title: New insights into systemic sclerosis related microcirculatory dysfunction by assessment of sublingual micr\ocirculation and vascular glycocalyx layer. Results from a preliminary study.
abstract: BACKGROUND
  Initial morphological and functional markers of systemic sclerosis (SSc) are evidenced in microvascular structural damage. However, nailfold videocapillaroscopy (NVC) explores only morphological abnormalities. Sidestream Dark Field (SDF) imaging of sublingual microcirculation enables assessment of both morphological and functional capillary impairment and allows measurement of the glycocalyx layer, which is an indicator of endothelial dysfunction.
  
  
  OBJECTIVE
  To describe and validate sublingual abnormalities assessed by SDF device in comparison with NVC findings and to measure the thickness of the glycocalyx layer.
  
  
  METHODS
  From February to May 2014, 26 subjects (16 SSc patients and 10 healthy controls) underwent standardised NVC and SDF imaging of sublingual microcirculation. Glycocalyx thickness was also measured.
  
  
  RESULTS
  Capillary density and percentage of perfused vessels were significantly reduced in patients with SSc (n = 13) compared to controls. Correlation between nailfold capillary density assessed by NVC and sublingual capillary density assessed by SDF was observed (r(2) = 0.59; P = 0.023). According to the NVC pattern, patients with "active" disease experienced greater reduction in capillary density than patients with "late" disease as suggested by the de Backer score (9.17 ± 0.81 vs 10.86 ± 1.19; P = 0.03). Additionally, the decrease in glycocalyx thickness was measured in SSc patients (n = 13) compared to controls (n = 10) (0.41 ± 0.03 versus 0.76 ± 0.29 P = 0.003).
  
  
  CONCLUSIONS
  Our results suggest for the first time in SSc, that sublingual microcirculation and glycocalyx are impaired and that SDF imaging findings correlate with those of NVC. Nevertheless, further studies are required for the validation of our preliminary results.
authors: Department of Internal Medicine, Rouen University Hospital, Rouen, France; Inserm U1096, University of Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, France.
authors: S
authors: S
authors: Miranda
authors: Department of Internal Medicine, Rouen University Hospital, Rouen, France; Inserm U1096, University of Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, France.
authors: G
authors: G
authors: Armengol
authors: Department of Internal Medicine, Rouen University Hospital, Rouen, France; Inserm U1096, University of Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, France.
authors: M
authors: M
authors: Le Besnerais
authors: Department of Internal Medicine, Rouen University Hospital, Rouen, France; Inserm U1096, University of Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, France.
authors: H
authors: H
authors: Lévesque
authors: Department of Internal Medicine, Rouen University Hospital, Rouen, France; Inserm U1096, University of Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, France. Electronic address: ygal.benhamou@chu-rouen.fr.
authors: Y
authors: Y
authors: Benhamou
mesh_terms: D000328:Adult; D000368:Aged; D002196:Capillaries / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D019276:Glycocalyx / Q000737:chemistry; D006801:Humans; D008297:Male; D008833:Microcirculation; D020678:Microscopic Angioscopy; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply*; D009262:Nails / Q000098:blood supply; D011928:Raynaud Disease / Q000503:physiopathology; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D014059:Tongue / Q000098:blood supply*
keywords: Endothelial glycocalyx; Microcirculation; Nailfold videocapillaroscopy; SDF imaging; Systemic sclerosis