Key Takeaways & Executive Findings
- •• Glycocalyx integrity is crucial for vascular health, and its shedding contributes to atherosclerosis and other diseases. • Exercise, including acute, aerobic, and resistance training, can influence glycocalyx thickness and shedding, with long-term training providing protective effects. • Glycocalyx damage markers may serve as diagnostic and prognostic tools for traumatic and vascular diseases. • The glycocalyx is a promising therapeutic target for non-pharmacological interventions in diseases like atherosclerosis, sepsis, and cancer.
Abstract
BACKGROUND: The glycocalyx serves as a selective permeability barrier that enables the controlled exchange of substances and maintains fluid balance between within and outside the blood vessels. It is also involved in various pathological processes, including inflammation, thrombus formation, and microcirculation disorders, and is significantly associated with the development and progression of diseases such as atherosclerosis, diabetes, and cancer. OBJECTIVE: To correlate glycocalyx with exercise and disease. METHODS: A literature search was conducted across international databases (MedReading, PubMed, and Web of Science) and Chinese databases (CNKI, WanFang, and VIP) to identify academic articles. The search terms used were “glycocalyx, physical exercise, disease” in Chinese and “glycocalyx, physical exercise, exercises, physical activity, acute exercise, isometric exercises, aerobic exercise, resistance training, exercise training, disease, diseases” in English. A total of 81 publications were included in the final analysis. RESULTS AND CONCLUSION: As a biological barrier of the vascular endothelium, the glycocalyx plays a key role in regulating vascular permeability, mediating inflammatory responses, sensing blood shear stress, and facilitating anticoagulation. The integrity of the glycocalyx is essential for maintaining stable normal blood circulation and ensuring the physiological functions of various organs in the body. Shedding of the glycocalyx can induce structural changes in the endothelial barrier, leading to an abnormal increase in endothelial permeability and accelerating the pathological processes associated with atherosclerosis. Research has confirmed that the extensive thickening and shedding of the glycocalyx on the surface of cancer cells promote tumor proliferation, metastasis, and disease progression. In traumatic diseases, the severity can be assessed by measuring the levels of debris resulting from glycocalyx injury. The glycocalyx is influenced by factors such as the duration of exercise, changes in exercise mode, and exercise intensity. Acute exercise can induce microvascular changes and increase glycocalyx thickness. Aerobic exercise-induced shedding sensitivity of glycocalyx components varies by sex, age, and body mass index. Resistance exercise has positive acute effects on endothelial glycocalyx. Long-term exercise training can protect the glycocalyx. The glycocalyx serves as an intervention target for atherosclerosis, sepsis, cancer, and other diseases, providing theoretical support for developing non-pharmacological therapeutic strategies. However, clinical application of glycocalyx damage markers is not yet standardized, and the mechanisms among glycocalyx, exercise, and disease require further investigation.
1. Introduction
The glycocalyx, a polysaccharide-protein complex on the luminal surface of vascular endothelial cells, is composed of glycosaminoglycans such as heparan sulfate and hyaluronic acid bound to core proteins. First observed by Danielli in 1940 as an electron-dense layer of approximately 200 nm, it was initially mistaken for an adsorbed plasma protein layer until Luft formally introduced the term 'glycocalyx' in 1975 [1]. The glycocalyx serves as a selective permeability barrier, controlling the exchange of substances and maintaining fluid balance between the intravascular and extravascular compartments. Its unique surface structure precisely regulates platelet and leukocyte activity, preventing abnormal thrombus formation. Moreover, heparan sulfate, a key component, activates protective signaling in endothelial cells, enhancing vascular barrier function and cell survival [2]. The glycocalyx also exhibits anti-inflammatory properties; preventing its shedding can inhibit the formation of inflammatory factors and reduce tissue damage. Exercise interventions have been shown to influence glycocalyx secretion.
This review synthesizes recent research on the glycocalyx, focusing on its structure, function, associations with various diseases, and the impact of exercise on its secretion. By exploring the mechanisms of glycocalyx action, this review aims to provide a theoretical basis for considering the glycocalyx as a potential therapeutic target in disease management.
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Ma Zhennan, Wang Yinfeng, Yao Lijuan, Chen Leqin (2026). Glycocalyx: the new link between exercise and disease. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21261
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Frequently Asked Questions
What is the glycocalyx and why is it important?
The glycocalyx is a carbohydrate-rich layer on the surface of vascular endothelial cells, composed of glycoproteins and proteoglycans. It acts as a selective permeability barrier, regulates cell communication, maintains electrostatic properties, and plays roles in mechanosensation and mechanotransduction. Its integrity is crucial for vascular health, and its shedding is associated with diseases like atherosclerosis and cancer.
How does exercise affect the glycocalyx?
Exercise influences the glycocalyx in various ways depending on duration, mode, and intensity. Acute exercise can increase glycocalyx thickness and induce microvascular changes. Aerobic exercise's effect on glycocalyx shedding varies with sex, age, and BMI. Resistance training has positive acute effects, and long-term training protects the glycocalyx.
What diseases are associated with glycocalyx dysfunction?
Glycocalyx dysfunction is linked to atherosclerosis, diabetes, cancer, sepsis, and inflammatory conditions. Shedding of the glycocalyx leads to increased vascular permeability, inflammation, and thrombosis, contributing to disease progression.
Can glycocalyx damage be used as a biomarker?
Yes, glycocalyx damage markers, such as syndecan-1 and heparan sulfate, can be measured in blood. Elevated levels indicate endothelial damage and are used to assess severity in traumatic diseases and predict outcomes in conditions like sepsis.
What is the therapeutic potential of targeting the glycocalyx?
The glycocalyx is a promising target for non-pharmacological interventions. Exercise and other lifestyle modifications can protect the glycocalyx, and drugs that prevent its shedding or promote its restoration may offer new treatments for vascular and inflammatory diseases.
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