Epidemiological studies continue to indicate associations between exposure to increased concentrations of ambient fine and ultrafine particles and adverse health effects in susceptible individuals. The ultrafine particle fraction in the ambient atmosphere seems to play a specific role. Yet, the dosimetry (including deposition patterns in the respiratory tract and, particularly, the biokinetic fate of ultrafine particles) is not fully understood. In contrast to fine particles, inhaled ultrafine particles seem to follow different routes in the organism. Cardiovascular effects observed in epidemiological studies triggered the discussion on enhanced translocation of ultrafine particles from the respiratory epithelium towards circulation and subsequent target organs, such as heart, liver, and brain, eventually causing adverse effects on cardiac function and blood coagulation, as well as on functions of the central nervous system. Current knowledge on systemic translocation of ultrafine particles in humans and animal models is reviewed. Additionally, an estimate of accumulating particle numbers in secondary target organs during chronic exposure is extrapolated from long-term translocation data obtained from rats. Toxicological studies aim to provide the biological plausibility of health effects of ultrafine particles and to identify cascades of mechanisms that are causal for the gradual transition from the physiological status towards pathophysiologcal alterations and eventually chronic disease. Considering the interaction between insoluble ultrafine particles and biological systems (such as body fluids, proteins, and cells), there still are gaps in the current knowledge on how ultrafine particles may cause adverse reactions. This paper reviews the current concept of interactions between insoluble ultrafine particles and biological systems.