Molecules differentially expressed in blood vessels among organs or between damaged and normal tissues, are attractive therapy targets; however, their identification within the human vasculature is challenging. Here we screened a peptide library in cancer patients to uncover ligand-receptors common or specific to certain vascular beds. Surveying ∼2.35 × 10 6 motifs recovered from biopsies yielded a nonrandom distribution, indicating that systemic tissue targeting is feasible. High-throughput analysis by similarity search, protein arrays, and affinity chromatography revealed four native ligand-receptors, three of which were previously unrecognized. Two are shared among multiple tissues (integrin α4/annexin A4 and cathepsin B/apolipoprotein E3) and the other two have a restricted and specific distribution in normal tissue (prohibitin/ annexin A2 in white adipose tissue) or cancer (RAGE/leukocyte proteinase-3 in bone metastases). These findings provide vascular molecular markers for biotechnology and medical applications. To discover or analyze functional ligand-receptor interactions in blood vessels under disease conditions, we have used combinatorial screenings based on phage display, which has enabled the targeted delivery of agents to specific vascular beds (8,9). This approach allows the selection of homing peptides to specific organs in vivo after systemic administration of random peptide libraries (10, 11). We have isolated ligand peptides and identified their tissue-specific receptors in rodents and in a patient, and have developed a ligand-receptor in prostate cancer (12, 13) that serves as the basis for an ongoing first-in-man trial.Over the past few years we have developed a tripartite approach to enable serial combinatorial selections to humans. First, we established an ethical framework to ensure respectful research in patients who were brain-dead or whose families decided to terminate life support (14,15). Second, we adapted techniques that were validated in rodents (16) to enable synchronous selection of ligands to multiple organs. Third, we integrated genomic tools, in which recovery of 10 6 peptides is ∼1;000-fold faster and ∼250-fold cheaper (17). Here, these quantitative and qualitative methods enabled refined combinatorial selections in patients and identified unique ligand-receptors.