This article is available online at http://www.jlr.org Supplementary key words lipoprotein • low-density lipoprotein metabolism • apolipoprotein • familial hypercholesterolemia HDL-associated apoM was recently shown to be a physiological carrier of sphingosine-1-phosphate (S1P) ( 1 ). S1P affects vascular integrity, and the S1P-dependent effects of HDL are dependent on apoM. Moreover, several studies have suggested that apoM can accelerate effl ux of cholesterol from foam cells, delay oxidation of LDL, and increase production of pre- -HDL, suggesting that apoM affects antiatherogenic functions of HDL ( 2-4 ). However, little is known about the plasma metabolism of apoM. ApoM is anchored in HDL via a retained hydrophobic signal peptide ( 5 ). Loss of the signal peptide abolishes apoM's binding to HDL, causing rapid clearance of the truncated apoM in the kidney. Even though >90% of plasma apoM resides in HDL plasma, apoM concentration has consistently been shown to be positively correlated with plasma LDL cholesterol in humans ( 6-8 ). Moreover, HDL-associated plasma apoM is increased 2-fold in Ldlr Ϫ / Ϫ mice lacking functional LDL receptors ( 9 ). These observations might refl ect that plasma apoM is controlled by the rate of LDL receptor-mediated clearance of apoBcontaining particles. LDL receptor binding and internalization of LDL represent a major pathway controlling plasma LDL levels ( 10, 11 ), and the ligand binding domain of the LDL receptor, as well as the LDL receptor binding domain in apoB, have been extensively characterized ( 12, 13 ). The clinical diagnosis of familial hypercholesterolemia (FH) and impaired clearance of LDL can be caused by mutations in the LDLR and APOB genes ( 14 ). Genetic studies Abstract ApoM is mainly associated with HDL. Nevertheless, we have consistently observed positive correlations of apoM with plasma LDL cholesterol in humans. Moreover, LDL receptor defi ciency is associated with increased plasma apoM in mice. Here, we tested the idea that plasma apoM concentrations are affected by the rate of LDL receptormediated clearance of apoB-containing particles. We measured apoM in humans each carrying one of three different LDL receptor mutations (n = 9) or the apoB3500 mutation (n = 12). These carriers had increased plasma apoM (1.34 ± 0.13 µM, P = 0.003, and 1.23 ± 0.10 µM, P = 0.02, respectively) as compared with noncarriers (0.93 ± 0.04 µM). When we injected human apoM-containing HDL into Wt (n = 6) or LDL receptor-defi cient mice (n = 6), the removal of HDLassociated human apoM was delayed in the LDL receptordefi cient mice. After 2 h, 54 ± 5% versus 90 ± 8% ( P < 0.005) of the initial amounts of human apoM remained in the plasma of Wt and LDL receptor-defi cient mice, respectively. Finally, we compared the turnover of radio-iodinated LDL and plasma apoM concentrations in 45 normocholesterolemic humans. There was a negative correlation between plasma apoM and the fractional catabolic rate of LDL ( r = ؊ 0.38, P = 0.009). These data suggest that the plasma clearance of apoM...