133 published papers on the glycocalyx
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
Non-invasive assessment of microvascular dysfunction in families with premature coronary artery disease
This brief research letter reports on the use of non-invasive imaging of the sublingual microcirculation to assess microvascular function in relatives of patients with premature coronary artery disease. The authors, who developed the sidestream dark-field perfused boundary region technique, position this approach as a way to detect microvascular/glycocalyx abnormalities in people at inherited risk of early coronary disease. No abstract text was available, so the specific numerical results cannot be reported here.
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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
Effects of ultrapure hemodialysis and low molecular weight heparin on the endothelial surface layer
In 20 hemodialysis patients, researchers measured the endothelial surface layer during dialysis sessions using sidestream dark-field imaging (perfused boundary region, PBR) and plasma markers of glycocalyx shedding, varying whether low molecular weight heparin was given at the start of dialysis or 120 minutes in. Plasma syndecan-1 rose significantly during hemodialysis, with the increase appearing to follow heparin administration, while PBR did not change measurably.
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Published paper
Association of kidney function with changes in the endothelial surface layer
This cross-sectional study used sublingual sidestream dark-field imaging (GlycoCheck) to measure the perfused boundary region (PBR), an inverse index of endothelial glycocalyx integrity, in men with end-stage renal disease, kidney transplant recipients, and healthy controls. Patients with ESRD and transplant recipients who developed interstitial fibrosis/tubular atrophy had larger PBR (worse glycocalyx) and higher circulating shed glycocalyx markers, whereas recipients with stable graft function were indistinguishable from controls. Reduced eGFR correlated with a larger PBR and higher endothelial activation markers.
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Published paper
Deeper penetration of erythrocytes into the endothelial glycocalyx is associated with impaired microvascular perfusion
In a population-based sample of 915 middle-aged Dutch adults, researchers used sidestream dark-field imaging with automated GlycoCheck software to measure the perfused boundary region (PBR, a marker of how deeply red blood cells penetrate the endothelial glycocalyx) in sublingual microvessels. Deeper red-cell penetration (higher PBR) was strongly associated with poorer microvascular perfusion, measured as the percentage of time vessel segments contained red blood cells. The authors interpret a low PBR (thicker glycocalyx) as reflecting more efficient microvascular perfusion.
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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
Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study
This small randomized pilot trial compared sublingual microcirculatory and tissue oxygenation responses one hour after transfusion of leukodepleted versus non-leukodepleted red blood cells in 20 septic ICU patients. Most between-group differences were not significant, though microvascular flow index and blood flow velocity changed more favorably with leukodepleted units. Glycocalyx was assessed by sidestream dark-field perfused boundary region (GlycoCheck software) and by serum syndecan-1, hyaluronan, and heparan sulfate.
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Published paper
Is the systemic microvascular endothelial glycocalyx in peritoneal dialysis patients related to peritoneal transport?
This small cross-sectional study measured the sublingual microvascular glycocalyx (perfused boundary region, PBR, and estimated blood vessel density) with sidestream dark-field imaging in 15 peritoneal dialysis patients and compared these with peritoneal membrane transport measured by a peritoneal permeability analysis. Overall, no associations were found between systemic glycocalyx measures and peritoneal transport. Some correlations appeared only in the subgroup of patients without fast peritoneal transport.
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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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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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Published paper
Effect of sulodexide on endothelial glycocalyx and vascular permeability in patients with type 2 diabetes mellitus
This small open-label study compared endothelial glycocalyx thickness in the sublingual and retinal microcirculation of 10 men with type 2 diabetes and 10 healthy age-matched men, then measured both groups again after 8 weeks of oral sulodexide (200 mg/day), a glycosaminoglycan mixture of heparan and dermatan sulfate. Men with diabetes had thinner glycocalyx in both vascular beds, higher albumin leakage from capillaries, and higher markers of hyaluronan breakdown. After sulodexide, glycocalyx dimensions increased in the diabetes group, with a non-significant trend toward normalized albumin leakage.
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Published paper
Acute ischemic injury to the renal microvasculature in human kidney transplantation
During transplant surgery, researchers used sidestream darkfield imaging to observe peritubular capillaries in kidneys from donors after cardiac death (DCD, substantial ischemia) and from living donors (minimal ischemia). DCD kidneys showed markedly poorer microvascular perfusion and biochemical and imaging signs of endothelial glycocalyx degradation, despite similar overall renovascular resistance. The authors conclude that ischemia-reperfusion in kidney grafts involves impaired capillary flow and loss of glycocalyx integrity.
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