Inflammation: 77 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
Early impairment of skeletal muscle endothelial glycocalyx barrier properties in diet-induced obesity in mice.
This mouse study examined whether the endothelial glycocalyx in skeletal muscle microvessels is damaged early in the course of diet-induced obesity. Using intravital measurement of glycocalyx barrier properties (accessibility of the glycocalyx to circulating tracers/red blood cells) in mice fed a high-fat diet, the authors found loss of glycocalyx barrier function before or alongside the development of overt metabolic disease. The findings suggest the glycocalyx is an early target of obesogenic diet rather than a late consequence of established obesity.
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Published paper
Rhamnan sulfate enhances the endothelial glycocalyx and decreases the LDL permeability of human coronary artery endothelial cells in vitro
Human coronary artery endothelial cell monolayers were treated for 24 hours with two isoforms of rhamnan sulfate (a sulfated polysaccharide) and then tested for how easily LDL cholesterol crossed the cell layer. Both isoforms cut LDL permeability about 5-fold and prevented the permeability rise caused by chemically induced apoptosis, while immunostaining showed greater heparan sulfate coverage, a key glycocalyx component. The authors propose that a thicker glycocalyx adds resistance to the 'leaky junction' route that LDL uses to cross the endothelium.
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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
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
Impact of dietary supplementation of glycocalyx precursors on vascular function in type 2 diabetes
This combined preclinical and clinical study tested whether a dietary mixture of glycocalyx precursors (glucosamine sulfate, fucoidan, superoxide dismutase, and high molecular weight hyaluronan) could restore the endothelial glycocalyx and improve vascular function in type 2 diabetes. In diabetic db/db mice, four weeks of supplementation restored glycocalyx length and improved flow-mediated dilation and arterial stiffness, and the same mixture promoted glycocalyx growth in cultured endothelial cells. However, in a pilot double-blind randomized placebo-controlled trial of 22 Veterans with type 2 diabetes, eight weeks of supplementation did not improve glycocalyx integrity or vascular function compared with placebo.
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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
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
Capillary leak and endothelial permeability in critically ill patients: a current overview
This narrative review synthesizes current understanding of capillary leak syndrome (CLS) in critical illness, covering pathophysiology, diagnosis, and management. It describes how systemic inflammation disrupts endothelial cell junctions via the angiopoietin-2/Tie2 axis and drives enzymatic shedding of the endothelial glycocalyx, producing fluid extravasation, edema, and hypoperfusion. The authors note there are no accepted diagnostic criteria and no specific treatment, so care remains supportive with phased fluid resuscitation and de-resuscitation.
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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
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
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
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
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
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
Vascular Endothelial Glycocalyx Damage in COVID-19
This narrative review, which includes a small structured literature search, argues that damage to the vascular endothelial glycocalyx is a common mechanism linking COVID-19 risk factors (hypertension, diabetes, obesity, smoking, cardiovascular disease) to severe outcomes such as ARDS, DIC, and microvascular thrombosis. The author proposes a new concept, 'systemic inflammation-reactive microvascular endotheliopathy' (SIRME), defined by inflammation, thrombogenic endothelial damage with increased permeability, and organ injury, with shed glycocalyx fragments or bilateral ground-glass lung shadows marking progression. Of six eligible clinical reports identified, all showed elevated circulating glycocalyx components in severe COVID-19.
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Published paper
Endothelial glycocalyx and microvascular perfusion are associated with carotid intima-media thickness and impaired myocardial deformation in psoriatic disease
This study compared sublingual endothelial glycocalyx and microvascular perfusion measures in 297 patients with psoriatic disease against 150 risk-factor-matched controls. Psoriatic patients showed a thinner glycocalyx (higher perfused boundary region) and poorer microvascular perfusion, and these changes tracked with disease severity, carotid intima-media thickness, coronary flow reserve, and left ventricular deformation.
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Published paper
Case Report: Endothelial Glycocalyx Damage in Critically ill Patients With SARS-CoV-2-Related Multisystem Inflammatory Syndrome (MIS-C)
This single-center case report describes two critically ill children with MIS-C in whom endothelial glycocalyx damage was documented using plasma syndecan-1 and sublingual video microscopy (GlycoCheck) alongside a marked systemic inflammatory response. Both children had abnormal perfused boundary region (PBR) values and reduced capillary density compared with a postoperative control child, and PBR normalized (1.68 and 1.54 microns) before transfer out of intensive care after immunoglobulin and methylprednisolone treatment plus supportive care. The authors argue that microcirculatory and glycocalyx involvement may partly explain shock, capillary leak, and prothrombotic features in MIS-C.
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Published paper
Apremilast improves endothelial glycocalyx and microvascular perfusion: a possible protective mechanism against COVID-19
In this randomized comparison, 90 patients with psoriasis received apremilast, etanercept, or cyclosporine for 4 months, with sublingual glycocalyx (perfused boundary region, GlycoCheck/SDF imaging), arterial stiffness, and echocardiographic measures assessed before and after treatment. Only apremilast was associated with a reduction in PBR (indicating thicker glycocalyx) and it produced greater improvements in microvascular perfusion, pulse wave velocity, central systolic blood pressure, and left ventricular strain than the comparators. The authors speculate that glycocalyx protection could relate to reported benefits of apremilast in COVID-19, but no COVID-19 outcomes were studied.
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Published paper
Endothelial glycocalyx integrity and microvascular perfusion are associated with novel echocardiographic markers and carotid intima-media thickness in patients with psoriasis
Researchers used sublingual sidestream dark-field imaging (GlycoCheck) to compare endothelial glycocalyx barrier properties and microvascular perfusion in 297 psoriasis patients versus 150 risk-factor-adjusted controls. Psoriasis patients showed a thicker perfused boundary region (indicating a thinner glycocalyx) and poorer microvascular perfusion, which correlated with reduced coronary flow reserve, impaired left ventricular deformation, and greater carotid intima-media thickness.
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Published paper
Links between Endothelial Glycocalyx Changes and Microcirculatory Parameters in Septic Patients
In this single-center prospective observational study, sublingual microcirculation (Cytocam incident dark field imaging) and glycocalyx perfused boundary region (PBR, GlycoCheck) were compared between adults with sepsis or septic shock and healthy age-matched volunteers. Septic patients had significantly increased PBR (indicating thinner glycocalyx) across all vessel diameter classes, and PBR in the smallest capillaries correlated inversely with capillary density measures. The authors conclude there may be a functional link between glycocalyx damage in the smallest capillaries and sepsis-related microcirculatory alterations.
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Published paper
Identification of novel sublingual parameters to analyze and diagnose microvascular dysfunction in sepsis: the NOSTRADAMUS study (link to Critical Care)
This single-center observational study used sublingual sidestream dark-field videomicroscopy with a new GlycoCheck software version to analyze microvessels in 1-micrometer diameter classes (4-25 um) in 34 septic ICU patients and 17 healthy controls. Sepsis was associated with loss of the very smallest capillaries, impaired capillary recruitment, and increased perfused boundary region (indicating a thinner/more permeable glycocalyx). The authors combined capillary blood volume and PBR into a composite 'Microvascular Health Score' that separated patients from controls and correlated with sepsis severity.
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Published paper
Non-invasive evaluation of macro- and microhemodynamic changes during induction of general anesthesia – A prospective observational single-blinded trial
In 150 women undergoing gynecologic surgery, non-invasive bioimpedance monitoring showed that induction of general anesthesia caused a larger fall in cardiac output (~40%) than in mean arterial pressure (~26%). Patients who later needed norepinephrine already had lower baseline cardiac output, stroke volume and contractility, and norepinephrine raised blood pressure without restoring cardiac performance. Sidestream dark-field imaging in a subset showed a 6.4% rise in perfused boundary region by the end of surgery, consistent with glycocalyx impairment.
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Published paper
Vascular conditioning prevents adverse left ventricular remodelling after acute myocardial infarction: a randomised remote conditioning study
In this randomized trial, 270 post-STEMI patients received either one cycle or two cycles of bilateral arm-cuff remote ischemic conditioning (RIC), or no conditioning. A single RIC cycle produced greater improvement in sublingual microvascular glycocalyx integrity (perfusion boundary region) and arterial stiffness, along with increases in cardioprotective microRNA-144 and nitrate-nitrite and reduced oxidative stress. At one year, single-cycle RIC was associated with greater reduction in left ventricular end-systolic volume, suggesting more favorable cardiac remodeling.
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Published paper
Does sublingual microscopy correlate with nailfold videocapillaroscopy in systemic sclerosis?
This single-center cross-sectional study compared automated sublingual videomicroscopy (GlycoCheck) with nailfold videocapillaroscopy (NVC), the standard test for scleroderma microvascular damage, in 39 systemic sclerosis patients on the same clinic day. Sublingual microvascular density correlated moderately with nailfold capillary number and inversely with the NVC microangiopathy evolution score. Functional measures (red blood cell fraction and glycocalyx perfused boundary region) did not correlate with NVC parameters in this mostly late-pattern cohort.
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Published paper
Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity
This prospective observational study in Vietnam re-analyzed stored sublingual sidestream dark-field videos with GlycoCheck software and measured plasma syndecan-1 and endocan in 75 patients with confirmed dengue and 12 outpatients with other febrile illness. Patients with the most severe grade of plasma leakage showed a thinner, more degraded glycocalyx (higher perfused boundary region) and much higher plasma levels of shed glycocalyx proteoglycans during the critical illness phase. There were no significant glycocalyx differences between mild outpatient dengue and other febrile illnesses.
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