Measuring the endothelial glycocalyx in cancer patients and determining the effect of chemotherapy

Functions of the endothelial glycocalyx are the preservation of the endothelial
barrier and to prevent adhesion of cells to the endothelial wall. In cancer,
elevated levels of heparanase and hyaluronidase are described, which are
enzymes extensively described in local tumour invasiveness. However, these
enzymes are also known for their glycocalyx degrading effects. The glycocalyx
has not been described in cancer patients yet. A damaged glycocalyx might allow
adhesion of cancer cells to the blood vessel wall and these cells can more
easily cross the vessel wall. This way, metastasis would be promoted. Also, the
hypercoagulant state in cancer might be in part due to a perturbation of the
glycocalyx. Chemotherapy is known to induce endothelial damage, probably also
to the glycocalyx, which may explain the hypercoagulant state caused by
chemotherapy. Alternatively, restoration of the glycocalyx may be one of the
anti-tumour effects of chemotherapy, possibly via inhibition of the production
of the glycocalyx degrading enzymes.

To investigate the state of the endothelial glycocalyx in cancer patients and
determine the effect of chemotherapy on this layer.

Observational case-control study

The patients will visit the hospital on three occasions, of which two in a semi
fasting state (3 hours no food-intake). On the first occasion, screening is
done and informed consent is taken. During the first research visit, before
chemotherapeutic therapy has been initiated, the patients will be asked to fill
out a questionnaire and they will undergo OPS measurement (non-invasive imaging
of the sublingual microcirculation) and venapuncture (blood withdrawal 30 ml).
Also, they will be asked to hand over one portion of urine.
During the second visit, after the start of chemotherapy, the same procedure
will take place.
After three months of follow-up, information about the progression of the
disease will be obtained (no extra visit needed).

Visits will be planned simultaneously with visits for regular patient care.
Also, blood withdrawings will be planned simultaneously with blood withdrawings
for regular patient care as much as possible.