Regulation of Vascular Smooth Muscle Relaxation by the Endothelium in Health and in Diabetes (with a Focus on Endothelium-Derived Hyperpolarizing Factor)

Amongst its wide repertoire of functions, the vascular endothelium plays a pivotal role in the regulation of vascular smooth muscle tone and ultimately tissue perfusion. In healthy vessels, the endothelium exerts a vasodilator influence on the underlying smooth muscle cells. In diabetes mellitus, endothelium-dependent vasodilation is impaired in various vascular beds and may contribute to the increased vascular tone and reduced tissue perfusion, which are features of this disease. There are regional variations in the extent of endothelial vasodilator dysfunction in diabetes, and the basis for this variation has yet to be resolved. The complement of vasodilators involved in endothelium-dependent relaxation varies in different vascular beds. In larger arteries and conduit vessels, the role of nitric oxide (NO) has been the focus of human and animal studies on diabetes. Small arteries and arterioles are important in the local regulation of tissue perfusion, and in many of these, another endothelial vasodilator, endothelium-derived hyperpolarizing factor (EDHF), plays an increasingly prominent role in overall endothelium-dependent relaxation. Surprisingly few studies have explored the influence of diabetes on EDHF; however, there is emerging evidence from a diverse range of vascular beds that the actions of EDHF are seriously compromised in diabetes. Vascular disease remains the leading cause of morbidity and mortality associated with diabetes mellitus. A better understanding of the regional differences and mechanisms involved in endothelial function and dysfunction in small arteries may reveal new strategies to aid in the prevention and/or therapeutic management of the vascular complications of diabetes mellitus.