Lp[a] are synthesized by hepatocytes, although the production of apo[a] is confined to the liver of humans and certain primates while production of apoB-100 is universally observed in mammalian hepatocytes (5, 6). Elevated circulating levels of Lp[a] in humans is associated with increased risk for a number of atherosclerotic diseases, including coronary artery disease and stroke, and this association has driven continued interest in the mechanisms that regulate plasma levels of this enigmatic lipoprotein species (4, 5, 7).Studies of the mechanisms underlying the remarkable genetic variability in Lp[a] levels in humans have demonstrated that differences largely reside in the production rate of this lipoprotein rather than changes in its catabolism (8-11). These differences in production rate appear to be reproducible within individuals and are not subject to significant modulation by diet or pharmacologic manipulations directed at lowering plasma cholesterol levels (12, 13). The most informative insight into the potential mechanisms regulating hepatic production of apo [a] derives from a series of studies demonstrating that variations at the APOA gene locus result in transcription of a variable number of copies of a repeating domain that resembles that of the kringle 4 (K4) found in plasminogen (14-20). Apo [a] contains varying numbers of these K4-like repeats and, in general, plasma levels of Lp[a] are inversely related to the number of these repeat domains (20,21). Studies by White and colleagues have demonstrated that the most plausible mechanism for this relationship is that apo[a] isoforms with larger numbers of K4 repeats undergo a size-dependent maturation process, with retention and folding in the endoplasmic reticulum representing an important and possibly dominant restriction point in the processing, folding, and secretion process (11,22).Much effort has focused on understanding the posttranslational control of apo[a] secretion from hepato-