Abstract. Niemann-Pick disease type C (NPC) is characterized by substantial intracellular accumulation of unesterified cholesterol. The accumulation of unesterified cholesterol in NPC fibroblasts cultured with low density lipoprotein (LDL) appears to result from the inability of LDL to stimulate cholesterol esterification in addition to impaired LDL-mediated downregulation of LDL receptor activity and cellular cholesterol synthesis. Although a defect in cholesterol transport in NPC cells has been inferred from previous studies, no experiments have been reported that measure the intracellular movement of LDLcholesterol specifically. We have used four approaches to assess intracellular cholesterol transport in normal and NPC cells and have determined the following: (a) mevinolin-inhibited NPC cells are defective in using (LDL) l (8). LDL is delivered to lysosomes where the protein/phospholipid coat is degraded, and LDL-cholesteryl esters are hydrolyzed to unesterified cholesterol. LDL-derived cholesterol is used by cells to synthesize cellular membranes, bile acids, and steroid hormones (8). LDL-derived cholesterol also elicits several regulatory responses, including suppression of cholesterol biosynthesis and LDL receptor activity, as well as activation of the cholesterol-esterifying enzyme, acyl coenzyme A/cholesterol acyl transferase (ACAT) (8). The process of receptor-mediated internalization of LDL and the effects of LDL-cholesterol on cellular cholesterol metabolism have been extensively studied (8); however, little information is known about the fate of cholesterol formed by lysosomal hydrolysis of LDL-cholesteryl esters. In particular, the pathway and mechanism of intracellular transport of LDL-cholesterol from lysosomes to cellular membranes are obscure. In addition, it is not known whether the regulatory actions of LDL-cholesterol require either the transport of cholesterol to regulatory sites within cells or metabolic transformation of the sterol.Somatic cells exhibiting specific defects in LDL metabolism may be useful in delineating the mechanisms of intracellular transport of and regulation by LDL-cholesterol. A defect in LDL-cholesterol metabolism in fibroblasts from patients with Niemann-Pick disease type C (NPC) has been described by Pentchev and co-workers (25-27) and our laboratory (21). Although LDL is bound and internalized, and the cholesteryl esters hydrolyzed normally in NPC fibroblasts, LDL-derived cholesterol does not elicit normal regulatory responses (21,(25)(26)(27). In NPC cells, LDL does not stimulate cholesterol esterification, and LDL suppression of cholesterol synthesis and LDL receptor activity is impaired (21,25,27). The defective regulation of cellular cholesterol metabolism in NPC cells appears to be specific for LDL-derived cholesterol, since 25-hydroxycholesterol, a nonlipoprotein effector, does stimulate cholesterol esterification as well as downregulate cholesterol synthesis and LDL receptor activity normally in NPC cells (21). Also, exogenously added mevalonate suppresses...