Sulodexide in the treatment of vascular disease: its therapeutic action on the endothelium

Sulodexide (SDX) is a mixture of highly purified glycosaminoglycans (GAGs), consisting of 80% fast-moving heparin (FMH) and 20% dermatan sulfate (DS). Recently it is becoming more widely used, not only in the treatment of chronic venous disease, but also many other vascular disorders. The efficacy of SDX in the treatment of peripheral arterial disease (PAD) or diabetic nephropathy has also been demonstrated. The way that SDX operates on the biology of vascular endothelial cells is not fully understood. It has anticoagulant, profibrinolytic and anti-aggregative properties. Moreover, it delivers substrates for the reconstruction of vascular endothelial glycocalyx and, at the same time, inhibits the activity of enzymes responsible for cleaving GAGs. Besides its effects on the glycocalyx, which is located on the surface of endothelium, part of a dose penetrates the endothelial cells and has an effect on the expression of multiple growth factors. It has been observed that SDX has protective, reparative, anti-inflammatory, anti-oxidant, anti-apoptotic and an anti-atherosclerotic influence on vascular endothelial cells. In this review article, each of these aspects of SDX’s activity has been thoroughly discussed in the context of chronic venous disease. Special regard was dedicated to the increasing amount of reports about the high efficiency of SDX in the treatment of patients with CVD at various stages. Sulodexide has a wide therapeutic range in the treatment of vascular disorders. Further research is needed to explain the precise mechanism of action of this pleiotropic drug.