Delivering therapeutic levels of lysosomal enzymes across the blood-brain barrier (BBB) has been a pivotal issue in treating CNS storage diseases, including the mucopolysaccharidoses. An inherited deficiency of -glucuronidase (GUS) causes mucopolysaccharidosis type VII that is characterized by increased systemic and CNS storage of glycosaminoglycans. We previously showed that the neonate uses the mannose 6-phosphate (M6P) receptor to transport phosphorylated GUS (P-GUS) across the BBB and that this transporter is lost with maturation. Induction of expression of this BBB transporter would make enzyme replacement therapy in the adult possible. Here, we tested pharmacological manipulation with epinephrine to restore functional transport of P-GUS across the adult BBB. Epinephrine (40 nmol) coinjected i.v. with 131 I-P-GUS induced the transport across the BBB in 8-week-old mice. The brain influx rate of 131 I-P-GUS (0.29 l/g per min) returned to the level seen in neonates. Capillary depletion showed that 49% of the 131 I-P-GUS in brain was in brain parenchyma. No increases of influx rate or the vascular space for 125 I-albumin, a vascular marker, was observed with epinephrine (40 nmol), showing that enhanced passage was not caused by disruption of the BBB. Brain uptake of 131 I-P-GUS was significantly inhibited by M6P in a dose-dependent manner, whereas epinephrine failed to increase brain uptake of nonphosphorylated GUS. Thus, the effect of epinephrine on the transport of 131 I-P-GUS was ligand specific. These results indicate that epinephrine restores the M6P receptor-mediated functional transport of 131 I-P-GUS across the BBB in adults to levels seen in the neonate.-glucuronidase ͉ drug delivery ͉ enzyme replacement therapy ͉ lysosomal storage disease ͉ phosphorylated -glucuronidase M ucopolysaccharidosis type VII (MPS VII) is characterized by abnormal lysosomal storage of glycosaminoglycans (GAGs) in most tissues including the CNS. MPS VII is caused by an inherited deficiency of -glucuronidase (-D-glucuronoside glucuronosohydrolase; EC 3.2.1.31) (GUS), an enzyme that cleaves glucuronic acid residues from nonreducing termini of GAGs. Enzyme replacement therapy (ERT) with murine or human GUS in MPS VII mice reduces visceral lysosomal storage, normalizes the pathological phenotype, and prolongs lifespan (1-3). It also improves abnormal storage in brain if treatment with GUS is begun before 2 weeks of age (2, 4). Delivering the enzyme to treat CNS storage disease has been a key problem because the blood-brain barrier (BBB) restricts the passage into brain of exogenously administrated enzymes. In a prior study, we found that human phosphorylated GUS (P-GUS) is transported across the neonatal BBB by mannose 6-phosphate (M6P) receptor-mediated transcytosis, and that this transport mechanism is progressively lost with maturation so that, by 7 weeks, mice have little or no transport left (5). Thus, alterations in the transport of a lysosomal enzyme across the BBB occur with postnatal development, which limits the eff...