Cyclosporin A (CsA) is an immunosuppressant that inhibits protein phosphatase 2B (PP2B/calcineurin) and is associated with hyperlipidemia, decreased cholesterol efflux via ATP-binding cassette transporter A1 (ABCA1), and increased risk of atherosclerosis. Apolipoprotein E (apoE) is an important regulator of lipid metabolism and atherosclerosis, the secretion of which from human macrophages is regulated by the serine/threonine protein kinase A (PKA) and intracellular calcium (Ca 2؉ ) (Kockx, M., Guo, D. L., Huby, T., Lesnik, P., Kay, J., Sabaretnam, T., Jary, E., Hill, M., Gaus, K., Chapman, J., Stow, J. L., Jessup, W., and Kritharides, L. (2007) Circ. Res. 101, 607-616). As PP2B is Ca 2؉ -dependent and has been linked to PKA-dependent processes, we investigated whether CsA modulated apoE secretion. CsA dose-and time-dependently inhibited secretion of apoE from primary human macrophages and from Chinese hamster ovary cells stably transfected with human apoE and increased cellular apoE levels without affecting apoE mRNA. [ 35 S]Met kinetic modeling studies showed that CsA inhibited both secretion and degradation of apoE, increasing the half-life of cellular apoE 2-fold. CsA also inhibited secretion from primary human Tangier disease macrophages and from mouse macrophages deficient in ABCA1, indicating that the effect is independent of the known inhibition of ABCA1 by CsA. The role of PP2B in mediating apoE secretion was confirmed using additional peptide and chemical inhibitors of PP2B. Importantly, kinetic modeling, live-cell imaging, and confocal microscopy all indicated that CsA inhibited apoE secretion by mechanisms quite distinct from those of PKA inhibition, most likely inducing accumulation of apoE in the endoplasmic reticulum compartment. Taken together,theseresultsestablishanovelmechanismforthepro-atherosclerotic effects of CsA, and establish for the first time a role for PP2B in regulating the intracellular transport and secretion of apoE.2 is a commonly administered immunosuppressant drug used in organ transplant recipients and in patients with autoimmune disorders. Its immunosuppressive activity is mediated by inhibition of protein phosphatase 2B (PP2B), also known as calcineurin. CsA binds to its intracellular receptor cyclophilin, and the CsA-cyclophilin complex binds PP2B and inhibits its activity. This results in complete inhibition of the translocation of nuclear factor of activated T cells to the nucleus, suppressing the transcription of inflammatory genes (1).Although effective as an immunosuppressive agent, CsA has been shown to cause hyperlipidemia, hypertension, and diabetes, and long term treatment with CsA is associated with an increased risk of cardiovascular disease-related morbidity and mortality (2). The potential mechanisms underlying these adverse cardiovascular effects are diverse. CsA increases cholesteryl ester transfer protein activity, stimulates the susceptibility of low density lipoprotein (LDL) oxidation, decreases bile acid synthesis and biliary cholesterol excretion, reduces...