There is increasing evidence that oxidized phospholipids (OxPLs) play an important role in atherosclerosis. These phospholipids accumulate in human and mouse lesions. Specific OxPLs have been identified as major regulators of many cell types present in the vessel wall. In endothelial cells, .1,000 genes are regulated. Some of these genes are pro-atherogenic and others anti-atherogenic. The anti-atherogenic effects are likely important in slowing the atherogenic process. Several receptors and signaling pathways associated with OxPL action have been identified and shown to be upregulated in human lesions. A structural model of the mechanism by which specific OxPLs serve as CD36 ligands has been identified. Specific oxidized phospholipids are also present in plasma and associated with Lp(a) particles. In humans, OxPL/apolipoprotein B has been shown to be a prognostic indicator and a separate risk factor for coronary events.
CHEMISTRY OF OXIDIZED PHOSPHOLIPIDSSeveral reviews and original articles have identified the structure of bioactive oxidized phospholipids that are formed from PUFAs at the sn-2 position (1-3). The number of oxidation products from each PUFA is likely at least 50, and effects of all of these products have not been examined. For the purposes of this review, we will only include structures of several well-studied molecules (Fig. 1). Bioactive oxidized phospholipids may contain fragmentation products of PUFA, such as 1-palmitoyl-2-oxovaleroyl-sn-glycero-3-phoshorylcholine and 9-keto-10-dodecendioic acid ester of 2-lyso-phosphatidyl choline (KOdiA-PC); prostaglandins, such as 15 deoxy-delta12,14 prostaglandin J2 (PGJ2) and 1-palmitoyl-2-(5,6-epoxyisoprostane E2)-sn-glycero-3-phosphoryl choline (PEIPC); and levuglandins. These molecules exhibit different biological activities. An important recent development is a better understanding of the initial interaction of oxidized phospholipids with cells. Receptors have been identified, including CD36, SRB1, EP2, VEGFR2, and the PAF receptor (1, 4). An interaction with TLR4 has also been suggested in some studies but not others (1, 5). A possible mechanism by which cells recognize oxidized phospholipids has been suggested involving the novel confirmation of these lipids in membranes (6). These studies demonstrated that, when present in vesicles, truncated oxidized fatty acids at the sn-2 position move from the hydrophobic interior to the aqueous exterior of the vesicle. This would allow their recognition by cell surface receptors. An earlier model of isoprostane-containing phospholipids suggests that they are highly twisted and may distort membrane areas in which they are present (7). These studies and others (8) suggest that phospholipid oxidation products can integrate into lipid membranes of cells and lipoproteins; they then can either act as ligands or may cause local membrane disruption. In addition, strong evidence has been presented for the ability of oxidized phospholipids to form protein adducts. Probably the most well characterized are th...