Human blood monocyte-derived macrophages that had been cultured for 7 days in the presence of 20% whole human serum exhibited saturable degradation of low-density lipoprotein (LDL). This degradation could be abolished by pre-incubating the cells with a high concentration of LDL in the medium and increased by pre-incubating the cells in medium containing lipoprotein-deficient serum. Cells obtained from the blood of homozygous familial-hypercholesterolaemic (FH) patients only exhibited a low rate of non-saturable degradation of LDL, even when pre-incubated without lipoproteins. Thus the saturable degradation of LDL by normal cells was mediated by the LDL receptors that are defective in FH patients and little LDL was taken up and degraded through any of the other endocytotic processes present in macrophages. Degradation by normal cells pre-incubated with lipoprotein-deficient serum had a higher apparent affinity for LDL than that of cells maintained in whole serum, which suggests that incubation with lipoprotein-deficient serum may not only induce the formation of LDL receptors but may also have a direct effect on the receptors themselves. Monocyte-derived macrophages from normal and FH subjects showed similar saturable degradation of acetylated LDL and also of LDL complexed with dextran sulphate. Maximal degradation of each was in the same range as the degradation of unmodified LDL by normal cells, and was not increased if the cells were pre-incubated with lipoprotein-deficient serum.