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. 2020 Oct 15;202(8):1178-1181.
doi: 10.1164/rccm.202007-2676LE.

Injury to the Endothelial Glycocalyx in Critically Ill Patients with COVID-19

Klaus Stahl  1 , Phillip Alexander Gronski  1 , Yulia Kiyan  1 , Benjamin Seeliger  1 , Anna Bertram  1 , Thorben Pape  1 , Tobias Welte  1 , Marius M Hoeper  1 , Hermann Haller  1 , Sascha David  1   2
Affiliations

Injury to the Endothelial Glycocalyx in Critically Ill Patients with COVID-19

Klaus Stahl et al. Am J Respir Crit Care Med. .
No abstract available

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Figures

Figure 1.
Figure 1.
Injury to the endothelial glycocalyx in severe coronavirus disease (COVID-19). Scatter dot plots (median [interquartile range]) show (A) sTie-2 and (B) syndecan-1 concentrations for control and patients with COVID-19. Concentrations for both syndecan-1 (control: 41.5 [32.6–105.4] ng/ml vs. COVID-19: 336.5 [196.7–377.1] ng/ml) and sTie-2 (control: 18.4 [16–21.3] ng/ml vs COVID-19: 22.3 [19.7–27.3] ng/ml) were increased in patients with COVID-19. (C) Although both Hpa-1 (heparanase-1) concentration and activity were not significantly altered in comparison with control subjects, patients with COVID-19 showed an acquired deficiency in Hpa-2 (heparanase-2) (control: 18.7 [10.6–31.1] U/ml vs. COVID-19: 4.7 [2.6–5.1] U/ml). Consequentially, the Hpa-1:Hpa-2 ratio was higher in patients with COVID-19 (control: 0.08 [0.05–0.17] ng/U vs. COVID-19: 0.35 [0.27–0.66] ng/U). (D) Sidestream darkfield imaging in patients allows the quantification of endothelial glycocalyx thickness as indicated by increased perfused boundary region; this was increased in patients with COVID-19 (control: 1.9 [1.8–1.9] μm vs. COVID-19: 2.1 [1.8–2.2] μm), indicating reduced endothelial glycocalyx thickness. For comparison of groups, first, the normal distribution (D’Agostino-Pearson omnibus and Shapiro-Wilk normality test) of variables was tested, and then (A and D) two-sided unpaired t tests and (B and C) Mann-Whitney tests were used accordingly. (E) Exemplary three-dimensional reconstruction of the heparan sulfate (HS) layer images of naive endothelial cells in a microfluidic chip (HS in red; DAPI nuclei staining in blue) after perfusion with serum of a patient with COVID-19 (middle row) compared with a healthy control subject (upper row) in both front and isometric view angles demonstrates the diffuse loss of HS-rich glycocalyx layer in cells treated with COVID-19 serum. In Hpa-2–overexpressing endothelial cells (lower row), the HS surface layer is protected from injurious effects by perfusion with COVID-19 serum. overexp = overexpressing; PBR = perfused boundary region; sTie-2 = soluble Tie-2.
See this image and copyright information in PMC

References

    1. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the seattle region: case series. N Engl J Med. 2020;382:2012–2022. - PMC - PubMed
    1. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802–810. - PMC - PubMed
    1. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395:1417–1418. - PMC - PubMed
    1. Schmidt EP, Yang Y, Janssen WJ, Gandjeva A, Perez MJ, Barthel L, et al. The pulmonary endothelial glycocalyx regulates neutrophil adhesion and lung injury during experimental sepsis. Nat Med. 2012;18:1217–1223. - PMC - PubMed
    1. Uchimido R, Schmidt EP, Shapiro NI. The glycocalyx: a novel diagnostic and therapeutic target in sepsis. Crit Care. 2019;23:16. - PMC - PubMed