Endothelial and Microvascular Function

The endothelium is more than just a passive vessel lining. New advances have revealed and expanded the multifactorial role of the endothelium in the homeostatic regulation of the microvasculature, including control of primary hemostasis, blood coagulation and fibrinolysis, platelet and leukocyte interactions with the vessel wall, lipoprotein metabolism, presentation of histocompatibility antigens, regulation of vascular tone and growth, and regulation of blood pressure. It possesses numerous receptors and releases compounds that affect the regulation of vascular tone and contribute to vascular permeability. Many crucial vasoactive endogenous compounds are formed in the endothelial cells to control the functions of vascular smooth muscle cells and circulating blood cells. Gap junctions facilitate the exchange of metabolites, ions, and other messenger molecules among endothelial cells and smooth muscle cells, and regulate cell growth. Among the numerous regulatory systems affecting microvascular function are the cholinergic and adrenergic (α₁, α₂, and β) systems. Flow-metabolism coupling is affected by a variety of signaling systems, including adenosine, oxygen, carbon dioxide, lactate, nitric oxide, and others. Agents such as the angiotensin system and endothelin, as well as others, play a role in autoregulation (maintenance of constant flow in the face of changing pressure). All of these are discussed in detail.