Chronic venous disease (CVD) involves complex pathophysiological mechanisms, particularly an imbalance between matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), contributing to venous remodeling and varicosities. Elevated MMP-2 and MMP-9 levels are commonly found in tissues affected by venous ulcers. Inflammation plays a central role in CVD, with higher levels of pro-inflammatory markers present in varicose veins compared to healthy ones. Syndecans, key components of the endothelial glycocalyx, are involved in inflammatory responses. Alterations in the glycocalyx structure are associated with vascular damage in both venous and arterial diseases. This study aimed to investigate inflammatory changes in CVD patients, focusing on glycocalyx damage and the therapeutic role of mesoglycan, a glycosaminoglycan-based drug. A prospective, monocentric study included 23 patients with C2 clinical–etiological–anatomical–pathological (CEAP) CVD. Serum samples were collected before and after mesoglycan treatment. Results showed significantly elevated levels of VCAM-1, MMP-2, MMP-9, SDC-1, IL-6, and IL-8 in blood from varicose veins versus the systemic circulation. Patients received 50 mg of mesoglycan orally every 12 h for 90 days. After treatment, a notable reduction in inflammatory markers was observed. These results support the hypothesis that mesoglycan may alleviate both local and systemic inflammation, providing insights into new therapeutic strategies for CVD management.

Chronic venous disease (CVD) involves complex pathophysiological processes where the imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) contributes to venous remodelling and varicosities. Elevated levels of MMP-2 and MMP-9 are notably observed in tissues affected by venous ulcers. Local inflammation is a key feature in CVD, with increased concentrations of pro-inflammatory markers in varicose veins compared to healthy veins. Syndecans, components of the endothelial glycocalyx, play critical roles in inflammation. Recent studies have shown that alterations in glycocalyx structure are indicative of vascular damage in both venous and arterial diseases. This study aims to explore the inflammatory alterations in CVD patients, focusing on glycocalyx damage and the potential therapeutic effects of mesoglycan, a compound used in CVD treatment. A prospective, monocentric study was conducted with 23 patients diagnosed with CVD of CEAP class C2. Serum samples were analyzed at baseline and after mesoglycan treatment. Results showed significantly higher levels of VCAM-1, MMP-2, MMP-9, SDC-1, IL-6, and IL-8 in blood from varicose veins compared to systemic circulation. After treatment with mesoglycan, there was a notable reduction in these inflammatory markers, indicating a positive therapeutic effect. These findings support the hypothesis that mesoglycan may help reduce local and systemic inflammation in CVD. This study contributes to a better understanding of the inflammatory mechanisms in CVD and the role of mesoglycan in modulating these processes, offering insights into potential therapeutic strategies for managing CVD.

Antiphospholipid syndrome (APS) is an acquired coagulation disorder with an unclear pathogenesis, diagnosed in the presence of thrombotic events, obstetric complications, or non-thrombotic manifestations, alongside persistently detectable antiphospholipid antibodies. aPLs seroconversion, defined as the transition from persistent antibody positivity to sustained antibody negativity, is typically confirmed by at least two negative tests ≥12 weeks apart and maintained for over one year. This phenomenon is distinct from seronegative APS (SNAPS), in which patients present with APS-like clinical features but never fulfill laboratory criteria. Thrombotic risk remains significant in APS, particularly in patients with prior events or persistently elevated aPLs titers. Immunomodulatory therapies, such as hydroxychloroquine, rituximab, eculizumab, sirolimus, or other agents, may reduce antibody levels and contribute to improved outcomes, though evidence is limited. Among these, hydroxychloroquine is the most established agent, particularly in refractory or recurrent thrombotic cases, and is recommended as adjunctive therapy alongside anticoagulation in high-risk thrombotic and obstetric APS. While these therapies may allow cautious adjustments in anticoagulation for low-risk patients, anticoagulants should not be discontinued solely based on seroconversion or adjunctive treatment. Overall, immunomodulatory drugs should be considered strictly as adjuncts, with patient selection guided by clinical phenotype, thrombotic risk, and available evidence.