In the communication by Feng et al titled ‘Anti-inflammatory effects of simvastatin during the resolution phase of experimentally formed venous thrombi’, the authors demonstrated that simvastatin targets inflammatory pathways in venous thrombosis.1 Using a rabbit model of thrombus induced in the inferior vena cava, they found that simvastatin alone and in conjunction with heparin reduced plasma level and local expression of P-selectin, interleukin (IL)-6 and monocyte chemoattractant protein-1 (MCP-1). Animals treated with simvastatin had reduced thrombus size compared with controls, suggesting that this modulation of inflammatory pathways may improve thrombus resolution.
The participation of inflammation in venous thrombosis has been thoroughly demonstrated by several groups.2–4 Statins are a lipid-lowering drug with pleiotropic effects including anti-inflammatory properties and profibrinolytic properties. In agreement with the authors, Wojick et al described the IL-6–MCP1–fibrosis pathway as the main pathway in experimental venous thrombosis, providing evidence that fibrosis can be reduced by early intervention on the inflammatory path targeting IL-6.2 After the JUPITER Trial was published in 2009,5 Patterson et al in 20133 and Kessinger et al in 20154 published seminal works clearly demonstrating that statins (rosuvastatin or atorvastatin) have both anti-inflammatory and profibrinolytic effects in vivo. In this communication, the authors confirmed these anti-inflammatory effects using an additional statin (simvastatin) in an additional animal model, strengthening the current scientific evidence of the non-lipid lowering effects of statins on venous thrombosis.
It is important to carefully consider the results from animal models without assuming direct clinical translation ability. This is especially relevant when considering post-thrombotic syndrome, which currently can only be modeled in terms of fibrosis in chronic venous thrombosis. Therefore, we as scientists must be careful to interpret basic science data within the contextual constraints of the models being used. While this communication confirms previous findings of the anti-inflammatory effects of statins, the impact this could have in regarding post-thrombotic syndrome humans remains in question.
Footnotes
Competing interests Jose Antonio Diaz, MD is on the Board of Directors of the American Venous Forum, as a Research Council Chair.
Provenance and peer review Not commissioned; externally peer reviewed.