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Dermatan sulfate (DS) is a naturally occurring, remarkably versatile glycosaminoglycan (GAG) characterized by repeating disaccharide units of N-acetyl-D-galactosamine and Iduronic acid with variable sulfation patterns. Its unique structure enables interactions with numerous biomolecules, mediating diverse biological functions including the organization of the extracellular matrix, promotion of wound healing, and modulation of cancer progression. DS also exhibits estrogen-like effects, promoting human bone marrow mesenchymal stromal cell (hBMSC) proliferation, reducing apoptosis, and enhancing osteogenic differentiation and mineralization, primarily through estrogen receptor alpha (ERα). Therapeutically, it is a component of mesoglycan, which inhibits thrombin and Factor Xa, and DS-mimetic glycopolymers are being developed as multi-targeted inhibitors for SARS-CoV-2 by binding to the viral spike protein and inhibiting heparanase and main protease. It is also explored in drug delivery systems, such as UiO-66/DS nanocomposites for methotrexate delivery, and as a component of bioinks for skin wound healing. Pathologically, its accumulation is linked to lysosomal storage disorders like Mucopolysaccharidosis I, VI, and X, and it serves as a biomarker for sepsis and ARDS.
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