Editorial |
From the Division of Endocrinology, Department of Medicine, Stanford University, Stanford, and the VA Palo Alto Health Care System, Palo Alto, Calif.
Correspondence to Fredric B. Kraemer, MD, Division of Endocrinology, S-005 Stanford University, Stanford, CA 94305-5103. E-mail fbk@stanford.edu
Key Words: Editorials macrophage sphingomyelinase lipoprotein receptors
Cholesteryl esterfilled
macrophages are the hallmark of atherosclerotic lesions.
Unraveling the pathways responsible for lipid accumulation in
macrophages has been viewed as an important aspect for
understanding a piece of the atherosclerotic
process.1 Investigations into
the mechanisms through which macrophages accumulate cholesteryl
esters from lipoproteins have delineated the involvement of several
different receptor- and nonreceptor-mediated pathways. For instance,
macrophages express LDL receptors as well as several other
members of the LDL receptor family, such as the LDL receptorrelated
protein (LRP) and the VLDL
receptor.2 The LDL receptor
family recognizes apolipoprotein (apo) B-100 and particularly
apoE-containing lipoproteins. The uptake of lipoproteins via LDL
receptor family members is facilitated by additional apoE, as well
as by the presence of lipoprotein lipase. Each member of the LDL
receptor family appears to be capable of contributing to a portion of
the uptake of lipoproteins by macrophages; however, the
contribution of each particular member will vary depending on the
underlying pathophysiological condition. For
instance, the LDL receptor is not functional in LDL receptor
deficiency, and the contribution of either the LRP or the VLDL receptor
would be expected to be low in apoE
deficiency.3 In addition,
macrophages express an apoE-independent pathway for the uptake
of triglyceride-rich lipoproteins that recognizes apoB-48
or the similar domain on apoB-100 and has been termed the apoB-48
receptor.4 Finally,
macrophages express several different scavenger receptors that
recognize modified lipoproteins, particularly lipoproteins that have
been modified by oxidation.5
Other lipoprotein modifications, such as aggregation, proteoglycan
complex formation, and glycation, can lead
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