Scavenger receptors were originally defined by their ability to bind and internalize modified lipoproteins. Macrophages express at least six structurally different cell surface receptors for modified forms of LDL that contribute to foam cell formation in atherosclerosis. In addition to their role in the pathology of atherosclerosis, macrophage scavenger receptors, especially SR-A, play critical roles in innate immunity, apoptotic cell clearance, and tissue homeostasis. In this review, we highlight recent advances in understanding the biology of macrophage scavenger receptors as pattern recognition receptors for both infectious nonself (pathogens) and modified self (apoptotic cells and modified LDL). We critically evaluate the potential of scavenger receptors and their ligands as targets for therapeutic intervention in human disease. -Greaves, D. R., and S. Gordon.
MACROPHAGE-DERIVED FOAM CELLSFatty streaks, which are the earliest forms of atherosclerotic lesion visible in the artery wall, consist almost entirely of macrophage-derived foam cells (1-3). Monocytes that have been recruited to the subendothelial space at sites of endothelial cell activation differentiate into macrophages and express a range of scavenger receptors, which mediate the endocytic uptake of modified forms of LDL (4). Brown, Goldstein, and colleagues (5, 6) coined the term "scavenger receptor" to distinguish the uptake of modified LDL by macrophages from LDL uptake via the classical LDL receptor, which is feedback inhibited by the accumulation of cholesterol within the cell. Molecular cloning and biochemical characterization of the cellular receptors that mediate the uptake of modified forms of LDL have revealed an unexpectedly large number of endocytic receptors (7, 8). These membrane proteins have widely different structures, and all the scavenger receptors characterized to date bind a number of ligands of biological importance other than modified LDL. Even more puzzling is the recently described scavenger receptor SR-PSOX (scavenger receptor that binds phosphatidylserine and oxidized lipoprotein), which can act both as a receptor [for oxidized LDL (OxLDL)] and as a ligand (the membranebound CXC chemokine, CXCL16).Their lack of feedback inhibition by intracellular cholesterol has made macrophage scavenger receptors scapegoats for the development of macrophage foam cell formation in the artery wall, but it is important to recognize that other metabolic pathways play an important role in the development of cholesteryl ester deposits in macrophage foam cells. Modified apolipoprotein B (apoB)-containing lipoproteins taken up via scavenger receptors are delivered to lysosomes and hydrolyzed to release free cholesterol and fatty acids. The conversion of free cholesterol into cholesteryl esters in macrophages is catalyzed by the enzyme ACAT, and free cholesterol can be converted by the mitochondrial enzyme Cyp27 into 27-hydroxycholesterol, one of several oxysterols that activate changes in macrophage foam cell transcription via the nuc...