Quantitative LC-MS/MS profiling reveals aberrant chondroitin sulfate in Alzheimer's disease

Chondroitin sulfate (CS) is an essential sulfated glycan in the brain, but standard LC-MS/MS disaccharide analysis provides only limited quantitative accuracy for detecting CS structural changes under physiological and pathophysiological conditions. Here, we incorporated eight distinct ¹³C-labeled CS disaccharide calibrants into the analytical workflow. Using this enhanced approach, we identified structural alterations in both sulfation patterns and total CS abundance in pre-clinical and clinical Alzheimer's disease (AD) brain samples compared with controls. Analysis of cerebrospinal fluid (CSF) from AD patients further revealed elevated levels of the CS-E disaccharide and reduced levels of hyaluronic acid. Functionally, we found that synthetic CS-E 19-mer-but not other synthetic CS 19-mer subtypes-impaired neuronal growth, underscoring the need to pinpoint specific CS structures that contribute to neurodegeneration. Because CS abnormalities are detectable in the pre-clinical AD brain, our findings raise the possibility that CS glycans could serve as early biomarkers for AD.