AR, IGF-IR, IR and Peripheral Artery Disease
AR, IGF-IR, IR and Peripheral Artery Disease
Peripheral artery Disease (PAD) is a major cardiovascular disease that can impair quality of
 life (QoL). It affects more often male patients and its pathophysiology is not completely
 known. Probably androgen receptors and metabolism alteration may play an important role in
 the onset and in the progression of PAD towards its dreadful complications. The aim of this
 study is to evaluate the role of Androgen Recetpr , IGF-I receptor, and Insulin Receptor on
 the arterial wall of male patients with PAD undergoing open revascularization surgery.
Peripheral artery disease (PAD) of lower limbs is one of the most common clinical
 manifestation of atherosclerosis and can be considered a major cardiovascular disease with
 important morbidity and mortality, affecting also quality of life (QoL), thus representing an
 important public health concern. From a clinical point of view, PAD may be initially
 symptomatic with intermittent claudication (IC), and in critical limb ischemia (CLI), an
 advanced stage of PAD, with rest pain, and also with leg skin ulceration, a complication that
 may even lead to limb loss for amputation. From a pathophysiological point of view, in the
 presence of atherosclerosis, endothelial activation and dysfunction lead to hemodynamic
 alterations such as turbulent flow, abnormal shear stress, loss of potential energy,
 anomalies of vascular tone with functional impairment during leg exercise in early stages,
 with IC onset, and in advanced stages, during CLI stage, also with rest pain as a result of
 an important demand/perfusion mismatch. Endothelial dysfunction, and vascular tone are also
 regulated by sex hormones, and incidence and prevalence of PAD have usually been found to be
 higher in men than in women, and, more in general, males have a higher risk of developing
 cardiovascular disease during the reproductive period in comparison with females of the same
 age. This sex related difference in developing the disease was hypothesized to be related to
 the protective role of estrogens in female subjects, and harmful effects of androgens in male
 individuals. Furthermore, the androgen receptor (AR) seems to have a role in neointima
 formation, in influencing the size and the composition of atherosclerotic plaques, and also
 vascular smooth muscle cells (VSMCs) activity. Moreover, sex-specific effects on the
 metabolic system are well-known and associated with different risk profiles for
 cardiovascular disease and they have been also related to differences in sex hormones
 activities. In fact, the insulin and IGF-I signaling is mediated by hormone interaction with
 the insulin receptor (IR) and the IGF-I receptor (IGF-IR) which are members of subclass II of
 the tyrosine kinase receptor super-family and they, on one hand, participate to the metabolic
 homeostasis, and on the other hand, they have a direct role on VMMCs, and also in some stages
 of the atherosclerotic process..

 The aim of this study is to evaluate the role of AR, IGF-IR, and IR on the arterial wall of
 male patients with PAD undergoing open revascularization surgery.
Inclusion Criteria:

 -  Male patients with peripheral artery disease (PAD) eligible to receive arterial
 reconstructive open surgery.

 Exclusion Criteria:

 -  active malignancy

 -  advanced liver disease

 -  advanced heart disease