Heparan sulfate (HS) is a structurally complex polysaccharide that interacts with a broad spectrum of extracellular effector ligands and thereby is thought to regulate a diverse array of biologic processes. The specificity of HS-ligand interactions is determined by the arrangement of sulfate groups on HS, which creates distinct binding motifs. Biologically important HS motifs are expected to exhibit regulated expression, yet there is a profound lack of tools to identify such motifs; consequently, little is known of their structures and functions. We have identified a novel phage display-derived antibody (NS4F5) that recognizes a highly regulated HS motif (HS NS4F5 ), which we have rigorously identified as (GlcNS6S-IdoA2S) 3 . HS NS4F5 exhibits a restricted expression in healthy adult tissues. Blocking HS NS4F5 on cells in culture resulted in reduced proliferation and enhanced sensitivity to apoptosis. HS NS4F5 is up-regulated in tumor endothelial cells, consistent with a role in endothelial cell activation. Indeed, TNF-␣ stimulated endothelial expression of HS NS4F5 , which contributed to leukocyte adhesion. In a mouse model of severe systemic amyloid protein A amyloidosis, HS NS4F5 was expressed within amyloid deposits, which were successfully detected by microSPECT imaging using NS4F5 as a molecularly targeted probe. Combined, our results demonstrate that NS4F5 is a powerful tool for elucidating the biological function of HS NS4F5 and can be exploited as a probe to detect novel polysaccharide biomarkers of disease processes.Heparan sulfate proteoglycans (HSPGs), 3 major components of the cell surface and the extracellular matrix, are involved in a variety of biological phenomena, including cell adhesion, proliferation, differentiation, and inflammation as well as being associated with pathologic events such as atherosclerosis and amyloidosis. Because of their high negative charge, HS chains interact with a variety of proteins, including growth factors/ morphogens and their receptors, the amyloid precursor protein serum amyloid protein A (AA), chemokines, and extracellular matrix proteins. HS-protein interactions vary with regard to specificity and may depend on charge density in addition to strict sequence motifs of HS.The interaction of heparin and HS with FGFs and their receptors has been characterized in great detail. Specific HS structures are predominantly determined by the regulated positioning of N-, 2-, 6-, and 3-O-sulfate groups along HS chains (1). For example, FGF-2 requires both N-and 2-O-sulfate groups for binding to HS. The 6-O-sulfate group is not essential for binding to FGF-2 but is critical for activation of the FGF receptor (2). In contrast, binding of hepatocyte growth factor, platelet-derived growth factor, lipoprotein lipase, and herpes simplex virus glycoprotein C to HS is dependent on 6-O-sulfation (3). The activation of antithrombin III by HS/heparin is mediated by a specific pentasaccharide in which a 3-O-sulfate group is crucial (4). Thus, the biological functions of HSPGs are contro...