New insights into antiphospholipid-related endothelial dysfunction by assessment of vascular glycocalyx layer: results from a preliminary cross-sectional study.
INTRODUCTION
Antiphospholipid syndrome (APS) is associated with greater atherothrombotic risk and endothelial dysfunction, suggesting that endothelial glycocalyx is impaired in this disease.


OBJECTIVES
The aim was to investigate the endothelial glycocalyx and the relationship between glycocalyx markers, endothelial dysfunction parameters and atherosclerotic markers in APS.


METHODS
A total of 15 primary arterial APS patients and healthy controls were included in the study. Glycocalyx was assessed in both groups by sublingual sidestream dark field imaging and syndecan-1 plasma level. Endothelial function was evaluated by brachial artery flow-mediated dilatation (FMD) and early atherosclerosis by carotid intima media thickness (IMT). Thrombotic profile was also performed by measuring the plasma level of the tissue factor (TF).


RESULTS
APS patients had significantly increased syndecan-1 plasma level 38.6 ± 5.0 pg/ml vs. 19.1 ± 3.5 pg/ml; p < 0.01 and a reduced glycocalyx thickness 0.26 ± 0.03 µm vs. 0.75 ± 0.07 µm; p < 0.01 compared with control. FMD was impaired in APS patients compared with control, 5.68% ± 0.42 vs. 8.29 ± 0.30, p < 0.01, respectively. IMT was significantly increased in APS patients compared with control, 0.52 ± 0.13 mm vs. 0.40 ± 0.06 mm, p < 0.01, respectively. Soluble TF, thiobarbituric acid-reactive substances levels were increased in the sera from APS patients compared with control.


CONCLUSIONS
This preliminary study supports, for the first time, that in APS patients endothelial glycocalyx is impaired, which could lead to thrombosis, endothelial dysfunction and early atherosclerosis.
['Miranda|S|S|https://orcid.org/0000-0001-6379-4272', 'Billoir|P|P|https://orcid.org/0000-0001-5632-7713', 'Le Besnerais|M|M|', 'Joannides|R|R|', 'Richard|V|V|', 'Lévesque|H|H|', 'Armengol|G|G|', 'Bellien|J|J|', 'Benhamou|Y|Y|']
D000293:Adolescent D000328:Adult D000368:Aged D016736:Antiphospholipid Syndrome D050197:Atherosclerosis D001323:Autoantibodies D015415:Biomarkers D001916:Brachial Artery D002339:Carotid Arteries D059168:Carotid Intima-Media Thickness D016022:Case-Control Studies D003430:Cross-Sectional Studies D004730:Endothelium, Vascular D005260:Female D019276:Glycocalyx D006801:Humans D008297:Male D008875:Middle Aged D012307:Risk Factors D053668:Syndecan-1 D013925:Thromboplastin D013927:Thrombosis D014664:Vasodilation D055815:Young Adult
Antiphospholipid syndrome thrombosis cardiovascular disease