The role of apoptosis in lower extremity primary varicose veins

2. ABSTRACTThe Role of Apoptosis in Lower Extremity Primary Varicose VeinsEven though different theories were developed for lower extremity varicoseveins, pathogenesis of lower extremity varicose veins still continuous for debating.Most recent proposed mechanism for development of varicose vein pathophysiologyis venous wall failure due to intrinsic venous wall abnormalities. The research studieswere shown importance of apopitotic role on vessel wall cell composition andmorphology control. In this study, we aim to investigate pro-apoptotic (bax andcaspase-9) and anti-apoptotic (bcl-2) changes in varicose vein and normal vein todetermine impotence of apoptotic activity for development of varices.Fifteen patients with normal vena saphena magna (VSM) underwent coronarybypass surgery (Control group, Group 1) and fifteen patients with primary varicosedilatation on lower extremity underwent surgery (Varicose vein group, Group 2)were enrolled in this study. Appearance of varicose dilatation and venous reflux onVSM were depicted by Doppler Ultrasonography in Group 2 (According CEAPclassification C2(s) Ep As Pr). VSM tissue specimens were obtained from calf2-3region. Pro-apoptotic bax and caspase-9 and anti-apoptotic bcl-2 were analyzed intissue slices by immuno-histochemical staining methods.Increased amount of collagen fibrils in tunica media and decreased smoothmuscle cells were observed in varicose veins slices. Degeneration of elastin layerwas prominent in varicose vein group. Bax and caspase-9 expression in tunica medialayer were significant higher in the varicose vein groups of samples than normal veingroups of samples (p<0.05, p<0.01). Increased bax and caspase-9 expression inentire vessel layers were significant in normal veins (p<0.05, p<0.01). Excesspositivity of bax and caspase-9 in the media layer of the varicose vein group may bedue to relative increase as a consequence of extreme loss of smooth muscle cells.Instead of there were no statically difference for bcl-2 expression by immunostainingbetween group 1 and group 2 (p>0.05).As a result, the whole layer of varicose veins evaluated together we observedthat apoptotic activity were decreased in varicose veins. Fibrotic degeneration andexcessed smooth muscle cell decrement may cause less apoptotic activity in varicoseveins. However high apoptotic activity in the layer of media in the early period ofillness may cause fibrosis and decrease in the smooth muscle cells.Key words: Varicose veins, Apoptosis, Vascular wall10