See page 1186ApoA-V is involved in the regulation of plasma triglyceride levels. Thus, human apoA-V transgenic mice have lower triglyceride levels than controls, whereas the knockouts have increased levels. 1 Because hypertriglyceridemia is an independent risk factor for the development of atherosclerosis and cardiovascular diseases, elucidation of the mechanism behind the regulation of apoA-V is of great importance.Expression of apoA-V is increased by interaction of the heterodimer PPAR␣ (peroxisome proliferator-activator receptor)/RXR (retinoid X receptor) with a "Direct Repeat"1 (DR1) sequence in the apoA-V promoter. 3,4 In this issue of Arteriosclerosis, Thrombosis, and Vascular Biology, Genoux et al 5 show that the retinoid-related orphan receptors alpha (ROR␣) 1 and 4 are also involved in the regulation of the apoA-V gene by interaction with the DR1 binding site. This interaction occurs with the human gene but not in mice, which is logical because the motive is not conserved in mice.ROR␣ has been crystallized with cholesterol in the binding site. 6 Also, cholesterol stabilizes ROR␣, and depletion of cellular cholesterol by statins has been shown to modulate the transcriptional activity of ROR␣. 6 For a review, see Boukhtouche et al. 7 However, it remains to be clarified whether cholesterol is a physiological ligand for ROR␣.The connection between apoA-V and ROR␣ opens up interesting possibilities, because ROR␣ has been shown to prevent atherosclerosis (see Boukhtouche et al 7 for review). Thus, both the knockout mice and the natural knockout, the so-called staggerer mice, have an increased frequency of atherosclerosis (see Boukhtouche et al 7 for review).ROR␣ has previously been shown to regulate the expression of apoA-I, which may be one of the reasons why the receptor prevents atherosclerosis. Moreover, it has been shown to inhibit inflammatory responses in smooth muscle cells by transcriptional regulation of the I-B␣ gene, which codes for the inhibitor of NF-B transcription factor activity. Thus, ROR␣ interferes with the signaling pathway of NF-B (see Boukhtouche et al 7 for review). It should also be kept in mind that ROR␣ appears to have an important role in lipid homeostasis in skeletal muscle. 8 Such an effect may affect the insulin sensitivity, thereby giving rise to a reduced incidence of atherosclerosis.Because hypertriglyceridemia is an independent risk factor for atherosclerosis, the observation that ROR␣ regulates apoA-V 5 may indicate that this protein must also be taken into account when explaining the antiatherogenic effect of ROR␣.What is the role of apoA-V in the regulation of plasma triglyceride levels? Two mechanisms have been proposed: (1) that apoA-V influences the removal of triglycerides from plasma; and (2) that apoA-V influences the secretion of VLDL.Degradation of plasma triglycerides is catalyzed by the enzyme lipoprotein lipase (LPL). This enzyme is mainly expressed in adipose tissue and muscle, and acts bound to the proteoglycans on the endothelial cells of the vasculature in...