Acute Local Metabolomic Alterations in Blood and Muscle Tissue in Intermittent Claudication

University of Tartu40 enrolled

Overview

The most common clinical presentation of lower extremity arterial disease is intermittent claudication. Current understanding of the pathophysiology of intermittent claudication, as well as its treatment options are limited. The progression of the disease may lead to lower limb amputation, which is devastating for patients' quality of life and is a huge socio-economic burden to society. Current study allows to determine the acute local metabolomic alterations in the ischaemic limb of the patient with intermittent claudication, and investigate the associations between the metabolomic alterations and the patient's maximal walking distance. This provides potentially valuable insight into the pathophysiology of this disease, and helps lay the groundwork for identifying potential novel targets for instituting more effective therapies for this high-risk population.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Peripheral Arterial Occlusive Disease Fontaine Stage IIa

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * LEAD group: Patients with diagnosis of lower extremity arterial disease (Fontaine IIa). * Control group: Healthy volunteers with no leg symptoms and an ankle-brachial index (ABI) of 1.0-1.4. Exclusion Criteria: * Fontaine stages I or IIb-IV * Exacerbation of limb ischaemia within the preceding 2 weeks; * strong rest pain of any cause; * age \<18 or \>80 years; * fasting \< 6 hours; * time since last use of tobacco products \< 6 hours; * body mass index ≥ 35 kg/m2 * poor sonographic visibility of femoral artery; * angina; * cardiac arrhythmia at the time of presentation; * presence of cardiac pacemaker; * myocardial infarction within the preceding 3 months; * stroke within the preceding 6 months; * ongoing anticoagulant therapy; * ongoing dual antiplatelet therapy; * any revascularization within the preceding 3 month; * marked heart failure (NYHA III-IV); * blood pressure ≥ 180/110 mmHg; * blood pressure \<100/70 mmHg; * clinically significant heart valve disease; * acute infectious disease; * active malignancy or chemotherapy or disease-free \< 5 years; * type I diabetes or insulin therapy; * other clinically significant and untreated endocrine disorders; * moderate to severe bronchial asthma (GINA 2016); * severe chronic obstructive pulmonary disease (mMRC grade 3-4); * acute (KDIGO 2012) or chronic renal disease (eGFR-EPI \<30mL/min/1.73 m2); * acute or chronic liver disease; * anemia (\<110 g/L); * neuroinflammatory or neurodegenerative disease; * active rheumatism; * other diseases and factors that markedly hinder the subject's ability to walk during the treadmill exercise. * For control group exclusively: history of lower extremity arterial disease / ABI \<1.0 or \>1.4.

Outcomes

Primary Outcomes

Change in local metabolomic profile after treadmill exercise as reflected by arteriovenous gradients of low-molecular metabolites.

Measured using liquid chromatography combined with mass spectrometry (AbsoluteIDQ MxP Quant 500 Kit, BIOCRATES Life Sciences AG, Austria).

Time frame: Blood sampling at two points in time: Baseline (Day 1) & 10-15 minutes after treadmill test (Day 2).

Change in local inflammatory profile after treadmill exercise as reflected by arteriovenous gradients of inflammatory mediators (IL-6, MPO, SOD, NOX isoform 1, NOX isoform 2, NOX isoform 5, nitrotyrosine, 8-iso-PGF2α).

Measured using enzyme linked immunosorbent assay. Measurement unit: ng/mL.

Time frame: Blood sampling at two points in time: Baseline (Day 1) & 10-15 minutes after treadmill test (Day 2).

Secondary Outcomes

Change in local metabolomic profile after treadmill exercise as reflected by absolute concentrations of low-molecular metabolites in muscle biopsy.

Measured using liquid chromatography combined with mass spectrometry (AbsoluteIDQ MxP Quant 500 Kit, BIOCRATES Life Sciences AG, Austria).

Time frame: Biopsy at two points in time: Baseline (Day 1) & 15-20 minutes after treadmill test (Day 2).

Correlations between maximal walking distance and exercise-induced changes in local metabolomic and inflammatory profiles.

Time frame: Data analysis after the enrollment period.

Correlations between baseline arterial functionality/hemodynamic parameters and exercise-induced changes in local metabolomic and inflammatory profiles.