A B S T R A C T Detailed studies of apolipoprotein E (apoE)-containing lipoproteins in abetalipoproteinemia have been performed in an attempt to resolve the apparent paradox of a suppressed low density lipoprotein (LDL) receptor pathway in the absence of apoB-containing lipoproteins. It was hypothesized that apoE-containing high density lipoproteins (HDL) in abetalipoproteinemia might functionally substitute for LDL in regulation of cholesterol metabolism in these patients.The mean (±standard deviation) plasma concentration of apoE in nine patients with abetalipoproteinemia was 44.8±8.2 ug/ml, slightly higher than the corresponding value for a group of 50 normal volunteers, 36.3±11 gg/ml. Fractionation of plasma lipoproteins by agarose column chromatography or by ultracentrifugation indicated that in abetalipoproteinemia, plasma apoE was restricted to a subfraction of HDL. This was in contrast to the results obtained with plasma from 30 normal volunteers, in whom apoE was distributed between very low density lipoproteins (VLDL) and HDL. Consequently, the mean apoE content of HDL in abetalipoproteinemia (44.8 ;g/ml) was more than twice that found in the normal volunteers (20.3 gg/ml).ApoE-rich and apoE-poor subfractions of HDL2 were isolated by heparin-agarose affinity chromatography. ApoE comprised a mean of 81% of the protein mass of the apoE-rich subfraction. Compared with the apoE-poor subfraction, the apoE-rich HDL2 was of larger mean particle diameter (141±7 vs. 115±15 A) and had a higher ratio of total cholesterol/protein (1.01±0.11 vs. 0.63±0.14).Plasma and HDL fractions from three patients were studied with respect to their ability to compete with 1251-LDL in specific binding to receptors on cultured