Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: a review

Abstract

The endothelial glycocalyx comprises a complex layer of membrane-bound proteoglycans, secreted glycosaminoglycans, glycoproteins, glycolipids and bound plasma proteins such as albumin and antithrombin associated with the endothelial surface. The glycocalyx plays an important role in vascular homeostasis, regulating vascular permeability and cell adhesion, and acts as a mechanosensor for hemodynamic shear stresses; it also has antithrombotic and anti-inflammatory functions. Plasma proteins such as albumin are physiologically bound within the glycocalyx, thus contributing to stability of the layer. Albumin is the major determinant of plasma colloid osmotic pressure. In addition, albumin transports sphingosine-1-phosphate which has protective endothelial effects, acts as a free radical scavenger, and has immunomodulatory and anti-inflammatory effects. This review examines the physiological function of the endothelial glycocalyx and the role of human albumin in preserving glycocalyx integrity and the microcirculation.

Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database

“…Moreover, a recent pilot study demonstrated the beneficial effects on skin endothelial function after albumin administration within 24 h of septic shock [ 33 ]. The endothelial dysfunction is involved in microcirculatory blood flow impairment and associated with vasomotor tone dysregulation, activation of coagulation, and glycocalyx damage, thus, the benefit of the albumin administration within 24 h may owe to its anti-oxidant properties [ 33 , 34 ]. Albumin infusion also helps maintain glomerular filtration via hemodynamic and oncotic mechanisms [ 35 ].…”

Newly Developed Recombinant Antithrombin Protects the Endothelial Glycocalyx in an Endotoxin-Induced Rat Model of Sepsis

“…Decreased glycocalyx thickness is reported to correlate with the severity of sepsis [ 33 ]. The combination of side-stream dark-field imaging and an automated computer calculation system enable the evaluation of the glycocalyx thickness and microperfusion.…”

The roles and potential therapeutic implications of C5a in the pathogenesis of COVID-19-associated coagulopathy

“…It is formed by glycoproteins and proteoglycans (PG) and has a multilayer structure that reduces endothelial contact with cellular and macromolecular blood components. The glycocalyx plays an important role in vascular homeostasis, regulating vascular permeability and cell adhesion [ 44 ]. It can also act as a mechanotransducer, enabling the detection of mechanical stress through its intracellular protein domain [ 44 ].…”

“…The glycocalyx plays an important role in vascular homeostasis, regulating vascular permeability and cell adhesion [ 44 ]. It can also act as a mechanotransducer, enabling the detection of mechanical stress through its intracellular protein domain [ 44 ]. The link between the glycocalyx and vascular endothelial cell dysfunction in COVID-19 requires further research [ 45 ]; however, evidence increasingly suggests that COVID-19 induces multiple injuries, including damage to the endothelial glycocalyx and endothelial dysfunction, which has been attributed to endothelial activation and dysfunction [ 46 ].…”