Endothelial dysfunction: from the particular to the general. Return to the «Old Paradigm»?
https://doi.org/10.24884/1682-6655-2019-18-2-19-27
Abstract
The vascular endothelium is a heterogeneous structure with diverse functions, being an active metabolic system. Endothelial cells mediate inflammatory and immune processes, regulate leukocyte adhesion, permeability and vascular tone, participate in the hemostasis system, stimulate the processes of angiogenesis. Endothelial dysfunction can initiate individual disorders, but more often it is a universal link in the pathogenesis of many diseases. Currently, endothelial dysfunction is presented as an imbalance between the production of vasodilating, angioprotective, antiproliferative factors, on the one hand, and vasoconstrictive, prothrombotic, proliferative factors, on the other hand. The manifestations of endothelial dysfunction, the direction and severity of these changes may vary depending on the disease. The review provides examples of combined endothelial disorders in the most studied and common diseases (essential hypertension, type 2 diabetes, systemic diseases of the connective tissue, atherosclerosis, and malignant tumors). Despite the presence of rare cases of isolated endothelial dysfunction, it can be argued that in the absolute majority of diseases, endothelial dysfunction has combined type of violations. The allocation of individual endothelial disorder spectra, typical for a specific disease, is problematic, due to the universality and nonspecificity of the manifestations of endothelial dysfunction. These conclusions allow us to return to the origins of this problem, considering endothelial dysfunction as a holistic concept, not limited to a certain range of its disorders.
About the Authors
T. D. Vlasov
Pavlov University
Russian Federation
Vlasov Timur D. – Advanced Doctor in Medical Sciences, professor, head of the Department of Pathophysiology with a course of clinical pathophysiology
Russian Federation
Vlasov Timur D. – Advanced Doctor in Medical Sciences, professor, head of the Department of Pathophysiology with a course of clinical pathophysiology
I. I. Nesterovich
Pavlov University
Russian Federation
Nesterovich Irina I. – Advanced Doctor in Medical Sciences, professor of the Department of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic
Russian Federation
Nesterovich Irina I. – Advanced Doctor in Medical Sciences, professor of the Department of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic
D. A. Shimanski
Pavlov University
Russian Federation
Shimanski Daniel A. – clinical resident of the Department of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic
Russian Federation
Shimanski Daniel A. – clinical resident of the Department of Hospital Therapy with a course of Allergology and Immunology named after acad. M. V. Chernorutsky with a clinic
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For citations:
Vlasov T.D., Nesterovich I.I., Shimanski D.A. Endothelial dysfunction: from the particular to the general. Return to the «Old Paradigm»? Regional blood circulation and microcirculation. 2019;18(2):19-27. (In Russ.) https://doi.org/10.24884/1682-6655-2019-18-2-19-27
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