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Stress failure of pulmonary capillaries: role in lung and heart diseasePulmonary capillaries have extremely thin walls to allow rapid exchange of respiratory gases across them. Recently it has been shown that the wall stresses become very large when the capillary pressure is raised, and in anaesthetised rabbits, ultrastructural damage to the walls is seen at pressures of 40 mm Hg and above. The changes include breaks in the capillary endothelial layer, alveolar epithelial layer, and sometimes all layers of the wall. The strength of the thin part of the capillary wall can be attributed to the type IV collagen in the extracellular matrix. Stress failure of pulmonary capillaries results in a high-permeability form of oedema, or even frank haemorrhage, and is apparently the mechanism of neurogenic pulmonary oedema and high-altitude pulmonary oedema. It also explains the exercise-induced pulmonary haemorrhage that occurs in all racehorses. Several features of mitral stenosis are consistent with stress failure. Overinflation of the lung also leads to stress failure, a common cause of increased capillary permeability in the intensive care environment. Stress failure also occurs if the type IV collagen of the capillary wall is weakened by autoantibodies as in Goodpasture's syndrome. Neutrophil elastase degrades type IV collagen and this may be the starting point of the breakdown of alveolar walls that is characteristic of emphysema. Stress failure of pulmonary capillaries is a hitherto overlooked and potentially important factor in lung and heart disease.
Document ID
20050000605
Acquisition Source
Legacy CDMS
Document Type
Reprint (Version printed in journal)
Authors
West, J. B.
(University of California San Diego La Jolla 92093-0623)
Mathieu-Costello, O.
Date Acquired
August 22, 2013
Publication Date
September 26, 1992
Publication Information
Publication: Lancet
Volume: 340
Issue: 8822
ISSN: 0140-6736
Subject Category
Life Sciences (General)
Funding Number(s)
CONTRACT_GRANT: HL17331-17
Distribution Limits
Public
Copyright
Other
Keywords
Review
NASA Discipline Cardiopulmonary
Review, Tutorial
Non-NASA Center

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