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The 'epi-endothelial matrix' and atherosclerosis

This session incorporated basic science and physiology for clinical scientists to understand the importance of endothelium.

The first speaker emphasized the importance of the “glycocalyx”, which is present on all endothelial surfaces, forming a protective layer between the blood stream and the endothelium. It is an important determinant of vascular permeability. Under physiologic conditions, it is an important contributor to the regulation of vascular permeability for macromolecules as well for the adhesion of circulating cells. The glycocalyx is made up of syndecan (heparin sulphate proteoglycan), glypican, hyaluronan (which is linked to cell membrane and can be bound to the receptor CD44), sialic acid, are important among many others. The glycocalyx repulses red blood cells from the endothelium.

Dr. Vink showed the effects of low shear on the glycocalyx, which is down regulated in the presence of low grade inflammation, resulting in increased cellular influx into the vessel wall, contributing to early atherosclerotic lesion formation as well as plaque destabilization in late stages. Also, hyperlipidemia may be an important contributor of reduced expression of endothelial glycocalyx, and glycocalyx may serve as a molecular sieve.

Dr. Siegel showed that LDL deposited strongly on proteoheparan sulfate surfaces, and this increased in the presence of calcium. This binding could be substantially slowed down with Fluvastatin experimentally or if a single dose of the drug had been ingested by patients and the serum applied and this action occurred without any reduction in lipid concentration.

Dr. Eriksson showed their recently reported findings in Nature, April 2010, that VEGF-B controlled endothelial uptake of fatty acids via transcription regulation of vascular fatty acid transport protein. Vegfb(-/-) mice showed less uptake and accumulation of lipid in muscle, heart and brown adipose tissue and was mediated by VEGF receptor 1 and neurophilin 1 expression by the endothelium.


The session was extremely helpful and all cardiologists need to understand the important role endothelial cells play not only in providing a protective anticoagulant surface but also in regulation of lipids and lipid transport.




The 'epi-endothelial matrix' and atherosclerosis
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.