Glycosaminoglycans (GAGs) are structurally diverse polysaccharides that regulate inflammation, coagulation, and cellular homeostasis through highly specific sulfation patterns and interactions with cationic proteins. Among GAG derivatives, 2-O, 3-O desulfated heparin (ODSH) is a chemically modified heparin derivative characterized by markedly reduced anticoagulant activity yet preserved affinity for key inflammatory mediators. This review summarizes current knowledge on ODSH structure–function relationships, molecular mechanisms, and therapeutic applications across inflammatory, vascular, and immune-mediated diseases. ODSH modulates several convergent pathogenic processes, including HMGB1-RAGE/TLR4 signaling, neutrophil elastase-mediated tissue injury, PF4-dependent platelet activation, selectin-mediated adhesion, and thrombin-induced endothelial permeability. These actions arise from both direct molecular interactions and indirect sequestration of extracellular mediators, collectively associated with reduced cytokine release, enhanced endothelial barrier stability, and attenuation of inflammation–coagulation crosstalk. Preclinical studies report protective effects in acute lung injury, cystic fibrosis, ischemia–reperfusion injury, traumatic brain injury, thrombocytopenia, and metastatic cancer. Some pilot clinical observations in acute myeloid leukemia and septic peritonitis have reported favorable biological effects. Despite multimodal activity, limitations include incomplete pharmacokinetic characterization, limited comparative studies with other desulfated heparins, and the need for dose–response and safety evaluation in human trials. Overall, available evidence suggests that ODSH may have therapeutic relevance in diseases characterized by excessive inflammation, endothelial dysfunction, and dysregulated host responses. This review integrates current evidence to guide future mechanistic and translational investigation into ODSH and related low-anticoagulant heparin derivatives.

Bacterial lipopolysaccharide (LPS) disrupts endothelial barrier stability by inducing inflammatory events that underlie acute lung injury (ALI). Effective pharmacologic therapies capable of modifying the disease mechanisms of ALI remain limited. We previously demonstrated that 2-O, 3-O desulfated heparin (ODSH), a modified heparin with minimal anticoagulant activity and anti-inflammatory properties, attenuates LPS-induced ALI in mice and preserves human lung microvascular endothelial cell (HLMVEC) barrier integrity. In the present study, we further investigated the mechanisms of ODSH-mediated protection in mice and HLMVECs, focusing on inflammatory mediator expression and the modulation of TLR4–MyD88–NF-κB signaling. HLMVECs were pretreated with ODSH before LPS exposure, and barrier function was monitored using transendothelial electrical resistance measurements. Complementary experiments were performed in CD-1 mice receiving intratracheal LPS with or without intravenous ODSH. Across both models, ODSH attenuated LPS-induced endothelial barrier dysfunction. ODSH significantly reduced bronchoalveolar lavage fluid (BALF) protein accumulation, inflammatory cell infiltration, IL-6 and TNF-α concentrations, Evans Blue dye extravasation, and pulmonary edema. Gene expression analyses demonstrated that ODSH suppressed multiple pro-inflammatory mediators and inflammatory signaling components, including IL-1β, TNF-α, IL-6, NOS2, MAPK14, MAPK1, ICAM1, and CCL2, while enhancing IL-10 and several barrier-associated genes (CDH5, OCLN, CLDN5, and TJP1). ODSH also reduced the mRNA expression of TLR4, MYD88, and RELA. Protein analyses confirmed a reduced expression of NF-κB, MyD88, and TNF-α. Furthermore, ODSH at concentrations of 5–100 μg/mL did not significantly affect cellular metabolic activity. Collectively, these findings indicate that ODSH preserves endothelial barrier function and attenuates inflammatory responses associated with TLR4–MyD88–NF-κB signaling in experimental ALI. The findings support the further mechanistic and preclinical investigation of ODSH in inflammatory lung injury.