a) What is the endothelial glycocalyx? Outline its potential importance in sepsis.
b) Name factors that can disrupt the endothelial surface layer (ESL).
c) What are the effects of glycocalyx disruption?
The endothelial glycocalyx forms the basal skeleton that in vivo interacts dynamically with plasma constituents forming an endothelial surface layer (ESL)
- forms the interface between the vessel wall and moving blood
- protein-free space below the glycocalyx
- maintenance of the vascular permeability barrier
- mediation of shear-stress-dependent nitric oxide production
- retention of vascular protective enzymes (e.g. superoxide dismutase)
- retention of coagulation inhibition factors (e.g. antithrombin, the protein C system and tissue factor pathway inhibitor)
- modulation of the inflammatory response by preventing leukocyte adhesion and binding
- various ligands (e.g. chemokines, cytokines and growth factors)
Glycocalyx shedding and disruption is associated with:
- TNFα, redox stress and oxidised lipoproteins
- artificial colloids such as hydroxyethyl starch
Effects of glycocalyx damage
- capillary leak
- loss of vascular responsiveness
- platelet aggregation
Pass rate: 42%
Highest mark: 8.5