Kleemann R, Kooistra T
Gaubius Laboratory TNO, Division Biomedical Research, Leiden, The Netherlands.
Curr Drug Targets Cardiovasc Haematol Disord. 2005 Dec;5(6):441-53. doi: 10.2174/156800605774962077.
Besides classical risk factors such as hypercholesterolemia and hypertension, chronic subacute inflammation has recently been recognized as an important force driving the development of atherosclerosis, the most common underlying cause of myocardial infarction and stroke. There is compelling evidence that a disturbance of cholesterol homeostasis contributes to the development of a chronic inflammatory state and that inhibitors of HMG-CoA reductase (statins) may dampen inappropriate inflammatory responses. We review the evidence and suggest mechanisms by which dietary cholesterol can induce an atherogenic inflammatory response in liver and vessel wall, with particular emphasis on the time course of this inflammatory response during atherogenesis and the interplay between these tissues. We discuss how statins interfere in this process, and whether they may reduce chronic subacute inflammation via a) their cholesterol-lowering effect, and/or b) their cholesterol-independent (pleiotropic) vasculoprotective activities. Recent studies performed in (humanized) animal models allow us to distinguish the lipid-lowering-dependent from the lipid-lowering-independent functions of statins. Using these data, we discuss the degree to which the lipid-lowering-dependent and lipid-lowering-independent effects of statins contribute to a reduction of inflammation, allowing estimation of the relevance of pleiotropic statin effects for the human situation.
除了高胆固醇血症和高血压等经典危险因素外,慢性亚急性炎症最近被认为是推动动脉粥样硬化发展的重要因素,动脉粥样硬化是心肌梗死和中风最常见的潜在病因。有令人信服的证据表明,胆固醇稳态紊乱会导致慢性炎症状态的发展,而HMG-CoA还原酶抑制剂(他汀类药物)可能会抑制不适当的炎症反应。我们回顾了相关证据,并提出膳食胆固醇可在肝脏和血管壁诱导致动脉粥样硬化炎症反应的机制,特别强调了动脉粥样硬化形成过程中这种炎症反应的时间进程以及这些组织之间的相互作用。我们讨论了他汀类药物如何干扰这一过程,以及它们是否可能通过以下方式减轻慢性亚急性炎症:a)降低胆固醇的作用,和/或b)其不依赖胆固醇的(多效性)血管保护活性。最近在(人源化)动物模型中进行的研究使我们能够区分他汀类药物的降脂依赖性和降脂非依赖性功能。利用这些数据,我们讨论了他汀类药物的降脂依赖性和降脂非依赖性作用在多大程度上有助于减轻炎症,从而评估他汀类药物多效性作用对人类情况的相关性。