Objective-To assess the role of apolipoprotein (apo) E in macrophage reverse cholesterol transport (RCT) in vivo. Methods and Results-ApoE exerts an antiatherosclerotic activity by regulating lipoprotein metabolism and promoting cell cholesterol efflux. We discriminated between macrophage and systemic apoE contribution using an assay of macrophage RCT in mice. The complete absence of apoE lead to an overall impairment of the process and, similarly, the absence of apoE exclusively in macrophages resulted in the reduction of cholesterol mobilization from macrophages to plasma, liver, and feces. Conversely, expression of apoE in macrophages is sufficient to promote normal RCT even in apoE-deficient mice. The mechanisms accounting for these results were investigated by evaluating the first step of RCT (ie, cholesterol efflux from cells). Macrophages isolated from apoE-deficient mice showed a reduced ability to release cholesterol into the culture medium, whereas the apoB-depleted plasma from apoE-deficient and healthy mice possessed a similar capacity to promote cellular lipid release from cultured macrophages. Conclusion-Our data demonstrate, for the first time to our knowledge, that apoE significantly contributes to macrophage RCT in vivo and that this role is fully attributable to apoE expressed in macrophages. A polipoprotein E (apoE) is a structural component of several lipoproteins, including very-low-density lipoproteins (LDLs) and their remnants, chylomicron remnants, and high-density lipoproteins (HDL). 1 ApoE is predominantly synthesized by the liver and accomplishes its physiological role by driving the hepatic clearance of the lipoproteins on which it resides through binding with very LDL and chylomicron-remnant receptors 2 and inhibiting triglyceride lipolysis. 3 Altogether, these activities contribute to the regulation of circulating lipoprotein levels. Several population studies 3-5 associated apoE defects with lipoprotein disorders and increased cardiovascular risk, thus revealing the key role played in atheroprotection. This beneficial activity was further demonstrated by the generation of mice lacking the apoE gene, characterized by hypercholesterolemia and abnormal lipid deposition in the proximal aorta and liver, even when receiving a normal chow diet. 6,7 Beyond the influence on lipoprotein metabolism, apoE atheroprotective activity is also related to the promotion of cholesterol efflux from macrophages. 8,9 Cholesterol efflux is the first ratelimiting step of reverse cholesterol transport (RCT), the process by which excess cholesterol is delivered from peripheral tissues to the liver for final excretion into the feces. 10 Macrophage is the primary cell type overloaded with cholesterol within atherosclerotic lesions, and this cholesterol pool is the most important for atherosclerosis development and progression. 11 Thus, the RCT that involves macrophage-derived cholesterol became fundamental concerning atheroprotection. Macrophage RCT can be estimated with a radioisotope-based assay, whose appli...