Endothelium protection by the glycocalyx

Abstract

Sepsis is still a major cause of elevated mortality rate in the intensive care unit. Endothelial cell function plays a key role in this pathophysiological process. Recent studies provide evidence that degradation of glycocalyx on the luminal cell membrane is an early step in endothelial dysfunction. The glycocalyx is composed of negatively charged glycoproteins, discovered by electron microscopy more than 40 years ago. The glycocalyx is a key determinant of vascular function regulating vascular permeability and interactions with peripheral blood cells. During sepsis, the glycocalyx may be degraded to various components including heparan sulfate and syndecan-1 that are released into the bloodstream. However, functional assessment and visualization of glycocalyx are still complex to establish. Preservation of glycocalyx could be a future therapeutic target for treatment. Therefore, development of therapeutic strategies to maintain and/or repair the glycocalyx may become a research focus in the management of septic patients.