Targeting hyaluronan of the endothelial glycocalyx for therapeutic intervention

The endothelial glycocalyx (EG) is an extracellular matrix (ECM) coating the luminal surface of the vascular endothelium. Hyaluronan (HA), a glycosaminoglycan, is an important constituent of the EG that regulates inflammation and repair. By providing a direct link between the endothelium and its ECM, HA contributes to maintaining glycocalyx integrity; emerging evidence indicates a close association between EG deterioration, concomitant loss of HA and the onset of endothelial dysfunction, a phenomenon that is involved in many disorders, including atherosclerosis, diabetes, hypertension and dyslipidemia. This review provides an overview of glycocalyx modification by pathological stimuli and considers the potential of the pharmacological targeting of HA synthesis and binding to limit endothelial dysfunction and to improve vasculoprotection.