title: The endothelial glycocalyx and its disruption, protection and regeneration: a narrative review.
abstract: The glycocalyx is a carbohydrate-rich layer that lines the luminal side of the vascular endothelium. Its soluble components exist in a dynamic equilibrium with the bloodstream and play an important role in maintaining endothelial layer integrity. However, the glycocalyx can be easily damaged and is extremely vulnerable to insults from a variety of sources, including inflammation, trauma, haemorrhagic shock, hypovolemia and ischaemia-reperfusion. Damage to the glycocalyx commonly precedes further damage to the vascular endothelium. Preclinical research has identified a number of different factors capable of protecting or regenerating the glycocalyx. Initial investigations suggest that plasma may convey protective and regenerative effects. However, it remains unclear which exact components or properties of plasma are responsible for this protective effect. Studies have reported protective effects for several plasma proteins individually, including antithrombin, orosomucoid and albumin; the latter of which may be of particular interest, due to the high levels of albumin present in plasma. A further possibility is that plasma is simply a better intravascular volume expander than other resuscitation fluids. It has also been proposed that the protective effects are mediated indirectly via plasma resuscitation-induced changes in gene expression. Further work is needed to determine the importance of specific plasma proteins or other factors for glycocalyx protection, particularly in a clinical setting.
authors.affiliation: Department of Clinical Sciences Lund, Medical Faculty, University of Lund, Lund, Sweden. ulf.schott@skane.se.|Department of Intensive and Perioperative Care, Skane University Hospital, Lund, Sweden. ulf.schott@skane.se.
authors.forename: Ulf
authors.initials: U
authors.lastname: Schött
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria.|CSL Behring, Marburg, Germany.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.affiliation: Department of Surgical and General Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fries
authors.affiliation: Department of Clinical Sciences Lund, Medical Faculty, University of Lund, Lund, Sweden.|Department of Intensive and Perioperative Care, Skane University Hospital, Lund, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Bentzer
mesh_terms: D004727:Endothelium / Q000293:injuries*; D019276:Glycocalyx / Q000378:metabolism*; D006801:Humans; D010949:Plasma / Q000378:metabolism; D012038:Regeneration
keywords: Bleeding management; Fresh frozen plasma; Glycocalyx; Protection; Regeneration