Supplementary key words cholesterol • diagnostic tools • liquid chromatography/tandem mass spectrometry • Niemann-Pick disease • oxysterols • neurodegenerationNiemann-Pick type C (NPC) disease is a rare, primarily pediatric disorder characterized by accumulation of cholesterol and other lipids in the viscera and central nervous system. Approximately 95% of NPC cases are caused by mutations of the NPC1 gene, whereas the remaining 5% are caused by mutations in the NPC2 gene ( 1, 2 ). Affected individuals typically present in early childhood with ataxia and progressive impairment of motor and intellectual function and usually die in adolescence. There are currently no FDA-approved therapies for this progressively fatal neurodegenerative disorder. However, a recent controlled study and a series of case reports suggests effi cacy for miglustat ( 3 ), an inhibitor of glycosphingolipid biosynthesis that is now licensed for use as a disease modifying therapy in multiple countries, including the European Union, Russia, Brazil, Australia, Canada, and Taiwan.Abstract Niemann-Pick type C1 (NPC1) disease is a rare, progressively fatal neurodegenerative disease for which there are no FDA-approved therapies. A major barrier to developing new therapies for this disorder has been the lack of a sensitive and noninvasive diagnostic test. Recently, we demonstrated that two cholesterol oxidation products, specifi cally cholestane-3  ,5 ␣ ,6  -triol (3  ,5 ␣ ,6  -triol) and 7-ketocholesterol (7-KC), were markedly increased in the plasma of human NPC1 subjects, suggesting a role for these oxysterols in diagnosis of NPC1 disease and evaluation of therapeutics in clinical trials. In the present study, we describe the development of a sensitive and specifi c LC-MS/ MS method for quantifying 3  ,5 ␣ ,6  -triol and 7-KC human plasma after derivatization with N,N-dimethylglycine. We show that dimethylglycine derivatization successfully enhanced the ionization and fragmentation of 3  ,5 ␣ ,6  -triol and 7-KC for mass spectrometric detection of the oxysterol species in human plasma. The oxysterol dimethylglycinates were resolved with high sensitivity and selectivity, and enabled accurate quantifi cation of 3  ,5 ␣ ,6  -triol and 7-KC concentrations in human plasma. The LC-MS/MS assay was able to discriminate with high sensitivity and specifi city between control and NPC1 subjects, and offers for the fi rst time a noninvasive, rapid, and highly sensitive method for diagnosis of NPC1