Soluble Adhesion Molecules in Brain Infarction - Adhesion Molecules - page 470

induced by high glucose in cultured human endothelial cells (Omi et al. 2004)
(Fig. 5) . In chronic SVD with lacunar infarctions and WMLs, an increase in AMs
has been observed (Hassan et al. 2003, Markus et al. 2005, Kawamura et al. 2006,
Umemura et al. 2008) and in many cases coexists with microbleeds as observed in
MRI T2*-weighted imaging, which has received attention in the last few years. In
the CASISP study (Huang et al. 2008) published in Korea, compared to an aspirin
group, a cilostazol group had signii cantly fewer hemorrhagic stroke events and in
all subjects in the latter group who had experienced such events, microbleeds had
been observed in imaging diagnosis conducted beforehand. In consideration of the
above, cilostazol might be the drug of i rst choice in the treatment of SVD in view
of its decreasing of AM and protection of the vessel endothelium in prevention
of the incidence and progression of the disease and its low hemorrhagic risk. As
statins and rennin-angiotensin system inhibitors have similar pleiotropic ef ects to
cilostazol, they should be investigated to see if they would ef ective in suppressing
the incidence and progression of SVD. In this regard, a study on the combined
use of antiplatelet agents, angiotensin-converting enzyme inhibitors and statins
prior to the incidence of acute SVD found that these agents signii cantly reduced
severity once the disease had developed (Kumar et al. 2006).
In the disruption of the microcirculation that occurs in acute brain infarctions,
there is an increase in AM expression that enhances interaction between leukocytes
Fig. 5 Ef ects of cilostazol on surface expression on the endothelial adhesion molecules
E-selectin, P-selectin, and ICAM-1 induced by high glucose. Cells were treated without (control)
or with 27.8 mM glucose for 48 hr (G) in the presence or absence of 1 μM cilostazol. Values
are expressed as means ± SEM. **P < 0.01 compared to the respective control, #P < 0.05, ##P <
0.01 compared to the respective cells treated with high glucose alone. (Adapted from Omi et al .
2004.)