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Significantly reduced levels of the anti-inflammatory gaseous transmitter hydrogen sulfide (H 2 S) are observed in diabetic patients and correlate with microvascular dysfunction. H 2 S may protect the microvasculature by preventing loss of the endothelial glycocalyx. We tested the hypothesis that H 2 S could prevent or treat retinal microvascular endothelial dysfunction in diabetes. Bovine retinal endothelial cells (BRECs) were exposed to normal (NG, 5.5 mmol/L) or high glucose (HG, 25 mmol/L) ± the slow-release H 2 S donor NaGYY4137  in vitro . Glycocalyx coverage (stained with WGA-FITC) and calcein-labeled monocyte adherence were measured.  In vivo , fundus fluorescein angiography (FFA) was performed in normal and streptozotocin-induced (STZ) diabetic rats. Animals received intraocular injection of NaGYY4137 (1 μM) or the mitochondrial-targeted H 2 S donor AP39 (100 nM) simultaneously with STZ (prevention) or on day 6 after STZ (treatment), and the ratio of interstitial to vascular fluorescence was used to estimate apparent permeability. NaGYY4137 prevented HG-induced loss of BREC glycocalyx, increased monocyte binding to BRECs ( p  ≤ 0.001), and increased overall glycocalyx coverage ( p  ≤ 0.001). In rats, the STZ-induced increase in apparent retinal vascular permeability ( p  ≤ 0.01) was significantly prevented by pre-treatment with NaGYY4137 and AP39 ( p  < 0.05) and stabilized by their post-STZ administration. NaGYY4137 also reduced the number of acellular capillaries (collagen IV + /IB4-) in the diabetic retina in both groups ( p  ≤ 0.05). We conclude that NaGYY4137 and AP39 protected the retinal glycocalyx and endothelial permeability barrier from diabetes-associated loss of integrity and reduced the progression of diabetic retinopathy (DR). Hydrogen sulfide donors that target the glycocalyx may therefore be a therapeutic candidate for DR.

Hydrogen Sulfide Is a Novel Protector of the Retinal Glycocalyx and Endothelial Permeability Barrier