Transforming Growth Factor Beta 1 (TGF-β1) in Patients with Obliterating Atherosclerosis of the Lower Limbs Arteries Undergoing Endovascular and Conservative Treatment

INTRODUCTION: The pathogenesis of atherosclerosis and its complications is based on complex biochemical mechanisms. One of the factors playing a fundamental role in the processes of proliferation and migration of cells, remodeling, fibrosis, regeneration and calcification of tissues, is the transforming growth factor beta 1 (TGF-β1). AIM: To assess the level of TGF-β1 in patients with obliterating atherosclerosis of the lower limb arteries (OALLA) in endovascular and conservative treatment. MATERIALS AND METHODS: The open prospective cohort study included 80 patients with stage II–IV chronic lower limb ischemia in A.V. Pokrovsky–Fontaine classification (categories 3–5 Rutherford) as a result of OALLA. All patients were divided into 2 groups, 40 patients in each: group 1 — patients with endovascular treatment, group 2 — with conservative therapy. The mean age of patients was 67.1±8.9 years (group 1) and 68.8±7.2 years (group 2). All patients underwent the following procedures before treatment and at 1, 3, and 12 months: physical examination, ultrasound examination of the lower limb arteries, determination of TGF-β1 level in the blood serum using ELISA before treatment and at 3 months. During one year of follow-up, the following factors were assessed: the development of restenosis of the arterial reconstruction zone in patients of group 1, the progression of chronic ischemia and the development of fatal outcomes in patients of both groups. RESULTS: TGF-β1 level in group 1 was 210.13 (131.51–721.50) ng/ml, in group 2 — 397.81 (153.11–873.00) ng/ml. The ankle-brachial index (ABI) was measured using ultrasound. By month 3 from the start of treatment, the ABI level increased in group 1 compared to the initial values, and decreased in group 2. Both groups showed a decrease in TGF-β1 level. ROC analysis allowed us to create a model for predicting the progression of chronic ischemia to a more severe stage 1 month after endovascular surgery based on the initial values of TGF-β1 levels. CONCLUSIONS: Comparative analysis of TGF-β1 level in patients with OALLA after 3 months of therapy revealed a statistically insignificant tendency to decrease in group 1 and a reliable decrease in group 2. In patients with initial TGF-β1 level ≥307.2 ng/ml, progression of chronic ischemia to a more severe stage was observed within 1 month after surgery.