Sapheno-Femoral Junction Pathology: Molecular Mechanism of Saphenous Vein Incompetence

Abstract

A molecular mechanism responsible for varicose vein occurrence was investigated. The role of potential cell cycle regulator p21 and programmed cell death in the pathology leading to the proximal long saphenous vein (LSV) incompetence was investigated. Proximal LSV specimens were obtained from 40 patients with primary varicose veins who had undergone crossectomy. The expression of the p21, p53, and fas encoding genes was investigated by the means of real-time RT-QPCR. Immunostaining for gene product presence, proliferating cell nuclear antigen (PCNA), and apoptotic cells (TUNEL assay) was carried out. The results were compared to the control healthy vein specimens and correlated with pathologic examination findings (of the valve and vein structure). A significant increase in p21, p53, and fas mRNA expression were reported in the proximal incompetent veins. The expression of p21 correlated with expression of p53 (r = 0.658; p<0.05) and negative correlation between media apoptotic index and p21 mRNA expression was found (r = -0.493; p<0.05). Decrease in the muscular component within the media and disturbances of the local structure in the incompetent LSVs were reported. Fas overexpression did not correlate with p53 expression level and did not correlate with apoptotic cell number in the respective vein layers. PCNA-positive cells were present more frequently in the media of the control veins, especially in young subjects. Apoptosis downregulation, cell cycle inhibition and smooth muscle cell hypertrophy are important factors influencing vein wall disturbances related to sapheno-femoral junction incompetence.

Assessment of apoptosis in the native vein used for hemodialysis access

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Molecular and other predictors for infertility in patients with varicoceles

“…Initially, the medial layers of smooth muscle decrease in thickness, which is attributed to apoptosis of the smooth muscle cells. This is followed by down-regulation of pro-apoptotic factors and up-regulation of anti-apoptotic proteins (417-420) with smooth muscle cell hypertrophy (418,419). Alterations in gene expression were consistent with changes in smooth muscle actin functionality and contractility (421).…”

Assessment of apoptotic cells in the wall of thrombophlebitic saphenous vein

“…[4][5][6] Studies have found that hypoxia can induce down-regulate apoptosis, acting as a cell cycle inhibitor, which results in hypertrophy of smooth muscle cells of the vein walls, thus affecting the remodeling of vein walls. 7,8 A decrease in expression of the Bax gene protein has been shown to reduce apoptosis of venous smooth muscle cells, and the apoptosis of varicose vein walls was found to be significantly lower than that of normal vein walls. 9 Thus, apoptosis of vein walls results from a metabolic imbalance in endothelial cells and smooth muscle cells, suppression of the endogenous apoptosis channel, cell accumulation, aging and structural abnormalities, all of which lead to changes in venous wall components and structure.…”