Peters Plus syndrome is an autosomal recessive disorder characterized by anterior eye chamber defects, disproportionate short stature, developmental delay, and cleft lip and/or palate. It is caused by splice site mutations in what was thought to be a 1,3-galactosyltransferase-like gene (B3GALTL). Recently, we and others found this gene to encode a 1,3-glucosyltransferase involved in the synthesis of the disaccharide Glc-1,3-Fuc-Othat occurs on thrombospondin type 1 repeats of many biologically important proteins. No functional tests have been performed to date on the presumed glycosylation defect in Peters Plus syndrome. We have established a sensitive immunopurification-mass spectrometry method, using multiple reaction monitoring, to analyze O-fucosyl glycans. It was used to compare the reporter protein properdin from Peters Plus patients with that from control heterozygous relatives. In properdin from patients, we could not detect the Glc-1,3-Fuc-O-disaccharide, and we only found Fuc-O-at all four O-fucosylation sites. In contrast, properdin from heterozygous relatives and a healthy volunteer carried the Glc-1,3-Fuc-O-disaccharide. These data firmly establish Peters Plus syndrome as a new congenital disorder of glycosylation.Glycosylation is the most common and diverse way by which protein molecules are modified. The biological importance of this co-and post-translational modification is becoming increasingly clear from the rapidly rising number of congenital disorders of glycosylation (CDG) 2 (1, 2). Recently, Lesnik Oberstein et al. (3) discovered that Peters Plus syndrome (MIM 261540) is caused by truncating mutations in a 1,3-galactosyltransferase-like gene (B3GALTL) that was originally identified by Heinonen et al. (4). The characteristic features of this disorder include anterior eye chamber defects, disproportionate short stature, developmental delay, and cleft lip and/or palate (5). Peters Plus syndrome was classified as a putative CDG (2), because it is not known whether the mutations affect a specific enzymatic activity or cause the formation of a defective glycan structure.In the meantime, we and others (6, 7) found that B3GALTL does not in fact code for a galactosyltransferase but rather for a glucosyltransferase, 3Glc-T, that is involved in the synthesis of the unusual disaccharide Glc-1,3-Fuc-O-. This small O-linked glycan has been found in the TSRs of thrombospondin-1 (8), properdin, f-spondin (9), ADAMTS-like 1 (10), and ADAMTS-13 (11). TSRs are independent folding modules of ϳ60 amino acids in length that contain three disulfide bonds and a core consisting of alternating tryptophan and arginine residues. The human genome encodes ϳ100 TSR-containing proteins that perform a variety of important biological functions, including regulation of the coagulation system by proteolysis, inhibition of angiogenesis, and cell and axon guidance (12).The biosynthesis of Glc-1,3-Fuc-O-is initiated by the protein O-fucosyltransferase 2 (POFUT2), which attaches the fucosyl residue to a serine or threoni...