The role of endothelial dysfunction, microcirculatory disorders, and hypoxia as mechanisms for the formation of lung lesions

Abstract

In a review article, the authors consider the significance of endothelial dysfunction, microcirculation disorders, and hypoxia in the development of lung diseases and in the comorbid course of a number of other diseases of the internal organs. The role of endotheliocytes in the systemic response to inflammatory processes in the case of damage to the bronchopulmonary system is considered. Endothelial cells counteract pathogens in the blood and send signals warning of infection, invasion, or injury. The importance of the anticoagulant and antithrombotic properties of the endothelium (including the pulmonary one), which contribute to the fight against thrombosis, is emphasized. It is indicated that endothelial cells have an endogenous mechanism to combat platelet activation. This function depends on the surface expression of ecto-ATPase, CD39, and the release of nitric oxide and prostacyclin. Attention is paid to the importance of activation of the renin-angiotensin-aldosterone system both through angiotensin-II and through aldosterone. The authors stressed the importance of endothelial dysfunction as an imbalance between the factors of relaxation and constriction, coagulation, and fibrinolysis, which provide hemostasis of the main vital regulatory systems, and the stage of disease compensation (via the participation of nitric oxide). Microcirculation disorders and hypoxia are considered phenomena that are compatible in pathogenesis not only with pulmonary diseases but also as common comorbid syndromes with other diseases of the internal organs. This is explained by the fact that the common links are chronic oxidative stress, the reaction of the immune system to damage, the formation of a low-grade chronic systemic inflammation syndrome, a violation of the microcirculation process, and an increase in hypoxic and ischemic processes. The importance of knowledge about the mechanisms of development of endothelial dysfunction, microcirculation disorders, and hypoxia for therapeutic and rehabilitation tactics is emphasized.