GlycoCheck: 117 papers
Peer-reviewed work on the endothelial glycocalyx, microvascular health and the ingredients in our formulas, newest first. Abstracts are indexed here and every paper links to the journal.
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Published paper
Effects of a single aerobic exercise on perfused boundary region and microvascular perfusion: a field study
This observational field study measured sublingual microvascular glycocalyx dimensions (perfused boundary region, PBR) and red blood cell filling percentage using sidestream dark-field imaging with GlycoCheck software in 14 healthy adults immediately before and after a 10 km trail run. A single bout of aerobic exercise produced no significant change in PBR, RBC filling percentage, or capillary density. However, individual changes in PBR were inversely associated with changes in RBC filling percentage, suggesting that a thicker endothelial surface layer accompanies better microvascular perfusion.
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Published paper
Association of COVID-19 with impaired endothelial glycocalyx, vascular function and myocardial deformation four months after infection
This case-control study compared 70 people four months after COVID-19 infection with 70 age- and sex-matched untreated hypertensive patients and 70 healthy controls, measuring glycocalyx thickness (sublingual perfused boundary region), endothelial and coronary function, arterial stiffness, cardiac strain, and blood markers. Post-COVID patients showed impaired glycocalyx, reduced flow-mediated dilatation and coronary flow reserve, and stiffer arteries — similar to hypertensive patients and worse than healthy controls — plus markedly higher oxidative stress and thrombomodulin. Right ventricular function was worse in the COVID group than in either comparison group, and residual cardiovascular symptoms tracked with these abnormalities.
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Published paper
Managing sepsis and septic shock in an endothelial glycocalyx-friendly way: from the viewpoint of surviving sepsis campaign guidelines
This narrative review examines how the endothelial glycocalyx — the gel-like carbohydrate layer lining blood vessels — is degraded in sepsis and how standard sepsis treatments may either protect or further injure it. The authors map recommendations in the Surviving Sepsis Campaign Guidelines 2021 (fluid strategy, albumin use, catecholamine limitation, corticosteroids, glycemic control, anticoagulants) onto the available evidence for glycocalyx preservation. They note that no current guideline recommendation is explicitly aimed at glycocalyx protection and call for this to be addressed in future sepsis research and guidelines.
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Published paper
Long-term efficacy of liposomal nanocarriers of preassembled glycocalyx in restoring cerebral endothelial glycocalyx in sepsis
Researchers used a chronic cranial window and sidestream dark-field imaging (GlycoCheck analysis) to track cerebral microvascular density and perfused boundary region (PBR, an inverse index of glycocalyx thickness) in mice given LPS to model sepsis. LPS reduced vascular density and increased PBR within 3 hours; intravenous liposomal nanocarriers carrying preassembled glycocalyx (glycosylated syndecan-1 inserted into liposomes) blunted the PBR rise, with two doses giving longer-lasting benefit than one. Untreated animals recovered PBR spontaneously by 48 hours and vascular density by 72 hours.
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Published paper
Doxycycline protects against sepsis-induced endothelial glycocalyx shedding
In a rat model of sepsis induced by intraperitoneal E. coli lipopolysaccharide, pretreatment with oral doxycycline (an inhibitor of matrix metalloproteinases) largely preserved the endothelial glycocalyx in heart and lung capillaries, as shown by electron microscopy, lower serum syndecan-1, and lower perfused boundary region on mesenteric video capillaroscopy. Doxycycline-pretreated animals also had less vascular leakage, less perivascular edema, fewer transmigrating neutrophils, and better microvascular health scores. The authors attribute the effect to MMP inhibition, although MMP activity was not measured directly.
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Published paper
Effect of Glycocalyx-targeted Therapy on Vascular Function in Older Adults: A Randomized Controlled Trial
In this small double-blind, placebo-controlled pilot trial, 23 older adults took a glycocalyx-targeted supplement (Endocalyx Pro, 3,712 mg/day) or placebo for 12 weeks. The supplement did not significantly change overall sublingual glycocalyx thickness (perfused boundary region), brachial artery flow-mediated dilation, blood pressure, or aortic stiffness. Two secondary/exploratory signals were seen: greater capillary glycocalyx thickness among participants not on antihypertensive medication, and improved FMD normalized to shear rate.
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Published paper
Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock
This prospective single-center observational study used sublingual video microscopy (GlycoCheck) to compare microcirculation and glycocalyx measures in 140 children with septic shock, 81 of whom received milrinone infusions. Children given milrinone maintained functional capillary density and capillary blood volume recruitment capacity at 24 hours and showed less glycocalyx degradation (lower perfused boundary region) than those not given milrinone, with the effect most apparent in children under two years old. Higher PBR was associated with mortality in both groups.
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Published paper
Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients
This retrospective single-center study of 178 children with sepsis compared the lactate/albumin ratio (LAR) measured on PICU admission with sublingual video microscopy measures of the microcirculation taken at the same time. An elevated LAR (>0.5) was associated with reduced microvascular blood flow, lower small-capillary (4–6 µm) density, greater inflammation, more vasoactive support and higher mortality, but was not associated with glycocalyx thickness as measured by the perfused boundary region (PBR).
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Published paper
The effect of 6-month treatment with coenzyme Q10 on endothelial, vascular and myocardial function in patients with nonalcoholic fatty liver disease
In this randomized placebo-controlled trial, 52 patients with non-alcoholic fatty liver disease received either 240 mg/day coenzyme Q10 or placebo for six months. The CoQ10 group showed improvements in sublingual microvascular glycocalyx thickness (perfused boundary region), arterial stiffness, brachial artery flow-mediated dilation, left ventricular global longitudinal strain, and liver steatosis on FibroScan, while the placebo group showed no significant change. The findings are reported as a conference abstract, so detailed methods and between-group statistics are not available.
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Published paper
The role of the endothelial glycocalyx in fibrotic interstitial lung disease
This prospective observational study (PREDICT-ILD) assessed whether sublingual side-stream dark-field video-microscopy (GlycoCheck) is an acceptable way to measure endothelial glycocalyx health in patients with fibrotic interstitial lung disease, comparing them with age- and sex-matched healthy controls. Perfused boundary region (PBR) in 5–25 µm vessels was used as a surrogate for glycocalyx width, alongside same-day pulmonary function testing and an acceptability questionnaire. The abstract describes the rationale and methods; no numerical results are reported in the text provided.
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Published paper
Sidestream dark field video microscopy demonstrates shelf-stable blood products preserve the endothelial glycocalyx in a canine hemorrhagic shock model
Six anesthetized dogs underwent induced hemorrhagic shock and were each resuscitated with five different fluid or blood-product strategies in a crossover design, with the endothelial glycocalyx assessed by sidestream dark field video microscopy (perfused boundary region, PBR). Crystalloid plus hydroxyethyl starch resuscitation was associated with increased PBR (indicating glycocalyx degradation), whereas chilled whole blood, plasma plus packed red cells, and shelf-stable products (freeze-dried plasma with a hemoglobin-based oxygen carrier, with or without lyophilized platelets) did not show significant PBR change from baseline.
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Published paper
Diminished Microvascular Health in Heart Transplant Recipients Relative to Healthy Controls
This conference abstract reports a prospective cross-sectional comparison of sublingual microvascular health in 90 heart transplant recipients versus 23 healthy adults, measured with a sidestream dark-field camera and GlycoCheck software. Transplant recipients showed lower capillary density and capillary blood flow, a lower global microvascular HealthScore, and higher perfused boundary region (PBR) values, the latter interpreted as glycocalyx damage.
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Published paper
Six-month supplementation with high dose coenzyme Q10 improves liver steatosis, endothelial, vascular and myocardial function in patients with metabolic-dysfunction associated steatotic liver disease: A Randomized Double-blind, Placebo Controlled Trial
In this single-center, double-blind randomized trial, 60 non-diabetic patients with MASLD received either a supplement containing 240 mg/day coenzyme Q10 (plus choline, milk thistle, cynara, selenium, vitamin C and B vitamins) or placebo for 6 months, alongside Mediterranean diet and exercise advice. The CoQ10 group showed reductions in liver fat (CAP), sublingual perfused boundary region (a marker of thicker endothelial glycocalyx), arterial stiffness and blood pressure, plus improved brachial flow-mediated dilation, coronary flow reserve and left ventricular global longitudinal strain, while the placebo group showed no significant change. Reductions in liver steatosis correlated with the vascular and myocardial improvements.
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Published paper
Microvascular Responses to Donor Specific HLA Antibodies in Heart Transplantation. Sidestream Dark Field Imaging Results
This conference abstract reports a cross-sectional comparison of sublingual microvascular health in 90 heart transplant recipients, measured with sidestream dark field imaging and GlycoCheck software. Patients with donor-specific HLA antibodies (DSA) did not show worse microvascular parameters than those without; in fact, capillary density and blood flow were somewhat higher in the DSA group. The authors conclude that, in this preliminary dataset, DSA presence was not associated with impaired microvascular health.
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Published paper
Biomarkers of endothelial glycocalyx damage are associated with microvascular dysfunction in resuscitated septic shock patients
This cross-sectional study compared 31 resuscitated septic shock patients with 20 healthy individuals, measuring circulating and urinary markers of endothelial glycocalyx shedding alongside sublingual microcirculation imaging with GlycoCheck. Higher levels of syndecan-1, soluble CD44, thrombomodulin, and urinary sulfated glycosaminoglycans corresponded to worse measured microvascular function in the septic patients.
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Published paper
The association between prolonged capillary refill time and microcirculation changes in children with sepsis
This prospective single-center cohort study measured sublingual microcirculation with GlycoCheck sidestream dark-field video microscopy and blood biomarkers in 132 children with sepsis, comparing those with normal versus prolonged (>2 s) capillary refill time. Children with prolonged capillary refill had thinner glycocalyx (higher perfused boundary region) and fewer small capillaries recruited. Persistence of these abnormalities, especially with normal blood pressure ('hemodynamic incoherence'), was linked to higher mortality and longer stay.
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Published paper
Effect of acute heparin administration on glycocalyx thickness and endothelial function in healthy younger adults
In this single-arm pilot study, 19 healthy young adults received one intravenous bolus of unfractionated heparin (5,000 U) and were reassessed 30 minutes later. Neither sublingual glycocalyx thickness (perfused boundary region by GlycoCheck), circulating syndecan-1 and heparan sulfate, nor brachial artery flow-mediated dilation changed. The authors conclude that acute heparin is not a usable way to experimentally degrade the glycocalyx in healthy humans.
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Published paper
Endothelial Damage and the Microcirculation in Critical Illness
This narrative review examines how endothelial glycocalyx damage relates to bedside-observable microcirculatory changes in critically ill patients, including sepsis, trauma, cardiogenic shock, cardiopulmonary bypass, and COVID-19. It compares biochemical markers of glycocalyx shedding (syndecan-1, heparan sulfate, hyaluronan, angiopoietin-2) with sidestream dark-field imaging measures such as perfused boundary region (PBR) and capillary density. The authors conclude that the two classes of measurement correlate in some conditions but results are highly variable, and argue that combined bedside imaging plus biomarkers could support patient phenotyping and personalized ICU care.
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Published paper
Associations Between Adipose Tissue Glycocalyx Quality, Nox Activity, and Microvascular Blood Flow
This undergraduate honors thesis reports a small within-subject human physiology experiment in which sublingual microvascular measures (GlycoCheck perfused boundary region, capillary density, red blood cell velocity) were compared under fasting conditions and during a hyperinsulinemic-euglycemic clamp, alongside adipose tissue microdialysis measures of lipolysis (glycerol), reactive oxygen species and blood flow. Insulin infusion was associated with a small but statistically significant increase in perfused boundary region (suggesting thinner/less dense glycocalyx) and decreases in red blood cell velocity and some vessel-diameter-specific densities, while microdialysis measures did not change significantly. The work is descriptive and exploratory, with only 6-8 participants analyzed per outcome.
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Published paper
Role of dietary interventions on microvascular health in South-Asian Surinamese people with type 2 diabetes in the Netherlands; a randomized controlled trial
This three-arm randomized, placebo-controlled trial tested a monthly 5-day fasting-mimicking diet (Prolon) versus a glycocalyx-mimetic supplement (Endocalyx, containing fucoidan, glucosamine sulfate and hyaluronic acid) versus placebo for 3 months in 56 South-Asian Surinamese patients with type 2 diabetes, with follow-up at 6 months. Sublingual microvascular measures were made with SDF imaging and GlycoCheck software. The fasting-mimicking diet lowered BMI and HbA1c temporarily but was associated with worsening of the dynamic perfused boundary region, while the supplement group showed improved dynamic PBR and microvascular health score and lower urinary MCP-1 relative to placebo.
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Published paper
Sidestream dark field imaging and biomarker evaluation reveal minimal significant changes to the microcirculation and glycocalyx in a canine hemorrhagic shock model
Eight anesthetized purpose-bred dogs underwent pressure-targeted hemorrhagic shock followed by fresh whole blood retransfusion, with sublingual sidestream dark field (GlycoCheck) imaging and plasma glycocalyx biomarkers measured at five time points. Despite marked drops in mean arterial pressure and cardiac output during shock, the perfused boundary region and microcirculatory variables did not change significantly, and only heparan sulfate showed a significant change (a decrease) over time.
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Published paper
The Microvascular Health Status Predicts Radio-Induced Acute Toxicities in Breast, Prostate and Head and Neck Cancer Patients
This conference abstract reports on 63 breast, 38 prostate, and 39 head and neck cancer patients whose sublingual microcirculation was measured with a sidestream dark-field camera and GlycoCheck software before radiotherapy. Patients with healthier baseline microvascular scores were less likely to develop clinically relevant acute radiation toxicity, and the association held across all three cancer sites.
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Published paper
Effect of high-dose intravenous ascorbic acid on microcirculation and endothelial glycocalyx during sepsis and septic shock: a double-blind, randomized, placebo-controlled study
This small double-blind randomized trial gave 23 ICU patients with sepsis or septic shock either high-dose intravenous ascorbic acid (50 mg/kg every 6 hours for 96 hours) or placebo, and measured sublingual microcirculation with handheld video microscopy plus glycocalyx thickness with GlycoCheck-based perfused boundary region (PBR). The ascorbic acid group showed a higher proportion of perfused small vessels at 6 hours and a lower PBR in the smallest capillaries right after the first infusion, but there were no differences in most other microcirculatory, hemodynamic, inflammatory, or mortality outcomes.
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Published paper
The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis
This prospective observational PICU study measured sublingual microcirculation and glycocalyx thickness (perfused boundary region, PBR, by GlycoCheck) plus plasma endothelial biomarkers in 125 children with sepsis, comparing those with low serum albumin (<3.0 g/dL, n=48) to those with normal albumin. Children with hypoalbuminemia had thinner glycocalyx (higher flow-corrected PBR), greater small-capillary recruitment, and higher angiopoietin-2 and annexin A5, and more often required mechanical ventilation. In an observational subgroup analysis, children whose hypoalbuminemia was corrected with 20% albumin infusion had less abnormal PBR at 24 hours, shorter PICU stay, and lower mortality.
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Published paper
Differential effects of heat-not-burn, electronic, and conventional cigarettes on endothelial glycocalyx
Fifty smokers were randomized to switch for one month to either heat-not-burn cigarettes (HNBC) or electronic cigarettes (Ecig), while 50 matched smokers who continued conventional cigarettes (Tcig) served as a non-randomized control group. Sublingual glycocalyx thickness was estimated by perfused boundary region (PBR) using GlycoCheck sidestream dark-field imaging at baseline and one month. Continued conventional smoking worsened PBR across all vessel ranges, whereas switching to Ecig left PBR unchanged and HNBC improved PBR only in the largest (20-25 µm) micro-vessels.
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Published paper
Endothelial Glycocalyx Integrity in Treatment-Naïve People Living with HIV before and One Year after Antiretroviral Treatment Initiation
This prospective observational study measured sublingual endothelial glycocalyx thickness (via the perfused boundary region, PBR) in 66 treatment-naive people living with HIV before and at 24 and 48 weeks after starting combination antiretroviral therapy. PBR fell progressively (indicating thicker, healthier glycocalyx) over the first year, with no significant difference between integrase inhibitor- and protease inhibitor-based regimens. Final values remained above previously reported healthy-control values, suggesting only partial recovery.
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Published paper
Cerebrovascular glycocalyx damage and microcirculation impairment in patients with temporal lobe epilepsy
Researchers used intraoperative sidestream dark-field video microscopy (GlycoCheck) to measure the endothelial glycocalyx and capillary blood flow directly on the exposed brain surface of 15 patients undergoing surgery for drug-resistant temporal lobe epilepsy and 15 non-epileptic surgical controls. Cortical perfused boundary region (PBR), an indirect marker of glycocalyx damage, was roughly twice as high in epilepsy patients, and their capillary recruitment capacity was markedly reduced. In vivo vessel surface area correlated strongly with ex vivo lectin-stained vessel area in the same resected tissue.
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Published paper
Glycocalyx-targeted therapy ameliorates age-related arterial dysfunction
In mice, researchers reduced glycocalyx thickness by knocking down hyaluronan synthase 2 (Has2) and found this reproduced hallmarks of arterial aging: impaired endothelium-dependent dilation and increased aortic stiffness. Conversely, feeding old mice for 10 weeks with a glycocalyx-component supplement (Endocalyx, containing high-molecular-weight hyaluronan, glucosamine sulfate, fucoidan and superoxide dismutase) or with high-molecular-weight hyaluronan alone restored glycocalyx thickness and barrier function and improved endothelial function, aortic stiffness and blood pressure. Aortic wall composition (collagen, elastin) in supplemented old mice also resembled that of young mice.
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Published paper
Endothelial and Glycocalyx Biomarkers in Children With Sepsis After One Bolus of Unbalanced or Balanced Crystalloids
This single-center prospective cohort study followed 106 children with sepsis or septic shock who received a bolus of either balanced or unbalanced crystalloid fluid. Glycocalyx integrity was assessed by sublingual video microscopy (perfused boundary region) plus blood biomarkers. Children given unbalanced crystalloids showed more glycocalyx degradation at 6 hours, along with markers of vascular permeability and apoptosis, and higher odds of metabolic acidosis and acute kidney injury; the perfused boundary region normalized by 24 hours.
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Published paper
Evaluation of miCRovascular rarefaction in vascUlar Cognitive Impairment and heArt faiLure (CRUCIAL): Study protocol for an observational study
This is a published study protocol (no results yet) for CRUCIAL, a multicenter observational program investigating whether microvascular rarefaction - loss of perfused small vessels - is a shared mechanism in vascular cognitive impairment and heart failure with preserved ejection fraction. Participants across four cohorts (75 VCI, 60 HFpEF, 60 aortic stenosis, 200 aging controls) undergo advanced brain and cardiac MRI, cognitive testing, echocardiography, retinal OCT angiography, sublingual videomicroscopy with the GlycoCheck system, blood biomarkers, and (in the surgical cohort) myocardial biopsy. The aim is to validate cheaper non-invasive surrogate markers of microvascular density against imaging and histology.
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Published paper
Microvascular rarefaction in patients with cerebrovascular events
This prospective observational study used sublingual sidestream darkfield videomicroscopy to assess microcirculation in 21 patients within 24 hours of an acute stroke or transient ischemic attack, with repeat measurements on day 3 and after one week, compared with age- and sex-matched healthy controls. Patients showed substantially lower capillary density than controls, and the perfused boundary region (an inverse marker of glycocalyx thickness) correlated strongly with red blood cell filling of capillaries. The authors conclude that cerebrovascular events are accompanied by measurable systemic microvascular changes detectable under the tongue.
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Published paper
Relationship of the main indicators of systemic COVID-associated endotheliopathy with the morphofunctional state and hemodynamics of the retina and chorioid in the acute period of the disease
Russian researchers compared retinal and choroidal imaging (OCT) with sublingual microvascular glycocalyx measurements (GlycoCheck PBR) in 44 people convalescing from moderate or severe COVID-19 and 18 healthy volunteers. Patients showed thicker choroids and wider peripapillary retinal vessels in proportion to disease severity, and these ocular changes correlated with inflammatory/coagulation blood markers and with glycocalyx indices. The authors interpret this as indirect evidence linking post-COVID retinal microangiopathy to systemic endotheliopathy.
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Published paper
Variability of microcirculatory measurements in healthy volunteers
Two experienced operators each performed three consecutive sublingual GlycoCheck (sidestream dark-field) microcirculation measurements in 49 healthy volunteers to test reproducibility. Single measurements of perfused boundary region (PBR), red blood cell filling percentage, and microvascular vessel density had poor intraobserver reliability, but averaging three measurements raised reliability to acceptable levels. Agreement between the two observers was only fair for PBR and RBC filling and poor for vessel density, though no systematic bias was found.
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Published paper
A Dietary Supplement Containing Fucoidan Preserves Endothelial Glycocalyx through ERK/MAPK Signaling and Protects against Damage Induced by CKD Serum
Researchers tested whether a commercial dietary supplement containing fucoidan, glucosamine sulfate, hyaluronan and antioxidants could protect the endothelial glycocalyx in laboratory models. Using atomic force microscopy on living endothelial cells, the supplement and fucoidan alone increased glycocalyx thickness, prevented heparinase-induced degradation, and reversed thinning caused by pooled serum from hemodialysis patients; effects depended on ERK/MAPK (and to a lesser extent PI3K) signaling and Golgi-dependent vesicular transport. In mice fed the supplement for two weeks, sidestream dark-field imaging of cremaster microvessels showed a reduced perfused boundary region, consistent with a thicker glycocalyx.
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Published paper
Differences in coronary flow reserve and flow-mediated dilation between plaque psoriasis and psoriatic arthritis
This cross-sectional study compared vascular and cardiac function in 311 patients with psoriatic disease (185 plaque psoriasis, 126 psoriatic arthritis) and 150 risk-factor-matched controls. Patients with psoriatic disease had thicker perfused boundary region (indicating a thinner, more damaged endothelial glycocalyx), lower coronary flow reserve, lower brachial flow-mediated dilation, and reduced left ventricular longitudinal strain. Glycocalyx impairment was similar in both psoriatic subgroups, whereas coronary microvascular and brachial endothelial function were worse in psoriatic arthritis.
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Published paper
Endothelial glycocalyx improvement after six months and one-year of antiretroviral therapy in treatment naive patients with human immunodeficiency virus
This conference abstract reports on 54-58 newly diagnosed, treatment-naive HIV patients whose sublingual microvascular glycocalyx was measured with sidestream dark-field imaging (GlycoCheck) before and after starting antiretroviral therapy. Perfusion boundary region (PBR), an inverse marker of glycocalyx thickness, fell at 6 months and further at 12 months, indicating improved glycocalyx integrity, even though body weight and blood pressure rose over the same period.
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Published paper
Perfused boundary region as biomarker for endothelial integrity in former preterms in adolescence
In the Belgian PREMATCH cohort, researchers measured sublingual perfused boundary region (PBR, an inverse index of glycocalyx thickness) by sidestream dark-field imaging in 93 adolescents born at extremely low birth weight (ELBW) and 87 healthy controls, alongside blood pressure, cystatin-C-based eGFR, and retinal vessel imaging. PBR did not differ between the groups even though ELBW survivors had higher blood pressure, lower eGFR, and altered retinal vessel width and tortuosity. The authors provide reference PBR values for adolescents but conclude that PBR correlates too weakly with other microvascular markers to serve as a stand-alone marker of endothelial integrity in this group.
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Published paper
Persistent capillary rarefication in long COVID syndrome
This prospective observational study used sublingual sidestream dark-field videomicroscopy with GlycoCheck software to compare microvascular structure and function in 27 long COVID patients, 15 healthy controls, and 16 historical critically ill COVID-19 patients. Long COVID patients showed a marked loss of the smallest capillaries and impaired capillary recruitment a median of ~18 months after infection, while glycocalyx thickness (PBR) was similar to healthy controls. The authors conclude that COVID-19 may leave persistent capillary rarefication, though the design cannot establish causality with symptoms.
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Published paper
Microvascular and proteomic signatures overlap in COVID-19 and bacterial sepsis: the MICROCODE study
This multi-center observational study compared sublingual microcirculation, glycocalyx dimensions (PBR by GlycoCheck) and 184 plasma proteins in 22 COVID-19 patients, 43 bacterial sepsis patients and 10 healthy controls. Microvascular and proteomic abnormalities were largely similar in the two diseases and tracked with illness severity rather than diagnosis. Two mutually opposed coregulated protein clusters were identified, and their ratio ("Microcode") predicted 28-day mortality/intubation in an independent COVID-19 cohort.
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Published paper
The microvascular endothelial glycocalyx: An additional piece of the puzzle in veterinary medicine
This narrative review summarizes the structure, functions, and disease relevance of the endothelial glycocalyx (eGlx), with a focus on the near-absence of research in cats and dogs. It compares direct visualization methods (perfusion/immersion fixation electron microscopy, lectin staining) with clinically applicable indirect methods (ELISAs for shed hyaluronan, syndecan-1, heparan sulfate; sidestream dark-field imaging of the perfused boundary region). It also reviews evidence for glycocalyx damage in sepsis, kidney disease, hypervolemia and hypertension, and outlines candidate protective or restorative strategies.
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