Abstract
The unique physiologic properties of the pulmonary vasculature allow it to play a highly active role in optimizing gas exchange. The process of gas exchange requires both alveolar ventilation and capillary perfusion; however, in certain disease states, including pneumonia and atelectasis, the distribution of either ventilation or perfusion is altered, creating a situation of ventilation-perfusion (V/Q) mismatch. The physiologic property of hypoxic pulmonary vasoconstriction (HPV) allows the pulmonary vasculature to partially correct for this mismatch by shunting blood away from poorly ventilated alveoli. However, although HPV improves oxygenation acutely, when uncontrolled or uncoupled, this adaptive response can have devastating consequences including vascular remodeling and ultimately pulmonary hypertension (PH). Additionally, in order for efficient gas exchange to take place, the body has evolved an extremely thin blood-gas barrier with a vast surface area; however, these structural properties also pose an additional challenge to the vasculature in terms of maintaining barrier function. The integrity of the endothelial monolayer is critical to fluid balance across the lung, and its disruption can lead to vascular leak, impaired gas exchange, and ultimately multisystem organ failure, characteristic of the acute respiratory distress syndrome (ARDS). Lastly, the proximity of the lung vasculature to the outside environment makes the lung highly susceptible to inflammatory processes caused by inhalation of microorganisms and inorganic particulate matter. Thus, the pulmonary endothelium plays a key role in modulating inflammation and hemostasis in order to contain infections, repair damaged vasculature, and prevent thrombosis. In this chapter we will describe the physiologic mechanisms underlying the contribution of the pulmonary vasculature to the processes of V/Q matching, barrier maintenance, inflammation, and hemostasis.
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Abbreviations
- AA:
-
Arachidonic Acid
- AJ:
-
Adherens Junction
- ALI:
-
Acute Lung Injury
- APC:
-
Activated Protein C
- ARDS:
-
Acute Respiratory Distress Syndrome
- ATP:
-
Adenosine Triphosphate
- CaM:
-
Calmodulin
- Cav-1:
-
Caveolin-1
- CD:
-
Cluster Differentiation
- DIC:
-
Disseminated Intravascular Coagulation
- ECM:
-
Extracellular Matrix
- eNOS:
-
Endothelial Nitric Oxide Synthase
- EPCR:
-
Endothelial Protein C Receptor
- ETC:
-
Electron Transport Chain
- FA:
-
Focal Adhesion
- GJ:
-
Gap Junction
- H2O2 :
-
Hydrogen Peroxide
- HIF:
-
Hypoxia-Inducible Factor
- HPV:
-
Hypoxic Pulmonary Vasoconstriction
- I-CAM:
-
Intercellular Adhesion Molecule
- JAM:
-
Junctional Adhesion Molecule
- K2P :
-
Two-Pore Potassium Channel
- KCa :
-
Calcium-Sensitive Potassium Channel
- Kf,c :
-
Filtration Coefficient
- Kir :
-
Inward Rectifier Potassium Channel
- KO:
-
Knockout
- Kv :
-
Voltage-Gated Potassium Channel
- IFN:
-
Interferon
- IL:
-
Interleukin
- LPS:
-
Lipopolysaccharide
- MAPK:
-
Mitogen-activated Protein Kinase
- MLC:
-
Myosin Light Chain
- MLCK:
-
Myosin Light Chain Kinase
- nmMLCK:
-
Nonmuscle Myosin Light Chain Kinase
- NO:
-
Nitric Oxide
- PA :
-
Alveolar Pressure
- Pa :
-
Arterial Pressure
- PAO2 :
-
Alveolar Partial Pressure of Oxygen
- PAI-1:
-
Plasminogen Activator Inhibitor 1
- PAMP:
-
Pathogen-Associated Molecular Pattern
- PASMC:
-
Pulmonary Artery Smooth Muscle Cell
- PE-CAM:
-
Platelet Endothelial Cellular Adhesion Molecule
- PGI2 :
-
Prostacyclin
- PH:
-
Pulmonary Hypertension
- pMLC:
-
Phosphorylated Myosin Light Chain
- Pv :
-
Venous Pressure
- ROS:
-
Reactive Oxygen Species
- S1P:
-
Sphingosine 1-Phosphate
- SNP:
-
Single Nucleotide Polymorphism
- SOD:
-
Superoxide Dismutase
- TF:
-
Tissue Factor
- TFPI:
-
Tissue Factor Pathway Inhibitor
- TJ:
-
Tight Junction
- TNF:
-
Tumor Necrosis Factor
- tPA:
-
Tissue Plasminogen Activator
- TLR4:
-
Toll-Like Receptor 4
- V/Q:
-
Ventilation/Perfusion
- V-CAM:
-
Vascular Cellular Adhesion Molecule
- VDCC:
-
Voltage-Dependent Calcium Channel
- VEGF:
-
Vascular Endothelial Growth Factor
- vWF:
-
von Willebrand Factor
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Rizzo, A.N., Fraidenburg, D.R., Yuan, J.XJ. (2014). Pulmonary Vascular Physiology and Pathophysiology. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_202-1
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DOI: https://doi.org/10.1007/978-3-642-37393-0_202-1
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