Sulonex (sulodexide) / Alfasigma - LARVOL DELTA

RESTORING THE ENDOTHELIAL GLYCOCALYX REVERSES NITRIC-OXIDE MECHANOTRANSDUCTION DEFECTS AND LIMITS PRESSURE-OVERLOAD REMODELING IN TAC (ACC 2026) - " C57BL/6J mice underwent TAC or sham surgery and were treated with either vehicle or a glycocalyx-restoring agent (sulodexide) for 8 weeks... Loss of the endothelial glycocalyx disrupts NO mechanotransduction and contributes to vascular stiffening and maladaptive cardiac remodeling under pressure overload. Pharmacological restoration of the glycocalyx rescues NO signaling, improves vascular compliance, and limits TAC-induced remodeling."

Cardiovascular • Fibrosis • Heart Failure • Immunology • NOS3

Empagliflozin-mediated protection of heparan sulfate-rich endothelial glycocalyx during vascular inflammation. (PubMed, Biochem Pharmacol) - "In contrast, inhibitors of endogenous sheddases released in response to TNF, such as sulodexide or SB-3CT, reduced eGC disruption in TNF-exposed aorta. Furthermore, Empa improved the nanomechanical properties of the endothelium by reducing cortical stiffness elevated during TNF-induced inflammation ex vivo and in db/db mice in vivo. These findings reveal a previously unrecognized effect of empagliflozin on the vasculature, demonstrating its ability to attenuate eGC degradation during inflammation and to improve endothelial nanomechanical properties under both inflammatory and diabetic conditions."

Journal • Diabetes • Inflammation • Metabolic Disorders

PET-microplastics trigger endothelial glycocalyx loss via ER stress and ROS unleashing IL-1β-driven SMC switching and early aortic structural impairment. (PubMed, J Nanobiotechnology) - "Crucially, restoration of the glycocalyx using sulodexide mitigated endothelial dysfunction and downstream smooth muscle cells phenotypic switching. These findings establish endothelial glycocalyx degradation via endoplasmic reticulum stress-reactive oxygen species as a novel mechanism for PET-MPs-induced vascular injury and highlight glycocalyx protection as a potential strategy against environmental microplastic hazards."

Journal • IL1B

The importance of glycocalyx in the development of pathology of the cardiovascular system (PubMed, Angiol Sosud Khir) - "The review article presents data on the structural organization of the endothelial glycocalyx and its function in health and endothelial dysfunction accompanying circulatory system pathology. Particular attention is paid to the possibilities and peculiarities of its visualization using various techniques, as well as modern trends in correcting disorders of its function and structure."

Journal • Review • Cardiovascular

Sulodexide for limb salvage in refractory diabetic foot ulcer with arteriosclerosis obliterans: a case report. (PubMed, Front Endocrinol (Lausanne)) - "This case report suggests that highly selected DFU patients unresponsive to standard therapies including successful revascularization, Sulodexide may be a plausible salvage or adjunctive therapeutic option. This observation is strictly hypothesis-generating and its potential role warrants investigation in future prospective clinical trials."

Journal • Atherosclerosis • Cardiovascular • Peripheral Arterial Disease

Sulodexide protected the heart against ischemia/reperfusion injury by reducing oxidative stress, inflammation, and apoptosis in the isolated rat heart. (PubMed, Perfusion) - "Levels of Bax were significantly lower in PreSDX (p < 0.001), PostSDX (p < 0.01) and PrePostSDX (p < 0.001) groups than the IR group. The Bcl-2-associated X protein (Bax)//Bcl-2 ratio was also significantly higher in IR group than all three SDX treated groups (p's < 0.001).ConclusionsIt was concluded that SDX has anti-apoptotic, anti-inflammatory and antioxidant effects in both pre-ischemia and pre- and post-ischemia treatment and might be added to cardioplegia solutions in clinical practice."

Journal • Preclinical • B Cell Lymphoma • Cardiovascular • Inflammation • Lymphoma • Myocardial Ischemia • Oncology • Reperfusion Injury • BAX • CASP3

Treatment of livedoid vasculopathy with sulodexide: A prospective study of 35 cases. (PubMed, J Dtsch Dermatol Ges) - "Our study demonstrates that sulodexide monotherapy is a clinically effective and well-tolerated therapeutic option for patients with LV. Adjunctive JAK inhibitor therapy, when clinically indicated, may yield superior therapeutic outcomes."

Journal • Thrombosis

Venous Thrombosis Prophylaxis after Endovenous and Open Surgery for Varicose Veins: A Systematic Review and Network Meta-Analysis. (PubMed, Vasc Endovascular Surg) - "Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration."

Journal • Retrospective data • Review • Cardiovascular • Hematological Disorders • Thrombosis • Varicose Veins • Venous Thromboembolism

Pharmacological support strategies following endovenous laser ablation in patients with varicose veins (PubMed, Khirurgiia (Mosk)) - "EVLA provides clinical improvement and reductions in inflammatory biomarkers, but the effect is less durable in advanced disease. MPFF primarily modulates MCP-1 and VEGF, while sulodexide acts on MMP-2 and MMP-9. Their combination shows complementary pathogenetic mechanisms, yielding the most durable biochemical and clinical benefits, and may represent the optimal pharmacological support for EVLA in patients with severe chronic venous disease."

Biomarker • Journal • Varicose Veins • MMP2 • MMP9

Sulodexide can ameliorates renal interstitial fibrosis in adenine-induced kidney injury rats. (PubMed, Eur J Pharmacol) - "The study demonstrated that SDX can delay renal interstitial fibrosis in adenine-induced kidney injury rats, which may be related to the inhibition of Wnt/β-catenin signaling pathway."

Journal • Preclinical • Fibrosis • Immunology • Renal Disease • WNT3A

Oral Sulodexide Downregulates Biomarkers of Endothelial Dysfunction Among Convalescent COVID-19 Patients (ASH 2024) - "No significant differences were observed between groups for P-selectin, fibrinogen, VCAM-1, or ICAM-1 levels.ConclusionsIn this study, patients with cardiometabolic risk factors who were in a convalescent phase from moderate or severe COVID-19 within 40 days of clinical presentation exhibit elevated serum levels of biomarkers indicative of ongoing endothelial cell activation and dysfunction. Patients receiving sulodexide for eight weeks showed a reduction in TM, vWF, D-dimer, CRP, and IL-6 serum levels compared to placebo, suggesting a potential protective effect against thromboinflammation and endothelial damage.These findings may translate into improved clinical outcomes, though further studies are needed to confirm these results and explore their long-term implications."

Biomarker • Clinical • Cardiovascular • Diabetes • Genetic Disorders • Hypertension • Infectious Disease • Inflammation • Metabolic Disorders • Novel Coronavirus Disease • Obesity • Respiratory Diseases • ICAM1 • IL6 • VCAM1

Chronic Cardiovascular Disorders Associated With COVID-19: A Literature Review. (PubMed, Cureus) - "Promising but still experimental methods, such as endothelial-protective agents like sulodexide and targeting inflammatory pathways, need thorough testing...They include higher healthcare use, long-term disability, and economic costs. This situation requires increased clinical attention and proactive cardiovascular monitoring for those recovering from COVID-19."

Journal • Review • Cardiovascular • Fibrosis • Hematological Disorders • Hypertension • Immunology • Infectious Disease • Inflammation • Novel Coronavirus Disease • Pediatrics • Respiratory Diseases • Thrombosis

Exacerbation of Psoriatic Lesions and Vascular Complications in a Patient Treated with Bimekizumab: A Case Report (EADV 2025) - "Between 2020 and 2023, the patient received methotrexate (15–25 mg/week, orally and subcutaneously), resulting in improvement of joint symptoms but no significant effect on nail involvement...Topical corticosteroids and systemic cyclosporine A provided no significant improvement...Sulodexide was initiated on January 21, 2025, followed by the introduction of oral acitretin (35 mg/day; 0.35 mg/kg) resulting in partial improvement, including slight initial improvement of acral skin involvement... Although rare, cases of vasculitis have been described with other IL-17 inhibitors. A similar mechanism may underlie the adverse effects observed with bimekizumab in this patient. Further research is needed to better understand these associations and to develop personalized treatment strategies that account for individual risk of adverse reactions."

Case report • Clinical • Dermatology • Hidradenitis Suppurativa • Immunology • Inflammatory Arthritis • Psoriasis • Psoriatic Arthritis • Rheumatology • Seronegative Spondyloarthropathies • Vasculitis • IL17A

A Novel Marine Bacterium-Derived Heparinase with High Potential for the Structure-Function Studies of Heparin/Heparan Sulfate. (PubMed, J Agric Food Chem) - "This property enables HD1492 to reveal the distribution and composition of nonsulfated domains in HP/HS─overcoming the limitation of conventional disaccharide analysis─as validated in mouse organ-derived GAGs and the drug sulodexide. Overall, the unique enzymatic properties of HD1492 confer innovative value that distinguishes it from terrestrial heparinases, providing a much-needed tool for the resolution of HP/HS structural and functional domains and the development and quality control of related products."

Journal

Clinicopathological Characteristics and Prognosis of IgA Nephropathy Combined With Malignant Hypertension Kidney Injury. (PubMed, J Clin Lab Anal) - "This study revealed that in IgAN-MHT patients, a higher proportion of glomerulosclerosis was independently associated with poorer renal outcomes, while the use of sulodexide showed a significant independent association with improved renal function."

Journal • Cardiovascular • Glomerulonephritis • Hypertension • IgA Nephropathy • Lupus Nephritis • Nephrology • Renal Disease

Protection of the Endothelium and Endothelial Glycocalyx by Albumin and Sulodexide in Porcine Model of Kidney Transplant. (PubMed, Exp Clin Transplant) - "We suggest that albumin and sulodexide may offer beneficial effects in preserving endothelial function during kidney transplant. The potential for these agents to enhance graft survival and improve kidney transplant outcomes warrants further investigation."

Biomarker • Journal • Preclinical • Cardiovascular • Chronic Kidney Disease • Nephrology • Reperfusion Injury • Transplantation • SDC1

Clinical study on the effect of glycosaminoglycans on vascular endothelial glycocalyx in sepsis (PubMed, Zhonghua Wei Zhong Bing Ji Jiu Yi Xue) - "Early glycocalyx degradation can occur in sepsis patients. GAG have a protective effect on,the vascular endothelium, reducing the severity of sepsis and providing organ protection. HS, CRP, APTT, IL-6, APACHE II score, SOFA score, and ISTH score are independent predictive factors for the prognosis of sepsis patients. The combination of HS and the above indicators can significantly improve the accuracy of prediction."

Journal • Cardiovascular • Critical care • Hematological Disorders • Infectious Disease • Oncology • Septic Shock • Thrombosis • CRP • IL6 • SDC1 • TNFA

Letter: Urticarial Vasculitis Triggered by Sulodexide in an Elderly Patient with Renal Impairment: A Case Report. (PubMed, Dermatitis) - No abstract available

Journal • Dermatology • Immunology • Renal Disease • Urticaria • Vasculitis

Efficacy and safety of Sulodexide in sepsis induced coagulation: a single-center, randomized, controlled, single-blind clinical study (ChiCTR) - P4 | N=202 | Not yet recruiting | Sponsor: The First Hospital of Jilin University; The First Hospital of Jilin University

New P4 trial • Infectious Disease • Septic Shock

Profiling of endothelial dysfunction biomarkers in long COVID syndrome (ISTH 2025) - "Results Patients (n=103 treatment group and n=103 reference group) administered with an orally active form of glycosaminoglycans (GAGs, sulodexide) for 8 weeks exhibited a reduction in endothelial dysfunction biomarkers such as TM, vWF, D-dimer, CRP, and IL-6 levels compared to reference group, suggesting a protective effect on the release of biomarkers associated with thromboinflammation and endothelial damage. No significant differences were observed between the groups for P-selectin, fibrinogen, VCAM-1, or ICAM-1 levels."

Biomarker • Cardiovascular • Infectious Disease • Inflammation • Novel Coronavirus Disease • Respiratory Diseases • CRP • ICAM1 • IL6 • VCAM1

Modulating Endothelial Thromboinflammation Biomarkers in Diabetic Convalescent COVID-19 Patients (ISTH 2025) - "Aims This study assesses the impact of Sulodexide on key serum biomarkers in convalescent diabetic COVID-19 patients...No significant differences were noted for P-selectin, VCAM-1, or ICAM-1 levels. Table or Figure Upload"

Biomarker • Clinical • Cardiovascular • Diabetes • Infectious Disease • Inflammation • Metabolic Disorders • Novel Coronavirus Disease • CRP • ICAM1 • IL6 • VCAM1

Endothelial Protection in Convalescent COVID-19 Patients (clinicaltrials.gov) - P4 | N=2 | Terminated | Sponsor: Pirogov Russian National Research Medical University | N=30 ➔ 2 | Recruiting ➔ Terminated; Lack of the eligible patients

Biomarker • Enrollment change • Trial termination • Cardiovascular • Hematological Disorders • Infectious Disease • Inflammation • Novel Coronavirus Disease • Thrombosis • ICAM1

A meta-analysis of efficacy and safety of sulodexide in the prevention and treatment of venous thromboembolism (PubMed, Zhonghua Yi Xue Za Zhi) - "Moreover, the incidence of bleeding events was lower in patients treated with sulodexide compared to those treated with other traditional anticoagulants [0.8% (2/251) vs 6.1% (40/656), RR=0.11, 95%CI: 0.03-0.37, P<0.001]. Sulodexide exhibits favorable efficacy and safety for VTE prevention in high-risk populations and recurrence reduction in VTE patients."

Clinical • Journal • Retrospective data • Cardiovascular • Venous Thromboembolism

Sulodexide in Controlling the Recurrence of Psoriasis (clinicaltrials.gov) - P3 | N=160 | Enrolling by invitation | Sponsor: Xijing Hospital

New P3 trial • Dermatology • Immunology • Psoriasis

"The Role of Venoactive Compounds in the Treatment of Chronic Venous Disease". (PubMed, J Vasc Surg Venous Lymphat Disord) - "The existing scientific evidence provides a strong rationale for incorporating VACs into a comprehensive treatment plan for CVD, alongside established interventional therapies and non-interventional approaches like compression, to optimize patient outcomes and improve quality of life."

Journal • Review • Inflammation • Pain • Venous Ulcer