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Iwai T, Kume H, Koizumi S, Sakurazawa K, Honma K, Ogasawara H, Takemura T, Kishino M, Kagayama T. Buerger Disease: Pathological Changes in Elderly Patients. Ann Vasc Dis 2022; 15:29-36. [PMID: 35432646 PMCID: PMC8958396 DOI: 10.3400/avd.oa.21-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
Reports of vascular lesion changes in elderly Buerger disease patients are rare. Patients are expected to continue to have typical Buerger disease even after the age of 50. However, after 50, when patients suffer from atherosclerotic risk factors, such as hypertension, diabetes mellitus, or hyperlipidemia, what kind of changes will occur? We will report on 3 cases of hypertension, diabetes mellitus, or hyper lipidemia after or around 50 years of age. As a result, atherosclerosis was present in the iliac or aortic regions in the remaining thromboangiitis lesions below the groin area. (This is secondary publication from the J Jpn Coll Angiol 2021; 61: 107–113.)
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Watanabe Y, Miyata T, Shigematsu K, Tanemoto K, Nakaoka Y, Harigai M. Current Trends in Epidemiology and Clinical Features of Thromboangiitis Obliterans in Japan - A Nationwide Survey Using the Medical Support System Database. Circ J 2020; 84:1786-1796. [PMID: 32879220 DOI: 10.1253/circj.cj-19-1165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The epidemiology and clinical features of thromboangiitis obliterans (TAO) in Japan have not been updated extensively.Methods and Results:This retrospective study used the Japanese Ministry of Health, Labour and Welfare (JMHLW) medical support system database and associated health insurance data. The number of medical financial support recipients registered as TAO patients and estimated prevalence of TAO decreased from fiscal year (FY) 2000 (10,089 and 7.95 [95% confidence interval, CI: 7.79-8.10] per 100,000 population) to FY 2010 (7,147 and 5.58 [95% Cl: 5.45-5.71] per 100,000) and leveled off until 2014. The prevalence of TAO among patients with peripheral arterial occlusive diseases declined from 7.15% (95% Cl: 7.00-7.31) in FY 2008 to 6.12% (95% Cl: 5.98-6.26) in FY 2014. Clinicodemographic features were obtained from 89 new recipients in FY 2013 and 2014: 12 (13%) women, 36 (40%) aged ≥50 years, 26 (29%) had probable onset age ≥50 years, 7 (8%) were non-smokers, and 12 (13%) had arteriosclerosis-related comorbidities. The symptoms were similar regardless of registration age, smoking history, or sex. Although 40 (45%) had digit ulcers, only 12 (13%) fulfilled Shionoya's criteria. They rarely had infrapopliteal lesions combined with upper extremity involvement or phlebitis. CONCLUSIONS The prevalence of TAO has decreased in Japan. In the current diagnosis of TAO, various clinical characteristics including late onset, arteriosclerotic factors, non-smoking, or mild symptoms should be considered.
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Affiliation(s)
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare, Mita Hospital
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Associations Between Elevated Plasma Total Homocysteine Level and Risk of Thromboangiitis Obliterans in a Chinese Population: A Matched Case-Control Study. Ann Vasc Surg 2019; 62:335-341. [PMID: 31472234 DOI: 10.1016/j.avsg.2019.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Elevated plasma total homocysteine level is a risk factor for various vascular diseases; however, an association with risk of thromboangiitis obliterans (TAO) has not been defined. This study aims to assess whether elevated plasma total homocysteine level is associated with risk of TAO. METHODS We performed a matched case-control study including 64 patients with TAO and 256 controls. Multivariate logistic regression models were used to estimate the association between elevated plasma homocysteine level and the risk of TAO. Interaction and stratified analyses were conducted according to age, sex, smoking, alcohol consumption, and histories of chronic diseases. RESULTS Patients with TAO versus controls had a higher mean plasma total homocysteine level (21.2 ± 12.8 μmol/L vs. 14.1 ± 4.9 μmol/L; P < 0.01). The risk of TAO was 3.68-fold increased in participants with plasma total homocysteine level >15 μmol/L (95% confidence interval [95% CI], 1.2-11.7). A 1 μmol/L increase in plasma total homocysteine level was associated with 20% higher risk of TAO (odds ratio, 1.2; 95% CI, 1.1-1.3). CONCLUSIONS Our findings suggest that the risk of TAO was significantly associated with elevated plasma total homocysteine level independently of other factors analyzed, including smoking. Studies on the use of homocysteine-lowering therapy to prevent TAO would allow testing causality of the latter association.
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Kodama A, Takahashi N, Sugimoto M, Niimi K, Banno H, Komori K. Three cases of dorsal metatarsal artery bypass in patients with Buerger disease. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:185-188. [PMID: 30148235 PMCID: PMC6105765 DOI: 10.1016/j.jvscit.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022]
Abstract
Buerger disease is a rare peripheral vascular disease that most frequently affects young men and is strongly correlated with tobacco use. Although several options have been suggested, no consensus exists on the management of patients with Buerger disease except for smoking cessation. Revascularization is sometimes required to salvage ischemic limbs; however, it is often not feasible because of a lack of distal target vessels. Herein, we present the cases of three patients with tissue loss and gangrene due to Buerger disease. These patients underwent dorsal metatarsal artery bypass and avoided amputation.
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Affiliation(s)
- Akio Kodama
- Correspondence: Akio Kodama, MD, PhD, Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Zheng JF, Chen YM, Chen DY, Lin CH, Chen HH. The Incidence and Prevalence of Thromboangiitis Obliterans in Taiwan: A Nationwide, Population-based Analysis of Data Collected from 2002 to 2011. Clinics (Sao Paulo) 2016; 71:399-403. [PMID: 27464297 PMCID: PMC4946527 DOI: 10.6061/clinics/2016(07)08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/10/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the incidence and prevalence of thromboangiitis obliterans in Taiwan in the period spanning from 2002 to 2011. METHODS We identified all incident and prevalent cases with a diagnosis of thromboangiitis obliterans (International Classification of Diseases, Ninth Revision code 443.1) in the period spanning from 2002 to 2011 using Taiwan's National Health Insurance Research Database. We calculated the age- and sex-specific incidence and prevalence rates of thromboangiitis obliterans during the study period. RESULTS From 2002 to 2011, 158 patients were diagnosed with thromboangiitis obliterans; of these, 76% were men. Most (63%) of the patients were <50 years old when they were first diagnosed. After reaching 20 years of age, the incidence rate increased with age and peaked among those aged ≥60 years. The average incidence rate of thromboangiitis obliterans during the 2002-2011 period was 0.068 per 105 years. The incidence of thromboangiitis obliterans decreased with time, from 0.10 per 105 years in 2002 to 0.04 per 105 years in 2011. The prevalence increased from 0.26 × 10-5 in 2002 to 0.65 × 10-5 in 2011. CONCLUSION This is the first epidemiologic study of thromboangiitis obliterans using claims data from a general population in Taiwan. This nationwide, population-based study found that the incidence and prevalence of thromboangiitis obliterans in Taiwan in the 2002-2011 period were lower than those in other countries before 2000. This study also revealed a trend of decreasing incidence with simultaneous increasing prevalence of thromboangiitis obliterans in Taiwan from 2002 to 2011.
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Affiliation(s)
- Jie-Fu Zheng
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
| | - Yi-Ming Chen
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
- Department of Medical Research
- Department of Medical Education, Taichung, Taiwan
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Der-Yuan Chen
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
- Department of Medical Research
- Department of Medical Education, Taichung, Taiwan
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Ching-Heng Lin
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hsin-Hua Chen
- Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology
- Department of Medical Research
- Department of Medical Education, Taichung, Taiwan
- National Yang-Ming University, School of Medicine, Taipei, Taiwan
- National Chung-Hsing University, Institute of Biomedical Science and Rong Hsing Taichung Veterans General Hospital, Taichung, Taiwan
- Chung-Shan Medical University, School of Medicine, Taichung, Taiwan
- National Yang-Ming University, Institute of Public Health and Community Medicine Research Center, Taiwan
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Igari K, Inoue Y, Iwai T. The Epidemiologic and Clinical Findings of Patients with Buerger Disease. Ann Vasc Surg 2015; 30:263-9. [PMID: 26370744 DOI: 10.1016/j.avsg.2015.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/26/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Buerger disease is a nonatherosclerotic peripheral arterial disease, which is mostly observed in young male smokers. Buerger disease is characterized by the observation of peripheral arterial occlusion by angiography. The condition may be caused by microembolization in the small-sized arteries of the distal extremities. Buerger disease is diagnosed based on the Shionoya's clinical diagnostic criteria, which include: (1) a history of smoking, (2) onset before the age of 50 years, (3) the presence of infrapopliteal arterial occlusions, (4) either upper limb involvement or phlebitis migrans, and (5) the absence of atherosclerotic risk factors other than smoking. Several studies have reported that oral bacterial infections (periodontitis) could activate the onset of Buerger disease. In this study, we report the epidemiologic and clinical manifestations of patients with Buerger disease. METHODS Fifty-eight patients who were surgically treated between July 1989 and June 2014 at Tokyo Medical and Dental University Hospital were enrolled in this study. All of the patients clinically diagnosed with Buerger disease based on Shionoya's clinical diagnostic criteria. Fifty-five male and 3 female patients were treated. The mean age of the patients was 48 years (range, 21-73 years). RESULTS All of the patients were either smokers or had a history of smoking. The mean Brinkman index score was 780 (range, 150-1,640). Their mean age at the onset of Buerger disease was 38 years (range, 21-50). The arterial lesions extended to the femoral arteries in 25% of cases, to the iliac arteries in 8% and to the abdominal aorta and/or visceral arteries in 6% of cases. Upper limb involvement, including cyanosis, paleness, and gangrene, was obvious in 84% of patients, and phlebitis migrans was recognized in 34%. The lower extremities symptoms involved intermittent claudication in 23% of the patients, rest pain in 13% of the patients, and ulceration or gangrene in 64% of the patients. Fifteen patients had undergone surgical arterial reconstruction, 4 patients had received endovascular therapy, 33 patients had undergone lumbar sympathectomy and 8 patients had undergone thoracic sympathectomy. Twenty percent of the patients needed minor limb amputations, and 4% required major limb amputations. In the patients who were examined for their oral conditions, periodontitis corresponding to grades B (moderate periodontitis), C (severe periodontitis), and D (edentulous patients) was revealed in 31%, 56%, and 13% of the patients, respectively. CONCLUSIONS More than half of the Buerger disease patients in this study were suffering from severe periodontitis. It is possible that not only the cessation of smoking, but also the improvement of periodontal care could improve the clinical symptoms related to Buerger disease.
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehisa Iwai
- Department of Vascular Surgery, Tsukuba Vascular Center, Buerger Disease Research Institute, Ibaraki, Japan
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Kobayashi M, Sugimoto M, Komori K. Endarteritis obliterans in the pathogenesis of Buerger's disease from the pathological and immunohistochemical points of view. Circ J 2014; 78:2819-26. [PMID: 25298073 DOI: 10.1253/circj.cj-14-0656] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Buerger's disease (thromboangiitis obliterans) is considered to be a nonatherosclerotic, inflammatory, and vaso-occlusive disease, although the details of the mechanisms of pathogenesis remain unknown. The occurrence of the disease is strongly related to tobacco abuse and its progression is closely linked to continued smoking. The purpose of this review article is to demonstrate the pathological characteristics of arteries affected with Buerger's disease from a possible immunoreactive point of view. In addition, we present the mechanisms for preserving the architecture of the arterial wall in affected vasculatures. Thereafter, we discuss the possibility that the pathogenesis of Buerger's disease is a type of endarteritis obliterans, deeply connected to the Notch pathway, distinct from arteriosclerosis obliterans and other vasculitides.
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Affiliation(s)
- Masayoshi Kobayashi
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, Nagoya University
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Sugimoto M, Miyachi H, Morimae H, Kodama A, Narita H, Banno H, Yamamoto K, Komori K. Fate of ischemic limbs in patients with Buerger's disease based on our 30-year experience: does smoking have a definitive impact on the late loss of limbs? Surg Today 2014; 45:466-70. [PMID: 24845736 DOI: 10.1007/s00595-014-0904-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE We herein review the long-term results of our series of critical ischemic limbs caused by Buerger's disease. METHODS A retrospective review of 103 patients with critical limb ischemia who were diagnosed with Buerger's disease by Shionoya's criteria between 1980 and 2010. RESULTS The age of onset was 38.0 ± 9.7 years (mean ± SD). The median follow-up was 97 months. Thirty-three patients had pain at rest, and 65 patients presented with ischemic ulcers in their toes and/or fingers. Gangrene was present in five patients. Sixteen patients achieved remission with medical therapy and smoking cessation. Sixty-six patients underwent sympathectomy. Bypass to the crural arteries was performed in 23 limbs, with assisted primary patency rates of 67.0 and 45.6 % at five and 10 years. Graft failure caused major amputation in two out of 10 smokers, but no limbs were lost among the 12 ex-smokers. Therapeutic angiogenesis using cell transplantation led to improvement in three ex-smokers; however, amputation was unavoidable in the one smoker who was treated. The limb salvage rate at 20 years was 90 % in ex-smokers and 69 % in smokers, which was not significantly different. CONCLUSIONS This study demonstrated no significant difference in the limb salvage rate between ex-smokers and smokers. Our results do not support any advantageous effect of smoking cessation on the long-term remission in patients with Buerger's disease.
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Affiliation(s)
- Masayuki Sugimoto
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan,
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Bucci F, Redler A, Fiengo L. Critical limb ischemia in a young man: saddle embolism or unusual presentation of thromboangiitis obliterans? Case Rep Vasc Med 2013; 2013:830540. [PMID: 24367737 PMCID: PMC3866721 DOI: 10.1155/2013/830540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/31/2013] [Indexed: 11/18/2022] Open
Abstract
Thromboangiitis obliterans (TAO), also known as Buerger's disease, is a rare cause of peripheral arterial disease in western countries. Tobacco smoking is strongly correlated to the pathogenesis of this inflammatory vascular disease. We report the case of a 32-year-old tobacco and cannabis consumer presenting with right critical limb ischemia. Computerized tomography angiography revealed a bilateral tibioperoneal arterial occlusion and an aortoiliac saddle embolus. The patient was treated with intravenous heparin, transcatheter thrombolysis, and selective Fogarty embolectomy. Instrumental and laboratory examinations revealed that patient's most likely diagnosis was TAO. Arterial embolism is uncommon in Buerger's disease but should be always excluded in these patients.
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Affiliation(s)
- Federico Bucci
- Vascular Surgery Department, Sud Gironde Community Hospital, rue Langevin, 33210 Langon, France
| | - Adriano Redler
- General and Vascular Surgery Department, “Umberto I” University Hospital, Viale del Policlinico, 00186 Rome, Italy
| | - Leslie Fiengo
- General and Vascular Surgery Department, “Umberto I” University Hospital, Viale del Policlinico, 00186 Rome, Italy
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Hida N, Ohta T. Current status of patients with buerger disease in Japan. Ann Vasc Dis 2013; 6:617-23. [PMID: 24130618 DOI: 10.3400/avd.oa.13-00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/05/2013] [Indexed: 11/13/2022] Open
Abstract
THE PREVALENCE AND CLINICAL CHARACTERISTICS OF JAPANESE PATIENTS WITH BUERGER DISEASE (THROMBOANGIITIS OBLITERANS: TAO) were analyzed based on the Ministry of Health, Labour and Welfare (MHLW) database in 2009. A total of 129 new patients and 3639 patients in follow-up were selected according to the clinical criteria of TAO. The current number of patients with TAO in Japan is estimated at about 4000. The clinical course is relatively favorable, and the rates of limb morbidity and mortality were not completely discouraging.
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Affiliation(s)
- Noriyuki Hida
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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13
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Tamai H, Kobayashi M, Takeshita K, Kodama A, Banno H, Narita H, Yamamoto K, Komori K. Possible involvement of Notch signaling in the pathogenesis of Buerger's disease. Surg Today 2013; 44:307-13. [PMID: 23605216 DOI: 10.1007/s00595-013-0566-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/04/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE Under pathological conditions, the Notch signal pathway is involved in the inflammatory process in arteriosclerosis, atherosclerosis and angiogenesis under ischemic conditions. The purpose of this study was to observe whether or not Buerger's disease is associated with Notch signal activation. METHODS All the patients were diagnosed between 1980 and 2009 at Nagoya University Hospital. Twenty-two specimens from 12 patients with Buerger's disease (TAO) and 13 specimens from nine patients with arteriosclerosis obliterans (ASO) were analyzed by immunohistochemistry for Notch1, Jagged-1 (a Notch ligand) and Hes-1 (a Notch 1 target transcription factor). RESULTS Notch1 and Jagged-1 were highly expressed in the endothelium in the new vasa vasorum and in the smooth muscle cells in the media of specimens from both groups. These Notch-related proteins were also remarkably expressed in inflammatory cells in the intima of specimens from TAO patients. Fewer inflammatory cells expressed Notch-related proteins in atheromatous plaques (Notch1 (%): 8.4 ± 0.76 versus 1.3 ± 0.43, P < 0.001; Jagged-1(%): 9.3 ± 1.1 versus 5.2 ± 1.1, P = 0.03). Indeed, Hes-1, which is a transcription factor downstream of Notch1, was remarkably expressed in the endothelium of new capillary vessels and inflammatory cells in TAO patients. Notch1-positive mononuclear cells were also seen in the thrombus in samples from the TAO group. CONCLUSIONS Our findings are the first demonstration that Notch signal activation in inflammatory cells may be involved in the pathophysiological mechanism underlying Buerger's disease.
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Affiliation(s)
- Hiroaki Tamai
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Dellalibera-Joviliano R, Joviliano EE, Silva JS, Evora PRB. Activation of cytokines corroborate with development of inflammation and autoimmunity in thromboangiitis obliterans patients. Clin Exp Immunol 2012; 170:28-35. [PMID: 22943198 DOI: 10.1111/j.1365-2249.2012.04624.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Thromboangiitis obliterans (TAO) is a segmental inflammatory occlusive disorder that affects the arm and leg arteries of young smokers. The immune system seems to play a critical role in the aetiology of TAO; however, knowledge of the aspects involved in the progression of vascular tissue inflammation and, consequently, the evolution of this disease is still limited. This study was carried out to investigate the cytokine levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-4, IL-17 and IL-23 in the plasma of TAO patients presenting with acute clinical manifestations. The study included 20 TAO patients (n = 10 women; n = 10 men) aged 38-59 years under clinical follow-up, classified into two groups: (i) TAO former smokers (n = 11) and (ii) TAO active smokers (n = 9); the control groups included normal volunteer non-smokers (n = 10, active smokers (n = 10) and former smokers (n = 10). Patients' plasma samples were measured using the sandwich enzyme-linked immunosorbent assay. Statistical analyses were performed using the non-parametric Mann-Whitney U-test, with parameters significant at P < 0·05. The activities of all cytokines were different in groups of TAO patients when compared with normal controls, and decreased for control smokers. Increased levels of TNF-α, IL-1β, IL-4, IL-17 and IL-23 were significant in patients with TAO when compared to the controls (P < 0·005, all parameters). The results presented here indicate an increased production of cytokines in TAO, possibly contributing to the inflammatory response observed in the patients' vascular levels. In addition, the increased levels of IL-17 and IL-23 suggest that the disturbance of TAO is involved with mechanisms of autoimmunity. Thus, the discovery of IL-17 and its association with inflammation and autoimmune pathology has reshaped our viewpoint regarding the pathogenesis of TAO, which was based previously on the T helper type 1 (Th1)-Th2 paradigm.
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Ikeda K, Yotsuyanagi T, Arai K, Suda T, Saito T, Ezoe K. Combined Revascularization and Free-Tissue Transfer for Limb Salvage in a Buerger Disease Patient. Ann Vasc Surg 2012; 26:422.e5-8. [DOI: 10.1016/j.avsg.2011.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/19/2011] [Accepted: 06/25/2011] [Indexed: 10/14/2022]
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Dellalibera-Joviliano R, Jacob-Ferreira ALB, Joviliano EE, Tanus-Santos JE, Evora PRB. Imbalanced matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 activities in patients with thromboangiitis obliterans. Vasc Med 2012; 17:73-8. [PMID: 22402936 DOI: 10.1177/1358863x11435979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pathogenic mechanisms of thromboangiitis obliterans (TAO) are not entirely known and the imbalance of matrix metalloproteinases (MMPs) plays a role in vascular diseases. We evaluated the MMP-2 and MMP-9 circulating levels and their endogenous tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) in TAO patients with clinical manifestations. The study included 20 TAO patients (n = 10 female, n = 10 male) aged 38-59 years under clinical follow-up. The patients were classified into two groups: (1) TAO former smokers (n = 11) and (2) TAO active smokers (n = 9); the control group included normal volunteer non-smokers (n = 10) and active smokers without peripheral artery disease (n = 10). Patient plasma samples were used to analyze MMP-2 and MMP-9 levels using zymography, and TIMP-1 and TIMP-2 concentrations were determined by enzyme-linked immunosorbent assays. The analysis of MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios (which were used as indices of net MMP-2 and MMP-9 activity, respectively) showed significantly higher MMP-9/TIMP-1 ratios in TAO patients (p < 0.05). We found no significant differences in MMP-2/TIMP-2 ratios (p > 0.05). We found higher MMP-9 levels and decreased levels of TIMP-1 in the TAO groups (active smokers and former smokers), especially in active smokers compared with the other groups (all p < 0.05). MMP-2 and TIMP-2 were not significantly different in patients with TAO as compared to the control group (p > 0.05). In conclusion, our results showed increased MMP-9 and reduced TIMP-1 activity in TAO patients, especially in active smokers compared with non-TAO patients. These data suggest that smoke compounds could activate MMP-9 production or inhibit TIMP-1 activity.
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Afsharfard A, Mozaffar M, Malekpour F, Beigiboroojeni A, Rezaee M. The Wound Healing Effects of Iloprost in Patients with Buerger's Disease: Claudication and Prevention of Major Amputations. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:420-3. [PMID: 22737505 PMCID: PMC3371931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/10/2011] [Indexed: 12/02/2022]
Abstract
BACKGROUND This study analyzes the therapeutic effects of intravenous infusion of iloprost in wound healing, healing of the amputation stump wound, improvement in intermittent claudication and prevention of major amputation in patients with Buerger's disease. METHODS In a prospective study, 19 patients with known Buerger's disease, received intravenous iloprost infusion, 6 hours per day for 10 days. Iloprost with a dose of 0.5-2 ng/kg/min according to the patients' tolerance and using cardiac monitoring during the whole infusion period was administered for 6 hours/day using saline solution. Patients with larger wounds underwent simultaneous transmetatarsal or Ray amputation of the involved toe(s). All patients were discharged after 10 days. Patients were followed to detect their healing changes. RESULTS Nineteen patients, 19-55 years old received 0.5-2 ng/kg/min iloprost intravenously for 6 hours/day for 10 days. During this period, there was relative improvement in resting pain, but no significant amelioration was noticed in wound healing. In a 2 years follow-up, 14 patients showed a complete healing of the amputation stump and increased distance of walking without any pain. Some previous candidates of major amputation did not need amputation anymore. Five patients (26%) did not respond to therapy. CONCLUSION Although Buerger's disease patients who were under iloprost therapy, may not show significant changes in wound healing during treatment and at discharge, late results have proved that iloprost infusion is promising in improving wound healing and claudication and preventing major amputations.
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Affiliation(s)
- A Afsharfard
- Department of General and Vascular Surgery, Shohada Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran,Correspondence: Abolfazl Afsharfard, MD, Professor of General and Vascular Surgery, Shohada Medical Center, Shaheed Beheshti University of Medical Sciences (SBMU), Tajrish Sq., Tehran, Iran. Tel.: +98-21-22718001, Fax: +98-21-2220-2318, E-mail:
| | - M Mozaffar
- Department of General and Vascular Surgery, Shohada Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - F Malekpour
- Department of General and Vascular Surgery, Shohada Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | | | - M Rezaee
- Department of General and Vascular Surgery, Shohada Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Baumann G, Stangl V, Klein-Weigel P, Stangl K, Laule M, Enke-Melzer K. Successful treatment of thromboangiitis obliterans (Buerger's disease) with immunoadsorption: results of a pilot study. Clin Res Cardiol 2011; 100:683-90. [PMID: 21380608 DOI: 10.1007/s00392-011-0298-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND No established therapy is available for patients with thromboangiitis obliterans (TAO) and critical limb ischemia. Since abnormalities of the immune system appear to be involved in the pathogenesis, we investigated in this pilot study the efficiency of Ig immunoadsorption (IA) therapy. METHODS Ten patients with advanced TAO underwent a single IA course over five consecutive days. Before IA angiography was performed. In addition, the following were conducted prior to IA, directly after, as well as 1, 3, and 6 months after IA: clinical examination, pain scale (0-10), treadmill test for evaluation of maximum walking distances, and several angiological methods for evaluation of disease extent: photoplethysmography, ultrasound Doppler, and transcutaneous assessment of partial carbon dioxide (tcPCO(2)) and oxygen (tcPCO(2)) pressure. RESULTS Immunoadsorption treatment was tolerated without side effects. Pain intensity decreased rapidly from 7.7 ± 0.8 (mean ± SEM) before treatment to 2.0 ± 1.2 at the second day of IA. One month after IA, all patients were without pain. This functional amelioration persisted over the follow-up period of 6 months. Correspondingly, maximum walking distances significantly increased from 301.7 ± 191.4 to 727.0 ± 192.7 m immediately after IA, and further continuously up to 1,811.0 ± 223.7 at 6 months after IA. Healing of ischemic ulcerations was observed in all patients during follow-up. (tcPCO(2)) and (tcPCO(2)) values as well as photopletysmographic data that were severely compromised before IA reflecting reduced tissue oxygenation and perfusion showed rapid amelioration reaching normal values at 1 month. CONCLUSION Anti-Ig IA appears to be an effective therapeutic option for patients with advanced TAO.
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Affiliation(s)
- Gert Baumann
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie Charité, Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Dellalibera-Joviliano R, Joviliano EE, Evora PRB. Determination of kininogens levels and kallikrein/kininase II activities in patients with thromboangiitis obliterans. Scand J Immunol 2010; 72:128-33. [PMID: 20618771 DOI: 10.1111/j.1365-3083.2010.02408.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Some components of the kinin system such as plasma kallikrein levels, the activities of tissue kallikrein (including saliva) and kininase II and the concentrations of kininogen fractions (low-molecular weight/LKg and high-molecular weight/HKg) were evaluated in the plasma of patients with thromboangiitis obliterans (TAO) presenting clinical symptoms of the condition. Twenty TAO were diagnosed by means of the traditional Shionoya and Olin criteria and later classified into non-smokers (n = 11) and active smokers (n = 9). Fifty-three normal, non-smoking/smoking individuals (control) were also studied. Kininogen levels were determined by ELISA; the activities of kallikreins and kininase II were determined using selective substrates. The levels of enzymes (kallikreins and kininase II) and protein (kininogens) were significantly higher in patients with TAO who were active smokers compared to the control groups (no matter whether control individuals were active smokers or non-smokers, P < 0.001 for all comparisons). Interestingly, regardless of the time of disease onset, a significant increase in the levels of these components of the kinin system was also observed in patients when TAO active smokers were compared with TAO ex-smokers (P < 0.01 for all analysed parameters). Activation of the kinin system in patients with TAO may indicate the involvement of vasodilatation in an attempt to control vascular changes, thereby favouring the deposition of immune complexes at the vascular level because of nicotine stimulation. Moreover, our results corroborate the idea that TAO can be an autoimmune disorder with specific mechanisms.
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Affiliation(s)
- R Dellalibera-Joviliano
- Integrated Faculty Fafibe, Ribeirão Preto Medical School, São Paulo University, São Paulo, Brazil.
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Efficacy of Bosentan in Digital Ischemic Ulcers. Ann Vasc Surg 2010; 24:690.e1-4. [DOI: 10.1016/j.avsg.2010.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/12/2010] [Accepted: 03/01/2010] [Indexed: 11/23/2022]
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Lee KS, Paik CN, Chung WC, Lee KM, Jung SH, Kawk JW, Jung JH, Baik JH. Colon Ischemia Associated with Buerger's Disease: Case Report and Review of the Literature. Gut Liver 2010; 4:287-91. [PMID: 20559539 DOI: 10.5009/gnl.2010.4.2.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/02/2009] [Indexed: 11/04/2022] Open
Abstract
Buerger's disease, or thromboangiitis obliterans, is a nonatherosclerotic inflammatory disease affecting the small- and medium-sized arteries and veins of the extremities (arms, hands, legs, and feet). It is most common in the Orient, Southeast Asia, India, and the Middle East, and usually affects men aged between 20 and 40 years, although it is becoming more common in women. It is well established that most such patients smoke heavily and experience an improvement in symptoms following smoking cessation. Mesenteric involvement in Buerger's disease is extremely rare; however, we describe herein two cases of colon ischemia in patients who were previously diagnosed with lower-extremity Buerger's disease. In one case, the patient developed colonic obstruction, and surgical resection was performed. Histopathologic findings were compatible with the chronic stage of Buerger's disease. In the other case, angiography revealed abrupt occlusion of the inferior mesenteric artery with numerous collateral vessels, just like the corkscrew appearance found in the extremities. If patients with established Buerger's disease of the extremities complain of gastrointestinal symptoms, early interventional diagnosis should be performed to prevent intestinal obstruction and gangrene.
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Affiliation(s)
- Kyeong Soo Lee
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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Małecki R, Zdrojowy K, Adamiec R. Thromboangiitis obliterans in the 21st century--a new face of disease. Atherosclerosis 2009; 206:328-34. [PMID: 19269635 DOI: 10.1016/j.atherosclerosis.2009.01.042] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/14/2009] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
Thromboangiitis obliterans (TAO) is a relatively rare disease of peripheral blood vessels, affecting small and medium sized arteries and veins. Although the first description of the disease was given by Winiwarter almost 130 years ago, etiology of TAO remains not elucidated. Smoking is considered as a precipitating factor of the disease. We emphasised some particular features of the new face of TAO - significant decrease in incidences, increased disease prevalence among women and coexistence of other than smoking atherosclerotic risk factors (especially disturbances of glucose metabolism). Contemporary methods of treatment were also discussed.
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Affiliation(s)
- Rafał Małecki
- Department of Angiology, Arterial Hypertension and Diabetology, Wrocław Medical University, Lower Silesia, Poland.
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Chen Z, Takahashi M, Naruse T, Nakajima T, Chen YW, Inoue Y, Ishikawa I, Iwai T, Kimura A. Synergistic contribution of CD14 and HLA loci in the susceptibility to Buerger disease. Hum Genet 2007; 122:367-72. [PMID: 17653770 DOI: 10.1007/s00439-007-0408-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 07/18/2007] [Indexed: 12/27/2022]
Abstract
Buerger disease (BD) is an occulusive vascular disease of unknown etiology. Although cigarette smoking is a well-known risk factor of BD, genetic factors may also play a role in the etiology. Because chronic bacterial infection such as oral periodontitis is suggested to be involved in the pathogenesis of BD, gene polymorphisms involved in the infectious immunity might be associated with BD as the genetic factor(s). We have previously reported that HLA-DRB1*1501 and B54 was associated with BD in Japanese. In this study, polymorphisms in HLA-DPB1, DRB1 and B were analyzed in 131 Japanese BD patients and 227 healthy controls. In addition, we investigated a functional promoter polymorphism, -260 C > T, of CD14 that is a main receptor of bacterial lipopolysaccharide. It was found that the frequencies of CD14 TT genotype [37.4 vs. 24.2%, P = 0.008 OR = 1.87, 95% confidence interval (CI); 1.18, 2.97], DRB1*1501 (34.4 vs. 13.2%, P (c) = 4.4 x 10(-5), OR = 3.44, 95%CI; 2.06, 5.73) and DPB1*0501 (79.4 vs. 55.1%, P (c) = 4.7 x 10(-5), OR = 3.14, 95%CI; 1.93, 5.11) were significantly higher in the patients than in the controls, demonstrating that at least three genetic markers were associated with BD. Stratification analyses of these associated markers suggested synergistic roles of the genetic factors. Odds ratios ranged from 4.72 to 12.57 in individuals carrying any two of these three markers. These findings suggested that the susceptibility to BD was in part controlled by genes involved in the innate and adaptive immunity.
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Affiliation(s)
- Zhiyong Chen
- Department of Vascular and Applied Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
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