ELAM-1 (endothelial-leukocyte adhesion molecule-1, E-selectin) is a cell adhesion molecule which is specifically expressed on cytokine-activated endothelial cells. It is known to bind a carbohydrate antigen sialyl Le(x) (sialyl SSEA-1) present on leukocytes, and the sialyl Le(x)/ELAM-1 adhesion system is suggested to play a physiologically important role in leukocyte recruitment in the process of inflammation. Some leukemia cells also express the sialyl Le(x) antigen, and in such a case, the sialyl Le(x)/ELAM-1 adhesion system will be involved in the organ infiltration of leukemia cells. On the other hand, in the adhesion of human cancer cells to endothelial cells, another carbohydrate antigen, sialyl Le(a), serves as the ligand for ELAM-1, as well as sialyl Le(x). These two carbohydrate determinants, sialyl Le(a) and sialyl Le(a), on cancer cells will be involved in the hematogenous metastasis of cancer cells. The physiological function of these two carbohydrate determinants at the surface of normal epithelial cells is most probably to mediate stage-specific cell-to-cell recognition and adhesion during the course of organogenesis in developing embryos, and the abnormal cell-adhesion behaviors of cancer cells are the results of aberrant expression of cell adhesion molecules which would play physiologically important roles under normal condition.