The blood that is carried away from the heart to all the parts of the body by the cardiovascularsystem plays a vital role in delivering oxygen and nutrients to all the cells in the body. While the smooth flow of blood without any blockage is crucial to the distribution of nutrients to the tissues and organs, the clotting of blood that develops in an injured blood vessel is a natural and necessary part of the healing process. Normally, bleeding as a result of disease or injury is stopped by the formation of clots, the result of coagulation of the blood, in around five minutes. If the blood clotting–which is embedded in the cardiovascular system of the body by the All-Merciful Lord– occurs, however, as a nonstop transformation of blood into a solid mass, it would then be impossible to survive, as the formation of internal blood clots would block the flow of blood to the vital organs. One would normally expect the blood vessels to become worn out as a result of blood circulation in the cardiovascular system over the years. However, the rapid passage of blood from the blood stream does not result in friction along the interior surface of the blood vessels, as our cardiovascular system has been created perfectly to regulate the smooth flow of blood. The endothelial cells are created in such a way that they play a vital role in preventing any harm by forming a thin layer on the interior surface of all vessels. Earlier, the endothelial cells were thought to be a simple protective layer; now they have become the subject for much research. Blood vessels are made up of two basic cells: the smooth muscle cells and the endothelial cells. The muscle cells are responsible for the strength and tone of the vessels. Today, we know that the role of the endothelial layer goes beyond a simple physical barrier. In addition, there are twenty-five different substances secreted by the endothelial cells that play a role in blood clotting, cell proliferation, the regulation of vessel permeability, and the functioning of the immune system. The endothelial cells are 10-15 μm wide and 20-25 μm long. They are located in the inner vessel wall in a single-cell layer. The total endothelial area in the body of an adult is around 5000-6000m2, and it weighs around 2.5 kg. Endothelial cells during inflammation Capillaries consist of an endothelial structure; they can only be seen under a microscope, but their total length is nearly 96,000 km. The blood brought by the arteries is conveyed to the vein through capillaries. At this stage, the gas, liquids, and nutrients are brought out through the vessels and the cells and tissues around are supplied with oxygen and nutrients. In return, the liquids that they discharge and other waste matter are conveyed to the vein through capillaries. This matter-exchange, which occurs both inside and outside of the capillaries, is regulated thanks to the permeability of the endothelial cell layer and the pressure balance of the capillary system. During cardiac failure and inflammation, liquid release is increased due to a pressure imbalance and the liquid retrieval is not sufficient to make up for the amount lost. This results in swelling in the area in question. Here, we need to underline that inflammation, which appears with symptoms such as edema, redness, fever, and pain, is not a harmful process. On the contrary, it is a miraculous defensive mechanism granted to our body; inflammation protects the body against serious damage. For instance, the inflammation that forms around a bee sting prevents the venom from spreading throughout the body. The endothelial cells are given an important role in the inflammation as well. The chemical molecules secreted by the endothelial cells in the inflamed spot cause the vessels to react by enlarging and thus perfusion is increased. Later, the endothelial layer becomes ready for leukocytes to settle; these are used in neutralizing the substance that caused the inflammation in the first place.

Balancing blood pressure
The layer of smooth muscle cells is stimulated with chemicals secreted by the endothelial cells and the tone of the vessels are controlled through the constriction and relaxation of the vessels. Therefore, an important duty in the regulation of blood pressure is given to these cells. During aninfection, bacteria circulate in the blood stream and the blood pressure falls extremely low. Tissue nutrition is upset (septic shock) and an excess of muscle-relaxing substance is released by the endothelial structure. Veins and arteries become too relaxed and there is a considerable drop in blood pressure (hypotension). On the other hand, with problems like atherosclerosis, the endothelial cells cannot fulfill their duty and due to a deficiency in nitrogen oxide, they become immune to the stimulus to relax the muscles. The resulting problem in this situation is hypertension.

Endothelial cells prevent hemorrhage
In order for a hemorrhage to stop the vessels that are bleeding need to narrow down. This is very important in the first stages of blood loss, particularly when there is a problem with blood clotting. When a hemorrhage begins, the endothelial cells are ordered to excrete a substance called endothelin. This starts the narrowing down of the bleeding vessels. Endothelin is not excreted in normal vessels. When the umbilical cord of a newborn is cut, it prevents the baby from losing blood.

Endothelial cells in blood clotting
The duty of endothelial cells can prevent or facilitate blood clotting, depending on the situation. First of all, they prevent the blood cells from adhering to the vessel walls and prevent clotting inside the vessels. Imagine water flowing through a pipe. The speed of the flow is greater in the center and lower at the periphery. Therefore, in the long run, some residue forms inside the pipe. In the veins and arteries, the flow of blood near the walls is also slower. To prevent the formation of any residue, both the endothelial cells and the blood cells are created with negative loaded surfaces and the blood cells are pushed towards the center. In addition, a substance called prostocyclin (PGI2) is excreted and the thrombocytes change their structure. As a result, residue formation and clotting is prevented along the vessel walls. In a case of any long term damage to the endothelium (e.g. due to smoking, diabetes, or hypertension), the relevant protection mechanism fails, and clotting inside the vessels results in thrombosis. Some serious cases can even necessitate the amputation of a limb. The endothelial cells can also facilitate clotting when necessary. In case of bleeding due to a wound, they function contrarily and help the blood to clot to prevent blood loss.

Endothelial cells in the bone marrow, the liver, and spleen
As a divine blessing, the endothelial cells form a looser layer in these organs and vessel permeability is increased. Thanks to this increase, matter Exchange with blood is easily realized; blood reaches these organs, which are responsible for the constant control of the contents of the blood, easily.

Endothelial cells in the brain and eyes
The endothelial cells in organs like the brain and eyes are very closely integrated forming a barrier between the blood and the organs. This is to such an extent that the major nutrients of the brain, like glucose and oxygen, pass without any obstacles, but several chemicals, including medication, are blocked by the selective-permeability of this protective mechanism. Research has proven that various substances injected into the bloodstream reach almost all the tissues except for the brain. Thanks to the efficient protective mechanism that has been given to these minute cells, the brain is saved from a great deal of negative effects. Even a single cell is not left to chance and nothing happens randomly. As can be seen throughoutthe universe, opposites are made to work hand in hand in the human body as well in a splendid harmony for the continuation of life.

References
Vinay Kumar, Abul K. Abbas, Nelson Fausto, Richard Mitchell, Robbins Basic Pathology, W.B. Saunders; 8th edition, 2007. Hall, John E., Arthur C. Guyton, Textbook of Medical Physiology,

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