Effect of Atorvastatin on Endothelial Function and Raynaud in Diffuse Scleroderma

 产品说明：系统性硬化症（SSc）是一种多系统自身免疫性疾病，其特征是血管病变、免疫系统激活和皮肤及内脏纤维化。SSc在美国每百万人中约有240人受影响，但这是一种没有FDA批准药物的疾病。目前的发病机制假说认为，血管损伤伴内皮功能障碍可能是导致免疫激活和纤维化的一个诱因。超过90%的SSc患者有血管并发症，包括雷诺现象，指溃疡或坏疽和肺动脉高压，微血管异常被认为有助于雷诺和指溃疡。众所周知，他汀类药物具有多效性，可改变SSc发病机制的各个方面。一些初步的他汀类药物研究发现了相互矛盾的结果，但使用的患者总体上长期存在疾病，当血管病变可能不适合治疗。在我们的初步工作中，我们发现他汀类药物可能介导极早期系统性硬化症患者的微血管内皮功能障碍。激光散斑衬度成像（LSCI）是一种较新的成像方式，评估微循环，并已提出作为全身微血管功能的替代标记。我们的初步数据显示，与健康年龄、性别和种族匹配的对照组相比，LSCI测量的微循环流量具有独特的模式，并有望作为SSc患者微血管功能的功能评估。我们的假设是，阿托伐他汀治疗一个明确的早期弥漫性SSc的队列将改善微血管内皮功能，通过EndoPAT测量，从而改善相关的雷诺症状。我们建议应用LSCI成像作为一种方式来评估微血管内皮功能对他汀类药物的反应，并假设这种方式将使我们能够预测他汀类药物的反应。

 DESCRIPTION: Systemic sclerosis (SSc) is a multisystem autoimmune illness characterized by vasculopathy, immune system activation and fibrosis of the skin and internal organs. SSc affects approximately 240 people per million in the US, but is a disease for which there is no FDA approved medication. Current hypothesis of pathogenesis suggest that a vascular injury with endothelial dysfunction may be an inciting event contributing to immunologic activation and fibrosis in the pathogenesis of the disease. More than 90% of individuals with SSc have vascular complications including Raynaud phenomenon, digital ulcers or gangrene and pulmonary hypertension, with microvascular abnormalities felt to contribute to Raynaud and digital ulcerations. Statin medications are well-recognized to have pleiotropic effects which may modify all aspects of SSc pathogenesis. A few preliminary statin studies have found conflicting results, but have used patients with overall longstanding disease, when the vasculopathy may have not been amenable to treatment. In our preliminary work we have found evidence that statins may mediate microvascular endothelial dysfunction in patients with very early systemic sclerosis. Laser speckle contrast imaging (LSCI) is a newer imaging modality that assesses microcirculation and has been proposed as a surrogate marker for systemic microvascular function. Our preliminary data showed a distinct pattern of microcirculatory flow as measured by LSCI compared to healthy age, gender and race-matched controls and holds promise as a functional assessment of microvascular function in SSc patients. Our hypothesis are that treatment with atorvastatin in a well-defined cohort of early diffuse SSc will improve microvascular endothelial function as measured by EndoPAT and thereby improve related Raynaud symptoms. We propose to apply LSCI imaging as a modality to assess microvascular endothelial function response to statins and hypothesize that this modality will allow us to predict responders to statins.