Abstract BACKGROUND AND AIMS Metabolic biomarkers are of high importance for the identification of early renal involvement in the course of type 2 diabetes mellitus (DM). Gangliosides, which are complex cell type-specific glycosphingolipids, consist of a sialylated oligosaccharide chain attached to a ceramide of different composition with respect to the sphingoid base and fatty acid residues [1]. Gangliosides play a major role in the pathogenesis of diabetic kidney disease (DKD). The aim of the study was to assess the pattern of urinary gangliosides in patients with type 2 DM. METHOD The urine gangliosidome of 30 type 2 DM patients (10 normo-, 10 micro-, and 10 macroalbuminuric) has been investigated in a cross-sectional pilot study, by a comparative assay with 10 healthy controls. Following the optimization of urine ganglioside extraction procedure [2, 3], we have determined the composition of native ganglioside mixtures from the 24-h collected urine samples using a modern bioanalytical platform based on nanoelectrospray ionization (nanoESI) high-resolution mass spectrometry (HR MS) on an Orbitrap instrument. RESULTS HR MS screening and fragmentation analysis by tandem MS revealed that: (i) the urinary gangliosidome of type 2 DM patients contains a significantly higher number of distinct species differing in either their glycan or ceramide structure than the controls; (ii) the ganglioside urinary level was significantly increased in normoalbuminuric patients compared with healthy control subjects; (iii) the gangliosidome of macroalbuminuric patients is characterized by an elevated overall sialic acid content than normo- and microalbuminuric diabetics and more complex structures, including fucosylated, O-GalNAc- and CH3COO--modified compounds; (iv) the degree of sialylation of species presented correlations with the level of albuminuria and renal function; (v) further detailed structural analysis of a type GQ1(d18:1/18:0) species (identified only in macroalbuminuric patients) demonstrated that the present isomer is of type D (all four syalic acids are linked to the inner galactose). CONCLUSION HR MS by tandem MS methods, using an Orbitrap instrument, are a reliable tool for the identification of a particular ganglioside profile in the urine of type 2 DM patients. The sialylated species and those altered by peripheral attachments to the glycan core might be considered useful indicators of early DKD.