This article is available online at http://www.jlr.org compartments, and return of LDLRs to the cell surface for further rounds of uptake (9-12). Naturally occurring mutations that hinder any step in the cycle compromise LDLR function and increase the circulating level of LDL, resulting in familial hypercholesterolemia (FH) (13). These mutations have been divided into five categories (13,14). Class I mutations are nulls and include most insertions, deletions, and premature stop codons. Class II mutations hinder folding, resulting in loss of LDLRs to endoplasmic reticulum-associated degradation (ERAD). Class III mutations disrupt lipoprotein binding. Class IV mutations inhibit LDLR internalization, thereby trapping LDLRs on the cell surface. Class V mutations disrupt endosomal handling (lipoprotein release and LDLR recycling), resulting in loss of surface LDLRs due to retention of LDLRs in endosomal compartments.The LDLR is a type I transmembrane protein that consists of seven LDLR type A repeats (LA repeats), two epidermal growth factor (EGF)-like repeats (EGF-A and EGF-B), six YWTD repeats that form a -propeller, a third EGF-like repeat (EGF-C), a region that is highly O-glycosylated, a single transmembrane helix, and a short, relatively unstructured cytoplasmic domain (Fig. 1A) (15). Class II (folding) mutations can be found throughout the ectodomain and are the most common type of FH mutation. Most class III (binding) mutations are in the LA repeats. Class IV (internalization) mutations are all within the cytosolic domain. Class V (release and recycling) mutations are found in the EGF-A, EGF-B, and -propeller domains (13).Biochemical and cellular experiments have shown that lipoprotein release can proceed through two distinct mechanisms. The first mechanism involves loss of calcium from the Abstract Lipoproteins internalized by the LDL receptor (LDLR) are released from this receptor in endosomes through a process that involves acid-dependent conformational changes in the receptor ectodomain. How acidic pH promotes this release process is not well understood. Here, we assessed roles for six histidine residues for which either genetic or structural data suggested a possible role in the acid-responsiveness of the LDLR. The LDL receptor (LDLR) supports uptake of lipoproteins that contain either apoE or apoB100 (1, 2). The LDLR is principally responsible for the uptake of two lipoproteins: LDL, which the LDLR binds in an apoB100-dependent manner, and VLDL remnants, which the LDLR binds in an apoE-dependent manner (3,4). Peripheral cells use the LDLR to take up LDL to supply the cholesterol needed for membrane and steroid hormone synthesis (5, 6). Liver hepatocytes use the LDLR to internalize both LDL and VLDL remnants for the purpose of reducing the circulating level of LDL (4). Uptake of VLDL remnants suppresses circulating LDL levels because VLDL remnants that are not internalized by the LDLR are converted into LDL (7,8).The LDLR uptake cycle consists of four steps: lipoprotein binding at the cell surface, int...