We examined the cold stability of microtubules (MT) in biopsied sural nerves. In control nerves, cold treatment reduced the density of MT in unmyelinated axons. The proportion of cold-insoluble MT was approximately 30% by morphological study. By contrast, the extraction study using essentially the same nerves showed that the ratio of cold-insoluble tubulin was 60-75%. These findings suggest the existence of a subpopulation of cold-stable tubulin which may not make up MT. However, in 2 patients with acute dysautonomia the proportion of cold-stable MT or tubulin was decreased compared to that in controls in both the morphological and extraction study. This suggests the altered local process involving MT in primary axonal degeneration.