The significance of microcirculation disorders and changes in blood rheological characteristics for the development of inflammatory bowel diseases
GASTROENTEROLOGY AND DIETOLOGY
Abstract
The review provides an analysis of literature data on changes in the blood microcirculation system at inflammatory bowel diseases and their impact on the development of general disorders in the body.It explores the consequences of damage to the inner lining of blood vessels (endothelium) and the slowdown in capillary blood flow. These processes are being studied because the hemostasis system and blood fluidity (haemorheology) ensure normal blood supply to tissues, and when these systems are disrupted, perfusion is severely impaired. An analysis of scientific data allows us to draw a clear conclusion: disruptions in microcirculation and a decrease in blood fluidity, primarily due to increased clumping of red blood cells and a loss of their flexibility, play a crucial role in the development of inflammatory bowel diseases. These abnormalities create a vicious cycle: the worse the blood supply to tissues, the more pronounced the tissue ischemia is, and the more severe the inflammation is. This combination causes the disease to worsen.
References
1. Grover Z., De Nardi A., Lewindon P.J. Inflammatory bowel disease in adolescents. Aust Fam Physician. 2017;46(8):565–571.
2. Тяжева А.А., Печкуров Д.В., Романова А.А., Стрепнёв Б.Б., Козарез Е.В. Случай диагностики болезни Крона у ребенка раннего возраста. Практическая медицина. 2018;2 (113):74–76. EDN: YXORSP.
3. Хавкин А.И., Богданова Н.М., Налетов А.В., Мацынина М.А., Ерохина М.И. Воспалительные заболевания кишечника и молочные продукты. Педиатрическая фармакология. 2024;21(5):455–461. https://doi.org/10.15690/pf.v21i5.2800.
4. Ивашкин В.Т., Шептулина А.Ф., Райхельсон К.Л., Лосик Е.А., Ивашкин К.В., Охлобыстин А.В. и др. Аутоиммунные заболевания органов пищеварительной системы. Вестник РАМН. 2015;70(2):139–151. https://doi.org/10.15690/vramn.v70i2.1306.
5. Хавкин А.И., Налётов А.В., Богданова Н.М., Мацынин А.Н. Этиологические предикторы в развитии воспалительных заболеваний кишечника. Вопросы диетологии. 2024;14(4):28–34. https://doi.org/10.20953/2224-5448-2024-4-28-34.
6. Золотова Н.А., Архиева Х.М., Зайратьянц О.В. Эпителиальный барьер толстой кишки в норме и при язвенном колите. Экспериментальная и клиническая гастроэнтерология. 2019;162(2):4–13. https://doi.org/10.31146/1682-8658-ecg-162-2-4-13.
7. Федорова О.В., Федулова Э.Н., Тутина О.А. Эндогенная интоксикация при хронических воспалительных заболеваниях толстой кишки у детей: от патогенеза к лечению. Медицинский альманах. 2008;(3):84–88. EDN: JTXKCB.
8. Федорова О.В., Федулова Э.Н., Тутина О.А., Копейкин В.Н., Коркоташвили Л.В. Патогенетическая сорбционная терапия эндогенной интоксикации воспалительных заболеваний кишечника у детей. Педиатрическая фармакология. 2009;6(5):34–37. EDN: KYLVFN.
9. Румянцев В.Г. Язвенный колит: руководство для врачей. М.: Медицинское информационное агентство; 2009. 424 с.
10. Danese S. Inflammation and the mucosal microcirculation in inflammatory bowel disease: the ebb and flow. Curr Opin Gastroenterol. 2007;23(4):384–389. https://doi.org/10.1097/MOG.0b013e32810c8de3.
11. Deban L., Correale C., Vetrano S., Malesci A., Danese S. Multiple pathogenic roles of microvasculature in inflammatory bowel disease: a Jack of all trades. Am J Pathol. 2008;172(6):1457–1466. https://doi.org/10.2353/ajpath.2008.070593.
12. Kono T., Omiya Y., Hira Y., Kaneko A., Chiba S., Suzuki T., Noguchi M., Watanabe T. Daikenchuto (TU-100) ameliorates colon microvascular dysfunction via endogenous adrenomedullin in Crohn’s disease rat model. J Gastroenterol. 2011;46(10):1187–1196. https://doi.org/10.1007/s00535-011-0438-2.
13. Cibor D., Domagala-Rodacka R., Rodacki T., Jurczyszyn A., Mach T., Owczarek D. Endothelial dysfunction in inflammatory bowel diseases: Pathogenesis, assessment and implications. World J Gastroenterol. 2016;22(3):1067–1077. https://doi.org/10.3748/wjg.v22.i3.1067.
14. Hagel S., Bruns T., Stallmach A., Schmidt C. A confocal view of the intestinal microcirculation in a patient with Crohn disease and portal vein thrombosis. Endoscopy. 2011;43(Suppl 2 UCTN):E126–E127. https://doi.org/10.1055/s-0030-1256161.
15. Harris N.R., Carter P.R., Yadav А.S., Watts M.N., Zhang S., Kosloski-Davidson M., Grisham M.B. Relationship between Inflammation and Tissue Hypoxia in a Mouse Model of Chronic Colitis. Inflamm Bowel Dis. 2011;17(3):742–746. https://doi.org/10.1002/ibd.21423.
16. Тытюк С.Ю., Пихур О.Л., Тишков Д.С., Иорданишвили А.К. Морфофункциональные особенности слизистой оболочки полости рта лиц, страдающих хроническими воспалительными заболеваниями кишечника. Курский научно-практический вестник «Человек и его здоровье». 2016;(3):49–55. https://doi.org/10.21626/vestnik/2016-3/08.
17. Danese S., Fiorino G., Angelucci E., Vetrano S., Pagano N., Rando G. et al. Narrow-band imaging endoscopy to assess mucosal angiogenesis in inflammatory bowel disease: a pilot study. World J Gastroenterol. 2010;16(19):2396–2400. https://doi.org/10.3748/wjg.v16.i19.2396.
18. Рахметов Н.Р., Рахметова К.У., Давилова Ж.А., Каржауов А.Н. Показатели эндотелиальной дисфункции при воспалительных заболеваниях кишечника. Вестник Каз НМУ. 2016;(4):7–11. EDN: YOEUEG.
19. Хлынова О.В., Степина Е.А. Особенности состояния сосудистого эндотелия у лиц с тяжелыми формами воспалительных заболеваний кишечника. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2018;28(5):98–104. https://doi.org/10.22416/1382-4376-2018-28-5-98-104.
20. Winderman R., Rabinowitz S.S., Vaidy K., Schwarz S.M. Measurement of Microvascular Function in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2019;68(5):662–668. https://doi.org/10.1097/MPG.0000000000002252.
21. Hatoum O.A., Miura H., Binion D.G. The vascular contribution in the pathogenesis of inflammatory bowel disease. Am J Physiol Heart Circ Physiol. 2003;285(5):H1791– 1796. https://doi.org/10.1152/ajpheart.00552.2003.
22. Zaidi D., Churchill L., Huynh H.Q., Carroll M.W., Persad R., Wine E. Capillary Flow Rates in the Duodenum of Pediatric Ulcerative Colitis Patients Are Increased and Unrelated to Inflammation. J Pediatr Gastroenterol Nutr. 2017;65(3):306–310. https://doi.org/10.1097/MPG.0000000000001495.
23. Nylund K., Jirik R., Mezl M., Leh S., Hausken T., Pfeffer F. et al. Quantitative contrast-enhanced ultrasound comparison between inflammatory and fibrotic lesions in patients with Crohn’s disease. Ultrasound Med Biol. 2013;39(7):1197–1206. https://doi.org/10.1016/j.ultrasmedbio.2013.01.020.
24. Caliskan Z., Keles N., Gokturk H.S., Ozdil K., Aksu F., Ozturk O. et al. Is activation in inflammatory bowel diseases associated with further impairment of coronary microcirculation? Int J Cardiol. 2016;223:176–181. https://doi.org/10.1016/j.ijcard.2016.08.141. 25. Tian Y., Zheng Y., Teng G., Li J., Wang H. Imbalanced mucosal microcirculation in the remission stage of ulcerative colitis using probe-based confocal laser endomicroscopy. BMC Gastroenterology. 2019;19(1):114. https://doi.org/10.1186/s12876-019-1037-6.
26. Foitzik T., Kruschewski M., Kroesen A., Buhr H.J. Does microcirculation play a role in the pathogenesis of inflammatory bowel diseases? Answers from intravital microscopic studies in animal models. Int J Colorectal Dis. 1999;14(1):29–34. https://doi.org/10.1007/s003840050179. 27. Zhukova N.V., Novgorodtseva T.P. Lipid composition of erythrocytes at cardiovascular and hepatobiliary diseases. Lipids: Categories, Biological functions and metabolism, nutrition and health. NY: Nova Science Publishers; 2010.
28. Miranda M., Balarini M., Caixeta D., Bouskela E. Microcirculatory dysfunction in sepsis: pathophysiology, clinical monitoring, and potential therapies. Am J Physiol Heart Circ Physiol. 2016;311(1):H24–35. https://doi.org/10.1152/ajpheart.00034.2016.
29. Мчедлишвили Г.И. Гемореология в системе микроциркуляции: ее специфика и практическое значение. Тромбоз, гемостаз и реология. 2002;4(12):18–23.
30. Тихомирова И.А., Муравьев А.В. Физиологическая роль и механизмы объединения эритроцитов в агрегаты. Российский физиологический журнал им. И.М. Сеченова. 2007;93(12):1382–1393. EDN: JSCIWF.
31. Соколова И.А. Агрегация эритроцитов. Регионарное кровообращение и микроциркуляция. 2010;9(4):4–26. /Sokolova I.A. Erythrocyte aggregation. Regional Blood Circulation and Microcirculation. 2010;9(4):4–26. (In Russ.)
32. Barshtein G., Ben-Ami R., Yedgar S. Role of red blood cell flow behavior in hemodinamics and hemostasis. Expert Rev Cardiovasc Ther. 2007;5(4):743–752. https://doi.org/10.1586/14779072.5.4.743.
33. Baskurt O.K, Meiselman H.J. Erythrocyte aggregation: basic aspects and clinical importance. Clin Hemorheol Microcirc. 2013;53(1-2):23–37. https://doi.org/10.3233/CH-2012-1573.
34. Левтов В.А., Регирер С.А., Шадрина Н.Х. Реология крови. М.: Медицина; 1982. 272 с. 35. Bishop J.J., Popel A.S., Intaglietta M., Johnson P.C. Rheological effects of red blood cell aggregation in the venous network: a review of recent studies. Biorheology. 2001;38(2-3):263-270.
36. Reinhart W.H., Nagy C. Albumin affects erythrocyte aggregation and sedimentation. Eur J Clin Invest. 1995;25(7): 523–528. https://doi.org/10.1111/j.1365-2362.1995.tb01739.x.
37. Lominadze D., Dean W.L. Involvement of fibrinogen specific binding in erythrocyte aggregation. FEBS Lett. 2002;517(1-3):41–44. https://doi.org/10.1016/s0014-5793(02)02575-9. 38. Ben-Ami R., Barshtein G., Mardi T., Deutch V., Elkayam O., Yedgar S., Berliner S. A synergistic effect of albumin and fibrinogen on immunoglobulin-induced red blood cell aggregation. Am J Physiol Heart Circ Physiol. 2003;285(6):H2663–9. https://doi.org/10.1152/ajpheart.00128.2003.
39. Barshtein G., Tamir I., Yedgar S. Red blood cell rouleaux formation in dextran solution: dependence on polymer conformation. Eur Biophys J. 1998;27(2):177–181. https://doi.org/10.1007/s002490050124.
40. Chien S., Sung L.A. Physicochemical basis and clinical implications of red cell aggregation. Clin Hemorheol Microcirc. 1987;7(1):71–91. https://doi.org/10.3233/СН-1987-7108.
41. Neu B., Meiselman H.J. Depletion-mediated red blood cell aggregation in polymer solutions. Biophys J. 2002;83(5):2482–2490. https://doi.org/10.1016/S0006-3495(02)75259-4. 42. Rampling M.W., Meiselman H.J., Neu B., Baskurt O.K. Influence of cell-specific factors on red blood cell aggregation. Biorheology. 2004;41(2):91–112.
43. Shiga T., Maeda N., Kon K. Erythrocyte rheology. Crit Rev Oncol Hematol. 1990;10(1):9–48. https://doi.org/10.1016/1040-8428(90)90020-s.
44. Martínez M., Vayá A., Gil L., Martí R., Dalmau J., Aznar J. The cholesterol/phospholipid ratio of the erythrocyte membrane in children with familial hypercholesterolemia. Its relationship with plasma lipids and red blood cell aggregability. Clin Hemorheol Microcirc. 1998;18 (4):259–263.
45. Ryazantseva N.V, Novitskii V.V., Stepovaya E.A., Bulavina Y.V., Fokin V.A. Typical changes of reversible erythrocyte aggregation in various pathological processes. Bull Exp Biol Med. 2003;135(1):26–28. https://doi.org/10.1023/a:1023429409048.
46. Ugurlu E., Kilic-Toprak E., Altinisik G., Kilic-Erkek O., Cengiz B., Kucukatay V. et al. Increased erythrocyte aggregation and oxidative stress in patients with idiopathic interstitial pneumonia. Sarcoidosis Vasc Diffuse Lung Dis. 2016;33(4):308–316.
47. Cho Y.I., Mooney M.P., Cho D.J. Hemorheological disorders in diabetes mellitus. J Diabetes Sci Technol. 2008;2(6):1130–1138. https://doi.org/10.1177/ 193229680800200622.
48. Vicaut E. Opposite effects of red blood cell aggregation on resistance to blood flow. J Cardiovasc Surg. 1995;36(4):361–368.
49. Bishop J.J., Nance P.R., Popel A.S., Marcos I., Johnson P.C. Relationship between erythrocyte aggregate size and flow rate in skeletal muscle venules. Am J Physiol Heart Circ Physiol. 2004;286(1):H113–20. https://doi.org/10.1152/ajpheart.00587.2003.
50. Meiselman H.J. In vivo circulatory correlates of altered RBC aggregation. Biorheology. 2002;39(5):636.
51. Popel S., Johnson P.C. Microcirculation and hemorheology. Annu Rev Fluid Mech. 2005;(37):43–69. https://doi.org/10.1146/annurev.fluid.37.042604.133933.
52. Mokken F.C., Kedaria M., Henny C.P., Hardeman M.R., Gelb A.W. The clinical importance of erythrocyte deformability, a hemorrheological parameter. Ann Hematol. 1992;64(3):113–122. https://doi.org/10.1007/BF01697397.
53. Зинчук В.В. Деформируемость эритроцитов: физиологические аспекты. Успехи физиологических наук. 2001;32(3):64–76. EDN: OBUHAU.
54. Nakache M., Caprani A., Dimicoli J., Massonnet S., Peronneau P., Jaulmes B. Relationship between deformability of red blood cells and oxygen transfer: a modelized investigation. Clin Hemoheol. 1983;3(2):177–189.
55. Kikuchi Y., Da Q.W., Fujino T. Variation in red blood cell deformability and possible consequences for oxygen transport to tissue. Microvasc Res. 1994;47(2):222–231. https://doi.org/10.1006/mvre.1994.1017.
56. Cicco G., Pirreli A. Red blood cell (RBC) deformability, RBC aggregability and tissue oxygenation in hypertension. Clin Hemorheol Microcirc. 1999;21(3-4):169–177.
57. Novacek G., Vogelsang H., Genser D., Moser G., Gangl A., Ehringer H., Koppensteiner R. Changes in blood rheology caused by Crohn’s disease. Eur J Gastroenterol Hepatol. 1996;8(11):1089–1093. https://doi.org/10.1097/00042737-199611000-00011.
58. Maharshak N., Arbel Y., Shapira I., Berliner S., Ben-Ami R., Yedgar S. et al. Increased strength of erythrocyte aggregates in blood of patients with inflammatory bowel disease. Inflamm Bowel Dis. 2009;15(5):707–713. https://doi.org/10.1002/ibd.20838.
59. Akman T., Akarsu М., Akpinar H., Resmi H., Taylan E. Erythrocyte deformability and oxidative stress in inflammatory bowel disease. Dig Dis Sci. 2012;57(2):458–464. https://doi.org/10.1007/s10620-011-1882-9.
60. Yakar T., Cosar A.M., Gokturk H.S., Kanat U.G., Parlakgumus A., Kozanoglu I., Serin E. Plasma viscosity: a potential predictor of both medical treatment response and clinical stage of ulcerative colitis. Ann Ital Chir. 2016;87:531–543.



