El telmisartán modula las respuestas al ejercicio en la enfermedad arterial periférica: Análisis del músculo esquelético del ensayo TELEX
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Kate Kosmac1, Jai K Joshi2,3, Mary M McDermott4
1Department of Physical Therapy, Augusta University, Augusta, GA.
JVS-vascular science
|August 21, 2025
Resumen
El telmisartán (TEL) en combinación con el ejercicio mejora las características musculares en pacientes con enfermedad arterial periférica (EAP). Este tratamiento aumentó el tamaño de la miofibra y redujo la miostatina, lo que sugiere un nuevo enfoque terapéutico para la EAP.
Área de la Ciencia:
- Biología muscular
- Farmacología
- Investigación de enfermedades de las arterias periféricas
Sus antecedentes:
- La enfermedad arterial periférica (EAP) se caracteriza por una disminución de la capacidad de caminar.
- El ejercicio es una intervención clave, pero sus efectos en el músculo a nivel celular y molecular requieren una mayor aclaración.
- El telmisartán (TEL) es un bloqueador de los receptores de la angiotensina II con efectos pleiotrópicos potenciales.
Objetivo del estudio:
- Investigar el impacto del telmisartán (TEL) combinado con ejercicio supervisado en las características celulares y moleculares del músculo en pacientes con EAP.
- Para analizar los cambios en el tamaño de la miofibra, el contenido de células satélite, la densidad capilar y los perfiles de expresión génica.
- Para comparar estos efectos con el ejercicio con placebo (PLA).
Principales métodos:
- En el ensayo Telmisartan Plus Exercise to Improve Functioning in Peripheral Artery Disease (TELEX) se recogieron biopsias musculares de 13 participantes con EAP.
- Los participantes fueron asignados al azar a los grupos de ejercicio + TEL o ejercicio + PLA.
- La inmunohistoquímica y el perfil espacial digital (GeoMx) se utilizaron para los análisis celulares y transcriptómicos.
Principales resultados:
- El ejercicio + TEL aumentó significativamente el área transversal media de la miofibra en comparación con el ejercicio + PLA.
- El número de células satélite asociadas con miofibras de tipo II también aumentó significativamente con el ejercicio + TEL.
- El análisis transcriptómico reveló una regulación al alza de las vías del receptor gamma activado por el proliferador peroxisómico (PPARγ) y una reducción de la expresión de miostatina en células α-SMA negativas con ejercicio + TEL.
Conclusiones:
- El telmisartán (TEL) puede mejorar los beneficios del ejercicio en la EAP mediante la modulación de las vías celulares y moleculares del músculo.
- Los efectos observados incluyen un aumento del tamaño de la miofibra, una reducción de la miostatina y una posible activación de la señalización de PPARγ.
- Estos hallazgos sugieren un papel prometedor para TEL en combinación con el ejercicio para el manejo de PAD, lo que justifica una investigación adicional.
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