Sialic acids are acidic monosaccharides, which are among the most important molecules of higher animals, and occur in some microorganisms. They are bound to complex carbohydrates and occupy prominent positions, especially in cell membranes. Their structural diversity is high and, correspondingly, the mechanisms for their biosynthesis are complex. Sialic acid substituents strongly influence the activity of catabolic enzymes, in particular the sialidases, and thus the turnover rate of glycoconjugates. These sugars are involved in manifold cell functions. Due to the surface location of the acidic molecules they shield macromolecules and cells from enzymatic and immunological attacks. But they also represent recognition sites for various physiological receptors as well as for toxins and microorganisms, and thus allow their colonization. Many viruses use sialic acids for the infection of cells. As sialic acids also play a decisive role in tumor biology they prove to be rather versatile molecules that modulate cell biological events in a sensitive way. It is discussed that their evolvement may have stimulated evolution and rendered organisms less vulnerable to environmental attacks. However, disturbance of their metabolism may cause diseases.