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Title: Vascular dysfunction in malaria: understanding the role of the endothelial glycocalyx
Authors: Bush, Margaret A.
Anstey, Nicholas M.
Yeo, Tsin Wen
Florence, Salvatore M.
Granger, Donald L.
Mwaikambo, Esther D.
Weinberg, J. Brice
Keywords: Science::Medicine
Issue Date: 2021
Source: Bush, M. A., Anstey, N. M., Yeo, T. W., Florence, S. M., Granger, D. L., Mwaikambo, E. D. & Weinberg, J. B. (2021). Vascular dysfunction in malaria: understanding the role of the endothelial glycocalyx. Frontiers in Cell and Developmental Biology, 9, 751251-.
Journal: Frontiers in Cell and Developmental Biology 
Abstract: Malaria caused by Plasmodium falciparum results in over 400,000 deaths annually, predominantly affecting African children. In addition, non-falciparum species including vivax and knowlesi cause significant morbidity and mortality. Vascular dysfunction is a key feature in malaria pathogenesis leading to impaired blood perfusion, vascular obstruction, and tissue hypoxia. Contributing factors include adhesion of infected RBC to endothelium, endothelial activation, and reduced nitric oxide formation. Endothelial glycocalyx (eGC) protects the vasculature by maintaining vessel integrity and regulating cellular adhesion and nitric oxide signaling pathways. Breakdown of eGC is known to occur in infectious diseases such as bacterial sepsis and dengue and is associated with adverse outcomes. Emerging studies using biochemical markers and in vivo imaging suggest that eGC breakdown occurs during Plasmodium infection and is associated with markers of malaria disease severity, endothelial activation, and vascular function. In this review, we describe characteristics of eGC breakdown in malaria and discuss how these relate to vascular dysfunction and adverse outcomes. Further understanding of this process may lead to adjunctive therapy to preserve or restore damaged eGC and reduce microvascular dysfunction and the morbidity/mortality of malaria.
ISSN: 2296-634X
DOI: 10.3389/fcell.2021.751251
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Organisations: Tan Tock Seng Hospital
Rights: © 2021 Bush, Anstey, Yeo, Florence, Granger, Mwaikambo and Weinberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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