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Differences in vascular permeability between normal tissue and a tumor. Vascular permeability, often in the form of capillary permeability or microvascular permeability, characterizes the capacity of a blood vessel wall to allow for the flow of small molecules (drugs, nutrients, water, ions) or even whole cells (lymphocytes on their way to the site of inflammation) in and out of the vessel.
Excessive or prolonged increases in permeability of the endothelium, as in cases of chronic inflammation, may lead to tissue swelling . Altered barrier function is also implicated in cancer extravasation. [6] Endothelial cells are involved in many other aspects of vessel function, including: Blood clotting (thrombosis and fibrinolysis).
The permeability of a capillary wall is determined by the type of capillary and the surface of the endothelial cells. A continuous, tightly spaced endothelial cell lining only permits the diffusion of small molecules. Larger molecules and blood cells require adequate space between cells or holes in the lining.
Timing is important to wound healing. Critically, the timing of wound re-epithelialization can decide the outcome of the healing. [11] If the epithelization of tissue over a denuded area is slow, a scar will form over many weeks, or months; [12] [13] If the epithelization of a wounded area is fast, the healing will result in regeneration.
Diffusion through the capillary walls depends on the permeability of the endothelial cells forming the capillary walls, which may be continuous, discontinuous, and fenestrated. [4] The Starling equation describes the roles of hydrostatic and osmotic pressures (the so-called Starling forces ) in the movement of fluid across capillary endothelium .
However, the endothelial barrier is subjected to damage as a result of viral infection. Therapeutics that enhance or regain the integrity endothelial barrier after it has been damaged have been considered as potential targets for emerging infectious diseases like COVID-19, Ebola, Dengue fever, and more.
Pericytes stabilize and monitor the maturation of endothelial cells by means of direct communication between the cell membrane as well as through paracrine signaling. [14] A deficiency of pericytes in the central nervous system can cause increased permeability of the blood–brain barrier. [6]
Endothelial dysfunction may be involved in the development of atherosclerosis [5] [6] [7] and may predate vascular pathology. [ 5 ] [ 8 ] Endothelial dysfunction may also lead to increased adherence of monocytes and macrophages , as well as promoting infiltration of low-density lipoprotein (LDL) in the vessel wall. [ 9 ]