The single amino acid mutation G26R in human apolipoprotein A-I (apoA-I IOWA ) leads to the formation of β-secondary structure rich amyloid fibrils in vivo. Here we show that full-length apoA-I IOWA has a decreased lipid binding capability, an increased amino terminal sensitivity to protease, and a propensity to form annular protofibrils visible by electron microscopy. The molecular basis for the conversion of apolipoprotein A-I to a pro-amyloidogenic form was examined by electron paramagnetic resonance spectroscopy. Our recent findings [Lagerstedt, J. O., Budamagunta, M. S., Oda, M. N., and Voss, J. C. (2007) J Biol Chem, 282,[9143][9144][9145][9146][9147][9148][9149] indicate that Gly26 in native apo-protein separates a preceding β-strand structure (residues 20-25) from a downstream largely α-helical region. The current study demonstrates that the G26R variant promotes a structural transition of positions 27-56 to a mixture of coil and β-strand secondary structure. Microscopy and staining by amyloidophilic dyes suggest that this alteration extends throughout the protein within one week of incubation in vitro, leading to insoluble aggregates of distinct morphology. The severe consequences of the Iowa mutation likely arise from the combination of losing the contribution of the native Gly residue in terminating β-strand propagation and the promotion of β structure when an Arg is introduced adjacent to succeeding residue of identical charge and size, Arg27.Apolipoprotein A-I (apoA-I) 1 is the primary protein component of high density lipoprotein (HDL), where it plays a key role in reverse cholesterol transport, a primary mediator of cholesterol efflux and phospholipid metabolism. In reverse cholesterol transport, apoA-I interacts with several members of this pathway, including ATP-binding cassette transporters (ABCA1, ABCG1, and ABCG4), lecithin:cholesterol acyltransferase (LCAT), and † This work was supported by National Institutes of Health grants HL77268, HL78615 and HL073826-01, and by the American Heart Association Scientist Development Grant 0235222N. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06 RR-12088-01 from the National Center (1) ]. The conformational adaptability of apoA-I (2),(3, 4) facilitates the processing of HDL by these distinct receptors and enzymes. For example with lipid binding, apoA-I undergoes a substantial change in structure, wherein the apoA-I helix bundle unfurls into an extended alpha helical "looped belt" conformation that resides on the periphery of the lipid particle [reviewed in (3, 5)]. This structural plasticity has made apoA-I difficult to examine and only recently has detailed structural information become available. Notably, the crystal structure of lipid-free apoA-I provides important new insight into the organization of the lipid-free protein, illuminating a N-terminal four-helix bundle followed by a more flexible C-terminal domain (6). However, features of the structure, parti...