The role of anti-endothelial cell antibodies in venous insufficiency

Summary

It is a hypothesis that autoimmune factors directed against endothelial cells play a role in developing venous insufficiency. We investigated the association between anti-endothelial cell antibodies (AECA) and the development of venous insufficiency and varicose veins. Patients, methods: 44 patients were evaluated with clinical examination and duplex ultrasound for diagnosing chronic venous insufficiency and varicose veins and 120 healthy volunteers were assigned as the control group without evidence of chronic venous insufficiency and varicose veins. All sera samples were analysed by using slides, each containing biochips coated with frozen sections of HUVEC (human umblical vein endothelial cells) and capillary-rich tissue such as skeletal muscle (Euroimmun, FB 1960–1005–2, Germany). If a positive reaction is obtained, specific antibodies of class IgA, IgG, IgM attach to the antigens. In a second step, the bound antibodies are stained with fluorescein labeled antihuman antibodies and visualised by fluorescence microscopy. Results: AECA was positive in 24 out of 44 patients (54.54%) and in 30 out of 120 volunteers (25%). We detected that anti HUVEC antibody occurred significantly more frequent in patients with chronic venous insufficiency or varicose veins: p = 0.0007, OR: 3.60 (1.65 < 7.92). Discussion: The presence of antibodies directed against the endothelial structure causes inflammatory cells of the immune system to move towards the location by both forming antigen-antibody complex and activating the complement system. Tissue damage may occur due to inflammation. In our study we have found a statistically significant relationship between antiendothelial cell antibodies and chronic venous insufficiency. Conclusion: Early diagnosis or prediction of venous insufficiency and/or varicose veins before the occurrence of symptoms may prevent the damage or even help to establish a prophylactic treatment.

Zusammenfassung

Autoimmune Faktoren, die gegen endotheliale Zellen gerichtet sind, spielen eine Rolle bei der Entwicklung und Progression degenerativer Venenklappen der Klappeninsuffizienz. Wir untersuchten die Beziehung zwischen antiendothelialen Zellantikörpern (AECA) und die Entwicklung der venösen Insuffizienz und primären Varikose. Patienten, Methoden: 44 Patienten wurden klinisch und mit farbkodierter Duplexsonographie untersucht, um die Diagnose chronische venöse Insuffizienz oder primäre Varikose zu verifizieren. 120 gesunde Freiwillige wurden als die Kontrollgruppe begutachtet. Wir inkubierten venöses Vollblut auf Objektträgern, die mit eingefrorenen Bestandteilen von HUVEC (humane Endothelzellen von Nableschnurvenen) und kapillarreichem Gewebe wie Skelettmuskel (Euroimmun FB 1960–1005–2, Deutschland) beschichtet sind (Biochip). Die Chips wurden fluoreszenzmikroskopisch ausgewertet. Ergebnisse: AECA war bei 24 von 44 Patienten (54,54%) und bei 30 von 120 Freiwilligen (25%) positiv. Der Vergleich von Patienten- und Kontrollgruppe zeigte, dass Anti-HUVEC Antikörper im Patienten mit venöser Insuffizienz und primärer Varikose sigifikant höher waren: p = 0,0007, OR: 3,60 (1,65 < 7,92). Discussion: Die Schädigung endo thelialer Strukturen scheint ein wesentlicher Faktor in der Entwicklung venöser und arterieller Erkrankungen zu sein. In unserer Studie haben wir eine statistisch signifikante Beziehung zwischen dem Auftreten von AECA und chronischer venöser Insuffizienz gefunden. Dies könnte die frühzeitige Diagnose oder die Vorhersage der Erkrankung vor dem Auftreten von Symptomen erlauben bzw. eine Intervention rechtfertigen, bevor ein irreparabler Schaden entstanden ist. Schlussfolgerung: AECA sind leicht zu bestimmen, kostengünstig und können als zuverlässige Marker für prognostische Studien eingesetzt werden.

Keywords

Anti-endothelial cell antibodies - chronic venous insufficiency - varicose veins

Schlüsselwörter

Anti-endotheliale Zellantikörper - venöse Insuffizienz - primäre Varikose

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