Tight junction structure, function, and assessment in the critically ill: a systematic review

David Vermette; Pamela Hu; Michael F Canarie; Melissa Funaro; Janis Glover; Richard W Pierce

doi:10.1186/s40635-018-0203-4

Tight junction structure, function, and assessment in the critically ill: a systematic review

Intensive Care Med Exp. 2018 Sep 26;6(1):37. doi: 10.1186/s40635-018-0203-4.

Authors

David Vermette¹, Pamela Hu¹, Michael F Canarie¹, Melissa Funaro², Janis Glover², Richard W Pierce³

Affiliations

¹ Department of Pediatrics, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT, 06520, USA.
² Cushing/Whitney Medical Library, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT, 06520, USA.
³ Department of Pediatrics, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT, 06520, USA. Richard.Pierce@yale.edu.

Abstract

Background: Epithelial and endothelial barrier integrity, essential for homeostasis, is maintained by cellular boarder structures known as tight junctions (TJs). In critical illness, TJs may become disrupted, resulting in barrier dysfunction manifesting as capillary leak, pulmonary edema, gut bacterial translocation, and multiple organ failure. We aim to provide a clinically focused overview of TJ structure and function and systematically review and analyze all studies assessing markers of endothelial and epithelial TJ breakdown correlated with clinical outcomes in critically ill humans.

Methods: We systematically searched MEDLINE, EMBASE, and PubMed. Additional articles were identified by targeted searches. We included studies that looked at the relationship between biomarkers of endothelial or epithelial TJ structure or function and critical illness. Results were qualitatively analyzed due to sample size and heterogeneity.

Results: A total of 5297 abstracts met search criteria, of which 150 articles met requirements for full text review. Of these, 30 studies met inclusion criteria. Fifteen of the 30 reports investigated proteins of endothelial tight junctions and 15 investigated epithelial TJ markers, exclusively in the gastrointestinal epithelium. No studies investigated TJ-derived proteins in primary cardiac or pulmonary pathology.

Conclusions: TJ integrity is essential for homeostasis. We identified multiple studies that indicate TJs are disrupted by critical illness. These studies highlight the significance of barrier disruption across many critical disease states and correlate TJ-associated markers to clinically relevant outcomes. Further study on the role of multiple tissue-specific claudins, particularly in the setting of respiratory or cardiac failure, may lead to diagnostic and therapeutic advances.

Systematic review registration: This systematic review is registered in the PROSPERO database: CRD42017074546 .

Keywords: Capillary leak; Cellular permeability; Critical care; Endothelial cells; Epithelial cells; Tight junctions.

Grants and funding

T32 HD068201/HD/NICHD NIH HHS/United States