Xin-Yuan Sun,1,* Hui Zhang,2,* Ji-Wang Deng,1,* Bang-Xian Yu,1 Yi-Han Zhang,1 Jian-Ming Ouyang2 1Department of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, 510230, Peopleâs Republic of China; 2Department of Chemistry, Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou, 510632, Peopleâs Republic of China*These authors contributed equally to this workCorrespondence: Xin-Yuan SunDepartment of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, 510230, Peopleâs Republic of ChinaEmail sunxinyuan1985@163.comJian-Ming OuyangDepartment of Chemistry, Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou, 510632, Peopleâs Republic of ChinaTel +86-20-85223353Email toyjm@jnu.edu.cnBackground: The interaction between urinary microcrystals and renal epithelial cells is closely related to kidney stone formation. However, the mechanism of cell state changes that affect crystalâcell interaction remains unclear.Methods: This study investigated the relationship between the sulfate group (âOSO3â) content in Porphyra yezoensis polysaccharide (PYP) and the ability to repair damaged cells, as well as the changes in cell adhesion and endocytosis of nano-calcium oxalate monohydrate (COM) crystals before and after PYP repair of damaged renal tubular epithelial cells. The sulfur trioxideâpyridine method was used to sulfate PYP (âOSO3â content of 14.14%), and two kinds of sulfated PYPs with âOSO3â content of 20.28% (SPYP1) and 27.14% (SPYP2) were obtained. The above three PYPs were used to repair oxalate-damaged human proximal tubular epithelial cells (HK-2), and the changes in the biochemical indicators of the cells before and after the repair and the changes in cell adhesion and endocytosis of nano-COM crystals were detected.Results: After repair by PYPs, the cell viability increased, the number of reactive oxygen species decreased, and the reduction of mitochondrial membrane potential and the release of intracellular Ca2+ were suppressed. The cells repaired by PYPs inhibited the adhesion of nano-COM crystals while promoting the endocytosis of the adhered crystals. The endocytosed crystals mainly accumulated in the lysosome. The ability of PYPs to repair cell damage, inhibit crystal adhesion, and promote crystal endocytosis was enhanced when the âOSO3â content increased. Among them, SPYP2 with the highest âOSO3â content showed the best biological activity.Conclusion: SPYP2 showed the best ability to repair damaged cells, followed by SPYP1 and PYP. SPYP2 may become a potential green drug that inhibits the formation and recurrence of calcium oxalate stones.Keywords: Porphyra yezoensis polysaccharide, polysaccharide sulfation, cell repair, adhesion and endocytosis, kidney stone