In low density lipoprotein receptor (LDLR)-deficient mice, overexpression of human plasma phospholipid transfer protein (PLTP) results in increased atherosclerosis. PLTP strongly decreases HDL levels and might alter the antiatherogenic properties of HDL particles. To study the potential interaction between human PLTP and apolipoprotein A-I (apoA-I), double transgenic animals (hPLTPtg/ hApoAItg) were compared with hApoAItg mice. PLTP activity was increased 4.5-fold. Plasma total cholesterol and phospholipid were decreased. Average HDL size (analyzed by gel filtration) increased strongly, hPLTPtg/hApoAItg mice having very large, LDL-sized, HDL particles. Also, after density gradient ultracentrifugation, a substantial part of the apoA-I-containing lipoproteins in hPLTPtg/hApoAItg mice was found in the LDL density range. In cholesterol efflux studies from macrophages, HDL isolated from hPLTPtg/ hApoAItg mice was less efficient than HDL isolated from hApoAItg mice. Furthermore, it was found that the largest subfraction of the HDL particles present in hPLTPtg/hApoAItg mice was markedly inferior as a cholesterol acceptor, as no labeled cholesterol was transferred to this fraction. In an LDLR-deficient background, the human PLTP-expressing mouse line showed a 2.2-fold increased atherosclerotic lesion area. These data demonstrate that the action of human PLTP in the presence of human apoA-I results in the formation of a dysfunctional HDL subfraction, which is less efficient in the uptake of cholesterol from cholesterol-laden macrophages.-Moerland, M., H. Samyn, T. van Gent, M. Jauhiainen, J. Metso, R. The incidence of coronary heart disease shows a strong inverse relationship with the concentration of plasma HDL (1). Therefore, HDL is believed to have antiatherogenic properties, which are attributed to its effects on endothelial cells, its antioxidant activity, and its role in reverse cholesterol transport, a pathway in which peripheral cellular cholesterol is transported to the liver (2-4). One important determinant of the plasma HDL concentration is phospholipid transfer protein (PLTP) activity. During lipolysis, PLTP transfers phospholipids from apolipoprotein Bcontaining lipoproteins to HDL (5). Furthermore, PLTP acts as an HDL conversion factor by remodeling HDL to produce large particles and small lipid-poor particles, known as preb-HDL (6-9). The latter HDL subfraction is a very efficient acceptor of cellular cholesterol. In this way, PLTP plays an important role in the early steps of reverse cholesterol transport (10-12).Although the involvement of PLTP in the cellular efflux of cholesterol and phospholipids is potentially antiatherogenic, different in vivo studies showed that an increase in plasma PLTP activity is associated with decreased HDL cholesterol levels (9, 13, 14) and increased atherosclerotic lesion development (15-17). The PLTP-dependent decrease in HDL levels was explained by an accelerated HDL catabolism (13). In addition to its effect on HDL cholesterol levels, PLTP may alter the antiathe...