Enzyme replacement therapy has been used successfully in many lysosomal storage diseases. However, correction of brain storage has been limited by the inability of infused enzyme to cross the blood-brain barrier. The newborn mouse is an exception because recombinant enzyme is delivered to neonatal brain after mannose 6-phosphate receptor-mediated transcytosis. Access to this route is very limited after 2 weeks of age. Recently, several studies showed that multiple infusions of high doses of enzyme partially cleared storage in adult brain. These results raised the question of whether correction of brain storage by repeated high doses of enzyme depends on mannose 6-phosphate receptor-mediated uptake or whether enzyme gains access to brain storage by another route when brain capillaries are exposed to prolonged, high levels of circulating enzyme. To address this question, we used an enzyme whose carbohydrate-dependent receptor-mediated uptake was inactivated by chemical modification. Treatment of human -glucuronidase (GUS) with sodium metaperiodate followed by sodium borohydride reduction (PerT-GUS) eliminated uptake by mannose 6-phosphate and mannose receptors in cultured cells and dramatically slowed its plasma clearance from a t1 ͞2 of <10 min to 18 h. Surprisingly, PerT-GUS infused weekly for 12 weeks was more effective in clearing central nervous system storage than native GUS at the same dose. In fact, PerT-GUS resulted in almost complete reversal of storage in neocortical and hippocampal neurons. This enhanced correction of neuronal storage by long-circulating enzyme, which targets no known receptor, suggests a delivery system across the blood-brain barrier that might be exploited therapeutically.deglycosylation ͉ enzyme replacement therapy ͉ hippocampal neurons ͉ lysosomal storage disease ͉ receptor-mediated endocytosis T he mucopolysaccharidosis (MPS) diseases, including MPS VII, are characterized by widespread storage of glycosaminoglycans in lysosomes in brain and viscera (1). Enzyme replacement therapy (ERT) has resulted in clearance of stored material from visceral organs and in clinical improvement in many patients with lysosomal storage diseases (LSDs) (2-5). Unfortunately, little infused enzyme crosses the blood-brain barrier (BBB), so limited improvement has been achieved in the central nervous system (CNS) (6).We have focused on improving delivery of enzyme to the brain by using -glucuronidase (GUS) in the mouse model of MPS VII (Sly syndrome). When enzyme was infused into newborn mice, considerable enzyme was delivered to brain, and CNS storage was reduced (7-9). However, brain storage was resistant to clearance if ERT was begun after 2 weeks of age. Recent studies indicated that this enzyme delivery to the CNS in the newborn period was caused by mannose 6-phosphate receptor (M6PR)-mediated transcytosis (10). Down-regulation of this receptor by age 2 weeks appeared to explain the resistance of brain to ERT in the adult. More recently, however, we observed that multiple infusions of large doses ...