b Mycobacterium avium subsp. paratuberculosis is a bacterium sometimes found in human blood and tissue samples that may have a role in the etiology of Crohn's disease in humans. To date, however, there have been few studies examining the interactions of these bacteria with human cells. Using the THP-1 human monocytic cell line, this study shows that the uptake and trafficking of M. avium subsp. paratuberculosis in human cells are cholesterol dependent and that these bacteria localize to cholesterol-rich compartments that are slow to acidify. M. avium subsp. paratuberculosis bacteria containing phagosomes stain for the late endosomal marker Rab7, but recruitment of the Rab7-interacting lysosomal protein that regulates the fusion of bacteriumcontaining phagosomes with lysosomal compartments and facilitates subsequent bacterial clearance is significantly reduced. Disruption of phagosome acidification via this mechanism may contribute to M. avium subsp. paratuberculosis persistence in human cells, but there was no evidence that internalized M. avium subsp. paratuberculosis also affects the survival of bacteria taken up during a secondary phagocytic event.M ycobacterium avium subsp. paratuberculosis is a bacterium that causes chronic enteritis in domestic and wild ruminants and other animals, including primates (35). The similarities between the gross pathology and histology of M. avium subsp. paratuberculosis-related disease in animals and Crohn's disease (CD) in humans (17) have led to the suggestion that M. avium subsp. paratuberculosis may also have a role in the etiology of the latter. CD is a chronic inflammatory disease of the human gastrointestinal tract that is characterized by weight loss, severe diarrhea, and abdominal pain (5). Several further observations strengthen this hypothesis: the detection of the specific DNA insertion sequence IS900 of M. avium subsp. paratuberculosis in relatively high numbers in the blood and tissues of patients with CD (1, 2), the finding of M. avium subsp. paratuberculosis-reactive T cells in CD patients (29), and the culture of viable M. avium subsp. paratuberculosis forms from blood of people with CD (28).In infected animals, M. avium subsp. paratuberculosis enters the body via the fecal-oral route, moves across the intestinal epithelium, and then uses complement-associated and non-complement-associated receptors to gain entry to host phagocytic cells (36,44), where it is able to persist by inhibiting phagosome-lysosome function (4, 23, 43). Mannosylated lipoarabinomannan (Man-LAM), a major component of the M. avium subsp. paratuberculosis cell wall, contributes to this via Toll-like receptor 2 (TLR2) signaling and activation of the M. avium subsp. paratuberculosis K-p38 signaling pathway (37, 42) that has been shown to block phagosomal acidification by signaling across the phagosome wall (11). However, additional pathways may also be involved in M. avium subsp. paratuberculosis survival, as has been reported for pathogenic mycobacteria such as M. tuberculosis and M. bovis....