Vital signs of endothelium

Book published in the United States by researchers from Brazil and other countries analyzes the role of the endothelium in health and as a signaler of cardiovascular diseases, cancer and cognitive problems.

By Maria Fernanda Ziegler  |  Agência FAPESP – The endothelium is an organ that lines the vascular system and balances the dilation and contraction of blood vessels, coagulation and anticoagulation, and other processes and hence is fundamental to the circulation of the blood. It also acts as an important signaler of diseases such as cancer, atherosclerosis, heart failure, and cognitive problems.

This complex role is detailed in the book Endothelium and Cardiovascular Diseases – Vascular Biology and Clinical Syndromes, published in the United States by Elsevier for practicing physicians, graduate students, undergraduates and researchers.

This book is an English translation and expanded edition of Endotélio e Doenças Cardiovasculares (Atheneu, 2005), which won the Jabuti, Brazil’s most prestigious book award. It contains new chapters and contributions from such internationally renowned scientists as Peter Libby, PK Shah, Noel Bairez, Emilio Ross, Salvador Moncada, and Valentin Fuster. The publication of the book was supported by Banco Bradesco and Fundação Zerbini.

“Most of the chapters are by leading Brazilian researchers, many of whose studies have funding from FAPESP or have had in the past,” said Protásio Lemos da Luz, Senior Full Professor at the University of São Paulo Medical School (FM-USP) in Brazil, Senior Researcher at FM-USP’s Heart Institute (InCor), and one of the book’s editors.

The other editors are Peter Libby, Mallinckrodt Professor of Medicine at Harvard Medical School (USA); Antonio Carlos Palandri Chagas, Professor at ABC Medical School (São Paulo State, Brazil); and InCor researcher Francisco Rafael Martins Laurindo.

The book has 50 chapters, increased from 30 in the original edition published in Brazil. The first 15 cover endothelial physiology and structure in considerable depth, including intimal genetic, cellular and molecular biology mechanisms, as well as the role of nitric oxide and other endothelial products. The other 35 chapters discuss alterations in the endothelium in clinical situations.

“They address methods of investigation, age and aging, stress, arterial hypertension, heart failure, atherosclerosis, coronary disease, and interventions such as angioplasty and surgery, among others. The association between endothelial functioning and diet is also addressed. Two more chapters address noncardiovascular diseases,” Lemos da Luz said.

One of the chapters on noncardiovascular diseases focuses on eclampsia, a complication of preeclampsia during pregnancy. The other addresses the link between nitric oxide and cancer. “It’s been shown that eclampsia starts basically with endothelial dysfunction,” Lemos da Luz explained. “In cancer, the endothelium plays a key role in tumor propagation. Nitric oxide, produced in the endothelium, is both a mediator and a signaler of metastasis.”

There is a clear link between endothelial dysfunction and problems such as heart attack or acute coronary syndrome. “In these cases, an alteration initially occurs in the endothelium, which ceases to be a continuous membrane and is damaged, facilitating thrombosis and heart disorders,” Lemos da Luz said.

The book also highlights the role of the endothelium role in atherosclerosis. The organ participates decisively in all stages of the narrowing of arteries due to plaque buildup on the artery walls, including the evolution and complications of the disease.

Nitric oxide

The endothelium, the layer of cells that line the intimal or innermost surface of blood vessels, interfaces with the entire organism, forming an extensive organ with many functions. The Nobel Prize in Physiology or Medicine for 1998 was awarded to Robert F. Furchgott, Louis J. Ignarro and Ferid Murad “for their discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system”. 

“More than 20 years ago, we knew nothing about the role of the endothelium in the cardiovascular system,” Lemos da Luz said. “Now we know that nitric oxide is the most important of its products, not least because of the therapeutic substances derived from it, such as type-5 phosphodiesterase inhibitors, which improve sexual function.”

Sexual stimulants such as Viagra, for example, act via endothelial nitric oxide release, which causes vasodilation. The widening of blood vessels is the basis for blood flow as well as for these drugs.

According to Lemos da Luz, there are techniques that can be used to analyze endothelial functions. “They aren’t simple or used routinely in clinical work, but they’re increasingly used in research. The suggestion is that early identification of endothelial dysfunction in the initial stages has prognostic value,” he said.

Both the physiological and pathological dimensions of the endothelium are covered in depth in Endothelium and Cardiovascular Diseases. “The book is designed for use by researchers and graduate and undergraduate students as well as clinicians. It has immediate application for professionals who work in clinical practice and deliver physiopathological treatment. Every chapter analyzes the physiopathological mechanisms that constitute the basis for endothelial functions,” Lemos da Luz explained.

Another aspect of the book he highlighted is the link between basic knowledge and clinical phenotypes. “It goes far beyond mere description of circulatory phenomena such as vasodilation and above all discusses how to understand the cellular and subcellular phenomena essential to the functioning of the endothelium and its pathologies,” he said.

Endothelium and Cardiovascular Diseases 
Editors: Protasio da Luz, Peter Libby, Antonio Chagas, Francisco Laurindo 
Published: 2018 
Publisher: Elsevier 
Price: USD 170.00 
Pages: 758 
More information: www.elsevier.com/books/endothelium-and-cardiovascular-diseases/da-luz/978-0-12-812348-5