Endothelium protection by the glycocalyx

Sepsis is still a major cause of elevated mortality ratein the intensive care unit. Endothelial cell function plays a key role in this pathophysiological process. Recent studies provide evidence that degradation of glycocalyx on the lumi- nal cell membrane is an early step in endothelial dysfunction. The glycocalyx is composed of negatively charged glycopro- teins, discovered by electron microscopy more than 40 years ago. The glycocalyx is a key determinant of vascular function regulating vascular permeability and interactions with peri- pheral blood cells. During sepsis, the glycocalyx may be degraded to various components including heparan sulfate and syndecan-1 that are released into the bloodstream. Howe- ver, functional assessment and visualization of glycocalyx are still complex to establish. Preservation of glycocalyx could be a future therapeutic target for treatment. Therefore, develop- ment of therapeutic strategies to maintain and/or repair the glycocalyx may become a research focus in the management of septic patients.