The role of oxidized lipoproteins in the pathogenesis of atherosclerosis.

1. Oxidized low density lipoprotein (LDL) has been suggested to play an important role in atherogenesis by facilitating the accumulation of lipids in macrophages. In vitro studies from this laboratory have shown that oxidized LDL is recognized not only by the specific receptor for it, but also by the receptor which is common for oxidized LDL and acetyl LDL. Probucol, originally developed as an antioxidant, prevents the oxidative modification of LDL in vitro. Recent studies by the authors show that probucol prevents the progression of atherosclerosis in homozygous Watanabe heritable hyperlipidaemic rabbits in vivo without any changes in plasma LDL cholesterol levels. 2. These results strongly suggest that oxidative modification of LDL could occur in vivo and probucol could slow the progression of atherosclerosis, without changes in plasma cholesterol levels. 3. In addition, recently the authors demonstrated that high density lipoprotein (HDL) particles are also oxidized. Once HDL particles were oxidized, they showed a lessened effect on the decrease of cholesteryl ester in foam cells, suggesting oxidative modification of HDL may stimulate development of atherosclerosis by limiting efflux of cholesterol from foam cells. Moreover, HDL particles from probucol-treated patients are hardly oxidized; subsequently, these HDL particles caused a marked efflux of cholesterol from foam cells.