Phosphatidylserine (PS) is asymmetrically distributed in mammalian cell membranes, being preferentially localized in the inner leaflet. Some studies have suggested that a disturbance in the normal asymmetric distribution of PS-e.g., PS exposure in the outer leaflet ofthe cell membrane, which can occur upon platelet activation as well as in certain pathologic red cells-serves as a potent procoagulant surface and as a signal for triggering their recognition by macrophages. These studies suggest that the regulation of PS distribution in cell membranes may be critical in controlling coagulation and in determining the survival ofpathologic cells in the circulation. In this paper we describe a sensitive technique, based on PS-dependent prothrombinase complex activity, for assessing the amount of PS on the external leaflet of intact viable cells. Our results indicate that tumorigenic, undifferentiated murine erythroleukemic cells express 7-to 8-fold more PS in their outer leaflet than do their differentiated, nontumorigenic counterparts. Increased expression of PS in the tumorigenic cells directly correlated with their ability to be recognized and bound by macrophages.Macrophages play an important role as effector cells in host defense against cancer metastasis (1) and viral diseases (2). When appropriately activated, macrophages are able to recognize and destroy a variety of tumorigenic and virusinfected cells, including cells resistant to other host defenses such as T cells and natural killer cells (1), while leaving normal cells unharmed. Macrophage-mediated tumor cell killing has been shown to be independent of such cell characteristics as surface receptors, drug resistance, cell cycle, and metastatic potential (1,3).The mechanism responsible for the ability of mononuclear phagocytes to discriminate between normal and pathologic cells is not known. The broad spectrum of target cells susceptible to macrophage-mediated cytolysis might suggest, however, that a uniform surface moiety could be involved in target cell recognition.An interesting feature of some cell membranes is the asymmetric distribution of membrane phospholipids between the two leaflets of the bilayer (4). In red blood cells (RBC), for example, most membrane phospholipids show some preference for either leaflet, whereas phosphatidylserine (PS) is the only phospholipid that adopts a totally asymmetric distribution, being localized exclusively in the cell's inner leaflet (5-7). Although the mechanisms responsible for maintaining an asymmetric distribution of PS are still unclear, recent evidence suggests that the preservation of PS in the cell's inner leaflet is of central importance in cellular physiology. For example, the exposure of PS that occurs in activated platelets (8) and in sickled RBC (9, 10) regulates hemostasis by serving as a potent procoagulant surface (11, 12) and as a signal for triggering the recognition of these cells by macrophages (13). Related experiments have shown that artificially generated phospholipid vesicles (14,15) a...