Endothelial glycocalyx: Role in body fluid homeostasis and fluid management

Kundra, Pankaj; Goswami, Shreya

doi:10.4103/ija.ija_751_18

Cited by 37 publications

(28 citation statements)

References 39 publications

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“…The use of colloids was similar and included hetastarch and albumin. Incidence of kidney injury and coagulopathy with starches and gelatins are reported [ 20 ] but we did not see an association with their use.…”

Section: Discussioncontrasting

confidence: 80%

Intraoperative factors contributory to myocardial injury in high-risk patients undergoing abdominal surgery in a South Indian population

et al. 2020

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Section: Discussioncontrasting

confidence: 80%

Intraoperative factors contributory to myocardial injury in high-risk patients undergoing abdominal surgery in a South Indian population

et al. 2020

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“…Epithelial cells maintain structural integrity of tissues including the small capillary vessels that surround the alveoli in the lungs and the capillaries of all other organs. Epithelial cells are lined with a gel-like surface of interconnected proteins call the endothelial glycocalyx (31).…”

Section: Acute Respiratory Distress Syndrome and Sepsismentioning

confidence: 99%

SARS-CoV-2 Bound Human Serum Albumin and Systemic Septic Shock

Johnson

Fatemi

Winlow

2020

Front. Cardiovasc. Med.

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The emergence of the COVID-19 virus and the subsequent pandemic have driven a great deal of research activity. The effects of COVID-19 are caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) and it is the underlying actions of SARs-CoV-2 virions on the endothelial glycocalyx that we consider here. One of the key factors in COVID-19 infection is its almost unique age-related profile, with a doubling in mortality every 10 years after the age of 50. The endothelial glycocalyx layer is essential in maintaining normal fluid homeostasis, but is fragile and prone to pathophysiological damage. It is physiologically significant in capillary microcirculation and in fluid distribution to the tissues. Human serum albumin (HSA), the most abundant protein in plasma, is created in the liver which also maintains its concentration, but this reduces by 10-15% after 50 years of age. HSA transports hormones, free fatty acids and maintains oncotic pressure, but SARS-CoV-2 virions bind competitively to HSA diminishing its normal transport function. Furthermore, hypoalbuminemia is frequently observed in patients with such conditions as diabetes, hypertension, and chronic heart failure, i.e., those most vulnerable to SARS-CoV-2 infection. Hypoalbuminemia, coagulopathy, and vascular disease have been linked in COVID-19 and have been shown to predict outcome independent of age and morbidity. Hypoalbuminemia is also known factor in sepsis and Acute respiratory distress syndrome (ARDS) occurs when fluids build-up in the alveoli and it is associated with sepsis, whose mechanism is systemic, being associated with the fluid and logistic mechanisms of the circulation. Glycocalyx damage is associated with changes plasma protein concentration, particularly HSA and blockage of albumin transport can produce the systemic symptoms seen in SARS-CoV-2 infection and sepsis. We therefore conclude that albumin binding to SARS-CoV-2 virions may inhibit the formation of the endothelial glycocalyx by inhibition of albumin transport binding sites. We postulate that albumin therapy to replace bound albumin might alleviate some of the symptoms leading to sepsis and that clinical trials to test this postulation should be initiated as a matter of urgency.

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“…6 In addition, there is a recent emphasis on studying the proposed therapeutic strategies aimed at preserving the EG structural and functional status in diverse clinical settings jeopardizing the glycocalyx integrity (Table 2). 4 To conclude, the literature surrounding EG bestows a new dimension to the actively researched area of modulating inflammatory response to CPB. Well-directed and focused studies can further support the endothelial preservation modalities, strengthening the emerging role of cardiac anesthesiologists as endotheliologists.…”

Section: Endothelial Glycocalyx and Cardiac Surgery: Newer Insightsmentioning

confidence: 99%

“…3 Table 1 enlists the various causes of EG disruption. 4 Postoperative syndecan-1 levels also have been linked to increased risk of acute kidney injury after pediatric cardiac surgery. 5 A wide variation in the preoperative levels and other relevant causes of elevation (ischemia reperfusion injury, etc) present peculiar impediments to a universal application of EG degradation products despite the above-mentioned associations.…”

Section: Endothelial Glycocalyx and Cardiac Surgery: Newer Insightsmentioning

confidence: 99%