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Semin Thromb Hemost 2010; 36(3): 223-224
DOI: 10.1055/s-0030-1253444
FOREWORD

© Thieme Medical Publishers

Under-Recognized Significance of Endothelial Heterogeneity: Hemostasis, Thrombosis, and Beyond

Emmanuel J. Favaloro1
  • 1Department of Haematology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW Australia
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Publication History

Publication Date:
20 May 2010 (online)

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Welcome to another issue of Seminars in Thrombosis and Hemostasis. In this issue, William Aird and Hau C. Kwaan have gathered together a collection of articles that review several different aspects of the endothelium, both within and beyond a role in hemostasis and thrombosis. This issue will therefore provide valuable resource material for readers from many different disciplines. Seminars in Thrombosis and Hemostasis last featured endothelial cells in an entire issue in the year 2000.[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] Accordingly, the current issue, some 10 years later, is certainly timely. That last issue, guest edited by Peter Nawroth, was entitled “Endothelial Dysfunction.” Interestingly, and perhaps fittingly, one of the guest editors to the current issue, William Aird, also contributed an article[2] to that earlier issue. Hau C. Kwaan has contributed extensively to Seminars in Thrombosis and Hemostasis, last guest editing an issue in 2007, “Hemostatic Dysfunction in Malignant Hematologic Diseases.”[13] Indeed, as a longtime supporter of this journal, Dr. Kwaan first guest edited an issue in 1990, “Clinical Aspects of Fibrinolysis.”

The content of the current issue is summarized appropriately by the guest editors in their introduction,[14] but I would like to add a few words to further highlight the importance of this issue. As we all know, the endothelial cell layer provides the interface between the blood and various tissues and organs. Understanding how a basic endothelial cell can differentiate into and then function as site-specific specialized cells is essential for appreciating the complexity of endothelial disorders and providing more focused treatments for site-specific disorders. As noted throughout this issue, the importance of endothelial heterogeneity can be seen at many levels. For example, although coronary artery disease is one example of a disease that targets the arterial endothelium, some arterial endothelial cells, such as the coronary arteries, are athero-susceptible, whereas other arterial endothelial cells, such as the iliac arteries, are athero-resistant.[15] As another example, vascular defects in the blood-brain barrier are associated with Alzheimer's disease.[16] Endothelial cells actively engage in inflammatory diseases by recruitment of leukocytes from the blood via the production of thrombotic factors, cytokines, chemokines, adhesion molecules, and other proteins; however, endothelial cell heterogeneity will confer different outcomes at different anatomical sites. Thrombotic thrombocytopenic purpura, bone marrow–associated thrombotic microangiopathy, and hemolytic uremic syndrome are all characterized by platelet sequestration and thrombosis in the renal, cerebral, and most other microvascular beds except those of the liver and lung.

William Aird nicely summarizes the state of affairs in his article: “In the final analysis, there is not a single disease that affects each and every blood vessel of the vascular tree. In summary, far from being a giant monopoly of cells, the endothelium represents a consortium of smaller enterprises of cells located within blood vessels of different tissues. Although united in certain functions, each enterprise is uniquely adapted to meet the demands of the underlying tissue.”[17]

In terms of treatment of disease, then, it becomes clear that one treatment does not fit all. Thus treatments that affect all endothelium will target disease-unaffected (or so-called healthy) sites as well as so-called diseased sites; this is both inefficient and undesirable. Disease treatment is best targeted specifically to diseased or disease-susceptible sites, and this can only be achieved by an understanding of endothelial heterogeneity.

This particular issue of Seminars in Thrombosis and Hemostasis is timely for an additional reason to that previously noted, being published just after the issue “Platelets, Inflammation and Cardiovascular Diseases.”[18] Platelets and endothelium are a marriage made in heaven during health but a devastating combination in disease. I would like to thank both William Aird and Hau C. Kwaan for putting together this excellent issue, and I hope that our readers enjoy its many treasures.

REFERENCES

Emmanuel J FavaloroPh.D. M.A.I.M.S. 

Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital

SWAHS, Westmead, NSW, 2145, Australia

Email: emmanuel.favaloro@swahs.health.nsw.gov.au

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