Abstract-Complement activation occurs in temporal correlation with the subendothelial deposition of LDL during early atherogenesis, and complement also plays a pathogenetic role in promoting lesion progression. Two lesion components have been identified that may be responsible for complement activation. First, enzymatic degradation of LDL generates a derivative that can spontaneously activate complement, and enzymatically degraded LDL (E-LDL) has been detected in the lesions. Second, C-reactive protein (CRP) colocalizes with complement C5b-9, as evidenced by immunohistological studies of early atherosclerotic lesions, so the possibility exists that this acute phase protein also fulfills a complement-activating function. Here, we report that addition of LDL and CRP to human serum did not result in significant C3 turnover. Addition of E-LDL provoked complement activation, which was markedly enhanced by CRP.Binding of CRP to E-LDL was demonstrated by sucrose flotation experiments. Binding was Ca 2ϩ -dependent and inhibitable by phosphorylcholine, and the complement-activating property of E-LDL was destroyed by treatment with phospholipase C. These results indicated that CRP binds to phosphorylcholine groups that become exposed in enzymatically degraded LDL particles. Immunohistological studies complemented these findings in showing that CRP colocalizes with E-LDL in early human atherosclerotic lesions. Thus enzymatic, nonoxidative modification of tissue-deposited LDL can be expected to confer CRP-binding capacity onto the molecule. The ensuing enhancement of complement activation may be relevant to the development and progression of the atherosclerotic lesion. Key Words: atherogenesis Ⅲ corrective protein Ⅲ complement Ⅲ LDL C omplement and C-reactive protein (CRP) are emerging as 2 components that may play important roles in atherogenesis. Early studies indicated that activated complement components 1,2 and CRP 3,4 are present in atherosclerotic lesions, and the demonstration followed that in situ C5b-9 generation occurred in temporal correlation with lipid deposition. 5 The search for a complement-activating entity led to the isolation of an LDL derivative, termed lesion complement activator (LCA), that had the capacity to activate the alternative complement pathway. 6 We are considering that the high content of free cholesterol in the LCA particles is important because unesterified cholesterol activates complement. 7 Similar lipidic moieties were isolated in other laboratories, 8,9 although their capacity to activate complement was not tested. Furthermore, fused LDL particles micromorphologically similar to LCA were visualized in extracellular location by deep freeze-etch electronmicroscopy in arteries of cholesterol-fed rabbits. 10 Collectively, these studies indicated that tissue-deposited LDL is modified extracellularly to yield lipid droplets with a high content of free cholesterol that have intrinsic complement-activating capacity.Subsequently, it was shown that LDL, but not HDL or VLDL, could be transformed...