Realizzazione di un DNA-Array di varianti genetiche nelle lesioni croniche di origine vascolare

Objective Wound healing in venous leg ulcer (VLU) is a multi-step process involving complex pathways. Scanty knowledge at molecular level hinders clinical assessment and treatment. Anomalous handling of local iron overload, as well as unbalancing in MMPs and transglutaminase, has a recognized role in VLU establishment. We selected a number of single nucleotide polymorphisms (SNPs) in candidate genes (HFE, FPN1, MMP12, FXIII) involved in VLU to identify potentially prognostic markers by means of DNA-array technology. Methods and Results DNA-array-genotyping was assessed in 638 subjects for the following SNPs: HFE [C282Y, H63D], FPN1 [-8CG], MMP12 [-82AG] and FXIII [V34L]. Of the subjects, 221 were affected by VLU (171 primary and 50 post-thrombosis), 112 by severe chronic venous insufficiency (CVI) (CEAP, C3-C4), while 305 were matched healthy controls. HFE and FXIII SNPs had been previously genotyped by conventional PCR-methods on the same group of subjects (J Vasc Surg 2005;42:309; J Vasc Surg 2006;44:554; J Vasc Surg 2006;44:815). For the purpose of DNA-array, they were re-genotyped by means of array-techniques resulting in a 100% matching. Inter-group statistical comparisons were performed. In the risk computation, the FPN1 -8GG genotype had an overall CVI risk of 4.3 (CI95%, 1.6-12) and a VLU risk of 5.2 (CI95%, 1.9-15) virtually the same among primary VLU (4.98; CI95%, 1.82-14.9). The MMP12 -82AA genotype had a VLU risk of 1.96 (CI95%, 1.18-3.2) only in primary VLU (P=.01). In the genotype-ulcer size association studies, from a sub-group of 167 cases, we observed a smaller mean ulcer size in the MMP12 GG-genotype compared with the other genotypes (P=.001). Combining the present results with our previous published data on the same population, we suggest them to apply as tentative prognostic indicators in primary CVI. Conclusion By analyzing simultaneously selected SNPs it might be possible to glean precious information in predicting VLU onset or in stratifying patients according to their potential to heal. Our findings must be considered preliminary and the proposed prognostic indicators considered with caution, before ulterior, more extensive studies in different populations can eventually confirm the present findings. Clinical Relevance DNA-array evaluation could be added to clinical CVI assessment. By analyzing simultaneously selected SNPs it is possible to have in advance precious information about several VLU clinical findings to perform prevention program in the initial patient assessment. Our results must be handled with extreme caution before consider them as prognostic indicators and further larger studies in different populations are mandatory.