Study: Narrative Review: 9 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
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
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
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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Published paper
Ways and Means of Cellular Reconditioning for Kidney Regeneration
This narrative review proposes 'cellular reconditioning' — repairing individual damaged cell components to trigger broader recovery — as an addition to regenerative nephrology. It catalogs mitochondrial, lysosomal/autophagy, and peroxisomal dysfunction alongside loss of endothelial glycocalyx integrity as interconnected contributors to acute and chronic kidney disease, and reviews the enzymes (metalloproteinases, heparanase-1, hyaluronidases) that shed the glycocalyx. It also summarizes clinical glycocalyx biomarkers and imaging methods, plus reported preventive and restorative interventions.
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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
Derangement of the endothelial glycocalyx in sepsis
This narrative review describes the structure and functions of the endothelial glycocalyx and how it is degraded during sepsis. It covers glycocalyx roles in leukocyte adhesion, anticoagulation, vascular permeability and mechanosensing, methods of assessment (circulating syndecan-1, heparan sulfate, hyaluronan; electron and intravital microscopy; sidestream dark-field imaging with automated PBR analysis), and candidate protective strategies. The authors conclude that no treatment has yet been proven clinically effective and that links between glycocalyx damage, sepsis severity and DIC remain inadequately defined.
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Published paper
Glycocalyx in vivo measurement
This review describes how the endothelial glycocalyx can be assessed in living patients. It contrasts laboratory measurement of circulating shedding products (syndecan-1, heparan sulfate, hyaluronan) with bedside video microscopy techniques such as sidestream dark-field imaging, which estimates glycocalyx dimensions in the sublingual microcirculation via the Perfused Boundary Region.
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Published paper
Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation
This European Society of Cardiology Working Group position statement reviews the available in-vivo and ex-vivo methods for assessing endothelial function, from invasive coronary angiography with acetylcholine to flow-mediated dilatation, pulse wave analysis, peripheral arterial tonometry, laser Doppler flowmetry, biochemical markers, endothelial microparticles, progenitor cells, and glycocalyx imaging. For each technique it outlines the physiological rationale, methodology, reproducibility, and clinical applications. The authors conclude that no single method is superior and that endothelial function testing may aid risk stratification but needs further validation before routine clinical use.
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