Apolipoprotein E (apoE) has been genetically linked to late-onset Alzheimer's disease (AD). The role of this lipid-transport protein in AD remains to be established. One hypothesis is that apoE, particularly the apoE4 isoform, may have neurotoxic effects as demonstrated using apoE-related synthetic peptides and the N-terminal fragment of apoE. ApoE is a heparan-sulfate binding protein, and apoE peptide neurotoxicity can be blocked by heparin and prevented by degrading heparan sulfate or inhibiting its biosynthesis. The possibility that heparin inhibition of toxicity is mediated by a specific oligosaccharide sequence was investigated using a bioassay to determine the inhibition of apoE peptide toxicity by glycosaminoglycans and purified glycosaminoglycan oligosaccharides. Studies on modified heparins showed that the presence of N-sulfo groups and either 2-or 6-O sulfo groups were required for inhibition of toxicity. Heparin oligosaccharides with eight or more saccharide residues with seven O-sulfo groups and four N-sulfo groups exhibited potent inhibition. Larger oligosaccharides, and heparin and heparan sulfate polymers, afforded comparable, or somewhat better, protective effects but also caused clumping and detachment of cells when administrated alone.Alzheimer's disease (AD) 1 remains the most common form of dementia, with four million Americans currently suffering from it and an estimated 22 million people throughout the world who will be afflicted by 2025. There are no current effective treatments for AD, and the cause of this illness remains unknown despite the tremendous increase in information regarding genetic linkages to the disease. The pathological hallmarks of AD include the accumulation of extracellular plaques containing amyloid and other proteins, the presence of intracellular neurofibrillary tangles, whose effect on neuronal function is not yet known, and the loss of nerve cells and synaptic connections within the areas of the brain responsible for learning and memory. Mutations in three known genes, the amyloid protein precursor and presenilin 1 and 2, nearly always cause the disease (1). These mutations, however, account only for a very small percentage (5-10%) of AD cases. A fourth genetic factor is apolipoprotein E (apoE). Unlike the three other genes, the apoE4 gene is a susceptibility locus accounting for approximately 40-70% of the cases of late-onset AD (2).ApoE is a 299-residue lipid-associated protein that binds and transports cholesterol-rich lipoproteins for internalization via receptors of the low-density lipoprotein (LDL) receptor family (3). In addition, apoE has other putative functions that do not seem to involve lipid transport (4). ApoE plays an important role in maintaining central nervous system functions (4, 5), and recent studies have suggested that apoE is a major risk factor in a number of diseases (6). The N-terminal domain (1-191) is composed of four amphipathic R-helices arranged in an antiparallel fashion and connected by loop regions (7). It contains the lo...