Master ReVasca Monograph 6.2.24 - Paper - Page 2
REVASCA™ PHYSICIAN MONOGRAPH
— Background – What is the Glycocalyx? —
The endothelial glycocalyx (eGCX) is a porous, hair-like
structure composed of proteoglycans, glycoproteins,
glycolipids, and glycosaminoglycans, in particular hyaluronan, and they are bound to the luminal surface of the
vascular endothelium.
Glycocalyx means “sweet husk” and was described in 1963
as the “extracellular polysaccharide coating on cells”. 1 At
physiological pH, the eGCX is negatively charged versus
the positively charged red blood cells flowing through the
vessels.
Plasma proteins bind to the negative charges of the eGCX
polysaccharides, increasing eGCX hydrostatic pressure and
forming a mechanically stable gel that prevents circulating
blood cells from touching the luminal endothelial cell
surface.
eGCX is an important gatekeeper of vascular permeability.
Capillaries are lined with the endothelial glycocalyx, and
when they are in good health the EGCX enables delivery
of essential oxygen and nutrients to all vital organs AND
aid in removal of toxins and CO2.
During acute injury, inflammatory conditions, smoking,
high oxidative stress, type 2 diabetes, viral infections, or
many other health issues, the endothelial glycocalyx is
damaged, and its degradation is accompanied by shedding of one or more glycocalyx components into the
blood. Syndecan-1, heparan sulfate, and hyaluronic acid
are the main components whose shedding has been
claimed to represent the endothelial glycocalyx state of
health. 2
Damage to the glycocalyx increases the transport of
water, proteins, cholesterol, and other molecules from the
plasma to outside of blood vessels. 3 The eGCX can restrict
certain molecules from passing through the endothelial
cell membrane, can modulate vascular resistance to
maintain blood flow homogeneity in the microcirculation,
can stimulate NO release, mechano-transduce fluid shear
stress to the endothelium and buffer endothelial cells
from plasma oxidants, cytokines, circulating immune cells,
and modulate inflammation and coagulation. 4, 5
The importance of endothelial glycocalyx in humans
includes: 6, 7
• Modulates capillary red blood cell filling
• Vascular permeability and tone
• Inflammation regulation
• Coagulation-related processes – eGCX helps
decrease risk of blood clots
• Signal sensor – signals to increase endogenous
vasoactive compounds like nitric oxide to dilate
blood vessels
• Cerebrovascular micro-homeostasis – BBB structure
and function
Age-related microvascular
dysfunction is common in the
aging human, and the endothelial glycocalyx is generally in a
state of deterioration - shedding.
Of great clinical importance,
glycocalyx deterioration may
precede traditional measurements of age-related vascular
dysfunction, such as impaired
endothelium-dependent dilation
and arterial stiffness.
Studies report that a deteriorating and damaged glycocalyx can
initiate age-related pathologies
including metaflammation, atherosclerosis, hypertension,
stroke, heart failure and myocardial infarction (MI), diabetes, dementia/cognitive issues, Type 2 diabetes, obesity,