to identify agents for raising the levels of HDL. To date, the most potent means for raising plasma HDL has been through the use of cholesteryl ester transfer protein (CETP) inhibitors. Both torcetrapib ( 1, 2 ) and anacetrapib ( 3 ) have demonstrated 2-fold elevations in human trials. However, the development of these new lipid-modulating drugs suffered a major setback in December 2006 with the termination of the phase 3 trials of torcetrapib due to an excess in overall mortality and adverse cardiovascular events ( 4, 5 ). The largest of these trials, the Investigation of Lipid Level Management to Understand Its Impact in Atherosclerotic Events (ILLUMINATE), involved 15,067 patients at high cardiovascular risk. At study termination, 93 deaths had occurred in the torcetrapib/atorvastatin group compared with 59 in atorvastatin group. Of the 34 excess deaths in the torcetrapib group, 14 were cardiovascular-related whereas 20 were noncardiovascular-related. Although the occurence of new infections during the trial was similar for the torcetrapib versus the atorvastatin group (182 versus 177), there were nine deaths from infection in the former group versus zero for the latter.That nearly half of the noncardiovascular excess in mortality for the ILLUMINATE trial was associated with infection raises the question as to whether torcetrapib, apart from its intended effect on CETP, might have interfered with the function of two other proteins in the same family of lipid binding proteins, both of which play important roles in antibacterial defense ( 6 ). The fi rst of these, lipopolysaccharide binding protein (LBP), is an acute phase Abstract The CETP inhibitor, torcetrapib, was prematurely terminated from phase 3 clinical trials due to an increase in cardiovascular and noncardiovascular mortality. Because nearly half of the latter deaths involved patients with infection, we have tested torcetrapib and other CETPIs to see if they interfere with lipopolysaccharide binding protein (LBP) or bactericidal/permeability increasing protein (BPI). No effect of these potent CETPIs on LPS binding to either protein was detected. Purifi ed CETP itself bound weakly to LPS with a Kd у 25 uM compared with 0.8 and 0.5 nM for LBP and BPI, respectively, and this binding was not blocked by torcetrapib. In whole blood, LPS induced tumor necrosis factor-␣ normally in the presence of torcetrapib. Furthermore, LPS had no effect on CETP activity. We conclude that the sepsis-related mortality of the ILLUMI-NATE trial was unlikely due to a direct effect of torcetrapib on LBP or BPI function, nor to inhibition of an interaction of CETP with LPS. Instead, we speculate that the negative outcome seen for patients with infections might be related to the changes in plasma lipoprotein composition and metabolism, or alternatively to the known off-target effects of torcetrapib, such as aldosterone elevation, which may have aggravated the effects of sepsis. In order to reduce the incidence of cardiovascular disease beyond that achieved through the use of sta...