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Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2012, Número 3

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Rev Mex Angiol 2012; 40 (3)


Glicosaminoglicanos en las enfermedades vasculares

Frati-Munari AC

Idioma: Español
Referencias bibliográficas: 100
Paginas: 89-99
Archivo PDF: 255.91 Kb.


RESUMEN

Los glicosaminoglicanos (GAGs) están formados por largas cadenas de dímeros constituidos por un aminoazúcar y un ácido urónico que están sulfatados y se unen a proteínas, formando proteoglicanos. Los GAGs forman parte de la matriz extracelular de todos los órganos y tienen múltiples funciones. En los vasos constituyen el glicocáliz endotelial y la matriz extracelular del endotelio y subendotelio. El glicocáliz es la primera barrera entre las células endoteliales y el torrente sanguíneo, con sus fuerzas de tensión, moléculas de adhesión, células circulantes y sistema de coagulación. En la matriz extracelular los GAGs (sobre todo heparán sulfato) regulan la acción de quimiocinas, citosinas, factores de crecimiento y la migración celular, así como la filtración de moléculas a través del endotelio. La hipertensión venosa crónica deteriora el glicocáliz y permite la acción de moléculas de adhesión y la inflamación que daña el endotelio y las capas venosas más profundas, lo que deforma las valvas y permite la filtración de líquido, proteínas y células al espacio pericapilar y perivenular que causan inflamación de la piel y finalmente su ulceración. El deterioro del glicocáliz y la disfunción endotelial son los pasos iniciales importantes en la aterosclerosis y también en la microangiopatía diabética. En la patogenia de estos procesos intervienen los GAGs. Los GAGs con acción terapéutica en enfermedades vasculares incluyen la heparina y la sulodexida; la primera para la prevención y tratamiento de trombosis, la segunda es particularmente útil en la enfermedad venosa crónica avanzada con úlceras cutáneas, también se han utilizado exitosamente en arteriopatía obstructiva de los miembros inferiores y en microangiopatía diabética.


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