Over the past decade, since it was first observed in vivo, there has been an explosion in interest in the thin (approximately 500 nm), gel-like endothelial glycocalyx layer (EGL) that coats the luminal surface of blood vessels. In this review, we examine the mechanical and biochemical properties of the EGL and the latest studies on the interactions of this layer with red and white blood cells. This includes its deformation owing to fluid shear stress, its penetration by leukocyte microvilli, and its restorative response after the passage of a white cell in a tightly fitting capillary. We also examine recently discovered functions of the EGL in modulating the oncotic forces that regulate the exchange of water in microvessels and the role of the EGL in transducing fluid shear stress into the intracellular cytoskeleton of endothelial cells, in the initiation of intracellular signaling, and in the inflammatory response.

BACKGROUND The safety and effectiveness of automated glycemic management have not been tested in multiday studies under unrestricted outpatient conditions. METHODS In two random-order, crossover studies with similar but distinct designs, we compared glycemic control with a wearable, bihormonal, automated, “bionic” pancreas (bionic-pancreas period) with glycemic control with an insulin pump (control period) for 5 days in 20 adults and 32 adolescents with type 1 diabetes mellitus. The automatically adaptive algorithm of the bionic pancreas received data from a continuous glucose monitor to control subcutaneous delivery of insulin and glucagon. RESULTS Among the adults, the mean plasma glucose level over the 5-day bionic-pancreas period was 138 mg per deciliter (7.7 mmol per liter), and the mean percentage of time with a low glucose level (<70 mg per deciliter [3.9 mmol per liter]) was 4.8%. After 1 day of automatic adaptation by the bionic pancreas, the mean (±SD) glucose level on continuous monitoring was lower than the mean level during the control period (133±13 vs. 159±30 mg per deciliter [7.4±0.7 vs. 8.8±1.7 mmol per liter], P<0.001) and the percentage of time with a low glucose reading was lower (4.1% vs. 7.3%, P = 0.01). Among the adolescents, the mean plasma glucose level was also lower during the bionic-pancreas period than during the control period (138±18 vs. 157±27 mg per deciliter [7.7±1.0 vs. 8.7±1.5 mmol per liter], P = 0.004), but the percentage of time with a low plasma glucose reading was similar during the two periods (6.1% and 7.6%, respectively; P = 0.23). The mean frequency of interventions for hypoglycemia among the adolescents was lower during the bionic-pancreas period than during the control period (one per 1.6 days vs. one per 0.8 days, P<0.001). CONCLUSIONS As compared with an insulin pump, a wearable, automated, bihormonal, bionic pancreas improved mean glycemic levels, with less frequent hypoglycemic episodes, among both adults and adolescents with type 1 diabetes mellitus. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov numbers, NCT01762059 and NCT01833988.)

BACKGROUND Automated control of blood glucose (BG) has been a goal of type 1 diabetes (T1DM) therapy. The normal pancreas uses insulin and glucagon to regulate BG. Therefore, we developed a “closed-loop” BG control system utilizing both insulin and glucagon. METHODS Subcutaneous delivery of insulin lispro and glucagon was controlled by a computer algorithm that responded solely to BG levels every 5 min and incorporated a pharmacokinetic model for lispro. Eleven C-peptide negative subjects with T1DM were studied for 27 hours. Outcomes included mean BG, number and severity of hypoglycemic episodes, and comparison between measured and mode-estimated lispro levels. RESULTS In six subjects, the system achieved an aggregate 24-hour mean BG of 140 mg/dL, with no hypoglycemic events requiring treatment in 133 hours of control (nadir BG 66 mg/dL). In retrospect, their time-to-peak lispro levels were similar to that assumed by the algorithm (tmax 56-–72 min). Five subjects with generally slower lispro absorption (tmax 71–191 min) had at least one treatment-requiring hypoglycemic episode (17 episodes in 104 hours). Adjustment of the pharmacokinetic model parameters for lispro eliminated hypoglycemia in repeat experiments in the same five subjects, but with a mean BG of 173 mg/dL. CONCLUSIONS The original algorithm achieved near-normal mean BG with negligible hypoglycemia in subjects with rapid lispro kinetics. In subjects with delayed lispro absorption, modifying the pharmacokinetic assumptions prevented hypoglycemia, albeit with increased mean BG levels. These results demonstrate the feasibility of a bi-hormonal artificial endocrine pancreas. (ClinicalTrials.gov number, NCT00811317.)

High-resolution near-wall fluorescent microparticle image velocimetry (micro-PIV) was used in mouse cremaster muscle venules in vivo to measure velocity profiles in the red cell-depleted plasma layer near the endothelial lining. micro-PIV data of the instantaneous translational speeds and radial positions of fluorescently labeled microspheres (0.47 microm) in an optical section through the midsagittal plane of each vessel were used to determine fluid particle translational speeds. Regression of a linear velocity distribution based on near-wall fluid-particle speeds consistently revealed a negative intercept when extrapolated to the vessel wall. Based on a detailed three-dimensional analysis of the local fluid dynamics, we estimate a mean effective thickness of approximately 0.33 micro m for an impermeable endothelial surface layer or approximately 0.44 micro m assuming the lowest hydraulic resistivity of the layer that is consistent with the observed particle motions. The extent of plasma flow retardation through the layer required to be consistent with our micro-PIV data results in near complete attenuation of fluid shear stress on the endothelial-cell surface. These findings confirm the presence of a hydrodynamically effective endothelial surface layer, and emphasize the need to revise previous concepts of leukocyte adhesion, stress transmission to vascular endothelium, permeability, and mechanotransduction mechanisms.

We show that many salient hemodynamic flow properties, which have been difficult or impossible to assess in microvessels in vivo, can be estimated by using microviscometry and fluorescent microparticle image velocimetry in microvessels >20 μm in diameter. Radial distributions in blood viscosity, shear stress, and shear rate are obtained and used to predict axial pressure gradient, apparent viscosity, and endothelial-cell surface-layer thickness in vivo. Based solely on microparticle image velocimetry data, which are readily obtainable during the course of most intravital microscopy protocols from systemically injected particle tracers, we show that the microviscometric method consistently predicted a reduction in local and apparent blood viscosity after isovolemic hemodilution. Among its clinical applications, hemodilution is a procedure that is used to treat various pathologies that require reduction in peripheral vascular-flow resistance. Our results are directly relevant in this context because they suggest that the fractional decrease in systemic hematocrit is ≈25–35% greater than the accompanying fractional decrease in microvascular-flow resistance in vivo. In terms of its fundamental usefulness, the microviscometric method provides a comprehensive quantitative analysis of microvascular hemodynamics that has applications in broad areas of medicine and physiology and is particularly relevant to quantitative studies of angiogenesis, tumor growth, leukocyte adhesion, vascular-flow resistance, tissue perfusion, and endothelial-cell mechanotransduction

Abstract-In recent years, the endothelial cell surface glycocalyx has emerged as a structure of fundamental importance to a broad range of phenomena that determine cardiovascular health and disease. This new understanding of the functional significance of the glycocalyx has been made possible through recently developed experimental techniques using intravital microscopy that are capable of directly probing the glycocalyx in vivo. Using fluorescent microparticle image velocimetry in venules and endothelialized cylindrical collagen microchannels, we show that the hydrodynamically relevant endothelial cell glycocalyx surface layer observed in microvessels in vivo (0.52Ϯ0.28 m thickness), which is a fundamental determinant of the hydrodynamic and mechanical environment at the endothelial cell surface, is absent from human umbilical vein (0.03Ϯ0.04 m thickness) and bovine aortic (0.02Ϯ0.04 m thickness) endothelial cells grown and maintained under standard cell culture conditions in vitro. An endothelial surface-bound glycosaminoglycan layer, not necessarily indicative of but having similar hydrodynamic properties to the endothelial glycocalyx observed in vivo, was detected (0.21Ϯ0.27 m thickness) only after hyaluronan and chondroitin sulfate were added to the cell culture media at hyperphysiological concentrations (0.2 mg/mL perfused for 75 minutes). The implications of this glycocalyx deficiency under standard cell culture conditions in these pervasive in vitro models broadly impact a myriad of studies involving endothelial cell monolayers in which inferences are made that may depend on endothelial cell surface chemistry. In light of these findings, conclusions drawn from such studies in the areas of microvascular permeability, inflammation, mechanotransduction, and atherosclerosis must be carefully reconsidered. (Circ Res. 2008;102:770-776.)Key Words: cell culture Ⅲ glycocalyx Ⅲ mechanotransduction Ⅲ microcirculation Ⅲ vascular inflammation Ⅲ vascular permeability N umerous studies of endothelial cells (ECs) in culture have been undertaken in recent years that are intended to elucidate mechanisms of EC function spanning a broad range of fields in cardiovascular physiology and pathophysiology, including inflammation, vascular permeability, EC mechanotransduction, and atherosclerosis. [1][2][3][4][5][6][7][8][9] The scientific utility of these and many other studies involving ECs in culture is often critically dependent on cultured systems bearing close morphological, structural, and functional similarities to the tissues they are designed to emulate. Whether or not acknowledged, cell surface chemistry and, specifically, the state of the EC surface glycocalyx in vitro, is a fundamental determinant of the outcome of many of these studies.Over the past decade, it has become well established that the EC surface glycocalyx, a membrane-bound layer of carbohydrates and adsorbed plasma proteins, previously thought to be less than Ϸ50 nm in thickness, in fact extends Ϸ500 nm from the surface of the vascular endothelium in vi...

The effectiveness and safety of continuous glucose monitors (CGMs) is dependent on their accuracy and reliability. The objective of this study was to compare 3 CGMs in adult and pediatric subjects with type 1 diabetes under closed-loop blood-glucose (BG) control. Twenty-four subjects (12 adults) with type 1 diabetes each participated in one 48-hour closed-loop BG control experiment. Venous plasma glucose (PG) measurements obtained every 15 minutes (4657 values) were paired in time with corresponding CGM glucose (CGMG) measurements obtained from 3 CGMs (FreeStyle Navigator, Abbott Diabetes Care; G4 Platinum, Dexcom; Enlite, Medtronic) worn simultaneously by each subject. The Navigator and G4 Platinum (G4) had the best overall accuracy, with an aggregate mean absolute relative difference (MARD) of all paired points of 12.3 ± 12.1% and 10.8 ± 9.9%, respectively. Both had lower MARDs of all paired points than Enlite (17.9 ± 15.8%, P < .005). Very large errors (MARD > 50%) were less common with the G4 (0.5%) than with the Enlite (4.3%, P = .0001) while the number of very large errors with the Navigator (1.4%) was intermediate between the G4 and Enlite (P = .1 and P = .06, respectively). The average MARD for experiments in adolescent subjects were lower than in adult subjects for the Navigator and G4, while there was no difference for Enlite. All 3 devices had similar reliability. A comprehensive head-to-head-to-head comparison of 3 CGMs revealed marked differences in both accuracy and precision. The Navigator and G4 were found to outperform the Enlite in these areas.

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