Procedures were developed for the determination of the activity of the microsomal enzyme 3-hydroxy-3-methylglutaryl CoA reductase (HMG CoA reductase, EC 1.1.1.34) in human liver. The enzyme assay could be carried out with as little as 20 mg of fresh liver tissue, thus making the method applicable to specimens obtained by percutaneous liver biopsy. Experiments were carried out to determine optimal assay conditions and to establish the identity and radiopurity of the reaction product formed from 3-¹⁴C-labeled 3-hydroxy-3-methylglutaryl CoA. The specific activity of the enzyme was measured in a number of patients with different disorders of lipid metabolism.