{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:32:05Z","timestamp":1786609925902,"version":"build-2736575974"},"reference-count":37,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["F31-DK128920"],"award-info":[{"award-number":["F31-DK128920"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01-DK119274"],"award-info":[{"award-number":["R01-DK119274"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["F31-HL174156"],"award-info":[{"award-number":["F31-HL174156"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01-HL148597"],"award-info":[{"award-number":["R01-HL148597"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01-HL149704"],"award-info":[{"award-number":["R01-HL149704"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01-HL171050"],"award-info":[{"award-number":["R01-HL171050"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["24PRE1193999"],"award-info":[{"award-number":["24PRE1193999"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["24PRE1196311"],"award-info":[{"award-number":["24PRE1196311"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["25EIA1369187"],"award-info":[{"award-number":["25EIA1369187"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["POST903198"],"award-info":[{"award-number":["POST903198"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Cilostazol is a phosphodiesterase 3 (PDE3) inhibitor and is one of the only approved medications shown to improve walking performance in patients with peripheral artery disease (PAD). However, its effects on skeletal muscle pathophysiology are poorly understood. Because skeletal muscle dysfunction contributes to mobility impairment in PAD, this study aimed to evaluate whether patients taking cilostazol exhibit differences in skeletal muscle pathophysiology compared to those not taking cilostazol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a cross-sectional analysis of 50 patients with PAD, including 15 patients taking cilostazol and 35 not taking cilostazol. Calf muscle strength was assessed via isometric dynamometry. Gastrocnemius muscle biopsies were analyzed for myofiber morphology, mitochondrial function using high-resolution respirometry, and gene expression via RNA sequencing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      No significant differences were observed in calf muscle strength (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.49), myofiber cross-sectional area (Type I:\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.53; Type IIa:\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.59), or capillary density (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.74) between groups. However, mitochondrial oxygen consumption under physiological energy demand was significantly higher in cilostazol-treated patients (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0137), although oxidative phosphorylation conductance (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.38) and mitochondrial hydrogen peroxide emission were not different. RNA sequencing revealed transcriptomic overlap between groups, but gene set enrichment analysis identified upregulation of pathways related to mitochondrial gene expression and downregulation of inflammatory signaling in patients taking cilostazol.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Cilostazol use in patients with PAD is associated with increased skeletal muscle mitochondrial oxygen consumption and modest transcriptomic changes, but it does not appear to alter muscle strength, fiber size, or capillarization. These findings suggest a limited impact of cilostazol on skeletal muscle structure, although potential metabolic effects warrant further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x261429979","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T09:54:22Z","timestamp":1781171662000},"page":"482-492","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cilostazol use and calf muscle pathophysiology in people with peripheral artery disease"],"prefix":"10.1177","volume":"31","author":[{"given":"Jaewon","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoungrae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trace","family":"Thome","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Vugman","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline G","family":"Pass","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria R","family":"Palzkill","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingping","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik M","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Florida, Gainesville, FL, USA"},{"name":"Malcom Randall VA Medical Center, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Fazzone","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Florida, Gainesville, FL, USA"},{"name":"Malcom Randall VA Medical Center, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A","family":"Berceli","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Florida, Gainesville, FL, USA"},{"name":"Malcom Randall VA Medical Center, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore T","family":"Scali","sequence":"additional","affiliation":[{"name":"Department of Surgery, The University of Florida, Gainesville, FL, USA"},{"name":"Malcom Randall VA Medical Center, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0780-029X","authenticated-orcid":false,"given":"Terence E","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA"},{"name":"Center for Exercise Science, The University of Florida, Gainesville, FL, USA"},{"name":"Myology Institute, The University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1507631"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30293-1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207899"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2024.07.041"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001251"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000727"},{"key":"e_1_3_2_8_2","article-title":"Cilostazol for intermittent claudication","volume":"2014","author":"Bedenis R","year":"2014","unstructured":"Bedenis R, Stewart M, Cleanthis M, et al. Cilostazol for intermittent claudication. Cochrane Database Syst Rev 2014; 2014: CD003748.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2007.01092.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.12.019"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-016-1030-6"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X18765667"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.015929"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.120.313831"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.122.322325"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(03)00602-5"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2006.04.003"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5876-11-230"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.redox.2014.07.002"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9082575"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41514-024-00147-3"},{"key":"e_1_3_2_22_2","first-page":"1208","article-title":"Ultrastructural alterations and mitochondrial dysfunction in skeletal muscle of peripheral artery disease patients: Implications for early therapeutic interventions","volume":"23","author":"Wilburn D","year":"2024","unstructured":"Wilburn D, Fletcher E, Papoutsi E, et al. Ultrastructural alterations and mitochondrial dysfunction in skeletal muscle of peripheral artery disease patients: Implications for early therapeutic interventions. EXCLI J 2024; 23: 1208\u20131225.","journal-title":"EXCLI J"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.123235"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.123.323161"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.124.325642"},{"key":"e_1_3_2_26_2","article-title":"The vascular effects of cilostazol","volume":"22","author":"Weintraub WS","year":"2006","unstructured":"Weintraub WS. The vascular effects of cilostazol. Can J Cardiol 2006; 22(suppl B): 56B\u201360B.","journal-title":"Can J Cardiol"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.111.230987"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vph.2015.01.002"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015197"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00141.2011"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2005.01.037"},{"key":"e_1_3_2_32_2","article-title":"Impaired muscle mitochondrial energetics is associated with uremic metabolite accumulation in chronic kidney disease","volume":"6","author":"Thome T","year":"2020","unstructured":"Thome T, Kumar RA, Burke SK, et al. Impaired muscle mitochondrial energetics is associated with uremic metabolite accumulation in chronic kidney disease. JCI Insight 2020; 6: e139826.","journal-title":"JCI Insight"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13395-020-00250-5"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/136.4.841"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00132185"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrc.2014.04.028"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20416"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00798.2017"}],"container-title":["Vascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X261429979","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1358863X261429979","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X261429979","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:26:12Z","timestamp":1786609572000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1358863X261429979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":37,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/1358863X261429979"],"URL":"https:\/\/doi.org\/10.1177\/1358863x261429979","relation":{},"ISSN":["1358-863X","1477-0377"],"issn-type":[{"value":"1358-863X","type":"print"},{"value":"1477-0377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}