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The adhesion of bacteria to target tissues is frequently a necessary first step in pathogenesis. Blocking of such adhesion can provide an efficient way of interfering in bacterial infections. A wide spectrum of microbial pathogens bind to cell surface heparan sulfate proteoglycans in order to facilitate adherence, attachment and cellular entry, as well as to evade defense mechanisms. Knowledge of these mechanisms is important for the development of novel antimicrobial agents and new therapies.