Influence of Peripheral Transluminal Angioplasty Alongside Exercise Training on Oxidative Stress and Inflammation in Patients with Peripheral Arterial Disease

Franziska Koppe-Schmeißer,Christine Espinola-Klein,Thomas Münzel,Julian Schmeißer,Jörn F. Dopheide,Andreas Daiber,Melanie Schwaderlapp

doi:10.3390/jcm10245851

Abstract

In patients with intermittent claudication, exercise training ameliorates inflammation by reducing oxidative stress. A total of 41 patients with intermittent claudication (Rutherford 3) were included in the study (with 21 patients treated by endovascular revascularization (ER), and 20 patients without ER). All patients were referred to home-based exercise training. Absolute and initial claudication distance (ACD, ICD) and ABI (ankle–brachial index) were measured. ROS (reactive oxygen species) formation was measured using the luminol analogue L-012. Follow-up was performed after 3 months. ROS production after NOX2 (NAPDH oxidase 2) stimulation showed a significant reduction in both groups at follow-up (PTA group: p = 0.002, control group: p = 0.019), with a higher relative reduction in ROS in the PTA group than in the control group (p = 0.014). ABI measurements showed a significant increase in the PTA (peripheral transluminal angioplasty) group (p = 0.001), but not in the control group (p = 0.127). Comparing both groups at follow-up, ABI was higher in the PTA group (p = 0.047). Both groups showed a significant increas ACD and ICD at follow-up (PTA group: ACD: p = 0.001, ICD: p < 0.0001; control group: ACD: p = 0.041, ICD: p = 0.002). There was no significant difference between both groups at follow-up (ACD: p = 0.421, ICD: p = 0.839). Endovascular therapy in combination with exercise training leads to a lower leukocyte activation state with a reduced NOX2-derived ROS production paralleled by an improved ABI, ACD and ICD. Our data support the strategy to combine exercise training with preceding endovascular therapy.

Highlights

Inflammation is the driving force in atherosclerotic diseases [1]
We previously reported a reduced level of oxidative stress through a reduction in reactive oxygen species (ROS) production and inflammation markers in peripheral artery disease (PAD) patients under home-based exercise training [6], with distinct benefits of supervisedvs. non-supervised exercise training [13]
Med. 2021, 10, x FOR PEER REVIEW At follow-up, we observed a significant increase in the absolute claudication distance (ACD) and initial claudication distance (ICD) in the group with exercise training (Figure 2a,b), as well as in the control group with exercise training only (Figure 2a,b)

Summary

Introduction

Patients with peripheral artery disease (PAD) have a high frequency of other atherosclerotic manifestations in the coronary and cerebral arteries and a high inflammatory status [2,3], due the fact that this group of patients represents a generalized form of atherosclerosis. This corresponds to a high mortality rate among PAD patients [4]. PAD patients should be treated as soon as possible according to the severity of the disease. Several studies highlight the efficacy of endovascular therapy on symptom relief, walking distance and quality of life in stable patients with intermittent claudication [11,12], despite the fact that this intervention may be associated with increased morbidity and mortality

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