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Expedition Glykokalyx

Ein neu entdecktes „Great Barrier Reef“

Expedition glycocalyx

A newly discovered „Great Barrier Reef“

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Zusammenfassung

Jedes gesunde Gefäß wird luminal von einer endothelialen Glykokalyx ausgekleidet, die mit dem Blutstrom interagiert und Filterfunktionen an der Gefäßwand wahrnimmt. Obwohl diese Struktur bereits vor fast 70 Jahren entdeckt wurde, blieb ihre physiologische Bedeutung lange Zeit unterschätzt. Neueren Erkenntnissen zufolge ist die Glykokalyx, neben den Endothelzellen selbst, ein wesentlicher Bestandteil der vaskulären Barriere. Die unterschiedlichen kolloidosmotischen Gradienten inner- und unterhalb dieser Struktur haben mittlerweile zu einer Modifizierung der Starling-Gleichung geführt. Das Interstitium weist in vielen Abschnitten eine Proteinkonzentration auf, die mit derjenigen des Plasmas vergleichbar ist. Der einwärts gerichtete Gradient, der Wasser und Protein im Gefäßsystem zurückhält, entsteht unterhalb der Glykokalyx durch selektive Proteinfilterung über diese Struktur hinweg. Die endotheliale Glykokalyx besitzt damit als weitere kompetente vaskuläre Permeabilitätsbarriere eine Schlüsselfunktion nicht nur für perioperative Flüssigkeits- und Proteinverschiebungen ins Gewebe, sondern scheint darüber hinaus eine bedeutende Rolle in der Pathophysiologie von Diabetes, Arteriosklerose, Sepsis und Ischämie/Reperfusion (I/R) und den damit verbunden vaskulären Dysfunktionen zu spielen. Die fragile Glykokalyx kann durch chirurgische Eingriffe, Trauma, Ischämie/Reperfusion, Sepsis oder Entzündungsmediatoren wie Tumor-Nekrose-Faktor- (TNF-)α zerstört werden; dies kann zu Leukozytenadhäsion, Thrombozytenaggregation und Ödembildung führen. Neuere Studien konnten zeigen, dass eine Protektion dieser Schicht nicht nur einen Schutz der Gefäßbarriere darstellt, sondern ein wichtiger Bestandteil einer rationalen perioperativen Flüssigkeitstherapie sein kann.

Abstract

Healthy vascular endothelium is luminally coated by an endothelial glycocalyx, which interacts with the bloodstream and assumes a filter function on the vascular wall. Although this structure was discovered nearly 70 years ago, its physiological importance has been underestimated for a long time. Recent findings indicate that the glycocalyx is, in addition to the endothelial cells themselves, a main constituent part of the vascular barrier. The existence of different colloid osmotic gradients within and beneath this structure has now led to a modification of the Starling equation. In many vascular beds the interstitial space features a protein concentration similar to that of the plasma. The inwardly directed gradient, which retains water and proteins in the vascular system, is generated beneath the glycocalyx by selective protein filtration over this structure. The endothelial glycocalyx, as an additional competent vascular permeability barrier has, therefore, not only a key role for perioperative fluid and protein shifts into the interstitial space, but it seems to be intimately involved in the pathophysiology of diabetes, arteriosclerosis, sepsis and ischemia/reperfusion, especially with respect to associated vascular dysfunctions. The fragile glycocalyx can be destroyed in the course of surgery, trauma, ischemia/reperfusion and sepsis and by inflammatory mediators such as TNF-α, causing leukocyte adhesion, platelet aggregation and edema formation. Recent studies have shown that protecting this structure not only maintains the vascular barrier, but constitutes an important component of a rational perioperative fluid therapy.

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  1. Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität, Nussbaumstr. 20, 80336, München, Deutschland

    D. Chappell, M. Jacob, K. Hofmann-Kiefer, P. Conzen & M. Rehm

  2. Walter-Brendel-Zentrum für Experimentelle Medizin, Ludwig-Maximilians-Universität, München, Deutschland

    B.F. Becker

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  1. D. Chappell
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  2. M. Jacob
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  4. K. Hofmann-Kiefer
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  5. P. Conzen
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Correspondence to D. Chappell.

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Unserem ehemaligen Chef, Herrn Prof. Dr. med. Dr. h.c. Klaus Peter, zum 70. Geburtstag gewidmet.

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Chappell, D., Jacob, M., Becker, B. et al. Expedition Glykokalyx. Anaesthesist 57, 959–969 (2008). https://doi.org/10.1007/s00101-008-1445-4

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