Endothelial glycocalyx as potential diagnostic and therapeutic target in cardiovascular disease

Purpose of review The endothelial glycocalyx has emerged as a potential orchestrator of vascular homeostasis. Under physiological conditions, the glycocalyx is an important contributor to the regulation of vascular permeability for macromolecules as well for the adhesion of circulating cells. In line, the potential role of the glycocalyx in maintaining the antiatherogenic properties of the vessel wall may have important clinical implications. In the present review, we provide an overview of recent developments and a glance at the future of establishing endothelial glycocalyx as a crucial player in cardiovascular protection. Recent findings Novel methods to estimate glycocalyx dimensions in vivo (using Orthogonal Polarization Spectral imaging or Sideview Darkfield imaging) as well as progressive insight into the enzymes involved in glycocalyx synthesis will be crucial in the assessment of this structure as a potential surrogate marker or therapeutic target for cardiovascular risk. The validation of these 'imaging' techniques and the integration with glycocalyx degradation products in plasma will allow us to test the value of the endothelial glycocalyx in estimating cardiovascular risk. Summary The endothelial glycocalyx, protecting the vascular wall against atherogenic influents, could be used for cardiovascular risk stratification. For this purpose, new methods to estimate glycocalyx dimension are promising.