Related Experiment Video
Updated: Sep 28, 2025
In vivo Measurement of the Mouse Pulmonary Endothelial Surface Layer
Published on: February 22, 2013
Endothelial glycocalyx degradation in multisystem inflammatory syndrome in children related to COVID-19
Noemi Veraldi1, Romain R Vivès2, Géraldine Blanchard-Rohner3,4
1Department of Diagnostics, Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland.
Insights
Multisystem inflammatory syndrome in children (MIS-C) involves endothelial glycocalyx injury, indicated by elevated syndecan-1 and heparan sulfate. These markers correlate with disease severity and may predict complications in COVID-19 patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Vascular biology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection.
- Endothelial dysfunction is implicated in COVID-19, but its role in MIS-C requires further characterization.
- The endothelial glycocalyx, a protective vascular lining, may be affected in MIS-C.
Purpose of the Study:
- To investigate endothelial glycocalyx degradation in children diagnosed with MIS-C.
- To correlate glycocalyx markers with clinical severity and inflammatory markers.
- To explore potential biomarker utility for MIS-C and severe COVID-19.
Main Methods:
- Blood and urine samples were collected from 17 MIS-C patients and 5 healthy controls.
- Proinflammatory cytokines, myocardial injury markers, and endothelial glycocalyx markers were measured.
- Levels of syndecan-1, heparan sulfate, and chondroitin sulfate were analyzed.
Main Results:
- All MIS-C patients exhibited signs of glycocalyx deterioration.
- Elevated blood syndecan-1 and urinary heparan sulfate/chondroitin sulfate were observed in MIS-C patients.
- The extent of glycocalyx shedding correlated with tumor necrosis factor-alpha levels and disease severity.
Conclusions:
- Children with MIS-C show significant endothelial glycocalyx injury.
- Syndecan-1 and heparan sulfate may serve as potential biomarkers for MIS-C severity.
- Further research is needed to validate these biomarkers for predicting complications in MIS-C and severe COVID-19.
Abstract:
Multisystem inflammatory syndrome in children (MIS-C) represents a rare but severe complication of severe acute respiratory syndrome coronavirus 2 infection affecting children that can lead to myocardial injury and shock. Vascular endothelial dysfunction has been suggested to be a common complicating factor in patients with coronavirus disease 2019 (COVID-19). This study aims to characterize endothelial glycocalyx degradation in children admitted with MIS-C. We collected blood and urine samples and measured proinflammatory cytokines, myocardial injury markers, and endothelial glycocalyx markers in 17 children admitted with MIS-C, ten of which presented with inflammatory shock requiring intensive care admission and hemodynamic support with vasopressors. All MIS-C patients presented signs of glycocalyx deterioration with elevated levels of syndecan-1 in blood and both heparan sulfate and chondroitin sulfate in the urine. The degree of glycocalyx shedding correlated with tumor necrosis factor-α concentration. Five healthy age-matched children served as controls. Patients with MIS-C presented severe alteration of the endothelial glycocalyx that was associated with disease severity. Future studies should clarify if glycocalyx biomarkers could effectively be predictive indicators for the development of complications in adult patients with severe COVID-19 and children with MIS-C. KEY MESSAGES : Children admitted with MIS-C presented signs of endothelial glycocalyx injury with elevated syndecan-1 and heparan sulfate level. Syndecan-1 levels were associated with MIS-C severity and correlated TNF-α concentration. Syndecan-1 and heparan sulfate may represent potential biomarkers for patients with severe COVID-19 or MIS-C.
