In acute cardiovascular lesions, functional recovery of the myocardium occurs when adequate reperfusion of the infarct-related artery and an adequate level of microcirculation and tissue flow in the lesioned area are achieved. The major regulators of these effects are the glycosaminoglycan component of the endothelial cellular coating (glycocalyx, extracellular matrix, interstitial material) and its catabolic enzymes and their inhibitors. The causes and consequences of glycocalyx abnormalities in vascular lesions are considered, along with the potential for glycocalyx reconstruction. The glycoprotein environment of cells has been found to regulate the biomechanical properties of vessels, tissue assembly and repair; it was also able to bind low-and high-molecular-weight ligands. Hydration of glycosaminoglycans determines the development of tissue edema and mediates the anticoagulant activity of the extracellular matrix. Binding of chemokines, growth factors, other proteins, and lipoproteins to glycosaminoglycans has been noted in relation to execution of their regulatory functions. The existence of special structural biding sites for such reactants has been demonstrated, along with a relationship between the biological effects induced by glycosaminoglycans and their molecular weights. The involvement of glycosaminoglycans in the pathophysiological processes occurring in vascular lesions is reviewed, as are promising approaches to regulating the state of the pericellular coatings via the precise and effective control of the level of glycosylation of biological substrates. 553 0091-150X/08/4210-0553