The glycocalyx, a gel-like layer covering the endothelium has emerged as a primary defence layer against atherogenic stimuli. Recently, we have developed techniques which allow reliable estimation of glycocalyx volume in humans. Using these techniques, we were able to show that during experimental hyperglycemia glycocalyx volume was firmly reduced (1.8 to 0.7 liters) with subsequent coagulation activation and endothelial dysfunction (Nieuwdorp 2006a). In subsequent experiments in diabetic patients, glycocalyx volume was found to be reduced by approximately 50% in uncomplicated diabetic patients, surmounting to more than 75% reduction in patients characterized by proteinuria (Nieuwdorp 2006b).

Combined, these findings have led to the hypothesis that reversal of glycocalyx damage may provide an attractive therapeutic target to lower the pro-atherogenic state. Unfortunately, to date no drugs are available, which have the capacity to specifically improve glycocalyx perturbation.
Current projects at the department of vascular medicine of the Academic Medical Center in Amsterdam aim to further develop and optimize clinical methods to assess systemic and microvascular glycocalyx dimensions in cardiovascular risk patients, which is combined with studies to test for the therapeutic potential of glycocalyx restoring strategies.