The selectins initiate many critical interactions among blood cells. The volume of information and diversity of opinions on the nature of the biologically relevant ligands for selectins is remarkable. This review analyzes the matter and suggests the hypothesis that at least some of the specificity may involve recognition of "clustered saccharide patches."Five years ago, the cloning of three vascular proteins resulted in identification of the selectin family of cell adhesion molecules (1-9). A shared N-terminal carbohydrate-recognition domain homologous to other Ca2+-dependent (C-type) mammalian lectins (10) strengthened predictions from functional studies (for review, see ref. 1) that the cognate ligands for these receptors would be cell-surface carbohydrates (Fig. 1). Several groups then reported that previously known mammalian oligosaccharides bearing Fuc and sialic acid (Sia) are recognized in a Ca2+-dependent manner by the selectins (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Evidence for the function of selectins in leukocyte trafficking, thrombosis and inflammation, as well as the possibility for therapeutic intervention in reperfusion injury, inflammation, allergy, autoimmunity, and cancer (for review, see refs. 1-9) attracted additional investigators (>500 articles in the last 5 yr).* More recently, specific macromolecular ligands for the selectins have been reported (25-38). Molecular cloning of the polypeptide backbones of some of these molecules indicates that ligand formation is indeed glycosylation-dependent (28,33,34,37,39,40). Some studies suggest that small sialylated, fucosylated oligosaccharides such as sialyl-Lewisx (SLex) and sialyl-Lewisa (SLea) (11,12,20,(22)(23)(24)(41)(42)(43)(44) lectin came from the inhibitory effects of phosphorylated monosaccharides and a phosphorylated yeast mannan on the interaction of lymphocytes with highendothelial venules (HEV) in lymph nodes (1). These studies were inspired by work on a different class of mammalian lectins, the mannose 6-phosphate receptors (52). However, sialidase treatment of lymph node sections abolished lymphocyte-HEV interaction, indicating a critical role for Sia (53). Subsequently, the selective inhibitory properties of various phosphorylated and sulfated saccharides (1) confirmed a lectin-like interaction. It is now evident that the selectin ligands are not themselves phosphorylated (nor always sulfated) and that the inhibitors worked either because of high concentrations or high charge density. In parallel, others (3) described monoclonal antibodies (mAbs) that recognized specific "addressins" involved in lymphocyte trafficking. The peripheral node addressin recognized by mAb MECA-79 (54) is a family of glycoproteins (gps), some of which interact with L-selectin in a Sia-dependent manner (25). Likewise, the mAb HECA-452 recognizes Sia-