Upon exposure to 0.25 mM cystine dimethyl ester, normal and cystinotic leukocytes accumulate substantially more intracellular cystine than is present endogenously in cystinotic cells. Leukocytes loaded by exposure to cystine dimethyl ester may have abnormally lucent and distended lysosomes, and the cystine is compartmentalized within the granular fraction of the cells. After the cells are exposed to cystine dimethyl ester, cystine clearance from normal leukocytes is much faster than from cystinotic cells. The ratios of labeled cysteine-N-ethylmaleimide to cystine are also greater in normals than in cystinotics 60 min after termination of loading. No overlap in ranges of cystine clearance half-times or cysteine-N-ethylmaleimide to cystine ratios was observed in normal compared to cystinotic leukocytes. Limited experiments with fibroblasts exposed to cystine dimethyl ester suggest a correspondingly prolonged cystine clearance for cystinotic cells. These experiments provide evidence for defective clearance of cystine from cystinotic lysosomes in situ.In classical cystinosis, an autosomal recessive disorder (1, 2), progressive kidney disease usually leads to death before age 10 unless renal transplantation is performed. Many cystinotic tissues, including leukocytes and cultured fibroblasts, have greatly increased concentrations offree cystine (1-4), with cystine compartmentalization in lysosomes (1, 2, 5-7).Although the fundamental metabolic defect remains unknown, one possibility is that cystinotic cells lack a mechanism for disposal ofcystine from their lysosomes. However, there is no direct evidence for defective efflux ofcystine from cystinotic lysosomes, despite attempts to assess transcellular uptake or efflux in whole cystinotic cells in comparison with normal cells (8,9). Examinations of subcellular transport have been limited by the inability to load normal cells or lysosomes to cystine concentrations approximating the cystinotic.Goldman and Kaplan (10) and Reeves (11) have demonstrated that certain amino acid methyl esters can be used to load isolated rat liver lysosomes with high concentrations of the corresponding amino acid. Apparently, the methyl esters penetrate lysosomal membranes and are hydrolyzed by esterases to free amino acids, which accumulate because of slow efflux from the lysosomes. Using radioactive amino acid methyl esters, Reeves characterized the efflux of certain amino acids from rat liver lysosomes (11). We have used related techniques to study amino acid efflux from isolated normal and cystinotic human leukocyte lysosomes (12)(13)(14).In this report, we demonstrate that intact normal and cystinotic human leukocytes incubated with cystine dimethyl ester accumulate cystine, primarily within lysosomes, in concentrations far exceeding those present endogenously in cystinotic cells. Loaded cystinotic leukocytes exhibited retarded cystine clearance when compared to normal cells. These observations strongly suggest that cystinotic lysosomes in situ are defective in their capacity t...