Browsing by Author "Kumar, Ananda"

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    Endothelial dysfunction in diabetes and impact of therapeutic approaches
    (Nova Science Publishers, Inc., 2014) Mishra, Manish; Kumar, Ananda; Dwivedi, Amit Nandan Dhar
    The endothelium is a thin mono-cellular layer which covers the inner surface of the blood vessels, separating the circulating blood from the tissues and also has the responsibility for uninterrupted maintenance of circulation to all the vital tissues. The endothelial cells originate from mesodermal progenitor and an adult man accounts for over 700 grams of endothelial cells from all blood vessels. Endothelium is a very active organ, it works as a receptor-effector organ and responds to each physical or chemical stimulus with the release of the appropriate substance with which it may maintain vasomotor balance and vascular-tissue homeostasis. It has the property of producing, independently, both agonistic and antagonistic substances that help to keep homeostasis and its function is not only autocrine, but also paracrine and endocrine. In this way it modulates the vascular smooth muscle cells producing relaxation or contraction, and therefore vasodilatation or vasoconstriction. The vascular endothelium is vulnerable to maximum wear and tear due to its positioning and requires prompt regeneration of the cells. Whenever the imbalance between substances with vasodilating, antimitogenic, and antithrombogenic properties and substances with vasoconstricting, prothrombotic and proliferative characteristics takes place, it causes a pathological condition known as endothelial dysfunction. These substances intervenes in cell proliferation and migration, in leukocyte adhesion and activation and in immunological and inflammatory processes, further which is responsible for apoptosis of vascular endothelial cells resulting in overall endothelial dysfunction and vasculopathy. On the basis of several studies, it?s clear that endothelial dysfunction in the periphery and in the coronary arteries contributes to the initiation and progression of atherosclerosis and could be considered an independent vascular risk factor. The process of atherosclerosis begins early in life, progresses silently through a long preclinical stage, and eventually manifests clinically, usually from middle age. Both type 1 and 2 diabetes like metabolic syndrome and other cardiovascular risk factors determine an abnormal endothelium response thought to precede the development of atherosclerosis and its also known to have independent risk factors for coronary heart disease, stroke, and peripheral arterial disease. Diabetes has been depicted as augmented oxidative stress and inflammatory markers with proinflammatory and proatherogenic properties. The impressive correlation between coronary artery disease and alterations in glucose metabolism has raised the hypothesis that atherosclerosis and diabetes may share common antecedents. The macro-vascular atherosclerosis can precede the development of diabetes, suggesting that rather than atherosclerosis being a complication of diabetes, both conditions may share genetic and environmental antecedents, a "common soil". An important corollary to the hypothesis that endothelial dysfunction contributes to the pathogenesis of CVD is the idea that reversing endothelial dysfunction will reduce risk. Although this corollary has not been tested directly, numerous studies have shown impact of lifestyle modification, dietary modifications, and anti-diabetics to the improvement in endothelial functions and many of these same interventions are known to limit cardiovascular risk. © 2014 by Nova Science Publishers, Inc. All rights reserved.