We have cloned and sequenced a cDNA encoding human liver carnitine palmitoylransferase (CPTase; pahnitoyl-CoA:L-carnitine O-palmitoyltransferase, EC 2.3.1.21), an inner mitochondrial membrane enzyme that plays a major role in the fatty acid oxidation pathway. Mixed oligonudeotide primers whose sequences were deduced from one tryptic peptide obtained from purified CPTase were used in a polymerase chain reaction, allowing the amplification of a 0. A major source for energy production in the cell is the mitochondrial p-oxidation of long-chain fatty acids. In order to cross the mitochondrial membranes, long-chain fatty acids are first activated by coenzyme A and then reversibly conjugated with L-carnitine, a reaction that is catalyzed by the enzyme carnitine palmitoyltransferase (CPTase; palmitoylCoA:L-carnitine O-palmitoyltransferase, EC 2.3.1.21) (1). One part of CPTase activity, conventionally referred to as CPTase I, is associated with the outer mitochondrial membrane, and another significant pool of CPTase activity, conventionally referred to as CPTase II, is in close relationship with the inner mitochondrial membrane (2). However, all the attempts to purify CPTase led to the identification of a single protein with a subunit of Mr 70 kDa (3)(4)(5)42).An important role in the regulation of CPTase activity is played by malonyl-CoA, an intermediate in fatty acid biosynthesis that inhibits the activity of outer (CPTase I) but not of inner (CPTase II) CPTase (6). The malonyl-CoA binding domain has been proposed to be located either on CPTase I (4) or on a regulatory protein without CPTase activity (7).CPTase activity is also under hormonal control of estrogen (8), insulin, and glucagon. Diabetes causes increased CPTase activity and decreased affinity for malonyl-CoA, both reversed by insulin (9). Glucagon has been reported to stimulate CPTase through phosphorylation by a cAMP-dependent protein kinase (10). Interestingly, hypoglycemic agents, such as sulfonylureas, exercise their pharmacological action by strongly inhibiting CPTase activity (11).CPTase seems also to play a role in the regulation of the hepatic synthesis of very low density lipoproteins (VLDL), since its inhibition increases VLDL production, whereas activation following depletion of malonyl-CoA levels decreases VLDL synthesis (12, 13). Accordingly, the hypolipidemic drug lovastatin causes a 2-fold increase in the activity of hepatic CPTase (14).From these observations it appears that CPTase has a role in the development of metabolic alterations in very common diseases such as diabetes and hyperlipoproteinemias. Furthermore, recessively inherited deficiency of CPTase in man has been described with two distinct phenotypes. In adults, CPTase deficiency causes a muscle disease with weakness, cramps, and myoglobinuria (15). In infants, CPTase deficiency is characterized by hyperammonemia, increased levels of serum transaminases and plasma-free fatty acids, hepatomegaly, nonketotic hypoglycemia, and coma (16). This life-threatening and often fatal d...