We have established a mouse model for human LCAT deficiency by performing targeted disruption of the LCAT gene in mouse embryonic stem cells. Homozygous LCAT-deficient mice were healthy at birth and fertile. Compared with age-matched wild-type littermates, the LCAT activity in heterozygous and homozygous knockout mice was reduced by 30 and 99%, respectively. LCAT deficiency resulted in significant reductions in the plasma concentrations of total cholesterol, HDL cholesterol, and apoA-I in both LCAT ؊/؊ mice (25, 7, and 12%; p < 0.001 of normal) and LCAT ؉/؊ mice (65 and 59%; p < 0.001 and 81%; not significant, p ‫؍‬ 0.17 of normal). In addition, plasma triglycerides were significantly higher (212% of normal; p < 0.01) in male homozygous knockout mice compared with wild-type animals but remained normal in female knockout LCAT mice. Analyses of plasma lipoproteins by fast protein liquid chromatography and two-dimensional gel electrophoresis demonstrated the presence of heterogenous pre␤-migrating HDL, as well as triglyceride-enriched very low density lipoprotein. After 3 weeks on a high-fat high-cholesterol diet, LCAT ؊/؊ mice had significantly lower plasma concentrations of total cholesterol, reflecting reduced levels of both proatherogenic apoB-containing lipoproteins as well as HDL, compared with controls. Thus, we demonstrate for the first time that the absence of LCAT attenuates the rise of apoB-containing lipoproteins in response to dietary cholesterol. No evidence of corneal opacities or renal insufficiency was detected in 4-month-old homozygous knockout mice. The availability of a homozygous animal model for human LCAT deficiency states will permit further evaluation of the role that LCAT plays in atherosclerosis as well as the feasibility of performing gene transfer in human LCAT deficiency states. Lecithin:cholesterol acyltransferase (LCAT)1 is a 63-kDa glycoprotein synthesized primarily by the liver, which plays a major role in the metabolism of HDL (1). In plasma, LCAT is preferentially associated with HDL (2) but may also interact with low density lipoproteins (3), where it catalyzes the transfer of a fatty acid from the sn-2 position of phosphatidylcholine to the 3-hydroxyl group of cholesterol, generating cholesteryl esters and lysolecithin. The newly formed cholesteryl esters (CE) are then transferred to the core of the HDL lipoprotein particle, a process that results in the formation and maturation of spherical HDL (4). LCAT-mediated esterification of free cholesterol in HDL helps maintain a concentration gradient for efflux of cholesterol from peripheral cells to the HDL particle surface for ultimate transport to the liver (4, 5). Thus, together with hepatic lipase and cholesteryl ester transfer protein LCAT appears to be essential for the process of reverse cholesterol transport, one of several proposed mechanisms by which HDL may protect against atherosclerosis (6, 7).The important role that LCAT plays in HDL metabolism has been established by the identification and characterization of patients...