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van Lanen RHGJ, Haeren RHL, Staals J, Dings JTA, Schijns OEMG, Hoogland G, van Kuijk SMJ, Kapsokalyvas D, van Zandvoort MAMJ, Vink H, Rijkers K. Cerebrovascular glycocalyx damage and microcirculation impairment in patients with temporal lobe epilepsy. J Cereb Blood Flow Metab 2023; 43:1737-1751. [PMID: 37231664 PMCID: PMC10581235 DOI: 10.1177/0271678x231179413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Temporal lobe epilepsy (TLE) is increasingly associated with blood-brain barrier dysfunction and microvascular alterations, yet the pathophysiological link is missing. An important barrier function is exerted by the glycocalyx, a gel-like layer coating the endothelium. To explore such associations, we used intraoperative videomicroscopy to quantify glycocalyx and microcirculation properties of the neocortex and hippocampus of 15 patients undergoing resective brain surgery as treatment for drug-resistant TLE, and 15 non-epileptic controls. Fluorescent lectin staining of neocortex and hippocampal tissue was used for blood vessel surface area quantification. Neocortical perfused boundary region, the thickness of the glycocalyx' impaired layer, was higher in patients (2.64 ± 0.52 µm) compared to controls (1.31 ± 0.29 µm), P < 0.01, indicative of reduced glycocalyx integrity in patients. Moreover, erythrocyte flow velocity analysis revealed an impaired ability of TLE patients to (de-)recruit capillaries in response to changing metabolic demands (R2 = 0.75, P < 0.01), indicating failure of neurovascular coupling mechanisms. Blood vessel quantification comparison between intraoperative measurements and resected tissue showed strong correlation (R2 = 0.94, P < 0.01). This is the first report on in vivo assessment of glycocalyx and microcirculation properties in TLE patients, confirming the pivotal role of cerebrovascular changes. Further assessment of the cerebral microcirculation in relation to epileptogenesis might open avenues for new therapeutic targets for drug-resistant epilepsy.
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Affiliation(s)
- Rick HGJ van Lanen
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Roel HL Haeren
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim TA Dings
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
| | - Olaf EMG Schijns
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Sander MJ van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dimitris Kapsokalyvas
- Department of Genetics & Cell Biology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Interdisciplinary Center for Clinical Research (IZKF), University Hospital RWTH Aachen, Aachen, Germany
| | - Marc AMJ van Zandvoort
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Department of Genetics & Cell Biology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Institute for Molecular Cardiovascular Research IMCAR, Universitätsklinikum, Aachen University, Aachen, Germany
| | - Hans Vink
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Academic Centre for Epileptology, Maastricht University Medical Centre and Kempenhaeghe, Maastricht/Heeze, The Netherlands
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Chalkias A, Papagiannakis N, Mavrovounis G, Kolonia K, Mermiri M, Pantazopoulos I, Laou E, Arnaoutoglou E. Sublingual microcirculatory alterations during the immediate and early postoperative period: A systematic review and meta-analysis. Clin Hemorheol Microcirc 2021; 80:253-265. [PMID: 34719484 DOI: 10.3233/ch-211214] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The incidence of postoperative microcirculatory flow alterations and their effect on outcome have not been studied extensively. OBJECTIVE This systematic review and meta-analysis was designed to investigate the presence of sublingual microcirculatory flow alterations during the immediate and early postoperative period and their correlation with complications and survival. METHODS A systematic search of PubMed, Scopus, Embase, PubMed Central, and Google Scholar was conducted for relevant articles from January 2000 to March 2021. Eligibility criteria were randomized controlled and non-randomized trials. Case reports, case series, review papers, animal studies and non-English literature were excluded. The primary outcome was the assessment of sublingual microcirculatory alterations during the immediate and early postoperative period in adult patients undergoing surgery. Risk of bias was assessed with the Ottawa-Newcastle scale. Standard meta-analysis methods (random-effects models) were used to assess the difference in microcirculation variables. RESULTS Thirteen studies were included. No statistically significant difference was found between preoperative and postoperative total vessel density (p = 0.084; Standardized Mean Difference (SMD): -0.029; 95%CI: -0.31 to 0.26; I2 = 22.55%). Perfused vessel density significantly decreased postoperatively (p = 0.035; SMD: 0.344; 95%CI: 0.02 to 0.66; I2 = 65.66%), while perfused boundary region significantly increased postoperatively (p = 0.031; SMD: -0.415; 95%CI: -0.79 to -0.03; I2 = 37.21%). Microvascular flow index significantly decreased postoperatively (p = 0.028; SMD: 0.587; 95%CI: 0.06 to 1.11; I2 = 86.09%), while no statistically significant difference was found between preoperative and postoperative proportion of perfused vessels (p = 0.089; SMD: 0.53; 95%CI: -0.08 to 1.14; I2 = 70.71%). The results of the non-cardiac surgery post-hoc analysis were comparable except that no statistically significant difference in perfused vessel density was found (p = 0.69; SMD: 0.07; 95%CI: -0.26 to 0.39; I2 = 0%). LIMITATIONS The included studies investigate heterogeneous groups of surgical patients. There were no randomized controlled trials. CONCLUSIONS Significant sublingual microcirculatory flow alterations are present during the immediate and early postoperative period. Further research is required to estimate the correlation of sublingual microcirculatory flow impairment with complications and survival.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, University ofThessaly, Faculty of Medicine, Larisa, Greece.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Nikolaos Papagiannakis
- First Department of Neurology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Mavrovounis
- Department of Emergency Medicine, University of Thessaly, Faculty of Medicine, Larisa, Greece
| | - Konstantina Kolonia
- Department of Anesthesiology, University ofThessaly, Faculty of Medicine, Larisa, Greece
| | - Maria Mermiri
- Department of Anesthesiology, University ofThessaly, Faculty of Medicine, Larisa, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, University of Thessaly, Faculty of Medicine, Larisa, Greece
| | - Eleni Laou
- Department of Anesthesiology, University ofThessaly, Faculty of Medicine, Larisa, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, University ofThessaly, Faculty of Medicine, Larisa, Greece
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Abstract
INTRODUCTION Monitoring the microcirculation may be helpful in guiding resuscitation in patients with circulatory shock. Sublingual side-stream dark field imaging cameras allow for noninvasive, bedside evaluation of the microcirculation, although their use in clinical practice has not yet been validated. The GlycoCheck system automatically analyzes images to determine glycocalyx thickness, red blood cell filling percentage, and vessel density. Although GlycoCheck has been used to study microcirculation in critically ill patients, little is known about the reproducibility of measurements in this population. MATERIALS AND METHODS A total of 60 critically ill patients were studied. Three consecutive microcirculation measurements were performed with the GlycoCheck system in 40 of these patients by one of two experienced observers. Twenty patients were assessed by both observers. Intra- and interobserver variability were assessed using intraclass correlation coefficients (ICCs). RESULTS ICCs of single measurements were poor for glycocalyx thickness and good for filling percentage and vessel density. Reproducibility could be substantially increased for all parameters when three consecutive measurements were performed and averaged. DISCUSSION GlycoCheck can be used to study microcirculation. However, to obtain reliable results three consecutive measurements should be performed and averaged. The variation of the measurements currently hampers the clinical application in individual patients.
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Hahn RG, Patel V, Dull RO. Human glycocalyx shedding: Systematic review and critical appraisal. Acta Anaesthesiol Scand 2021; 65:590-606. [PMID: 33595101 DOI: 10.1111/aas.13797] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The number of studies measuring breakdown products of the glycocalyx in plasma has increased rapidly during the past decade. The purpose of the present systematic review was to assess the current knowledge concerning the association between plasma concentrations of glycocalyx components and structural assessment of the endothelium. METHODS We performed a literature review of Pubmed to determine which glycocalyx components change in a wide variety of human diseases and conditions. We also searched for evidence of a relationship between plasma concentrations and the thickness of the endothelial glycocalyx layer as obtained by imaging methods. RESULTS Out of 3,454 publications, we identified 228 that met our inclusion criteria. The vast majority demonstrate an increase in plasma glycocalyx products. Sepsis and trauma are most frequently studied, and comprise approximately 40 publications. They usually report 3-4-foldt increased levels of glycocalyx degradation products, most commonly of syndecan-1. Surgery shows a variable picture. Cardiac surgery and transplantations are most likely to involve elevations of glycocalyx degradation products. Structural assessment using imaging methods show thinning of the endothelial glycocalyx layer in cardiovascular conditions and during major surgery, but thinning does not always correlate with the plasma concentrations of glycocalyx products. The few structural assessments performed do not currently support that capillary permeability is increased when the plasma levels of glycocalyx fragments in plasma are increased. CONCLUSIONS Shedding of glycocalyx components is a ubiquitous process that occurs during both acute and chronic inflammation with no sensitivity or specificity for a specific disease or condition.
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Affiliation(s)
- Robert G. Hahn
- Research UnitSödertälje Hospital Södertälje Sweden
- Karolinska Institute at Danderyds Hospital (KIDS) Stockholm Sweden
| | - Vasu Patel
- Department of Internal Medicine Northwestern Medicine McHenry Hospital McHenry IL USA
| | - Randal O. Dull
- Department of Anesthesiology, Pathology, Physiology, Surgery University of ArizonaCollege of Medicine Tucson AZ USA
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The Endothelial Glycocalyx and Organ Preservation-From Physiology to Possible Clinical Implications for Solid Organ Transplantation. Int J Mol Sci 2021; 22:ijms22084019. [PMID: 33924713 PMCID: PMC8070558 DOI: 10.3390/ijms22084019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/14/2023] Open
Abstract
The endothelial glycocalyx is a thin layer consisting of proteoglycans, glycoproteins and glycosaminoglycans that lines the luminal side of vascular endothelial cells. It acts as a barrier and contributes to the maintenance of vascular homeostasis and microperfusion. During solid organ transplantation, the endothelial glycocalyx of the graft is damaged as part of Ischemia Reperfusion Injury (IRI), which is associated with impaired organ function. Although several substances are known to mitigate glycocalyx damage, it has not been possible to use these substances during graft storage on ice. Normothermic machine perfusion (NMP) emerges as an alternative technology for organ preservation and allows for organ evaluation, but also offers the possibility to treat and thus improve organ quality during storage. This review highlights the current knowledge on glycocalyx injury during organ transplantation, presents ways to protect the endothelial glycocalyx and discusses potential glycocalyx protection strategies during normothermic machine perfusion.
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Wang JW, Wu AS, Yue Y, Wu Y. Perioperative Ulinastatin helps preserve endothelial glycocalyx layer in periampullary carcinoma patients undergoing Traditional Whipple Procedure. Clin Hemorheol Microcirc 2020; 75:135-142. [PMID: 31903986 DOI: 10.3233/ch-190688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jia-Wan Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yun Yue
- Department of Anesthesiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yan Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
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Astapenko D, Benes J, Pouska J, Lehmann C, Islam S, Cerny V. Endothelial glycocalyx in acute care surgery - what anaesthesiologists need to know for clinical practice. BMC Anesthesiol 2019; 19:238. [PMID: 31862008 PMCID: PMC6925438 DOI: 10.1186/s12871-019-0896-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022] Open
Abstract
The endothelial glycocalyx (EG) is the thin sugar-based lining on the apical surface of endothelial cells. It has been linked to the physiological functioning of the microcirculation and has been found to be damaged in critical illness and after acute care surgery. This review aims to describe the role of EG in severely injured patients undergoing surgery, discuss specific situations (e.G. major trauma, hemorrhagic shock, trauma induced coagulopathy) as well as specific interventions commonly applied in these patients (e.g. fluid therapy, transfusion) and specific drugs related to perioperative medicine with regard to their impact on EG.EG in acute care surgery is exposed to damage due to tissue trauma, inflammation, oxidative stress and inadequate fluid therapy. Even though some interventions (transfusion of plasma, human serum albumin, hydrocortisone, sevoflurane) are described as potentially EG protective there is still no specific treatment for EG protection and recovery in clinical medicine.The most important principle to be adopted in routine clinical practice at present is to acknowledge the fragile structure of the EG and avoid further damage which is potentially related to worsened clinical outcome.
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Affiliation(s)
- David Astapenko
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.,Centrum for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Benes
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Plzen, Pilsen, Czech Republic.,Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic.,Biomedical centrum, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Jiri Pouska
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Plzen, Pilsen, Czech Republic.,Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Christian Lehmann
- Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada.,Department of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Sufia Islam
- Department of Pharmacy, East West University, A/2 Jahurul Islam Avenue, Dhaka, Bangladesh
| | - Vladimir Cerny
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic. .,Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic. .,Centrum for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic. .,Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. .,Departments of Anaesthesiology, Perioperative and Intensive care medicine, J.E. Purkinje 21 University, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, 400 11, Usti nad Labem, Czech Republic.
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