Assessment of the endothelial glycocalyx state in patients with axial spondyloarthritis associated with Crohn’s disease

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BACKGROUND: Epithelial barrier dysfunction, including their permeability increment, is supposed to be a pathogenetic link in the development of various immunoinflammatory diseases, including Crohn’s disease and axial spondyloarthritits. Endothelial permeability regulation is provided by both intercellular contacts and endothelial glycocalyx.

AIM: To study the microcirculatory state by measuring the endothelial glycocalyx thickness in patients with axial spondyloarthritits associated with Crohn’s disease. To identify an association between the endothelial glycocalyx thinning and the epithelial permeability severity in patients with Crohn’s disease, axial spondyloarthritits and their combination.

MATERIALS AND METHODS: 12 patients with axial spondyloarthritits associated with Crohn’s disease (group A), 22 patients with idiopathic axial spondyloarthritits (group B), 24 patients with Crohn’s disease (group C) and 16 healthy individuals (group D) were examined. The endothelial glycocalyx thickness was assessed in the sublingual region using dark-field microscopy. Fecal calprotectin and fecal zonulin was studied.

RESULTS: A statistically significant increase in the perfused boundary region high flow was found (p = 0.001), as well as the MicroVascular Health Score (p = 0.004) in group A compared with the control. In Group A, a positive correlation between perfused boundary region high flow and scores Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index 10 (p < 0.05) was found; perfused boundary region 5–9 mµ correlated positively with the fecal calprotectin (p = 0.007). Perfused boundary region high flow measurement provides 77.1% accuracy for correct classification of axial spondyloarthritits associated with Crohn’s disease and idiopathic axial spondyloarthritits (p = 0.010). In group C, a positive correlation between fecal zonulin and perfused boundary region 5–9 mµ, 10–19 mµ, 5–25 mµ (p < 0.05) was also found.

CONCLUSIONS: The findings suggest that the patients with axial spondyloarthritits associated with Crohn’s disease have endothelial glycocalyx impairment; the detection of these abnormalities may be useful in assessing the disease integral activity and in the differential diagnosis of axial spondyloarthritits associated with Crohn’s disease and idiopathic axial spondyloarthritits. Further studies of microcirculation will allow better understanding of spondyloarthritis and inflammatory bowel diseases pathogenesis and improve the management of patients with these diseases.

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作者简介

Denis Davydov

Academician I.P. Pavlov First St. Petersburg State Medical University

编辑信件的主要联系方式.
Email: davydov.rheum@gmail.com
ORCID iD: 0000-0002-5524-1616
SPIN 代码: 1132-5294
Scopus 作者 ID: 57217159189
Researcher ID: JWP-2975-2024

MD, postgraduate student

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022

Valerii Marchenko

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: marchvn@mail.ru
ORCID iD: 0000-0002-2440-7222
SPIN 代码: 1711-4150
Scopus 作者 ID: 57206419660

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022

Daria Kuznetsova

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: lariwar@mail.ru
ORCID iD: 0000-0001-5318-354X
SPIN 代码: 6110-6168
Scopus 作者 ID: 57205585994

MD, Cand. Sci. (Med.)

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022

Zinaida Malakhova

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: zina_spb@mail.ru
ORCID iD: 0000-0003-2062-290X
SPIN 代码: 1225-4143
Scopus 作者 ID: 56349857400

MD, Department of Ultrasound Diagnostics

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022

Tatiana Lozovaya

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: lozota@inbox.ru
ORCID iD: 0009-0004-6589-5754
SPIN 代码: 2592-8347

Cand. Sci. (Med.), MD, Functional Diagnostics Department №1

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022

Artem Rubinstein

Academician I.P. Pavlov First St. Petersburg State Medical University; Institute of Experimental Medicine

Email: arrubin6@mail.ru
ORCID iD: 0000-0002-8493-5211
SPIN 代码: 6025-1790
Scopus 作者 ID: 57417440100

ординатор

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022; Saint Petersburg

Timur Vlasov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: tvlasov@yandex.ru
ORCID iD: 0000-0002-6951-7599
SPIN 代码: 8367-1246
Scopus 作者 ID: 7003323018
Researcher ID: C-6843-2014

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, 6/8 L’va Tolstogo St., Saint Petersburg, 197022

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2. Pic. 1. Schematic representation of the endothelial glycocalyx perfused boundary region (generated in biorender.com)

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3. Fig. 2. Comparison of the value of the MicroVascular Health Score in the studied groups. Statistically significant difference: axial spindyloarthritis associated with Crohn’s disease vs axial spondyloarthritis (p = 0,010) and control (p = 0,004). axSpA — axial spondyloarthritis; CD — Crohn’s disease; CD-axSpA — axial spindyloarthritis associated with Crohn’s disease

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4. Fig. 3. Evaluation of the prognostic significance of the perfused boundary region high flow in the differential diagnosis between idiopathic axial spondyloarthritis and axial spondyloarthritis associated with Crohn’s disease

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5. Fig. 4. Evaluation of the effect of systemic glucocorticoid therapy on the glycocalyx parameters of microcirculatory vessels of various diameters in the patients with Crohn’s disease

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6. Fig. 5. Scatter diagram of the correlation of articular activity with Perfused Boundary Region in CD-axSpA and idiopathic axSpA. axSpA — axial spondyloarthritis, CD-axSpA — axial spondyloarthritis associated with Crohn’s diseasers in the patients with Crohn’s disease

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