The clearance of free cholesterol from plasma lipoproteins by tissues is of major quantitative importance, but it is not known whether this is passive or receptormediated. Based
Plasma high density lipoprotein (HDL)1 plays a key role in maintaining cholesterol homeostasis. Epidemiological studies demonstrated a strong inverse correlation between HDL levels and the risk of coronary artery disease (1). Although detailed mechanisms remain uncertain, it has been proposed that HDL promotes reverse cholesterol transport by facilitating transfer of cholesterol from peripheral tissues to the liver for secretion into bile (Ref. 2; see Ref. 3 for a recent review). Early studies using HDL and low density lipoprotein (LDL) with radiolabeled free cholesterol (FC) showed that FC in HDL is the preferred source for biliary cholesterol (4 -8). Recent work with plant sterols provided further evidence that HDL is the preferred carrier for the transport of cholesterol into bile (9). Based on the observations that HDL FC is preferentially utilized for biliary secretion and that, in tissue culture studies, HDL, but not LDL, selectively binds FC (10), Schwartz et al. (5) predicted that a cell-surface HDL receptor might be involved in the hepatic uptake of HDL FC. As a counterpoint to this idea, free cholesterol exchanges readily between lipoproteins and cells, suggesting that passive FC uptake by the liver might be possible.Scavenger receptor BI (SR-BI) has recently been identified as an authentic HDL receptor that mediates the selective uptake of HDL cholesteryl ester (CE) (11) and bi-directional transfer of FC between HDL and cells (12, 13). Its tissue distribution (11,14) and regulatable expression in the adrenal gland, testis, and ovary (14, 15) indicate that the receptor plays an important physiological role in cholesterol metabolism (16,17). Hepatic overexpression of SR-BI leads to decreased HDL levels in mice (18 -20) due to accelerated hepatic uptake of HDL CE and subsequently increased HDL CE and protein catabolism (19). On the other hand, decreased expression of SR-BI in gene-targeted mice results in increased HDL levels (21, 22). Furthermore, SR-BI mRNA is expressed in thickened intima of atheromatous aorta (12), and the receptor suppresses the development of atherosclerosis in SR-BI transgenic (SR-BI Tg)/LDL receptor-deficient compound mice fed the Paigen diet (23).In our previous work, we found that, in transfected Chinese hamster ovary cells, SR-BI mediates the cellular uptake of HDL FC as well as CE (12). Moreover, SR-BI promotes cholesterol efflux from cells to HDL (12, 13) or protein-free phospholipid (PL) vesicles (13), and the efflux rates correlate with the expression level of SR-BI in different cell lines (Refs. 12 and 13; see Ref. 24 for review). In mice with hepatic overexpression of SR-BI, the biliary concentration of cholesterol is increased (18,25). These results led us to hypothesize that SR-BI plays a physiological role in vivo in promoting the hepatic uptake of HDL FC and facilitating the secretion of...