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Review Article

Targeting the endothelial glycocalyx in acute critical illness as a challenge for clinical and laboratory medicine

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Pages 343-357 | Received 29 Jan 2017, Accepted 11 Sep 2017, Published online: 29 Sep 2017
 

Abstract

The purpose of this manuscript is to review the role of endothelial glycocalyx (EG) in the field of critical and perioperative medicine and to discuss possible future directions for investigations in this area. Under physiological conditions, EG has several well-defined functions aimed to prevent the disruption of vessel wall integrity. Under pathological conditions, the EG represent one of the earliest sites of injury during inflammation. EG structure and function distortion contribute to organ dysfunction related to sepsis, trauma, or global ischemia of any origin. Discovering new therapeutic approaches (either pharmacological or non-pharmacological) aimed to protect the EG against injury represents a promising direction in clinical medicine. Further, the currently-used common interventions in the acutely ill – fluids, blood products, nutritional support, organ-supporting techniques (e.g. continuous renal replacement therapy, extracorporeal circulation), temperature modulation and many others – should be re-evaluated during acute illness in terms of their EG “friendliness”. To assess new therapies that protect the EG, or to evaluate the effect of currently-used interventions on EG integrity, a relevant marker or method to determine EG damage is needed. Such marker or method should be available to clinicians within hours, preferably in the form of a point-of-care test at the bedside. Collaborative research between clinical disciplines and laboratory medicine is warranted, and targeting the EG represents major challenges for both.

Acknowledgements

All rights reserved. The authors are grateful to Ian McColl and Daniel Diaz for assistance with the manuscript.

Disclosure statement

No conflict of interest was reported by the authors.

Additional information

Funding

Supported by Ministry of Health of the Czech Republic, grant no. 15-31881A. All rights reserved.

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