Oxidatively modified lipoproteins

There is ample evidence that oxidized lipoproteins exist in vivo, not only in atherosclerotic lesions, but also associated with some experimental models of diabetes. Whether the lipoprotein oxidation is an epiphenomenon of other atherogenic or diabetogenic agents or processes or whether it is causally related to lesion formation in atherosclerosis or other forms of tissue damage in people with diabetes is unresolved. Intense interest in testing these ideas derives from in vitro observations of the ways in which oxidized lipoproteins interact with cells that are unlike the interactions with native lipoproteins. Many of these altered interactions suggest known features of atherosclerotic lesions, and recent data show that antioxidant treatment reduces the progression of vascular lesions. There are reasons to believe that hyperglycemia may worsen lipid and lipoprotein oxidation. If this observation is the case in vivo, and if it is ultimately proved that lipoprotein oxidation facilitates lesion development, these events may help explain the accelerated atherosclerosis suffered by diabetic patients. The multiple pathways for which there is evidence that hyperglycemia may contribute to oxidative events--for example, by enhancing free radical production in stimulated inflammatory cells or by forming glycation products that can propagate free radical events--suggest avenues for further research and may ultimately indicate points for intervention in the various manifestations of the disease.

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“…The possible cellular interactions of oxidized LDL now go far beyond the early observations above (9)(10)(11)(12)(13).…”

Section: Oxidized Lipoproteins and Atherosclerosismentioning

confidence: 94%

Lipoprotein Oxidation and Lipoprotein-lnduced Cell Injury in Diabetes

1992

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New approaches to atherosclerosis: An overview

McCarthy

1993

Medicinal Research Reviews

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The mechanisms of action and selected agents for a variety of approaches to the treatment of atherosclerosis have been reviewed. In Table I, each approach is listed according to its primary physiological effect. This is a simplification, of course, and some agents, such as ACAT inhibitors, may have primary effects in all of these categories. As one goes from left to right, the benefit of each physiological effect becomes more speculative. There is no question of the benefit of LDL reduction, but less evidence exists for the clinical benefits of HDL elevation. With regard to direct anti-atherosclerotic effects, most approaches have yet to gather clinical data of any type. Perhaps as a result, the degree of medicinal chemistry effort in each area to date declines as one goes from left to right. This situation is changing rapidly, however. As evidence supporting the HDL hypothesis accumulates and knowledge of how to elevate HDL levels grows, very exciting opportunities for medical advances present themselves. Likewise, the knowledge base for nonlipid intervention is growing and very rapid advances are being achieved with the plaque-imaging techniques needed for evaluating such agents in man. Such results can only lead to greater opportunities for pharmacological intervention. Thus, in the future, much greater research effort will likely be dedicated to HDL elevation and nonlipid approaches. Through these efforts, physicians of the future should be armed with several complementary agents that can reduce the risk of cardiovascular disease in all patient populations.

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