We have previously shown that interferon-gamma (IFN-gamma) is a potent enhancer of atherogenesis. Interleukin-18 (IL-18) promotes inflammatory responses through release of IFN-gamma, although it can also exert direct actions on other inflammatory mediators. In this present study, we determined the effects of IL-18 on atherogenesis and the role of IFN-gamma in this response. Male apolipoprotein E(-/-) mice (apoE(-/-); aged 16 weeks, n=10/group) were fed a normal diet and injected intraperitoneally for 30 days with either recombinant IL-18 (30 ng/g/day) or saline. Atherosclerotic lesion size was quantified in 2 vascular beds: the ascending aorta and the aortic arch. IL-18 administration did not affect serum cholesterol concentrations or lipoprotein-cholesterol distribution; however, exogenous IL-18 administration increased lesion size 2-fold in both the ascending aorta (50 642 +/- 12 515 versus 112 399 +/- 13 227 microm(2) P=0.004; saline versus IL-18 groups, respectively) and the aortic arch (3.1 +/- 0.3% versus 6.2 +/- 0.9% area, P=0.006). Exogenous IL-18 promoted a 4-fold increase in the number of lesion-associated T lymphocytes (11 +/- 3 versus 50 +/- 5 cells; P<0.0001) and cells expressing major histocompatability complex class II (9 +/- 3 versus 40 +/- 6 cells; P=0.0002). To determine the role of IFN-gamma production in this response, exogenous IL-18 was administered to apoE(-/-) mice that were IFN-gamma deficient. These studies demonstrated that lack of endogenous IFN-gamma ablated the effects of IL-18 on atherosclerosis. Therefore, these data strongly implicates IL-18 in the atherogenic process and suggests that IL-18 increases lesion development through enhancement of an inflammatory response involving an IFN-gamma-dependent mechanism. The full text of this article is available at http://www.circresaha.org.