Positive Effect of Diosmin on Venous Disease in Terms of Factors Responsible for Angiogenesis
A study published last year monitored the impact of diosmin on laboratory and clinical parameters related to the pathophysiology of chronic venous disease in patients.
Properties and Mechanism of Action of Diosmin
Diosmin is a natural substance primarily found in citrus fruits, but also in plants of the Rutaceae family. It has a broad spectrum of pharmacological effects, improving lymphatic drainage, supporting microcirculation, exerting venotonic effects, increasing vascular elasticity and capillary resistance, while reducing capillary filtration and hyperpermeability. Additionally, it has anti-inflammatory effects and reduces oxidative stress. Overall, it is a useful medication for chronic venous diseases, as confirmed by numerous expert studies. However, intensive research into the molecular mechanisms of diosmin's action is still ongoing.
Monitored Laboratory and Clinical Parameters
Skin lesions that occur in advanced stages of chronic venous insufficiency are the result of increased capillary proliferation and microcirculation abnormalities. Their cause may be an imbalance in factors responsible for angiogenesis, including vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), angiostatin, or plasminogen (PLG), from which angiostatin is formed by protease activity. Elevated blood pressure and impaired blood circulation present in patients with chronic venous insufficiency lead to leukocyte adhesion to the capillary endothelium and the initiation of an inflammatory reaction, involving a number of inflammatory mediators (e.g., tumor necrosis factor TNF-α, interleukin IL-6).
Study Methodology
Polish scientists conducted a clinical study to better explore the effect of diosmin on dysregulated angiogenesis. A total of 35 patients with chronic venous disease were given 600 mg of this flavonoid twice daily. Before the treatment and after 3 months, plasma concentrations of TNF-α, IL-6, VEGF-A, VEGF-C, angiostatin, FGF2, and PLG were measured using ELISA tests. Clinical manifestations of the disease were monitored using ultrasound imaging methods, the visual analog scale of pain (VAS), and measurements of the lower limb circumference.
Results
Most of the monitored laboratory parameters significantly improved after 3 months of diosmin treatment (decreased levels of TNF-α: p < 0.001; VEGF-C: p < 0.05; VEGF-A: p < 0.05; IL-6: p < 0.01; FGF2: p < 0.01; increased level of angiostatin: p < 0.05). Significant reduction in edema (p < 0.05), reduction in the average circumference of the lower limb, and pain relief were also observed after treatment, in line with other studies on this topic. A total of 13 patients were reassigned to a group with lower disease intensity (from C3 to C2 according to the CEAP classification [Clinical-Etiological-Anatomical-Pathophysiological classification]).
Conclusion
Three months of diosmin administration positively modulated both pro-inflammatory and pro- and anti-angiogenic mechanisms involved in the pathophysiology of chronic venous disease. It confirmed that diosmin, as an effective venotonic, helps patients with chronic venous insufficiency prevent the progression of edema.
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Source: Feldo M., Wójciak-Kosior M., Sowa I. et al. Effect of diosmin administration in patients with chronic venous disorders on selected factors affecting angiogenesis. Molecules 2019; 24 (18): 3316, doi: 10.3390/molecules24183316.
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