Objective-Peroxisome proliferator-activated receptor-␣ (PPAR␣) is a ligand-activated transcription factor that controls lipid metabolism and inflammation. PPAR␣ is activated by fibrates, hypolipidemic drugs used in the treatment of dyslipidemia. Previous studies assessing the influence of PPAR␣ agonists on atherosclerosis in mice yielded conflicting results, and the implication of PPAR␣ therein has not been assessed. The human apolipoprotein E2 knock-in (apoE2-KI) mouse is a model of mixed dyslipidemia, atherosclerosis, and nonalcoholic steatohepatitis (NASH). The aim of this study was to analyze, using homo-and heterozygous PPAR␣-deficient mice, the consequences of quantitative variations of PPAR␣ gene levels and their response to the synthetic PPAR␣ agonist fenofibrate on NASH and atherosclerosis in apoE2-KI mice. Methods and Results-Wild-type (ϩ/ϩ), heterozygous (ϩ/Ϫ), and homozygous (Ϫ/Ϫ) PPAR␣-deficient mice in the apoE2-KI background were generated and subjected to a Western diet supplemented with fenofibrate or not supplemented. Western diet-fed PPAR␣Ϫ/Ϫ apoE2-KI mice displayed an aggravation of liver steatosis and inflammation compared with PPAR␣ϩ/ϩ and PPAR␣ϩ/Ϫ apoE2-KI mice, indicating a role of PPAR␣ in liver protection. Moreover, PPAR␣ expression was required for the fenofibrate-induced protection against NASH. Interestingly, fenofibrate treatment induced a similar response on hepatic lipid metabolism in PPAR␣ϩ/ϩ and PPAR␣ϩ/Ϫ apoE2-KI mice, whereas, for a maximal antiinflammatory response, both alleles of the PPAR␣ gene were required. Surprisingly, atherosclerosis development was not significantly different among PPAR␣ϩ/ϩ, PPAR␣ϩ/Ϫ, and PPAR␣Ϫ/Ϫ apoE2-KI mice. However, PPAR␣ gene level determined both the antiatherosclerotic and vascular antiinflammatory responses to fenofibrate in a dose-dependent manner. Key Words: Atherosclerosis Ⅲ PPAR␣ Ⅲ fatty liver disease Ⅲ inflammation Ⅲ murine model F ibrates are lipid-lowering drugs widely used in clinical practice to treat dyslipidemia. 1 Studies performed in peroxisome proliferator-activated receptor-␣ (PPAR␣)-deficient mice have demonstrated that the hypolipidemic effects of fibrates are due to activation of PPAR␣, a ligand-activated transcription factor that modulates lipid metabolism. 2 PPAR␣ is expressed in many tissues, particularly in tissues with high fatty acid oxidation rates, such as liver, kidney, heart, and muscle. After activation by fibrates, PPAR␣ binds as a heterodimer with the retinoid X receptor to PPAR response elements in the promoters of genes implicated in lipid and lipoprotein metabolism. In addition to its effects on lipid metabolism, PPAR␣ also inhibits proinflammatory pathways by negatively interfering with other signaling pathways, such as nuclear factor-B, signal transducer and activator of transcription, or activator protein-1. Consequently, through its effects on lipid metabolism and inflammation, PPAR␣ may modulate pathophysiological pathways implicated in fatty liver disease and atherosclerosis. Data concerning the implicat...