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Review
. 2020 May;21(5):e291-e300.
doi: 10.1097/PCC.0000000000002266.

The Endothelial Glycocalyx: A Fundamental Determinant of Vascular Permeability in Sepsis

Jaime Fernández-Sarmiento  1   2 , Lina María Salazar-Peláez  1 , Joseph A Carcillo  3
Affiliations
Review

The Endothelial Glycocalyx: A Fundamental Determinant of Vascular Permeability in Sepsis

Jaime Fernández-Sarmiento et al. Pediatr Crit Care Med. 2020 May.

Abstract

Objectives: Sepsis is a significant cause of morbidity and mortality. Children with sepsis often have alterations in microcirculation and vascular permeability. Our objective is current evidence regarding the role of the endothelial glycocalyx as a determinant of capillary leakage in these patients.

Data sources: We reviewed PubMed, EMBASE, and Google scholar using MeSH terms "glycocalyx", "fluids", "syndecan", "endothelium", "vascular permeability", "edema", "sepsis", "septic shock", "children".

Study selection: Articles in all languages were included. We include all studies in animals and humans related to glycocalyx and vascular permeability.

Data extraction: Studies in children and adults, as well as animal studies, were included.

Data synthesis: One of the fundamental components of the endothelial barrier structure is the glycocalyx. It is a variable thickness layer distributed throughout the whole body, which fulfills a very important function for life: the regulation of blood vessel permeability to water and solutes, favoring vascular protection, modulation, and hemostasis. In the last few years, there has been a special interest in glycocalyx disorders and their relationship to increased vascular permeability, especially in patients with sepsis in whom the alterations that occur in the glycocalyx are unknown when they are subjected to different water resuscitation strategies, vasopressors, etc. This review describes the structural and functional characteristics of the glycocalyx, alterations in patients with sepsis, with regard to its importance in vascular permeability conservation and the possible impact of strategies to prevent and/or treat the injury of this fundamental structure.

Conclusions: The endothelial glycocalyx is a fundamental component of the endothelium and an important determinant of the mechanotransduction and vascular permeability in patients with sepsis. Studies are needed to evaluate the role of the different types of solutions used in fluid bolus, vasoactive support, and other interventions described in pediatric sepsis on microcirculation, particularly on endothelial integrity and the glycocalyx.

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Conflict of interest statement

Drs. Fernández-Sarmiento, Salazar-Peláez, and Carcillo conceived the idea for the article. Dr. Fernández-Sarmiento carried out the systematic literature review and designed the figures that represent the glycocalyx. All the authors drafted the article and contributed significantly to the article revision. All authors approved the final article as submitted and agree to be accountable for all aspects of the work. None of the researchers have conflicts of interest to declare.

The authors have disclosed that they do not have any potential conflicts of interest

Figures

Figure 1.
Figure 1.
Electron micrograph of a goat coronary capillary stained with alcian blue. Courtesy of B.M. van den Berg, Leiden University Medical Center, The Netherlands.
Figure 2.
Figure 2.
An approximate graphic representation of the glycocalyx. A, A graphic representation of the healthy glycocalyx and its relation to vascular structures and plasma proteins. B, An enlargement of the image. The proteoglycans are shown, principally syndecan with its transmembrane protein core joined to the glycosaminoglycans (GAGs) and interacting with proteins such as albumin (ALB-green). The other glycocalyx component is also shown as the glycoproteins (adhesion molecule).
Figure 3.
Figure 3.
Glycocalyx damage and increased permeability in sepsis. The figure depicts the passage of molecules and fluids through the damaged glycocalyx as well as the release of its degradation products (syndecans) into systemic circulation. A platelet, RBC, and macrophage are shown interacting with plasma proteins (green points) and the glycocalyx. Green points represent the transendothelial migration of proteins when the glycocalyx is injured.
See this image and copyright information in PMC

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