The endothelial glycocalyx, the gel layer covering the endothelium, is composed of glycosaminoglycans, proteoglycans, and adsorbed plasma proteins. This structure modulates vessels’ mechanotransduction, vascular permeability, and leukocyte adhesion. Thus, it regulates several physiological and pathological events. In the present review, we described the mechanisms that disturb glycocalyx stability such as reactive oxygen species, matrix metalloproteinases, and heparanase. We then focused our attention on the role of glycocalyx degradation in the induction of profibrotic events and on the possible pharmacological strategies to preserve this delicate structure.
In this situation, a promising agent is sulodexide, a mixture of 80% fast-moving heparin and 20% of dermatan sulfate. Sulodexide has antithrombotic, profibrinolytic, anti-inflammatory, antioxidant, and anti-ischemic properties. In addition, its proposed mode of action is the inhibition of heparanase and also the modulation ofMMP-9 production .  in clinical evaluation, sulodexide was able to restore endothelial glycocalyx and vascular permeability in patients with type 2 diabetes.

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