iloprost and Diabetes-Mellitus

The aim of this study is to evaluate the role of Iloprost as an early predictor of successful revascularization in patients affected by ischemic diabetic foot ulcers (DFUs).. Consecutive patients with ischemic DFUs with persistent low TcPO2 (<30mmHg) one day after a technical successful Percutaneous Transluminal Angioplasty (PTA) have been included. All patients underwent Iloprost infusion and TcPO2 has been recorded at days 3, 14 and 30. According to the TcPO2 reported at day 3, patients were divided into two groups: group A (patients with TcPO2 ≥30mmHg) and group B (patients with TcPO2 <30mmHg). Baseline TcPO2 values at days 3, 14 and 30 after Iloprost infusion and needing of re-intervention (re-PTA) have been evaluated.. Twenty-five patients have been included, 12/25 (48%) in Group A and 13/25 (52%) in Group B. There were no significant differences at the baseline and one day after PTA between the two groups while TcPO2 values recorded in Group A at days 3, 14 and 30 after Iloprost infusion were significant higher in comparison to the Group B (χ = 0.005). The rate of re-PTA were respectively 33,3% (Group A) and 53,8% (Group B) (p = 0.03).. Iloprost may be an early predictor of successful revascularization in patients affected by critical limb ischemia (CLI) and DFUs.

Topics: Diabetes Mellitus; Diabetic Foot; Epoprostenol; Foot Ulcer; Humans; Iloprost; Ischemia

Topics: Diabetes Mellitus; Epoprostenol; Foot Ulcer; Humans; Iloprost; Ischemia; Limb Salvage

Iloprost given in a standard dose regimen (0.5-2 ng/kg/min for 6 hours daily over 21-28 days) has proven to be effective and safe in hospitalized patients with critical limb ischemia. Major drawbacks of the standard regimen are the high frequency of side effects, the long duration of the daily infusion, and a hospital stay of 3 to 4 weeks. Recently, the efficacy of low doses of iloprost (25 mg/day) was demonstrated. This open pilot study was undertaken to identify a more practical and cost-effective regimen with less side effects. The feasibility, efficacy and safety of an individually adapted, intermittently applied low-dose iloprost regimen in an outpatient setting were evaluated.. Twenty-seven patients with severe peripheral ischemia in the limbs or part of the limb due to various etiologies, who were eligible for outpatient treatment, were enrolled into the study. The infusion of iloprost (50 microg in 250 ml 0.9% saline) was started at 0.5 ng/kg BW/min and titrated to the individual optimum dose, which was defined as the maximum dose at which the patient felt entirely comfortable. The frequency of the iloprost infusions and the duration of the treatment were individually determined in each patient according to the severity of the clinical condition. Outcome endpoints were the response rates achieved by day 28, defined as substantial relief from rest pain and evidence of ulcer healing. The patients were followed up for a minimum of 6 months.. A total of 27 patients (15 male, 12 female, mean age 65 years) were treated. Twenty-four patients received daily infusions with a break at weekends (5 times/week); 3 patients were treated every second day (3 times a week). The mean daily iloprost dose actually given was 20+/-5 microg, the mean duration of treatment was 3.6+/-0.8 weeks, i.e. a mean of 17+/-4 infusions were administered. Six patients with one-vessel run-off underwent percutaneous transluminal angioplasty (PTA) of their single calf vessel. Twenty-six patients showed clinical improvement by day 28; excluding those who had had PTA, the response rate to iloprost was 74% (20/27). No patient required admission to hospital while receiving outpatient treatment; no side effects occurred after adjustment to the optimum dose. At long-term follow-up (11+/-3 months), 76% of patients were alive and had a viable limb.. In a limited number of patients with severe peripheral ischemia of various etiologies, long-term outpatient treatment with an individually adapted low-dose iloprost regimen was feasible and safe. Our data suggest that flexible treatment modalities might be as effective as rigid standard treatment regimens, the former being more advantageous in terms of greater practicability and cost-effectiveness due to outpatient management. Further studies are needed to confirm the efficacy of this individually adapted, low-dose outpatient iloprost treatment regimen in a larger number of patients.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Angioplasty, Balloon; Blood Pressure; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus; Dose-Response Relationship, Drug; Drug Evaluation; Female; Follow-Up Studies; Humans; Iloprost; Infusions, Intravenous; Ischemia; Leg; Male; Middle Aged; Pilot Projects; Platelet Aggregation Inhibitors; Recurrence; Severity of Illness Index; Time Factors; Treatment Outcome

Diabetes is associated with gender-specific macrovascular complications arising from increased oxidant stress in the vascular wall. In this study, male and female rats were treated with two structurally unrelated drugs sharing antioxidant properties, lercanidipine and Leucoselect (both 3 mg/kg/day), for 1 week starting 1 day after streptozotocin-diabetes induction. Concentration-response curves to L-nitroarginine methylester (L-NAME), superoxide dismutase and acetylcholine in aortic rings showed significantly greater nitric oxide-mediated relaxation in female compared with male non-diabetic rats. Diabetes increased contractility to noradrenaline and L-NAME in both genders, whereas relaxation to acetylcholine and iloprost were significantly attenuated in females only. Treatment with lercanidipine and Leucoselect restored, at least in part, responses to noradrenaline, acetylcholine and iloprost without affecting those to L-NAME and sodium nitroprusside. Unexpectedly, both drugs impaired superoxide dismutase response in female tissues. In conclusion, female rat aorta is markedly exposed to short-term diabetic vascular injury, which may be prevented by antioxidant treatment.

Topics: Acetylcholine; Animals; Antioxidants; Aorta, Thoracic; Blood Glucose; Diabetes Mellitus; Diabetes Mellitus, Experimental; Dihydropyridines; Female; Iloprost; In Vitro Techniques; Male; Muscle, Smooth, Vascular; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Donors; Nitroprusside; Norepinephrine; Rats; Sex Factors; Superoxide Dismutase; Vasoconstriction; Vasodilator Agents

Oxidation and glycation of low-density lipoprotein (LDL) has been claimed to play a central role in the pathogenesis of atherosclerosis. Therefore, the inhibition of this processes is of major therapeutic importance. In the present paper the influence of prostaglandin (PG)I2, and its stable analogues taprostene and iloprost on copper-induced oxidation of native, glycated and glycoxidated LDL was investigated. The results show, that the most pronounced effect on inhibition of native LDL-oxidation was obtained by taprostene in the whole concentration range tested (0.2 microg-10 microg/ml) reaching a maximal inhibition of 95% at 10 microg/ml. Examining glycoxidated LDL the inhibitory effect on oxidation was less pronounced reaching only about 10%. In case of glycated LDL, however, no significant inhibitory effect on oxidation was seen. Iloprost was effective as inhibitory agent against oxidation of native LDL at concentrations of 10 and 20 microg/ml, showing a maximal inhibition of 86% at a concentration of 20 microg/ml. Iloprost was ineffective on oxidation of glycated and glycoxidated LDL. Examining the extremely short-lived PGI2 itself, no significant inhibitory effect on oxidation of native, glycated or glycoxidated LDL, however, was seen. This finding might be of relevance for patients with diabetes mellitus, showing a decreased endogenous PGI2-production in particular those with bad metabolic control and high concentrations of circulating advanced glycosylation end products (AGEs).

Topics: Adult; Aged; Diabetes Mellitus; Dose-Response Relationship, Drug; Epoprostenol; Female; Glycation End Products, Advanced; Humans; Iloprost; Lipoproteins, LDL; Male; Middle Aged; Oxidation-Reduction

A young woman with acute upper extremity edema and ischemia after intraarterial drug injection is presented. Unsatisfactory results from standard treatment were the reason for changing the therapy to temporary thrombolysis, which led to significant improvement. Some days later severe impairment forced another attempt at applying standard therapy, again unsuccessful. Only after continuous intraarterial infusion of Iloprost, a new improvement occurred and saving of the hand was possible. It became obvious that more effective therapeutic measures ought to be applied when severe hand ischemia following intraarterial drug injection is present.

Topics: Acute Disease; Adult; Azlocillin; Diabetes Mellitus; Female; Hand; Humans; Iloprost; Injections, Intra-Arterial; Ischemia; Radiography; Thrombolytic Therapy

Topics: Adult; Age Factors; Aged; Binding, Competitive; Blood Platelets; Cardiovascular Agents; Cell Membrane; Diabetes Mellitus; Epoprostenol; Humans; Iloprost; Kinetics; Middle Aged; Receptors, Epoprostenol; Receptors, Prostaglandin; Smoking