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The objective of this study was to determine if breakdown of the endothelial glycocalyx (eGC) occurs during malaria infection in children. Measures of eGC integrity, endothelial activation, and microvascular reactivity were prospectively evaluated in 146 children: 44 with moderately severe malaria (MSM), 42 with severe malaria (SM), and 60 healthy controls (HC). Biochemical measures of eGC integrity included plasma syndecan\u20101 and total urinary glycosaminoglycans (GAG). Side\u2010stream dark field imaging was used to quantitatively assess integrity of eGC. Plasma angiopoietin\u20102 (Ang\u20102) was measured as a marker of endothelial activation and also as a possible mediator of eGC breakdown. Our results show that urinary GAG, syndecan\u20101, and Ang\u20102 were elevated in patients with MSM and SM compared with HC. Syndecan\u20101 and GAG levels correlated significantly with each other and with plasma Ang\u20102. The eGC breakdown products also inversely correlated significantly with hemoglobin and platelet count. In the MSM group, imaging results provided further evidence for eGC degradation. Although not correlated with markers of eGC degradation, vascular function (assessed by non\u2010invasive near infrared spectroscopy [NIRS]) demonstrated reduced microvascular reactivity, particularly affecting the SM group. Our findings provide further evidence for breakdown of eGC in falciparum malaria that may contribute to endothelial activation and adhesion of parasitized red blood cells, with reduced nitric oxide formation, and vascular dysfunction.<\/jats:p>","DOI":"10.1096\/fj.202100277rr","type":"journal-article","created":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T14:51:31Z","timestamp":1629211891000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Degradation of endothelial glycocalyx in Tanzanian children with falciparum malaria"],"prefix":"10.1096","volume":"35","author":[{"given":"Margaret A.","family":"Bush","sequence":"first","affiliation":[{"name":"School of Medicine Duke University and Durham VA Medical Centers Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore M.","family":"Florence","sequence":"additional","affiliation":[{"name":"Hubert Kairuki Memorial University Dar 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