medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-008medsovet-9066Research ArticleПРАКТИКАPRACTICEО влиянии гликокаликса на биосинтез NO: роль сулодексидаOn the influence of glycocalyx on NO biosynthesis: The role of sulodexidehttps://orcid.org/0000-0002-7663-710XГромоваО. А.GromovaO. A.

Громова Ольга Алексеевна, д.м.н., профессор, ведущий научный сотрудник

119333, Москва, ул. Вавилова, д. 44, корп. 2

Olga A. Gromova, Dr. Sci. (Med.), Professor, Leading Researcher

44, Bldg. 2, Vavilov St., Moscow, 119333

unesco.gromova@gmail.comhttps://orcid.org/0000-0002-2659-7998ТоршинИ. Ю.TorshinI. Yu.

Торшин Иван Юрьевич, к.ф.-м.н., к.х.н., ведущий научный сотрудник

119333, Москва, ул. Вавилова, д. 44, корп. 2

Ivan Yu. Torshin, Cand. Sci. (Phys.-Math.), Cand. Sci. (Chem.), Leading Researcher

44, Bldg. 2, Vavilov St., Moscow, 119333

tiy135@yahoo.comhttps://orcid.org/0000-0002-5070-5450ЧучалинА. Г.ChuchalinA. G.

Чучалин Александр Григорьевич, акад. РАН, д.м.н., профессор, заведующий кафедрой госпитальной терапии педиатрического факультета

117997, Москва, ул. Островитянова, д. 1

Alexander G. Chuchalin, Acad. RAS, Dr. Sci. (Med.), Professor, Head of the Department of Hospital Therapy, Faculty of Pediatrics 

1, Ostrovityanov St., Moscow, 117997

Федеральный исследовательский центр «Информатика и управление» Российской академии наукРоссияFederal Research Center “Computer Science and Control” of the Russian Academy of SciencesRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation20250405202505196205Copyright © Громова О.А., Торшин И.Ю., Чучалин А.Г., 20252025Громова О.А., Торшин И.Ю., Чучалин А.Г.Gromova O.A., Torshin I.Y., Chuchalin A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9066

Гликокаликс – это особая сверхтонкая структура из гликозаминои протеогликанов толщиной 0,2–5 мкм, покрывающей эндотелий. Поддержание механизмов синтеза и секреции сигнальной молекулы NO, этого регулятора сосудистого тонуса, митохондриального дыхания, нейротрансмиссии и иммунитета, происходит посредством реконструкции гликокаликса. Сулодексид – комбинация природных гликозаминогликанов – гепарана сульфата и дерматана сульфата, входящих в состав гликокаликса. Хорошо известно антитромботическое действие сулодексида, реализуемое через подавление адгезии и агрегации тромбоцитов, мягкий антикоагулянтный и профибринолитический эффекты. Помимо профилактики тромбообразования, применение сулодексида – одно из важных направлений терапии эндотелиальной дисфункции через восстановление гликокаликса и биосинтеза NO. Доказательные данные показывают, что использование сулодексида перспективно для лечения как артериальных, так и венозных тромботических расстройств у пациентов с сахарным диабетом 2-го типа (СД2), артериальной гипертонией (АГ), коронавирусной инфекцией COVID-19, после хирургических вмешательств, при тромбофилии и др. Метаанализ данных исследований демонстрирует снижение риска смерти от сердечно-сосудистых причин при применении сулодексида. В рамках персонализированного назначения сулодексида следует учитывать результаты диагностики эндотелиальной дисфункции. При наличии у пациента риска тромботических событий следует использовать антикоагулянты и антиагреганты в соответствии с клиническими рекомендациями. Сулодексид обладает антитромботическими свойствами и характеризуется низким уровнем кровотечений, его следует использовать при невозможности применения антикоагулянтов при высоком риске кровотечения, а также при наличии у пациента АГ, СД2, хронических заболеваний вен, заболеваний артерий нижних конечностей.

The glycocalyx is a special ultra-fine structure of glycosaminoand proteoglycans, 0.2–5 μm thick, covering the endothelium. Maintenance of the mechanisms of synthesis and secretion of the signaling molecule NO, this regulator of vascular tone, mitochondrial respiration, neurotransmission and immunity, occurs through the reconstruction of the glycocalyx. Sulodexide is a combination of natural glycosaminoglycans – heparan sulfate and dermatan sulfate, which are part of the glycocalyx. The antithrombotic effect of sulodexide, realized through the suppression of platelet adhesion and aggregation, mild anticoagulant and profibrinolytic effects, is well known. In addition to the prevention of thrombus formation, the use of sulodexide is one of the important areas of endothelial dysfunction therapy through the restoration of glycocalyx and NO biosynthesis. Evidence shows that the use of sulodexide is promising for the treatment of both arterial and venous thrombotic disorders in patients with type 2 diabetes mellitus (T2DM), arterial hypertension (AH), coronavirus infection COVID-19, after surgery, with thrombophilia, etc. A meta-analysis of study data demonstrates a reduced risk of death from cardiovascular causes with the use of sulodexide. As part of the personalized prescription of sulodexide, the results of endothelial dysfunction diagnostics should be taken into account. If the patient has a risk of thrombotic events, anticoagulants and antiplatelet agents should be used in accordance with clinical guidelines. Sulodexide has antithrombotic properties and is characterized by a low level of bleeding; it should be used when it is impossible to use anticoagulants with a high risk of bleeding, as well as if the patient has hypertension, type 2 diabetes, chronic venous diseases, and diseases of the arteries of the lower extremities.

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The authors declare that there are no conflicts of interest present.