R eactive oxygen species (ROS) (eg, superoxide, peroxide, and hydroxyl radicals) and reactive nitrogen species (eg, peroxynitrite) are generated in both atherogenesis and advanced atherosclerosis, 1 particularly by macrophages. 2 ROS have many actions, including oxidative modification of LDL and oxidative damage of DNA.
Oxidative Modification of LDLAlthough LDL is essential to deliver cholesterol to tissues, increased LDL cholesterol is associated with increased risk of cardiovascular disease. Oxidative modification of LDL promotes recruitment and retention of monocytes 3 with formation of fatty streaks, the earliest lesions in atherosclerosis. 4 Both macrophages and vascular smooth muscle cells (VSMCs) bind oxidized LDL via specific scavenger receptors, 5,6 forming foam cells. Macrophage foam cells contain potent oxidant-generating systems that target lipids, including myeloperoxidase, nitric oxide (NO) synthase, and 15-lipoxygenase, allowing increased recognition and uptake by macrophages, creating a positive feedback loop.
Oxidative Damage to DNAROS also induce oxidative damage of DNA, including strand breaks and base and nucleotide modifications, particularly in sequences with high guanosine content. 7 Oxidative modification induces a robust repair response, characterized by excision of modified bases and nucleotides. Double-stranded DNA breaks also activate DNA repair enzymes, including ATM (mutated in ataxia telangiectasia) and ATR (ATMrelated kinase). Both ATM and ATR directly phosphorylate and activate specific checkpoint kinases, such as chk2 and hCDS1, with subsequent phosphorylation of the tumor suppressor gene p53.p53 is the commonest mutation in human cancer and has a major role in genomic surveillance. p53 stimulates base excision repair 8 but also coordinates the cell's response to damage. p53 phosphorylation stabilizes the protein and increases its transcriptional activity, inducing both growth arrest and apoptosis. Thus, ROS-induced DNA damage leads to p53 activation, and growth arrest and apoptosis after DNA damage depend partly on p53.Although the presence of ROS within the atherosclerotic plaque is not disputed, the major target cells of ROS in vivo are unclear. In particular, ROS induce toxicity in many vascular cell types in culture. 9 In view of this, the study by Martinet et al 10 in this issue of Circulation Research provides important insights into the role of ROS in atherogenesis and plaque stability. These investigators demonstrated that cholesterol feeding of rabbits induces oxidative damage in plaques, manifested by expression of 8-oxo-G, an oxidative modification of guanine residues in DNA, 7 DNA strand breaks, and apoptosis. A graded response was seen, the percentage of cells expressing markers being 8-oxoGϾstrand breaksϾapoptosis, consistent with fewer cells demonstrating increasing degrees of oxidative damage. These changes were associated with expression of DNA repair enzymes and p53. Importantly, these markers of oxidative damage were rapidly reversible with cholesterol loweri...