Assessment of endothelial glycocalyx injury in the pathophysiology of acute respiratory distress syndrome (ARDS) due to influenza A virus infection

• Grant number: 16/22147-1
• Support Opportunities: Regular Research Grants
• Duration: February 01, 2017 - January 31, 2019
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Carlos Henrique Miranda
• Grantee: Carlos Henrique Miranda
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Introduction: Endothelial glycocalyx is a thin layer of proteinaceous material observed in the endothelial surface of the vessel. Recently, it has been pointed out some physiological functions such as: control of vascular permeability, participation in the adhesion of inflammatory cells and platelet, etc. The Acute Respiratory Distress Syndrome (ARDS) can be observed during infection with influenza A virus (H1N1), showing high mortality even in young patients. Pulmonary involvement mechanisms in ARDS secondary to this virus is not completely known, however, change in vascular permeability, migration of macrophages and inflammatory activation are frequently observed in the alveolar-capillary unit of these patients.Objective: To evaluate the participation of endothelial glycocalyx injury in ARDS triggering induced by influenza A (H1N1) virus infection.Methodology: Biomarkers dosage of the endothelial glycocalyx injury (syndecan-1) and endothelial cell injury (thrombomodulin) are performed by ELISA commercial kit into three groups: patients with flu-like syndrome without ARDS (n = 25), patients with flu-like syndrome with ARDS (n = 25) and healthy control subjects (n = 25). It will also evaluate the correlation of the levels of these markers with the levels of some inflammatory cytokines (TNF-alpha, IL-6 and IL-1 beta).Significance: If confirmed glycocalyx endothelial damage in ARDS due to influenza A H1N1 infection will allowed a new potential therapeutic approach aimed at the preservation / restoration of the glycocalyx in the prevention and treatment of ARDS. In addition, a positive result of this cross-sectional study will allow for potential proospective cohort, using this biomarker for selection of patients under risk of ARDS development after influenza A infection, allowing the establishment of individual antiviral therapy and higher clinical surveillance in this patients. (AU)