Dysregulated Apoptosis in Primary Varicose Veins

• Published in: European journal of vascular and endovascular surgery Vol. 29; no. 3; pp. 316 - 323
• Main Authors: Ducasse, E., Giannakakis, K., Chevalier, J., Dasnoy, D., Puppinck, P., Speziale, F., Fiorani, P., Faraggiana, T.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2005
• Subjects: Adult; Aged; Apoptosis; Apoptosis - physiology; bcl-2-Associated X Protein; Caspase 9; Caspases - analysis; Female; Humans; Male; Middle Aged; Mitochondrial pathway; Primary varicose veins; Proto-Oncogene Proteins c-bcl-2 - analysis; Varicose vein; Varicose Veins - physiopathology; Vascular apoptosis; Varicose vein; Vascular apoptosis; Mitochondrial pathway; Primary varicose veins; Apoptosis
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2004.12.012

Programmed cell death plays a critical role in various physiological processes. To investigate its possible pathogenic role in primary varicose veins we studied histological changes in surgical specimens from human varicose veins. In varicose and healthy veins, we also determined the number of cells in apoptosis, and investigated mediators regulating the intrinsic apoptotic mitochondrial pathway (Bax and caspase 9).
A total 23 varicose veins were obtained from 18 patients undergoing lower-extremity varicose vein surgery for primary varicose disorders. We used nine healthy veins obtained from nine patients undergoing distal arterial bypass grafting surgery as controls. The venous segment analysed was the distal part of the greater saphenous vein. Specimens for histological examination were stained with hematoxylin and eosin, trichromic and Victoria blue. Cell apoptoses and mediators of the mitochondrial pathway were detected in the media by immunohistochemistry using antibodies to peroxidase
in situ apoptosis, Bax and caspase 9. Results were expressed as indexes for the three antibodies tested. The Mann–Whitney test was used to compare the results obtained in the two groups.
Varicose vein specimens exhibited a more disorganised architecture than healthy veins and showed an increased number of collagen fibres and a decrease in the density and size of elastic fibres. All anti-apoptotic antibodies tested detected significantly fewer immunoreactive cells in tissue sections from the media of varicose veins than of healthy veins (peroxidase
in situ, varicose veins (VV) median 2.4% (inter-quartile range 1.6–3.9) versus control (C) 14% (IQR 8.8–19); Bax, VV 1.4% (IQR 0.36–2.4) versus C 11% (IQR 7.6–15); and caspase 9, VV 1.7% (IQR 0.06–3.4) versus C 10% (IQR 9.1–12),
P=0.0001 (Mann–Whitney test).
Apoptosis is down regulated in the medial layer of varicose veins. This dysregulation of the cellular mechanism that maintains normal tissue integrity is mediated through the intrinsic apoptotic pathway and may be among the causes of primary varicose veins.