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J Appl Physiol 105: 380, 2008; doi:10.1152/japplphysiol.00181.2008
8750-7587/08 $8.00
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LETTER TO THE EDITOR

Commentary on Viewpoint: The human cutaneous circulation as a model of generalized microvascular function

SKIN AND MICROCIRCULATION

to the editor: The microvasculature supplies nutrients and oxygen, removes metabolites and CO2, and maintains an adequate hydrostatic pressure in tissues.

Impaired tissue perfusion via the microcirculatory network is a factor common to chronic conditions, including hypertension, obesity, and diabetes, and may underlie much of the tissue and organ dysfunction related to associated ischemic complications (2). Impaired vasodilatory function and structural changes such as remodeling and rarefaction of the microvascular network may reduce blood flow and decrease the blood:tissue exchange. There is evidence that microvascular abnormality may be important in the development and maintenance of the elevated peripheral vascular resistance and glucose resistance associated with hypertension, obesity, and diabetes (6). The very first indication along this line dates back to 1933, when an abnormally low number of small conjunctival vessels was found in hypertensive patients (5). There is now evidence that capillary rarefaction in the skin may antedate the clinical onset of essential hypertension and even in normotensive subjects with familial predisposition to the disease (4). Finally, in hypertensive patients, whether treated or not, the Framingham score for cardiovascular risk was negatively correlated to capillary density (1).

The cutaneous circulation is a unique site allowing simple, noninvasive and reproducible assessment of capillary density and endothelial function. If, as convincingly pointed out by Holowatz and colleagues (3), the cutaneous circulation is a valuable model of generalized microcirculation; its study is a stimulating and potentially fruitful challenge.

FOOTNOTES


Address for reprint requests and other correspondence: B. I . Lévy (e-mail: levy{at}larib.inserm.fr)

REFERENCES

  1. Debbabi H, Uzan L, Mourad JJ, Safar M, Levy BI, Tibirica E. Increased skin capillary density in treated essential hypertensive patients. Am J Hypertens 19: 477–483, 2006.[CrossRef][Web of Science][Medline]
  2. Feihl F, Liaudet L, Waeber B, Levy BI. Hypertension: a disease of the microcirculation? Hypertension 48: 1012–1017, 2006.[Free Full Text]
  3. Holowatz LA, Thompson-Torgenson CS, Kenney WL. Viewpoint: The cutaneous circulation as a model of generalized microvascular function. J Appl Physiol; doi:10.1152/japplphysiol.00858.2007.[Free Full Text]
  4. Noon JP, Walker BR, Webb DJ, Shore AC, Holton DW, Edwards HV, Watt GC. Impaired microvascular dilatation and capillary rarefaction in young adults with a predisposition to high blood pressure. J Clin Invest 99: 1873–1879, 1997.[Web of Science][Medline]
  5. Ruedemann AD. Conjunctival vessels. J Am Med Ass 101: 1477–1481, 1933.[Abstract/Free Full Text]
  6. Serné EH, de Jongh RT, Eringa EC, Ijzerman RG, Stehouwer CD. Microvascular dysfunction: a potential pathophysiological role in the metabolic syndrome. Hypertension 50: 204–211, 2007.[Free Full Text]

Bernard I. Lévy
 Physiology, Non-Invasive Investigation, Inserm U689, Hôpital Lariboisière, Paris, France





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