Title:
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Vascular pleiotrophic effects of bisphosphonates in postmenopausal women : cellular mechanisms and functional consequences
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Although traditionally vjewed as separate disease entities that increase in prevalence
with aging, accumulating evidence indicates that similar pathophysiological
mechanisms underlie cardiovascular disease and osteoporosis. This evidence has
both clinical and biochemical foundations, however the complex interaction of
common risk factors and genetic or molecular determinants; requires further
research to clearly define these mechanisms. Nitrogen containing bisphosphonates
inhibit the isoprenoid biosynthetic enzyme, farnesyl diphosphate (FFP) synthase, in
the same cholesterol biosynthesis pathway as statins. Inhibition of FFP synthase
leads to loss of farnesylation and geranylation of small GTPase proteins. Statins
have been shown to exert cholesterol-independent vaso-protective effects mediated,
through inhibition of these small GTPase proteins, Rho and Rac. By inhibIting both
Rho and Rac GTPase activity via inhibition of geranylgeranylation, endothelial nitric
oxide synthase (a vasodilator) is up-regulated and superoxide (a vasoconstrictor)
production is decreased. Although it has been previously been considered that
current dosing regimens and low absorption have resulted in a low body "burden" of
N-BPs, an expanding body of evidence would suggest that considerable work is still
required to fully elucidate the effect of these drugs beyond the bone matrix.
Endothelial dysfunction is the initial step in the atherosclerotic process. This thesis
aims to determine if women with post-menopausal osteoporosis have impaired
endothelial function and if treatment with Risedronate over a 24 week period has an
influence on non-invasive vascular measures of endothelial function. We examine
both peripheral and central arterial beds, using well established non-invasive
methods to obtain a global measure of endothelial function. We employ novel
methods of flow velocity waveform analysis to extract potentially meaningful
differences in arterial flow waveforms that would indicate subclinical vascular
disease.
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