The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection

Atherosclerosis research typically focuses on the evolution of intermediate or advanced atherosclerotic lesions rather than on prelesional stages of atherogenesis. Yet these early events may provide decisive leads on the triggers of the pathologic process, before lesions become clinically overt. The...

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Autor principal:	Michael Torzewski
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	initial atherosclerotic lesion lipoprotein insudation enzymatically modified LDL (eLDL) oxidized LDL (oxLDL) macrophage C-reactive protein Biology (General) QH301-705.5 Chemistry QD1-999
Acceso en línea:	https://doaj.org/article/c38919653fc94925b0eaff5da690c9b4
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spelling	oai:doaj.org-article:c38919653fc94925b0eaff5da690c9b42021-11-11T16:57:06ZThe Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection10.3390/ijms2221114881422-00671661-6596https://doaj.org/article/c38919653fc94925b0eaff5da690c9b42021-10-01T00:00:00Zhttps://www.mdpi.com/1422-0067/22/21/11488https://doaj.org/toc/1661-6596https://doaj.org/toc/1422-0067Atherosclerosis research typically focuses on the evolution of intermediate or advanced atherosclerotic lesions rather than on prelesional stages of atherogenesis. Yet these early events may provide decisive leads on the triggers of the pathologic process, before lesions become clinically overt. Thereby, it is mandatory to consider extracellular lipoprotein deposition at this stage as the prerequisite of foam cell formation leading to a remarkable accumulation of LDL (Low Density Lipoproteins). As progression of atherosclerosis displays the characteristic features of a chronic inflammatory process on the one hand and native LDL lacks inflammatory properties on the other hand, the lipoprotein must undergo biochemical modification to become atherogenic. During the last 25 years, evidence was accumulated in support of a different concept on atherogenesis proposing that modification of native LDL occurs through the action of ubiquitous hydrolytic enzymes (enzymatically modified LDL or eLDL) rather than oxidation and contending that the physiological events leading to macrophage uptake and reverse transport of eLDL first occur without inflammation (initiation with reversion). Preventing or reversing initial atherosclerotic lesions would avoid the later stages and therefore prevent clinical manifestations. This concept is in accordance with the response to retention hypothesis directly supporting the strategy of lowering plasma levels of atherogenic lipoproteins as the most successful therapy for atherosclerosis and its sequelae. Apart from but unquestionable closely related to this concept, there are several other hypotheses on atherosclerotic lesion initiation favoring an initiating role of the immune system (‘vascular-associated lymphoid tissue’ (VALT)), defining foam cell formation as a variant of lysosomal storage disease, relating to the concept of the inflammasome with crystalline cholesterol and/or mitochondrial DAMPs (damage-associated molecular patterns) being mandatory in driving arterial inflammation and, last but not least, pointing to miRNAs (micro RNAs) as pivotal players. However, direct anti-inflammatory therapies may prove successful as adjuvant components but will likely never be used in the absence of strategies to lower plasma levels of atherogenic lipoproteins, the key point of the perception that atherosclerosis is not simply an inevitable result of senescence. In particular, given the importance of chemical modifications for lipoprotein atherogenicity, regulation of the enzymes involved might be a tempting target for pharmacological research.Michael TorzewskiMDPI AGarticleinitial atherosclerotic lesionlipoprotein insudationenzymatically modified LDL (eLDL)oxidized LDL (oxLDL)macrophageC-reactive proteinBiology (General)QH301-705.5ChemistryQD1-999ENInternational Journal of Molecular Sciences, Vol 22, Iss 11488, p 11488 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	initial atherosclerotic lesion lipoprotein insudation enzymatically modified LDL (eLDL) oxidized LDL (oxLDL) macrophage C-reactive protein Biology (General) QH301-705.5 Chemistry QD1-999
spellingShingle	initial atherosclerotic lesion lipoprotein insudation enzymatically modified LDL (eLDL) oxidized LDL (oxLDL) macrophage C-reactive protein Biology (General) QH301-705.5 Chemistry QD1-999 Michael Torzewski The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection
description	Atherosclerosis research typically focuses on the evolution of intermediate or advanced atherosclerotic lesions rather than on prelesional stages of atherogenesis. Yet these early events may provide decisive leads on the triggers of the pathologic process, before lesions become clinically overt. Thereby, it is mandatory to consider extracellular lipoprotein deposition at this stage as the prerequisite of foam cell formation leading to a remarkable accumulation of LDL (Low Density Lipoproteins). As progression of atherosclerosis displays the characteristic features of a chronic inflammatory process on the one hand and native LDL lacks inflammatory properties on the other hand, the lipoprotein must undergo biochemical modification to become atherogenic. During the last 25 years, evidence was accumulated in support of a different concept on atherogenesis proposing that modification of native LDL occurs through the action of ubiquitous hydrolytic enzymes (enzymatically modified LDL or eLDL) rather than oxidation and contending that the physiological events leading to macrophage uptake and reverse transport of eLDL first occur without inflammation (initiation with reversion). Preventing or reversing initial atherosclerotic lesions would avoid the later stages and therefore prevent clinical manifestations. This concept is in accordance with the response to retention hypothesis directly supporting the strategy of lowering plasma levels of atherogenic lipoproteins as the most successful therapy for atherosclerosis and its sequelae. Apart from but unquestionable closely related to this concept, there are several other hypotheses on atherosclerotic lesion initiation favoring an initiating role of the immune system (‘vascular-associated lymphoid tissue’ (VALT)), defining foam cell formation as a variant of lysosomal storage disease, relating to the concept of the inflammasome with crystalline cholesterol and/or mitochondrial DAMPs (damage-associated molecular patterns) being mandatory in driving arterial inflammation and, last but not least, pointing to miRNAs (micro RNAs) as pivotal players. However, direct anti-inflammatory therapies may prove successful as adjuvant components but will likely never be used in the absence of strategies to lower plasma levels of atherogenic lipoproteins, the key point of the perception that atherosclerosis is not simply an inevitable result of senescence. In particular, given the importance of chemical modifications for lipoprotein atherogenicity, regulation of the enzymes involved might be a tempting target for pharmacological research.
format	article
author	Michael Torzewski
author_facet	Michael Torzewski
author_sort	Michael Torzewski
title	The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection
title_short	The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection
title_full	The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection
title_fullStr	The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection
title_full_unstemmed	The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection
title_sort	initial human atherosclerotic lesion and lipoprotein modification—a deep connection
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c38919653fc94925b0eaff5da690c9b4
work_keys_str_mv	AT michaeltorzewski theinitialhumanatheroscleroticlesionandlipoproteinmodificationadeepconnection AT michaeltorzewski initialhumanatheroscleroticlesionandlipoproteinmodificationadeepconnection
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The Initial Human Atherosclerotic Lesion and Lipoprotein Modification—A Deep Connection

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