Kaibkhanov U, Konyshev M, Ovsienko A, Khromov A, Glushets D, Molchanova M, Meilikhovich S, Kopitko O, Solomonenko A, Mamedova R, Larina A, Boyko V, Kutenko A, Gaponova N, Ermolenko E
1North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia.
2Saint-Petersburg State Pediatric Medical University, Russia.
Georgian Med News. 2025 Mar(360):210-217.
The endothelial glycocalyx is a highly dynamic, carbohydrate-rich layer that lines the luminal surface of blood vessels and plays a fundamental role in vascular homeostasis. Although once considered a passive structural barrier, it is now recognized as a critical regulator of endothelial permeability, mechanotransduction, leukocyte adhesion, and thrombosis. Its degradation has been implicated as a pivotal event in the initiation and progression of atherosclerosis. This review synthesizes current evidence on the structure, physiological functions, mechanisms of degradation, and clinical significance of the endothelial glycocalyx in the context of atherosclerosis. We also highlight diagnostic approaches and emerging therapeutic strategies aimed at glycocalyx preservation and restoration. A growing body of evidence demonstrates that glycocalyx degradation precedes overt endothelial dysfunction and facilitates lipid infiltration, immune cell recruitment, and thrombogenic transformation of the vascular surface. Multiple triggers, including pro-inflammatory cytokines, oxidative stress, disturbed shear stress, and metabolic derangements, contribute to the loss of glycocalyx integrity. Clinical studies have identified circulating glycocalyx fragments as biomarkers of vascular damage and cardiovascular risk. Experimental and early clinical data suggest that interventions such as glycosaminoglycan supplementation, enzyme inhibition, antioxidant therapy, and lifestyle modification can restore glycocalyx structure and function. Preservation of the endothelial glycocalyx represents a promising therapeutic frontier in the prevention and treatment of atherosclerosis. Continued advances in glycocalyx imaging, molecular profiling, and targeted interventions are expected to redefine vascular risk stratification and foster the development of glycocalyx-centered therapies.
内皮糖萼是一层高度动态、富含碳水化合物的结构，覆盖在血管腔表面，在血管稳态中发挥着重要作用。尽管它曾被视为一个被动的结构屏障，但现在人们认识到它是内皮通透性、机械转导、白细胞黏附及血栓形成的关键调节因子。其降解被认为是动脉粥样硬化发生和发展的关键事件。这篇综述综合了目前关于内皮糖萼在动脉粥样硬化背景下的结构、生理功能、降解机制及临床意义的证据。我们还重点介绍了旨在保护和恢复糖萼的诊断方法及新兴治疗策略。越来越多的证据表明，糖萼降解先于明显的内皮功能障碍，并促进脂质浸润、免疫细胞募集及血管表面的血栓形成转变。多种触发因素，包括促炎细胞因子、氧化应激、紊乱的剪切应力及代谢紊乱，都导致了糖萼完整性的丧失。临床研究已将循环中的糖萼片段确定为血管损伤和心血管风险的生物标志物。实验和早期临床数据表明，诸如补充糖胺聚糖、酶抑制、抗氧化治疗及生活方式改变等干预措施可以恢复糖萼的结构和功能。保护内皮糖萼代表了动脉粥样硬化预防和治疗中一个有前景的治疗前沿。糖萼成像、分子谱分析及靶向干预的持续进展有望重新定义血管风险分层，并推动以糖萼为中心的治疗方法的发展。
