The interaction of human high density lipoproteins (HDL) with isolated human monocytes from control and Tangier patients was studied in tissue culture experiments. It was observed that normal monocytes, similar to mouse peritoneal macrophages, bind HDL to a cell surface receptor, internalize the bound HDL particles, transport the internalized HDL intracellularly through the cytoplasmic compartment without significant degradation, and ultimately resecrete intact HDL. The cellular interaction of Tangier monocytes with normal HDL was markedly different from control monocytes. HDL binding to Tangier monocytes was moderately increased and cell-associated HDL radioactivity was 6-to 10-fold enhanced in Tangier monocytes. The bulk of the internalized HDL, however, was detected in secondary lysosomes. Only minor amounts of the internalized HDL were resecreted from the Tangier monocytes, and most of this was degraded. These data suggest that the cellular metabolism of HDL is abnormal in Tangier monocytes. It is postulated that Tangier disease may be a disorder of intracellular membrane traffic in which HDL is diverted into the lysosomal compartment and degraded instead of being secreted through its regular transcellular route.Tangier disease is a rare, autosomal recessive disorder of serum lipoprotein metabolism characterized by the complete absence of normal high density lipoproteins (HDL) from serum and a great increase in the cellular concentration of cholesteryl esters in macrophages and Schwann cells of peripheral nerves (1-5). Patients have large pharyngeal tonsils, splenomegaly, and transient peripheral neuropathy (1-4). Major serum abnormalities noted in homozygous abnormal patients include hypocholesterolemia, hypertriglyceridemia, the absence of a-migrating-lipoproteins on agarose electrophoresis, and decreased apolipoprotein A-I (apoA-I) concentrations (1, 3, 4, 6, 7). In obligate Tangier heterozygotes, HDL cholesterol and apoA-I concentrations are reduced to 50% of controls (2, 8).Several hypotheses have been formulated to explain the molecular defect in Tangier disease. These include (i) accelerated catabolism of HDL despite normal rates of apoA-I synthesis (6, 9-12), (ii) abnormal structure ofapoA-I (13), (iii) impaired interconversion of proapoA-I to mature apoA-I (14-17), and (iv) a failure ofproapoA-I to associate with HDL (18,19 Recent experiments suggest that HDL bind to specific cellular receptors on fibroblasts, arterial smooth muscle cells (20,21), and macrophages (22). Our preliminary studies with macrophages revealed that, subsequent to receptor-mediated binding, HDL are internalized and resecreted after prior interaction with cytoplasmic cholesteryl ester droplets. This is in contrast to low density lipoproteins (LDL), which are degraded in the lysosomal compartment after uptake. The detailed molecular events ofthe retroendocytosis of HDL are not yet understood. We here report upon studies of the interaction of serum HDL with human blood monocytes, the precursor cells of tissue macrophages...