Search

Traditionally, low-density lipoprotein (LDL) are separated with respect to their size, density and apolipoprotein composition. Fractionation of LDL according to their electrical charge is also interesting as modified LDL have been implicated in the onset of atherosclerosis. This review discusses possible mechanisms underlying charge heterogeneity of human plasma LDL, such as oxidation, glycation, conjugation with aldehydes, carbamylation and changes in sialic acid content and protein composition.

It is well known that coronary heart disease (CHD) is multifactorial, with environmental and inherited risk factors both playing a role. Apolipoprotein B (apo B) is of major importance in lipoprotein metabolism and might play a central role in atherogenesis. The apo B gene is the obvious candidate gene to study the relations between lipid concentrations and CHD. Some rare mutations in the apo B gene affect plasma cholesterol levels, leading to either familial hypobetalipoproteinemia or familial defective apolipoprotein B100. Other frequent polymorphisms have little biological effect but, because of their high frequency, might contribute to the development of CHD in a given population. Many apo B gene polymorphisms are associated with variations in plasma lipid concentrations, including the response of plasma lipids to dietary intervention, and peripheral and coronary atherosclerosis. Age, body mass index and gender affect the degree and nature of the association between apo B genetic markers and normal lipid and lipoprotein levels. However, negative and contradictory results have also been reported. One likely explanation is differences between studies, including populations of different geographic origin, arbitrary definition of cases and controls and multiple criteria for CHD. Future work on the effect of the apo B locus on hyperlipidaemia and atherosclerosis must involve large numbers of patients belonging to carefully defined populations. Prospective studies using a combination of genetic markers in well-defined populations should lead to firm conclusions on the role of apo B in atherogenesis and coronary heart disease.

The role of plasma LDL in atherogenesis is now well established. Cholesteryl ester accumulation within macrophages leads to foam cell formation, an early atherosclerotic process. In vitro, foam cell formation scarcely ever occurs in the presence of native LDL. Modification of these lipoproteins is necessary for their binding to macrophage scavenger receptors. In vitro modifications reported have involved chemical reactions, physical mechanisms, enzymatic reactions, cellular interactions and association with macromolecules. In vivo, they can occur by glycation or desialylation, smoking or by hemodynamic interactions. Alterations of the physicochemical properties of LDL are induced by oxidation and include an increase in their density and their net electronegative charge, changes in lecithin composition, polyunsaturated fatty acid peroxidation of lipids and apolipoprotein B100 degradation. Apolipoprotein B100 fragmentation leads to an impairment of uptake through LDL receptors, while uptake through macrophage scavenger receptors is enhanced. Modified LDL have also other particularities such as cytotoxicity, chemotactism for circulating monocytes, inhibition of resident macrophage mobility, vasoconstriction, perturbation of the arachidonic acid cascade, involvement in haemostasis and immune mechanisms. Hypotheses concerning the role of modified LDL, in particular oxidized LDL, in atherogenesis open new therapeutic prospects.