Vascular ossification – calcification in metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and calciphylaxis – calcific uremic arteriolopathy: the emerging role of sodium thiosulfate

Springer Science and Business Media LLC - 2005
Melvin R. Hayden1, Suresh C. Tyagi2, Lisa Kolb3, James R. Sowers4, Ramesh Khanna5
1Department of Family and Community Medicine, University of Missouri Columbia, Missouri, PO BOX 1140 Lk. Rd. 5-87, Camdenton, Missouri, 65020, USA
2Department of Physiology and Biophysics, University of Louisville, 500 South Preston Street, Louisville, Kentucky, 40292, USA
3Capital City Medical Associates, 1505 Southwest Blvd, Jefferson City, Missouri, 65109, USA
4Department of Internal Medicine, University of Missouri School of Medicine Health Sciences Center, MA410, DC043.00, Columbia, Missouri, 65212, USA
5Department of Internal Medicine, University of Missouri School of Medicine Health Sciences Center, MA 436, Columbia, Missouri, 65212, USA

Tóm tắt

AbstractBackgroundVascular calcification is associated with metabolic syndrome, diabetes, hypertension, atherosclerosis, chronic kidney disease, and end stage renal disease. Each of the above contributes to an accelerated and premature demise primarily due to cardiovascular disease. The above conditions are associated with multiple metabolic toxicities resulting in an increase in reactive oxygen species to the arterial vessel wall, which results in a response to injury wound healing (remodeling). The endothelium seems to be at the very center of these disease processes, acting as the first line of defense against these multiple metabolic toxicities and the first to encounter their damaging effects to the arterial vessel wall.ResultsThe pathobiomolecular mechanisms of vascular calcification are presented in order to provide the clinician – researcher a database of knowledge to assist in the clinical management of these high-risk patients and examine newer therapies. Calciphylaxis is associated with medial arteriolar vascular calcification and results in ischemic subcutaneous necrosis with vulnerable skin ulcerations and high mortality. Recently, this clinical syndrome (once thought to be rare) is presenting with increasing frequency. Consequently, newer therapeutic modalities need to be explored. Intravenous sodium thiosulfate is currently used as an antidote for the treatment of cyanide poisioning and prevention of toxicities of cisplatin cancer therapies. It is used as a food and medicinal preservative and topically used as an antifungal medication.ConclusionA discussion of sodium thiosulfate's dual role as a potent antioxidant and chelator of calcium is presented in order to better understand its role as an emerging novel therapy for the clinical syndrome of calciphylaxis and its complications.

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