Microcirculation: Revolutionizing medical treatment

The human body is such a complex creation with all the tissues and cells functioning in a highly coordinated manner to maintain health. Essential nutrients and gases in the blood and other tissue fluids, get distributed to all the cells through circulation. When we hear circulation, we always have in mind the big blood vessels supplying the various organs of the body. Little do we realize that the circulation goes much deeper into what is now known as "microcirculation."

Microcirculation involves the flow of blood and other tissue fluids, especially – though not exclusively – in the tiny blood vessels. It cannot be seen grossly by the naked eye. The complex structure and processes of microcirculation are only seen and appreciated using sophisticated types of high-resolution microscopes. It is at this level where most processes involved in normal bodily function take place. It is through microcirculation that every living cell and tissue of the body get nourished so they can function normally.

This is where one can appreciate the beauty of God’s creation. Microscopically infinitesimal as the cell might seem, it is basically the key to health and disease. A problem in microcirculation can lead to a malfunction of cells, which can lead to a failure of one organ, the entire system of organs and ultimately, death of the entire body. A perfect example is the classical shock syndrome, where there is total circulatory collapse and multi-organ failure. It all starts as a problem in microcirculation.

Because it is micro in dimension, one might think that microcirculation cannot measure to any size comparable to other organs of the body like the heart, lungs or kidneys. It is said that if one were to spread the microcirculation on the ground, all its cells will be sufficient to cover two tennis courts. In this regard, many consider it as the biggest organ of the body.

Once regarded as a passive receptacle for nutrient exchange, it is now accepted that microcirculation determines what happens in the bigger circulation – called systemic circulation. If microcirculation is significantly compromised, one may even develop circulatory shock which reflects a breakdown of the entire circulation.

When it was first described by Claude Bernard as the "milieu internal" more than 75 years ago, there was not much enthusiasm in the field of microcirculation and it was mainly relegated to the background with only academic intellectuals pursuing further studies to know more about it. Over the last two decades, the enthusiasm has picked up considerably and many scientists and physicians now recognized it as the core foundation of clinical and applied medicine.

During the 4th Asian Congress for Microcirculation held in 2000, it was concluded that a comprehensive understanding of microcirculation is the gateway for various health solutions in this millennium. This conclusion is not without good basis. Problems in microcirculation inevitably leads to disease in the cardiovascular, gastrointestinal, immune, neurologic, endocrine, reproductive and all the systems in the body. Consequently, treatment of all these diseases necessarily entail protecting and maintaining the integrity of microcirculation.

When microcirculation falters, many pathological or disease-producing processes take place and this explains why diseases develop. Initially, this leads to ischemia or a lack of oxygenation and nourishment of the organs, but if uncorrected, it leads to malfunction and ultimately shutdown of vital organs such as the heart, brain, lungs and kidneys.

Many pharmaceutical breakthroughs in the last decade have been based on research studies on microcirculation. Acquired knowledge on this field of medicine is already revolutionizing treatment for serious diseases such as shock syndrome, diabetes, atherosclerosis, heart attack, stroke, cancers, erectile dysfunction or impotence, and diseases in the kidneys and gastrointestinal tract.

Not only is microcirculation the basis of many drug therapies, it is also proving to be the key of all interventions to prevent and control most disease processes. A healthy microcirculation somehow equates to good health.

It is heartening to note that the microcirculation field is now getting the attention and respect it truly deserves. It is no longer the obscure science that it used to be. Practicing physicians and scientists are taking keen interest in it, realizing its importance in any living organism.

The Philippine Chapter of the Asian Union for Microcirculation (PhilAUM) was organized in March 2000 to encourage the development of microcirculatory science. To achieve this, the society promotes and supports the conduct and dissemination of basic clinical research in this field.

Specifically, the PhilAUM encourages and helps young scientists and clinicians to join this field by providing research grants for investigative studies, study grants for visits to other institutions to learn new techniques, and travel grants for presenting and disseminating the results of these researches. The society has been supporting various educational and research activities in the field of microcirculation.

The PhilAUM is hosting the 5th Asian Congress for Microcirculation at the Westin Philippine Plaza on Feb. 20-22, where specialists from all over Asia will exchange ideas and insights on the rapid developments on microcirculation.

PhilAUM president Dr. Xenia Tigno assures that the congress will cover a variety of scientific offerings for almost all medical specialties, including neurology, endocrinology, gastroenterology, neurosurgery, vascular surgery, cardiology and basic medical sciences. (Those who would like to register for the congress may contact the secretariat at 400-9483 or e-mail [email protected].)

So much has been known about microcirculation, but there are still so many unanswered questions. With continuing research and educational fora on this field, it is hoped that the previously yawning gap between it and its clinical application will be narrowed down. When that is achieved, prevention of many diseases is likely and growing to a ripe old age may no longer be such an uncertain goal.

(Dr. Camilo Roa is a professor at the University of the Philippines College of Medicine, the current vice president of the PhilAUM and a member of the CHARTER Advisory Board. Dr. Rafael Castillo is the current president and executive director of CHARTER, an acronym for Clinical Hypertension and Atherosclerosis Research on Therapies, Epidemiology and Risk-management, a non-stock, non-profit research foundation which promotes healthy lifestyle changes in the prevention of many common medical problems. It is based at the Manila Adventist Medical Center. Free membership is open to health-conscious medical, paramedical and lay individuals. For an archive of health-related topics and to register as a member, log on to www.chartermamc.org.)