs such as antiplatelet agents and statins are not completely effective in reducing ISR risk. Since the number of these patients continues to rise, it is pivotal to detect patients who are at a higher risk of ISR. In addition, identification of biochemical markers of ISR could give the right perspective on choosing the proper strategy to treat these patients. Several pathophysiological pathways including oxidative stress (OS) are implicated in the progression of ISR. Hence, this study aimed to evaluate the association between oxidative/anti-oxidative markers and ISR.
Methods:
This was a case-control study which comprised 21 ISR, 26 NISR (non-ISR), and 20 healthy subjects. The serum levels of OS markers including malondialdehyde (MDA), thiol groups (GSH), total antioxidant capacity (TAC), and the activity of serum antioxidant enzymes such as glutathione peroxidase (GPx) and superoxide dismutase (SOD) were assessed by colorimetric methods. The overall oxidative burden was assessed using a pro-oxidant-antioxidant balance (PAB) assay.
Results:
MDA levels were considerably higher in the ISR group when compared to healthy subjects (P = 0.004). PAB also indicated significantly higher values in both ISR (P < 0.001) and NISR (P < 0.001) groups related to healthy subjects. No significant differences were observed between the studied groups regarding thiol levels, antioxidant enzyme activities, and TAC. Multinomial logistic regression analysis showed that elevated serum levels of MDA (OR: 1.028, 95% CI: 1.008-1.048; P = 0.006) and PAB (OR: 1.076, 95% CI: 1.017-1.139; P = 0.011) were significantly associated with higher ISR risk; however, increased values of TAC (OR: 0.990, 95% CI: 0.982-0.999; P = 0.030) were significantly associated with decreased ISR risk, while after adjustment for confounders, only SOD activity (OR: 0.0, 95% CI: 0.0-0.0; P < 0.001) and PAB value (OR: 1.866, 95% CI: 1.856-1.900; P < 0.001) showed association with ISR risk.
Conclusion:
According to the present findings, some oxidative and antioxidative markers like PAB and SOD activity showed the potential in the prediction of ISR risk.
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