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J Appl Physiol 105: 385, 2008; doi:10.1152/japplphysiol.90314.2008
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LETTER TO THE EDITOR

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

TO THE EDITOR: It is accepted that a single test is unlikely to be able to provide a measure of vascular function that is truly representative of general arterial function and of the microcirculation. Holowatz and colleagues (4) in their Viewpoint article effectively highlight the ability to obtain a generalized measure of microvascular function by using the cutaneous circulation as a surrogate. An important point they discussed is that methodologies used to explore the cutaneous microcirculation evoke an integrated vascular response, which represents in vivo human integrative physiology that is not unique to the cutaneous microvascular bed. Thus, when used in the correct manner, and accounting for the possible endothelial, neural, and smooth muscle pathways involved (3), the skin circulation offers great potential as a valuable, easily accessible site for monitoring the development and progression of microvascular dysfunction (5), and for characterizing overall cardiovascular risk (6). Techniques such as flow-mediated dilatation of the brachial artery provide valuable information of the role of endothelial function in vascular disease (2). However, the methodology in obtaining such measurements with adequate sensitivity and accuracy requires technical expertise and is highly operator dependent, making its applicability challenging in a clinical setting. The strive to provide vascular testing as a realistic approach to improving cardiovascular risk assessment depends on the ability to make relatively simple, operator independent assessments of the vasculature. Methods for probing the skin microvasculature, such as those using laser-Doppler technology, offer such potential (1).

FOOTNOTES


Address for reprint requests and other correspondence: F. Khan, Univ. Dundee, Dundee, UK (e-mail: f.khan{at}dundee.ac.uk)

REFERENCES

  1. Binggeli C, Spieker LE, Corti R, Sudano I, Stojanovic V, Hayoz D, Lüscher TF. Statins enhance postischemic hyperaemia in the skin circulation of hypercholesterolemic patients. A monitoring test of endothelial dysfunction for clinical practice? J Am Coll Cardiol 42: 71–77, 2003.[Abstract/Free Full Text]
  2. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel J. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery. A Report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 39: 257–265, 2002.[Abstract/Free Full Text]
  3. Cracowski JL, Minson CT, Salvat-Melis M, Halliwill JR. Methodological issues in the assessment of skin microvascular endothelial function in humans. Trends Pharmacol Sci 27: 503–508, 2006.[CrossRef][Medline]
  4. Holowatz LA, Thompson-Torgerson CS, Kenney WL. The human cutaneous circulation as a model of generalized microvascular function. J Appl Physiol; doi:10.1152/japplphysiol.00858.2007.[Free Full Text]
  5. Khan F, Elhadd TA, Greene SA, Belch JJF. Impaired skin microvascular function in children, adolescents, and young adults with type I diabetes. Diabetes Care 23: 215–220, 2000.[Abstract]
  6. Kruger A, Stewart J, Sahityani R, O'Riodan E, Thompson C, Adler S, Garrick R, Vallance P, Goligorsky MS. Laser Doppler flowmetry detection of endothelial dysfunction in end-stage renal failure patients: correlation with cardiovascular risk. Kidney Int 70: 157–164, 2006.[CrossRef][Web of Science][Medline]

Faisel Khan
 University of Dundee, Dundee, United Kingdom





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