The endothelial glycocalyx in critical illness: A pediatric perspective.
The endothelial glycocalyx in critical illness: A pediatric perspective.
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DOI：
10.1016/j.mbplus.2022.100106
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发表时间：
2022-06
影响因子：
--
通讯作者：
Richter JR
中科院分区：
文献类型：
--
作者：
Richter RP;Payne GA;Ambalavanan N;Gaggar A;Richter JR
内皮糖萼随着年龄和心血管合并症而变薄。内皮糖萼受严重儿科疾病的影响，并且是其组成部分。对内皮糖萼损伤的原因/影响的机制洞察是至关重要的。儿科危重病中血管糖萼损伤值得进一步研究。血管内皮是循环血液和终末器官之间的界面，因此在保护器官功能方面具有关键作用。内皮细胞由富含聚糖的糖萼内衬，该糖萼通过调节白细胞和血小板与血管壁的相互作用、血管渗透性、凝血和血管反应性来独特地促进内皮功能。因此，内皮糖萼的降解可促进血管功能障碍、炎症传播和器官损伤。内皮糖萼及其在血管病理生理学中的作用在过去十年中得到了越来越多的关注。虽然表征成人疾病和动物模型中血管糖萼损伤及其下游后果的研究已经蓬勃发展，但评价儿科疾病中糖萼损伤的研究相对较少。由于儿童具有与成人不同的独特生理学，因此我们对儿科危重病中内皮糖萼不完整的原因和影响的理解仍存在重大知识差距。在这篇叙述性文献综述中，我们从成人和临床前数据以及儿科临床经验出发，对内皮糖萼在儿科危重疾病中的作用提供了独特的观点，以阐明内皮表面层的显著紊乱如何导致儿童血管生物学异常。通过引起人们对这一新兴领域的关注，我们希望加大研究力度，以解决儿科血管生物学中的重要知识缺口，这些知识缺口可能会为新型治疗策略的开发提供信息。
The endothelial glycocalyx thins with age and cardiovascular comorbidities. Endothelial glycocalyx is affected by and integral to severe pediatric illnesses. Mechanistic insight into cause/effect of endothelial glycocalyx injury is paramount. Vascular glycocalyx damage in pediatric critical illness warrants further study. The vascular endothelium is the interface between circulating blood and end organs and thus has a critical role in preserving organ function. The endothelium is lined by a glycan-rich glycocalyx that uniquely contributes to endothelial function through its regulation of leukocyte and platelet interactions with the vessel wall, vascular permeability, coagulation, and vasoreactivity. Degradation of the endothelial glycocalyx can thus promote vascular dysfunction, inflammation propagation, and organ injury. The endothelial glycocalyx and its role in vascular pathophysiology has gained increasing attention over the last decade. While studies characterizing vascular glycocalyx injury and its downstream consequences in a host of adult human diseases and in animal models has burgeoned, studies evaluating glycocalyx damage in pediatric diseases are relatively few. As children have unique physiology that differs from adults, significant knowledge gaps remain in our understanding of the causes and effects of endothelial glycocalyx disintegrity in pediatric critical illness. In this narrative literature overview, we offer a unique perspective on the role of the endothelial glycocalyx in pediatric critical illness, drawing from adult and preclinical data in addition to pediatric clinical experience to elucidate how marked derangement of the endothelial surface layer may contribute to aberrant vascular biology in children. By calling attention to this nascent field, we hope to increase research efforts to address important knowledge gaps in pediatric vascular biology that may inform the development of novel therapeutic strategies.