Clinical Aspects of Microcirculation

**91**

stroke

**1. Introduction**

**Chapter 5**

**Abstract**

Endothelial Dysfunction in

Endothelium is the inner most cell layer of blood vessels. Endothelial cells make special barrier that separate blood from extravascular tissues. Intact

endothelium regulates vascular tone and permeability and maintains non-inflammatory, anti-thrombotic surface. Through its ability to express pro-coagulants, anticoagulants, vasoconstrictors, vasodilators, cell adhesion molecules, and cytokines, the endothelium has emerged as one of the pivotal regulators of vascular homeostasis. Under physiological conditions, endothelial cell sustains a vasodilatory, anticoagulant, and fibrinolytic state in which coagulation, platelet adhesion, as well as leukocyte activation and inflammation are suppressed. In contrast, during endothelial disturbances, a prothrombotic and pro-inflammatory state of vasoconstriction gets support from the endothelial surface. Release of platelet-activating factor (PAF) and endothelin-1 promotes vasoconstriction, whereas production of von Willebrand factor (vWF), tissue factor (TF), and plasminogen activator inhibitor (PAI)-1 shifts the haemostatic balance towards a procoagulant state. Several factors like infection, hyperglycaemia, hyperlipidaemia, malignancy, oxidative stress, and aging can interfere in endothelial function. It is believed that most of the cardiovascular diseases originate from endothelial dysfunction. Endothelial dysfunction has been shown to be involved in atherosclerosis, thrombosis, hypertension, diabetes, and other cardiovascular diseases. In this review we will specifically highlight the role of endothelial dysfunction in

**Keywords:** endothelial dysfunction, atherosclerosis, hypertension, heart failure,

Vascular endothelium is considered as a largest endocrinal organ in the body, which has been shown to have a role in homeostasis in the body by exerting various functions [1]. It is made up of simple squamous epithelial cells that line blood vessels, lymphatic vessels, and the heart. The vascular endothelium has a total weight of about 1.5 kg. The endothelium has been recognized as a smart barrier and a key regulator of blood flow in micro- and macro-vascular circulation [2]. Endothelial function is very important, as it interacts with nearly every system in the body and selectively supplies nutrients and growth factors to every organ. On the other hand, endothelium also receives active metabolites and delivers them back to the

Cardiovascular Diseases

*Indranil Biswas and Gausal A. Khan*

development of cardiovascular diseases.
