Suloxide, a mix of purified glycosaminoglycans?
Sulodexide, traded as Aterina, is a highly purified mixture of glycosaminoglycans composed of heparan sulfate (80%) and dermatan sulfate (20%). - (Sulodexide - Wikipedia)
Meta-analysis on BP lowering:
Considering the effects of glycosaminoglycans on endothelial function and sodium homeostasis, we hypothesized that sulodexide may lower blood pressure (BP). In this meta‐analysis, we therefore investigated the antihypertensive effects of sulodexide treatment.
Methods
We selected randomized controlled trials that investigated sulodexide treatment of at least 4 weeks and measured BP at baseline and after treatment. Two reviewers independently extracted data on study design, risk of bias, population characteristics and outcome measures. In addition, we contacted authors and pharmaceutical companies to provide missing data.
Results
Eight studies, totalling 3019 subjects (mean follow‐up 4.4 months) were included. Mean age was 61 years and mean baseline BP was 135/75 mmHg. Compared with control treatment, sulodexide resulted in a significant systolic (2.2 mmHg [95% CI 0.3, 4.1], P = 0.02) and diastolic BP reduction (1.7 mmHg [95% CI 0.6, 2.9], P = 0.004). Hypertensive patients displayed the largest systolic BP and diastolic BP reductions (10.2/5.4 mmHg, P < 0.001). Higher baseline systolic and diastolic BP were significantly associated with larger systolic (r 2=0.83, P < 0.001) and diastolic BP (r 2=0.41, P = 0.02) reductions after sulodexide treatment. In addition, systolic (r 2=0.41, P = 0.03) and diastolic BP reductions (r 2=0.60, P = 0.005) were significantly associated with albuminuria reduction.
Conclusion
Our data suggest that sulodexide treatment results in a significant BP reduction, especially in hypertensive subjects. This indicates that endothelial glycosaminoglycans might be an independent therapy target in cardiovascular disease. Future studies should further address the BP lowering potential of sulodexide.
Sulodexide is a highly purified mixture of glycosaminoglycans (GAGs) that is currently marketed in a number of countries in Europe, South America and Asia for various cardiovascular conditions. GAGs are large, negatively charged, linear polymers that are present on the surface of all endothelial cells and in the extracellular matrix. Here, GAGs interact with a wide range of processes that are involved in the development of cardiovascular disease, including shear mediated nitric oxide (NO) production and non‐osmotic sodium storage 6. Sulodexide has been shown to improve endothelial function and lipid profiles, exert anti‐inflammatory, anti‐thrombotic and fibrinolytic activity, inhibit leucocyte adhesion and diminish platelet aggregation 7. Because of these vasoprotective effects, sulodexide has been studied in numerous clinical trials. For instance, sulodexide has been shown to decrease claudication symptoms in peripheral artery disease patients and to prevent atherothrombotic events after acute myocardial infarction 8, 9. In addition, a series of small studies demonstrated that sulodexide decreased albuminuria 10. However, two recently performed large randomized controlled trials could not reproduce these findings 11, 12. Noticeably, no clinical trials have thus far investigated the antihypertensive potency of sulodexide.
The BP lowering effects of sulodexide may relate to both increased NO production and non‐osmotic sodium storage
Non‐osmotic sodium storage may also contribute to the antihypertensive potency of sulodexide 6. Sulodexide consists of negatively charged GAGs, which have been shown to be able to bind and osmotically inactivate sodium ions in the skin interstitium 36, 37, 38. In addition, GAGs in the ESL have been shown to be able to bind sodium under flow conditions 39. Considering the large systemic volume of the ESL, non‐osmotic sodium storage in the ESL may have significant implications for BP and extracellular volume regulation 40. Sulodexide may therefore increase the capacity for non‐osmotic sodium storage and prevent sodium from deteriorating endothelial cell function or expanding extracellular volume and causing BP to rise
A cardiovascular outcome trial in 3986 myocardial infarction patients demonstrated that sulodexide was able to reduce mortality and reinfarction rate compared with standard therapy, excluding antiplatelet and anticoagulant therapy
Is it safe, is this a good source?
Toxicity
Sulodexide seems to be well tolerated. Most adverse effects reported are related to the GI system and seem to be transient in nature. Among others adverse reactions are diarrhea, epigastralgia, dyspepsia, heartburn and dizziness. Allergic reactions, such as skin rash, have also been reported but are very rare. (https://go.drugbank.com/drugs/DB06271)
What do people think? Has anyone heard of this before?
BP and Sodium is more complicated (tissue sodium accumulation e.g in skin might play a role).
