Fibroblasts from patients with I-cell disease (mucolipidosis H) or with pseudo Hurler polydystrophy (mucolipidosis EII) are markedly deficient in UDP-N-acetylglucosamine:lysosomal enzyme N-acetylglucosamine-l-phosphotransferase. As a consequence, the common phosphomannosyl recognition marker ofacid hydrolases is not generated, and these enzymes are not targeted to lysosomes. We have developed a sensitive assay for the transferase that uses a-methyl mannoside as an acceptor, and this has allowed us to distinguish between fibroblasts from these two types of patients. The enzyme activity is less in the former than in the latter (<0.4-2.0 pmol/mg per hr vs 2.9-39.4). This may provide an explanation for the difference in clinical severity, between the two syndromes. However, in two siblings with pseudo Hurler polydystrophy (GM 3391 and GM 3392), the enzyme activity was normal when assayed by using a-methyl mannoside as acceptor whereas it was low when assayed with endogenous glycoprotein acceptors or with human placental &-hexosaminidase A. The apparent Km values of the mutant enzyme toward a-methyl mannoside, high-mannose oligosaccharides, and UDP-GlcNAc were not different from those of the normal enzyme. Mixing experiments demonstrated that the mutant fibroblasts contained endogenous acceptors and were free ofinhibitors. We conclude that the N-acetylglucosaminylphosphotransferase in the mutant fibroblasts has normal catalytic activity but is defective in the ability to recognize lysosomal enzymes as specific substrates for phosphorylation. This variant form of pseudo Hurler polydystrophy demonstrates the biological importance of this recognition mechanism in the generation of the phosphomannosyl marker. Acid hydrolases are a heterogeneous group of proteins that acquire a common phosphomannosyl recognition marker which is responsible for targeting them to their common destination, the lysosomes (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). This posttranslational modification of the high-mannose-type oligosaccharides of lysosomal enzymes is generated by the sequential action of two enzymes: UDP-Nacetylglucosamine:lysosomal enzyme N-acetylglucosamine-lphosphotransferase [referred to herein as N-acetylglucosaminylphosphotransferase (GlcNAcPlase)] and a-N-acetylglucosaminyl phosphodiesterase. The first enzyme catalyzes the transfer ofGlcNAc 1-phosphate to the 6 position ofmannose residues on high-mannose-type oligosaccharides; the second enzyme removes the outer GlcNAc residues to generate a phosphomonoester (12-18). We have recently shown that fibroblasts from patients with I-cell disease (mucolipidosis TI) or pseudo Hurler polydystrophy (mucolipidosis III) are markedly deficient in the first enzyme of this sequence (19). This explains why both diseases are characterized by decreased intracellular activities of many lysosomal enzymes and markedly increased levels of the same enzymes in the body fluids. Similar findings have been reported by Hasilik et al (20).In this report, we describe a variant form of pseudo Hurler ...