Marine sulfated polysaccharides as biofunctional agents for enhancing hemocompatibility and endothelialization of tissue-engineered vascular grafts

Small-diameter vascular grafts (<= 6 mm) continue to face high failure rates due to thrombosis, intimal hyperplasia, and inadequate endothelialization. While bioresorbable and hybrid materials offer promising alternatives to conventional prostheses, challenges in hemocompatibility and host integration remain. Marine sulfated polysaccharides (MSPs)-including fucoidans, carrageenans, and fucosylated chondroitin sulfates-have emerged as biofunctional agents capable of modulating coagulation, inflammation, and vascular cell behavior. These structurally diverse, highly sulfated glycans mimic features of the native endothelial glycocalyx, enabling interactions with coagulation factors and promoting endothelial regeneration. This review brings together current insights into MSPs structure-function relationships, anticoagulant mechanisms, and endothelial support, and discusses how these features can be strategically harnessed for vascular graft design and clinical translation. We examine recent strategies for MSPs functionalization of electrospun and 3D-printed scaffolds and evaluate emerging evidence from in vitro and in vivo studies. Finally, we explore current challenges and future directions for the clinical application of MSP-functionalized vascular biomaterials. Collectively, these insights position marine sulfated polysaccharides as a versatile and underexplored class of biomolecules with the potential to address long-standing barriers in vascular tissue engineering.