© 2018 Elsevier Ltd Fucosylation is a biological process broadly observed in vertebrates, invertebrates, plants, bacteria, and fungi. Fucose moieties on cell-surface glycans are increasingly recognized as critical to many cell-cell interaction and signaling processes. One of the characteristic roles of fucose is its regulation of selectin-dependent leukocyte adhesion that has been well studied over the last two decades. Recent studies of fucose in immune cell development and function regulation have significantly expanded the contemporary understanding of fucosylation. From cellular adhesion to immune regulation, herein we discuss the use of gene knockout studies, competitive inhibitors of fucose-containing glycan, and metabolic inhibitors of fucose biosynthesis to probe fucosylated glycan biosynthesis and signaling and its functional consequences. Promising clinical and preclinical applications in sickle cell disease, rheumatoid arthritis, tumor inhibition, metastasis prevention, antibody-dependent cell-mediated cytotoxicity, chemoresistance reversal, and in improving chemotherapy-related side effects and recovery are reviewed. Fucose occurs very specifically in cell-surface glycan and may be thought of as a privileged sugar residue in glycobiology. Fucose is necessary for many critical cell adhesion and signaling events. Genetic modulation or modulation by fucose-specific reagents has revealed exciting new biology and opened new opportunities for the treatment of human diseases. In this review, Li et al. describe the tools used to discover new fucose biology, its impact on living systems, and initial clinical trial results.