The endothelial glycocalyx is a recently discovered structure at the luminal side of blood vessels consisting of proteoglycans and glycosaminoglycans, which play an important role in vascular barrier function and cell adhesion. Due to its vulnerability, the endothelial glycocalyx may easily be altered by hypoxia , TNFα , oxidized lipoproteins  and other nonphysiological conditions. We raised the question of whether the glycocalyx may be shed from the endothelium in dependence of severity of sepsis.
This clinical prospective study - approved by the local ethics committee - was performed to assess plasma levels of the glycocalyx components (hyaluronane, syndecan, heparan sulfate) by ELISA technique and polymorphonuclear leukocyte (PMN) function by flow cytometry in eight healthy volunteers (HV) and 37 patients who were prospectively enrolled within 24 hours of onset of signs of infection, if they met the criteria for sepsis (n = 10), severe sepsis (n = 9) and septic shock (n = 18) as defined by the members of the ACCP/SCCM Consensus Conference Committee (Table 1). Blood was drawn within 24 hours after onset of sepsis. Informed consent was obtained from all patients or their legal representatives, respectively.
Plasma levels of the glycocalyx components were significantly higher in septic patients than in healthy volunteers and even more pronounced in patients with severe sepsis and septic shock (all P < 0.05; Figure 1). Hyaluronan and syndecan plasma levels correlated positively with the APACHE II, SOFA and MOD scores (Figure 1 and Table 2). Hyaluronan displayed a positive correlation with the C-reactive protein, procalcitonin and IL-6 in plasma (Table 3). The PMN dysfunction - characterized by an increase in cytotoxic capability and a decrease in microbicidity - showed a parallel course to the heparan sulfate plasma levels.
Elevated plasma levels of hyaluronan, syndecan and heparan sulfate are suggestive of a glycocalyx shedding from endothelium with increasing sepsis severity. This process might contribute to the vascular dysfunction and development of edema in septic patients.
Rehm M, Bruegger D, Christ F, et al.: Shedding of the endothelial glycocalyx in patients undergoing major vascular surgery with global and regional ischemia.Circulation 2007, 116: 1896-1906. 10.1161/CIRCULATIONAHA.106.684852
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.