Document Detail


Shedding of the endothelial glycocalyx in patients undergoing major vascular surgery with global and regional ischemia.
MedLine Citation:
PMID:  17923576     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The astonishing thickness of the endothelial glycocalyx, which rivals that of endothelial cells in the microvasculature, was disclosed in the last 15 years. As already demonstrated, this structure plays a key role in the regulation of inflammation and vascular permeability. METHODS AND RESULTS: Two components of the glycocalyx, syndecan-1 and heparan sulfate, were measured in arterial blood of 18 patients undergoing surgery of the ascending aorta with cardiopulmonary bypass (n=12 with and n=6 without deep hypothermic circulatory arrest) and of 14 patients undergoing surgery for infrarenal aortic aneurysm. Basal values of syndecan-1 (1.2 microg/dL) and heparan sulfate (590 microg/dL) of patients were similar to those of control subjects. Anesthesia and initiation of surgery caused no changes. Global ischemia with circulatory arrest (n=12) was followed by transient 42- and 10-fold increases in syndecan-1 and heparan sulfate, respectively, during early reperfusion (0 to 15 minutes). After regional ischemia of heart and lungs (cardiopulmonary bypass; n=6), syndecan-1 increased 65-fold, and heparan sulfate increased 19-fold. Infrarenal ischemia was followed by 15- and 3-fold increases, respectively (n=14). The early postischemic rises were positively correlated (r=0.76, P<0.001). Plasma concentrations of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 did not change. Circulating polymorphonuclear granulocytes and the level of postischemic heparan sulfate corresponded negatively. Immunohistochemical imaging and immunoassay of isolated hearts (guinea pig) substantiated syndecan-1 and heparan sulfate as components of the endothelial glycocalyx released into the coronary venous effluent. Electron microscopy revealed shedding of the glycocalyx after ischemia/reperfusion. CONCLUSIONS: This study provides the first evidence in humans for shedding of the endothelial glycocalyx during ischemia/reperfusion procedures.
Authors:
Markus Rehm; Dirk Bruegger; Frank Christ; Peter Conzen; Manfred Thiel; Matthias Jacob; Daniel Chappell; Mechthild Stoeckelhuber; Ulrich Welsch; Bruno Reichart; Klaus Peter; Bernhard F Becker
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-10-08
Journal Detail:
Title:  Circulation     Volume:  116     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-29     Completed Date:  2008-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1896-906     Citation Subset:  AIM; IM    
Affiliation:
Clinic of Anesthesiology, Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany. markus.rehm@med.uni-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Animals
Aorta / metabolism,  surgery,  ultrastructure
Aortic Aneurysm / metabolism*,  pathology
Cardiopulmonary Bypass*
Circulatory Arrest, Deep Hypothermia Induced
Coronary Vessels / metabolism*,  ultrastructure
Endothelium, Vascular / metabolism*,  ultrastructure
Glycocalyx / metabolism*
Granulocytes / metabolism,  pathology
Guinea Pigs
Heparitin Sulfate / blood
Humans
Intercellular Adhesion Molecule-1 / blood
Lung / blood supply,  metabolism,  ultrastructure
Male
Myocardial Ischemia / blood*,  pathology
Myocardial Reperfusion
Syndecan-1
Vascular Cell Adhesion Molecule-1 / blood
Chemical
Reg. No./Substance:
0/SDC1 protein, human; 0/Syndecan-1; 0/Vascular Cell Adhesion Molecule-1; 126547-89-5/Intercellular Adhesion Molecule-1; 9050-30-0/Heparitin Sulfate

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