Study: Case-Control Study: 10 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
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
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
Uncoupling of Microvascular Blood Flow and Capillary Density in Vascular Cognitive Impairment
Researchers used sublingual video microscopy (GlycoCheck system) to compare how the smallest blood vessels respond to spontaneous changes in blood flow in 15 men with vascular cognitive impairment from cerebral small vessel disease and 15 male controls. In healthy controls, the number of red-cell-perfused capillaries rose as feed vessel flow rose, whereas in patients with cognitive impairment it did not. The authors interpret this as an uncoupling of microvascular flow from perfused capillary density, which could limit oxygen and nutrient exchange when metabolic demand increases.
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Published paper
Impaired Arterial Elastic Properties and Endothelial Glycocalyx in Patients with Embolic Stroke of Undetermined Source
This case-control study compared 90 patients who had an embolic stroke of undetermined source with 90 controls carrying similar cardiovascular risk factors. ESUS patients had thinner endothelial glycocalyx (higher sublingual perfused boundary region), stiffer arteries (higher pulse wave velocity), more oxidative stress, and impaired left atrial function. Glycocalyx damage correlated with arterial stiffness, which in turn related to left atrial reservoir strain.
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Published paper
Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives
This cross-sectional case-control study compared sublingual glycocalyx thickness (measured as perfused boundary region, PBR, by sidestream dark-field imaging/GlycoCheck) in 320 untreated hypertensive patients and 160 normotensive controls. Hypertensives had thicker PBR (indicating thinner, more damaged glycocalyx), stiffer arteries, lower coronary flow reserve, and reduced left ventricular longitudinal strain. Higher PBR remained independently associated with arterial stiffness, coronary microcirculatory dysfunction, and impaired myocardial deformation after adjustment for standard risk factors.
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Published paper
Perturbation of the microvascular glycocalyx and perfusion in infants after cardiopulmonary bypass
Researchers used sidestream dark-field imaging at the ear conch to measure the perfused boundary region (an inverse marker of glycocalyx thickness) and microcirculatory perfusion in 40 infants having congenital heart surgery, compared with children undergoing cardiac catheterization or cleft palate surgery. After surgery with cardiopulmonary bypass, the perfused boundary region increased significantly (indicating glycocalyx thinning) and microvascular perfusion transiently fell, both recovering to baseline by day 7. Control groups showed no significant glycocalyx changes.
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Published paper
Sublingual microvascular glycocalyx dimensions in lacunar stroke patients
Researchers used sidestream dark-field imaging of the sublingual microcirculation to estimate glycocalyx thickness (via the perfused boundary region, PBR) in 31 patients with lacunar stroke and 19 healthy controls. Overall, PBR did not differ between stroke patients and controls, but the subgroup of stroke patients who also had white matter lesions on MRI showed a significantly larger PBR, suggesting a thinner or more permeable glycocalyx. The authors interpret this as evidence of impaired endothelial barrier function in more extensive cerebral small vessel disease.
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Published paper
Skeletal muscle capillary density and microvascular function are compromised with aging and type 2 diabetes
This cross-sectional comparison measured muscle capillary density (from biopsies), whole-body insulin sensitivity, and sublingual microvascular measures in 15 young men, 15 older men, and 15 older men with type 2 diabetes. Both aging and type 2 diabetes were associated with fewer capillary contacts per muscle fiber and lower insulin sensitivity. Men with type 2 diabetes also showed a thicker erythrocyte-perfused boundary region on sidestream dark-field imaging, consistent with impaired endothelial glycocalyx function.
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Published paper
Damage of the endothelial glycocalyx in dialysis patients
This cross-sectional case-control study compared the sublingual microvascular glycocalyx in 40 dialysis patients (23 hemodialysis, 17 peritoneal dialysis) with 21 age- and sex-matched healthy controls using sidestream dark-field (SDF) imaging, plus blood markers of glycocalyx shedding. Dialysis patients showed a larger perfused boundary region (PBR) and perfused diameter, indicating red cells penetrating closer to the vessel wall, along with higher serum hyaluronan, syndecan-1, hyaluronidase activity, and sE-selectin. Higher inflammation (CRP >10 mg/L) and a history of cardiovascular disease were associated with greater PBR.
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Published paper
Alteration of the sublingual microvascular glycocalyx in critically ill patients
Using sidestream dark-field video microscopy of the sublingual microcirculation, researchers compared the Perfused Boundary Region (PBR), an index of glycocalyx damage, between 50 critically ill patients and 16 healthy volunteers. PBR was significantly higher in ICU patients, and tended to be highest in those with sepsis, indicating greater glycocalyx disruption. Higher PBR also correlated with more rolling leukocytes in post-capillary venules in a subgroup of septic patients.
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