Protecting the endothelial glycocalyx in COVID-19

COVID-19 is a respiratory infection caused by the highly transmissible SARS-CoV-2.While most infected patients exhibit mild to moderate symptoms, a minority may develop severe vascular damage, which can be fatal.One example of this damage is disruption to the endothelial glycocalyx (EG) layer.EG alterations have been implicated in microcirculation changes and severe endothelial dysfunction in COVID-19 [1,2].Current evidence suggests that host-pathogen interactions, such as hyperimmune activation or persistent presence of viral antigens, are associated with EG damage and may potentially bring about continuous endothelial dysfunction even after clinical recovery.Notably, the glycocalyx is also present on the epithelium, but we will focus on the EG and its implication on vascular health in COVID-19.Additionally, we will propose possible mediators that are linked with EG damage and suggest therapeutic agents that could aid EG restoration and protection.