Human data raised the possibility that coronary heart disease is associated with mutations in the apolipoprotein gene cluster APOA1/C3/A4 that result in multideficiency of cluster-encoded apolipoproteins and hypoalphalipoproteinemia. To test this hypothesis, we generated a mouse model for human apolipoprotein A-I (apoA-I)/C-III/A-IV deficiency. Homozygous mutants (Apoa1/c3/a4 2/2 ) lacking the three cluster-encoded apolipoproteins were viable and fertile. In addition, feeding behavior and growth were apparently normal. Total cholesterol (TC), high density lipoprotein cholesterol (HDLc), and triglyceride levels in the plasma of fasted mutants fed a regular chow were 32% (P , 0.001), 17% (P , 0.001), and 70% (P , 0.01), respectively, those of wild-type mice. When fed a high-fat Western-type (HFW) diet, Apoa1/ c3/a4 2/2 mice showed a further decrease in HDLc concentration and a moderate increase in TC, essentially in non-HDL fraction. The capacity of Apoa1/c3/a4 2/2 plasma to promote cholesterol efflux in vitro was decreased to 75% (P , 0.001), and LCAT activity was decreased by 38% (P , 0.01). Despite the very low total plasma cholesterol, the imbalance in lipoprotein distribution caused small but detectable aortic lesions in one-third of Apoa1/c3/a4 2/2 mice fed a HFW diet. In contrast, none of the wild-type mice had lesions. These results demonstrate that Apoa1/c3/a4 2/2 mice display clinical features similar to human apoA-I/C-III/A-IV deficiency (i.e., marked hypoalphalipoproteinemia) and provide further support for the apoa1/c3/a4 gene cluster as a minor susceptibility locus for atherosclerosis in mice. Supplementary key words apoa1/c3/a4 gene cluster (mouse) . APOA1/ C3/A4 gene cluster (human) . knockout mouse . hypoalphalipoproteinemia . high-fat Western-type diet . atherosclerosis A strong inverse association exists between plasma high density lipoprotein cholesterol (HDLc) levels and the incidence of coronary artery disease in humans (1). The major locus controlling HDLc levels is APOA1 (for apolipoprotein A-I), a member of the apolipoprotein gene cluster APOA1/C3/A4 (2). The cluster genes, APOA1, APOC3, and APOA4, are evolutionarily related and tandemly organized in a region of 17 kb DNA on human chromosome 11, proximal to APOA5, a new member of the apolipoprotein gene family (3). These APOA1/C3/A4 genes code for three apolipoproteins, apoA-I, apoC-III, and apoA-IV, respectively. ApoA-I is a 28 kDa protein synthesized in the liver and small intestine (4). It is the major protein component of HDL. Through its ability to promote cholesterol efflux from cultured cells (5) and to activate LCAT (6), apoA-I plays a key role in reverse cholesterol transport, a mechanism postulated to prevent extrahepatic tissues from accumulating excess cholesterol (7). Apolipoprotein C-III is a 9 kDa protein produced predominantly in the liver. It is a major component of plasma chylomicrons and VLDL. ApoC-III inhibits the hydrolysis of triglyceride by lipoprotein lipase. Apolipoprotein A-IV is a 46 kDa protein associat...