Iloprost therapy acutely decreases oxidative stress in patients affected by systemic sclerosis

Background. Oxidative stress has
been considered a leading factor in
the pathogenesis of systemic sclerosis
(SSc). Consistently with this hypothesis
the determination of urinary isoprostanes,
a reliable method for evaluation
of oxidative stress, has recently
showed increased levels of isoprostanes
in SSc patients. Data about the
effect on oxidative stress of accepted
therapies for SSc such as iloprost therapy
are lacking.
Objective. The aim of this prospective
study was to verify whether iloprost
therapy in patients with SSc acutely reduces
oxidative stress assessed by determination
of 8-Iso PGF2α urinary levels.
Methods: urine samples were obtained
before and after a five-day cycle of iloprost
infusion and urinary 8-Iso PGF2α levels were determined using a commercially
available enzyme immunoassay.
Results. Consistent with previous reports,
we found an increased level of
oxidative stress in SSc patients with
respect to healthy controls. Basal urinary
8-iso PGF2α levels in SSc patients
were significantly higher than those in
healthy controls [2002(1122-3575) pg/
mg creatinine vs. 334(225.7-441) pg/mg
creatinine, p<0.001]. Moreover, as expected,
urinary 8-iso PGF2α levels after
iloprost therapy were significantly lower
than basal levels [1277.5 pg/mg creatinine
(742.7-2017.3) vs. 2002 pg/mg creatinine
(1122-3575), p=0.001] but persisted
significantly elevated respect to
the levels of healthy controls (p<0.001).
The effect of iloprost on oxidative stress
appeared significant in patients with
early and limited form of disease.
Conclusions. This prospective openlabel
explorative study suggests that
standard course of iloprost therapy
may acutely reduce oxidative stress in
SSc patients. This effect appears to be
more consistent in the early phases and
in the limited subset of disease. Further
larger trials are needed to confirm our
results and to explain the pathway of
such reduction, its clinical significance
and potential therapeutic implications.