The Diversity of Microvascular Damage

MV repair (endothelial regrowth and angiogenesis) is a rapid response to physical trauma that ranges from minor cuts and abrasions to gunshot wounds and burns elicited by both fire and chemicals. In this context, MV repair occurs as a component of "wound healing."

Surgery also disrupts the integrity of the MV system. For example, in organ transplantation or vein graft bypass surgery, whole organs or tissues are excised and reimplanted. Since the microvessels that supply these tissues are severed, it is implicit that the tissue is no longer supplied with blood and therefore is deprived of oxygen and nutrients. This applies to all forms of surgery, and therefore rapid MV repair is crucial for the success of surgical procedures.

The infection of wounds or systemic infection (septicemia) is known to damage the MVs. An example of this scenario is acute respiratory distress syndrome, in which endotoxins derived from bacteria precipitate extensive adhesion of leukocytes and platelets to the pulmonary vascular endothelium. In turn, these cells release a battery of cytokines and factors that are cytotoxic or apoptotic and that eventually destroy the endothelium.

Cardiovascular risk factors and metabolic status can compromise MV repair. For example, diabetes mellitus is associated with impaired angiogenesis and endothelial regrowth, as are oxidized lipids and homocysteine.

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