Interaction between sphingomyelin and oxysterols contributes to atherosclerosis and sudden death

Despite major public health efforts, coronary heart disease continues to be the leading cause of death in the United States. Oxidized lipids contribute to heart disease both by increasing deposition of calcium on the arterial wall, a major hallmark of atherosclerosis, and by interrupting blood flow, a major contributor to heart attack and sudden death. Oxidized cholesterol (oxysterols) enhances the production of sphingomyelin, a phospholipid found in the cellular membranes of the coronary artery. This increases the sphingomyelin content in the cell membrane, which in turn enhances the interaction between the membrane and ionic calcium (Ca(2+)), thereby increasing the risk of arterial calcification. Patients undergoing bypass surgery had greater concentrations of oxysterols in their plasma than cardiac catheterized controls with no stenosis, and had five times more sphingomyelin in their arteries than in the artery of the placenta of a newborn. The oxysterols found in the plasma of these patients were also found in the plasma of rabbits that had been fed oxidized cholesterol and in frying fats and powdered egg yolk intended for human consumption. Together these findings suggest that oxysterols found in the diet are absorbed and contribute to arterial calcification. Oxidized low-density lipoprotein (OxLDL) further contributes to heart disease by increasing the synthesis of thromboxane in platelets, which increases blood clotting. Cigarette smoke and trans fatty acids, found in partially hydrogenated soybean oil, both inhibit the synthesis of prostacyclin, which inhibits blood clotting. By increasing the ratio of thromboxane to prostacyclin, these factors interact to interrupt blood flow, thereby contributing to heart attack and sudden death. Levels of oxysterols and OxLDL increase primarily as a result of three diet or lifestyle factors: the consumption of oxysterols from commercially fried foods such as fried chicken, fish, and french fries; oxidation of cholesterol in vivo driven by consumption of excess polyunsaturated fatty acids from vegetable oils; and cigarette smoking. Along with the consumption of trans fatty acids from partially hydrogenated vegetable oil, these diet and lifestyle factors likely underlie the persistent national burden of heart disease.

Vitamin B6 compounds are capable of reducing the superoxide radical and lipid peroxide levels induced by H2O2 in vascular endothelial cells in culture

Pyridoxamine, pyridoxine, and pyridoxal phosphate were tested to examine if they have antioxidant properties. Endothelial cells exposed to 0.5 mM H(2)O(2) for 2 hours increased the superoxide anion and lipid peroxide levels as biomarkers of oxidative stress. The increase of superoxide was mainly due to the activation of NADPH-oxidase by H(2)O(2). Preincubation of the endothelial cells with 0.1 or 1.0 mM of pyridoxamine or pyridoxal phosphate for one-half hour before H(2)O(2) exposure significantly reduced the superoxide and lipid peroxide compared to the cells exposed to H(2)O(2) only. Preincubation of the cells with 0.1 or 1.0 mM of pyridoxine also significantly reduced the lipid peroxide but did not significantly affect the superoxide level unless the preincubation time was extended to 24 hours. The prostacyclin release by endothelial cells was also significantly inhibited by H(2)O(2). However, the preincubation of endothelial cells with 1.0 mM of pyridoxamine, pyridoxine, or pyridoxal phosphate did not prevent that inhibition. These results indicate that pyridoxamine, pyridoxine, and pyridoxal phosphate acted as antioxidants and reduced the superoxide and lipid peroxides induced by H(2)O(2), but did not protect the cells from the effects directly related to H(2)O(2) itself.

The negative effects of hydrogenated trans fats and what to do about them

Partially hydrogenated vegetable oils have been in the American diet since 1900. More than 50 years ago they were found to contain trans fatty acids that were different from natural fatty acids in plant oils and in animal fat. There was growing evidence that the consumption of trans fats have negative health effects, including increasing plasma lipid levels. In 2003, the Food and Drug Administration (FDA) ruled that the amount of trans fat in a food item must be stated on the label after January 1, 2006; food items could be labeled 0% trans if they contain less than 0.5g/serving. Since the initial ruling, it is now known that the fatty acids in partially hydrogenated vegetable oil are 14 cis and trans isomers of octadecenoic and octadecadienoic acids that are formed during hydrogenation. They cause inflammation and calcification of arterial cells: known risk factors for coronary heart disease (CHD). They inhibit cyclooxygenase, an enzyme required for the conversion of arachidonic acid to prostacyclin, necessary for the regulation of blood flow. There have been several reformulations of hydrogenated fat containing varying amounts of trans fatty acids and linoleic acid, an essential fatty acid that is converted to arachidonic acid. Epidemiological data suggest that when trans fat percentages go up and linoleic acid percentages go down, death rates rise; when trans goes down, death rates go down. In spite of the harmful effects of trans fats, the FDA allows it in the food supply as long as the amount in a food item is declared on the label. Trans fat should be banned from the food supply.

Low magnesium stimulated prostacyclin generation in cultured human endothelial cells

Prostacyclin, synthesized from arachidonic acid, is a strong vasodilator and the most powerful inhibitor known for platelet aggregation. Magnesium deficiency as a risk factor for cardiovascular diseases was related to imbalance of thromboxane and prostacyclin in the vasculature. In this study, we examined the effect of a low level of magnesium on prostacyclin generation in cultured human umbilical vein endothelial cells by measuring arachidonic acid release, 6-ketoprostaglandin F1alpha (6-keto-PGF1alpha) production, calcium ((45)Ca2+) influx, and activity of phospholipase A2 (PLA2) and cyclooxygenases (COX), which are the two main enzymes that control the synthesis of prostacyclin. We found that lower levels of magnesium in the culture medium induced a time- and dose-dependent increase in arachidonic acid release. Low magnesium also enhanced 6-keto-PGF1alpha production, activated PLA2 and COX, enhanced (45)Ca2+ influx and decreased the remaining arachidonic acid in phospholipids. Our data indicate that the enhanced 6-keto-PGF1alpha production could be due to (1) the stimulated (45)Ca2+ influX resulting in an activation of PLA2, (2) the increased arachidonic acid liberation from the cell phospholipid, and (3) the activated COX activity. The increased prostacyclin production could provide protection against the cardiovascular effect of thromboxane which was increased by magnesium deficiency.

27-Hydroxycholesterol causes remodeling in endothelial cell membrane lipid composition comparable to remodeling in the failed vein grafts of CABG patients

Our objective is to determine if vascular remodeling in CABG patients is related to oxysterols, therefore, we compared failed vein grafts from 18 patients, available after a second coronary artery bypass grafting (CABG), with human endothelial cells (ECs). The ECs were cultured in minimum essential medium (MEM) with or without 27-hydroxycholesterol (27OHC), one of the oxysterol products of oxidatively modified low density lipoproteins (ox-LDL), as an agent to alter molecular mechanisms in vascular cells. Significant changes in phospholipid composition, in fatty acid profile and in calcium concentration were found in the failed vein compared to the native saphenous vein from the same (CABG) patient. The failed vein contained significantly less phosphatidylethanolamine, more sphingomyelin, less arachidonic acid, more linoleic acid and more calcium than the native saphenous vein. Comparable changes in phospholipid composition, in fatty acid profile and increased calcium influx were reproduced in ECs cultured in medium containing 27OHC indicating that an oxysterol is an agent that can alter the lipid composition of vascular cell membranes. Our study indicates that a lipid agent, as well as protein agents that have previously been linked to the process of vascular remodeling, may be fundamental to many vascular diseases.

Inhibition of prostacyclin release by cigarette smoke extract in endothelial cells is not related to enhanced superoxide generation and NADPH-oxidase activation

Exposure of human umbilical endothelial cells (ECs) to cigarette smoke extract (CSE) activated the NADPH-oxidase enzyme and increased the production of superoxide (O-2) as well as reactive oxygen species (ROS). CSE also inhibited the prostacyclin (PGI2) formation by ECs. Preincubation of ECs with diphenylene iodonium (DPI), the inhibitor of NADPH oxidase, blocked the increase of O-2 production, but neither lowered the ROS level nor prevented the inhibition of PGI2 formation in CSE-treated cells. Preincubation of ECs with a medium supplemented with 1 mM vitamin C did not decrease, but rather increased the O-2 production in CSE-treated cells. However, adding 1 mM glutathione (GSH) to vitamin C decreased the O-2 production, indicating that vitamin C was overwhelmed by the prooxidant in CS, and GSH enhanced the recycling process and spared vitamin C. The ROS level remained high in CSE-treated cells even after preincubation with vitamin C or vitamin C + GSH compared to the control cells. These results are discussed in light of the possible decrease of antioxidant enzyme activities in CSE-treated cells and the increase of cellular hydrogen peroxide (H2O2) generated from the CSE, which cause an imbalance between oxidizing species and the antioxidants producing oxidative stress in CSE-treated cells. These results demonstrate that CSE has a direct inhibitory effect on PGI2 formation and enhances the level of ROS in CSE-treated ECs, regardless of the activation of NADPH-oxidase.

Atorvastatin reduces the plasma lipids and oxidative stress but did not reverse the inhibition of prostacyclin generation by aortas in streptozotocin diabetic rats

The effect of atorvastatin (Lipitor) on diabetes-induced changes in plasma lipids, oxidative stress and the ability of aortic tissues to generate prostacyclin was studied in streptozotocin diabetic rats. In diabetic rats, plasma total cholesterol, triglycerides and serum glucose significantly increased compared to nondiabetic rats. Atorvastatin administration to diabetic rats did not affect hyperglycemia but significantly reduced plasma total cholesterol and triglycerides compared to diabetic rats. The oxidative stress markers urinary isoprostane, liver thiobarbituric acid reactive substances (TBARS) and plasma protein carbonyl content significantly increased in diabetic rats compared to nondiabetic rats. Atorvastatin admnistration to diabetic rats significantly reduced oxidative stress levels compared to diabetic rats, but urinary isoprostane and liver TBARS remained significantly higher than nondiabetic rats. Prostacyclin (PGI(2)) generation by aortic tissues significantly decreased in diabetic rats compared to nondiabetic rats. Atorvastatin administration to diabetic rats did not reverse that inhibition. These results were discussed in the light of the possible effects of hyperglycemia and statins on NAD(P)H-oxidase and cyclooxygenase-2 activities and the genetic difference between rats and other mammals regarding the level of vascular superoxide dismutase (SOD) activity.

Vitamin C or Vitamin B6 supplementation prevent the oxidative stress and decrease of prostacyclin generation in homocysteinemic rats

We hypothesize that homocysteinemia causes oxidative stress, decreases the aortic ability to generate prostacyclin and that antioxidants have a protective role. Four groups of eight rats each were fed for 8 weeks the control diet (group A), control diet with folic acid omitted and excess methionine (Me) added to drinking water (group B), diet B + 500 mg/kg of Vitamin C (group C) or diet B + 60 mg/kg Vitamin B6 (group D). The three groups of rats fed folic acid deficient (FD) diets (groups B, C and D) were homocysteinemic as indicated by the significant increase in their serum homocysteine (HC) concentration. Rats fed diet B had oxidative stress as indicated by an increase in serum thiobarbituric acid reactive substances (TBARS) and advanced oxidation protein products (AOPP) and urinary isoprostanes and had a decreased ability of their aortas to generate prostacyclin. Homocysteinemic rats fed a FD diet + Vitamin C (group C) or Vitamin B6 (group D) also had high levels of serum homocysteine but the oxidative stress markers and the ability of their aortas to generate prostacyclin returned to normal. This indicates that the homocysteinemic effect is through an oxidative mechanism and that Vitamin C as a free radical scavenger prevents these effects. Serum Vitamin C and liver glutathione concentrations significantly increased in rats fed excess Vitamin B6 compared to the control or FD rats. This may explain why Vitamin B6 has an antioxidative effect.

27-Hydroxycholesterol inhibits neutral sphingomyelinase in cultured human endothelial cells

To study the effect of 27-hydroxycholesterol (27OHC) on the catabolism of sphingomyelin, we cultured endothelial cells (ECs) from human umbilical veins with 27OHC, then measured activities of acid sphingomyelinase (ASMase) and neutral sphingomyelinase (NSMase) and sphingomyelin consumption by using [14C]sphingomyelin, and determined NSMase mRNA expressions by RT-PCR method. The results indicated that [14C]sphingomyelin accumulated in cells treated with 27OHC, and that the activities of both NSMase and ASMase were inhibited in ECs cultured with 27OHC. To further study the effect of 27OHC on NSMase, we used desipramine, an inhibitor of ASMase, to exclude the possible interference of ASMase's residual activity at neutral condition. Also, we observed the significant inhibition of NSMase activity by using glutathione, an inhibitor of NSMase, but found no further impact when 27OHC was added later. To determine whether the inhibition of NSMase activity was directly due to the effect of 27OHC, we exposed cell homogenate to 27OHC, and found no inhibitive effect of 27OHC on the activity of NSMase. All of our data confirmed that 27OHC had only an indirect inhibitive effect on NSMase. Our finding that no change of the NSMase mRNA expression by 27OHC indicated that the inhibitive effect of 27OHC on NSMase activity occurred at a post-transcriptional level. We suggest that an altered membrane fluidity caused by 27OHC could be involved in the inhibited activity of NSMase.

High density lipoprotein can modulate the inhibitory effect of oxLDL on prostacyclin generation by rat aorta in vitro

To examine the effect of oxidized low density lipoprotein (oxLDL) on prostacyclin (PGI2) generation by rat aorta in vitro and whether high density lipoprotein (HDL) has any protective effect against the inhibition of PGI2 generation induced by oxLDL is the objective of this study. Preincubation of aortas with oxLDL resulted in significant inhibition of PGI2 generation compared to preincubation with normal low density lipoprotein (nLDL) or buffer only. The inhibitory effect of oxLDL resided in its lipid moiety while the lipid fraction of nLDL showed no effect. Aortas preincubated with 10 microg/ml of lyso phosphatidycholine (lyso PC) also showed 30% inhibition of PGI2 generation, indicating that lyso PC was among the lipid components of oxLDL which inhibited PGI2 generation. Preincubation of aortas with a mixture of HDL and oxLDL at a ratio of 10:1 showed a significant recovery of PGI2 generation compared to aortas preincubated with only oxLDL, indicating a protective role for HDL. When HDL was incubated with oxLDL the transfer of lyso PC from oxLDL to HDL suggested that HDL trapped lyso PC from oxLDL thus preventing it from acting on the aorta. However, when a mixture of HDL and oxLDL at a ratio of 3:1 was preincubated with aortas, no protective effect of HDL was observed. Preincubation of aortas with a mixture of HDL plus oxLDL at a ratio of 8:1, which was incubated for 1 h at 37 degrees C, produced significantly less PGI2 than aortas preincubated only with oxLDL, indicating that HDL under these conditions was not protective but even enhanced the inhibitory effect of oxLDL. Similarly, aortas preincubated with HDL plus whole oxLDL (at a ratio of 10:1); containing all the small molecular weight oxidation products and characterized by high levels of thiobarbituric acid reactive substance (TBARS) and lipid hydroperoxides; produced significantly less PGI2 than aortas preincubated with whole oxLDL. These results were evaluated in light of possible modification of HDL by oxLDL and its lipid oxidation products such as aldehydes and lipid peroxides. The modified HDL can add more lipid peroxides and increase the effectiveness of lipid peroxides originally present in oxLDL.

Trans fatty acids in hydrogenated fat inhibited the synthesis of the polyunsaturated fatty acids in the phospholipid of arterial cells

Our hypothesis that the trans fatty acids in hydrogenated fat inhibited the synthesis of polyunsaturated fatty acids in the phospholipid of arterial cells was tested with five groups each with six pregnant porcine fed from d 35 of gestation and during lactation. The basal diet contained 2% corn oil (control). The other four diets included the control + 10% butter or 10% hydrogenated fat plus two levels of Mg. Plasma, milk and aortic phospholipid fatty acids, phospholipid composition and calcium content of the aorta from the piglets were determined. At 48 +/- 2 d of age, the aorta phospholipid of piglets from porcine fed hydrogenated fat contained a significantly higher concentration of linoleic acid, less arachidonic acid, and less long chain polyunsaturated fatty acid (PUFA) than did piglets from porcine fed either butterfat or the control diet. Mg had no effect. These changes in composition in piglets from porcine fed hydrogenated fat indicate that trans fat inhibits the metabolic conversion of linoleic acid to arachidonic acid and to other n-6 PUFA. The aortic calcium content data showed a significant interaction of calcium concentration with age. We concluded: 1) that dietary trans fat perturbed essential fatty acid (EFA) metabolism which led to changes in the phospholipid fatty acid composition in the aorta, the target tissue of atherogenesis, 2) this inhibition of EFA to PUFA by the isomeric fatty acids in hydrogenated fat is a risk factor in the development of coronary heart disease.

Antioxidative effects of lovastatin in cultured human endothelial cells

The effects of lovastatin on glutathione peroxidase activity, hydrogen peroxide consumption, [3H]cholesterol uptake and [14C]acetate incorporation were investigated in cultured human endothelial cells. Treatment of endothelial cells with lovastatin in a medium without serum for 4 hr significantly increased both glutathione peroxidase activity and hydrogen peroxide consumption. This treatment also significantly inhibited cholesterol synthesis and cholesterol esterification. However, lovastatin stimulated cholesterol uptake by the cells. These alterations produced by lovastatin continued up to 24 hr. When serum was present in the culture medium, only decreased cholesterol synthesis and esterification were detected. We suggest that the in vitro antioxidative ability of lovastatin resulted, in part at least, from its activating effect on glutathione peroxidase, its stimulative effect on the ability of endothelial cell to scavenge H(2)O(2), and its hypolipidemic effect.

Effect of low magnesium concentration and cholestane-3beta, 5alpha, 6beta-triol on levels of LDL receptor in cultured fibroblasts

We investigated the level of low density lipoprotein receptors (LDLR) in fibroblasts upon treatment with low magnesium and/or cholestane-3beta, 5alpha, 6beta-triol (TriolC). After 72 h of incubation with low magnesium at a level of 188 micromol or lower, the LDLR levels, determined with immunoblotting analysis, were significantly reduced in the cultured cells. TriolC at a level of 1 microg/ml or higher also decreased LDLR level. However, no further decrease of LDLR level was detected in the cells treated with low magnesium plus TriolC at a level of 0.1 microg/ml, compared with the LDLR level from the cells treated with low magnesium only. Our results showed that both low magnesium concentration and TriolC reduced the LDLR level, but the reducing effect was not accentuated when both were present in the culture medium.

The levels of bilirubin may be related to an inflammatory condition in patients with coronary heart disease

In agreement with previous reports, we found that the bilirubin level is significantly lower in the blood of patients with coronary heart disease (CHD) than in age and sex matched controls. However, we found that the level of bilirubin in the blood seemed to be an age-dependent phenomenon and closely related to the activation of leukocytes. In 1,000 cardiac catheterised patients from Urbana, USA suffering from CHD, the level of blood bilirubin was found to be lower than in age and sex-matched controls. The same results were obtained on 300 patients with acute ischemia from three hospitals from Bucharest, Romania. The activation of polymorphonuclear leukocytes increased in the catheterised patients, as well in Romanian patients. An activation of leukocytes triggered by a chronic inflammatory process may increase the lysis of erythrocytes. The erythrocytes of patients with 100% stenosis exhibited a higher rate of in vitro lysis in the presence of activated leukocytes and homocysteine. The increased hemolysis may trigger the activation and removal of the resulting bilirubin from blood. Such a mechanism may depend on the liver clearing function. This function was decreased in catheterized patients over 60 years of age, but had accelerated in younger patients. An individual variation in liver function may explain the widespread bilirubin levels in the blood of patients suffering from CHD.

Oxidized low-density lipoprotein (LDL) enhances thromboxane A(2) synthesis by platelets, but lysolecithin as a product of LDL oxidation has an inhibitory effect

Oxidation of low-density lipoprotein (LDL) by copper sulfate led to a significant increase in lysophosphatidylcholine (lyso PC) at the expense of phosphatidylcholine. Incubation of different concentrations of oxidized LDL (oxLDL) (32-650 microg protein/ml) with platelets for 1 h at 37 degrees C increased lyso PC content. The increase was dependent on oxLDL concentration. Incubation of platelets with various concentrations of lyso PC in solution for 5 or 15 min showed that lyso PC percentage was increased in the platelet membrane and the increase was dose dependent. Platelets incubated with various concentrations of lyso PC (2-100 microM) for 5 or 15 min and then triggered with thrombin also showed a significant decrease of thromboxane A(2) (TXA(2)) release as lyso PC concentration reached 10 microM or 6 microM, respectively. The decrease of TXA(2) release was more significant as lyso PC concentration was increased. The present study showed that this inhibition of TXA(2) release by lyso PC was due to 1) inhibition of phospholipase A(2) and the decrease of free arachidonic acid liberation from platelet phospholipid and 2) inhibition of cyclooxygenase. These inhibitory effects of lyso PC were discussed in relation to its effect on membrane fluidity. Lyso PC at concentrations of 30, 50, and 100 microM caused a sudden drop in TXA(2) release and a sudden increase of lactic dehydrogenase loss from the platelets due to their lysis and inhibition of cyclooxygenase enzyme. The present study shows that oxLDL contains high levels of lyso PC that are transferable to the platelets and can weaken their responsiveness to thrombin and decrease TXA(2) release. In our previous study, we found that oxLDL also contained high levels of oxysterols and thiobarbituric acid reactive substances (TBARS), which enhanced platelet reactivity to thrombin and increased TXA(2) release. We conclude that the net effect of oxLDL on platelets will depend on its degree of oxidation and the ratio between oxysterols plus TBARS/lyso PC. Variations in this ratio may explain some of the contradictions cited in the literature concerning the effect of oxLDL on platelet activation.

Cholesterol-rich diets have different effects on lipid peroxidation, cholesterol oxides, and antioxidant enzymes in rats and rabbits

The objective of this study was to compare the effect of cholesterol feeding of rats and rabbits. The levels of lipid peroxidation products and oxysterols in the plasma of the two species plus the antioxidant enzyme activities in the liver and erythrocytes were measured to explain their different susceptibilities to atherosclerosis. Our study showed that rats are less susceptible than are rabbits to the atherogenic effect of a cholesterol-rich diet because of differences in lipid peroxidation products as well as antioxidant enzymes activities in their livers. In rabbits, cholesterol feeding produced severe hypercholesterolemia (43-fold increase) and increased plasma and liver lipid peroxidation. Total as well as the individual oxysterol contents of 7alpha-, 7beta-hydroxycholesterol, alpha-epoxy, beta-epoxycholesterol, cholestanetriol, 7-keto, and 27-hydroxycholesterol significantly increased in the plasma of hypercholesterolemic (HC) rabbits. Erythrocyte glutathione peroxidase (GSH-Px) activity significantly decreased whereas catalase activity significantly increased in HC rabbits. In rats cholesterol feeding increased the plasma cholesterol only twofold and had no effect on plasma or liver lipid peroxidation. Only 7alpha- and 7beta-hydroxycholesterol increased and no change was observed in any of the antioxidant enzymes activity in the erythrocytes. Although cholesterol feeding caused a 10-fold increase of liver cholesterol as ester in both rats and rabbits, the antioxidant enzyme GSH-Px and catalase activities in the liver significantly increased in rats but significantly decreased in rabbits. The increase of GSH-Px and catalase activities in the liver of cholesterol fed rats could have a protective role against oxidation, thus preventing the formation of lipid peroxidation and oxysterols.

An excess concentration of oxysterols in the plasma is cytotoxic to cultured endothelial cells

To test if there is an excess concentration of oxysterols in the plasma of the patients with cardiovascular disease, we analyzed the oxysterol content in the plasma from 105 cardiac catheterized patients with angina and 80+/-8% stenosis in their coronary arteries. The result showed that the plasma contained a significantly higher concentration of oxysterols than did plasma from 105 age- and sex-matched, non-catheterized and angina-free controls (P<0.05). We used endothelial cells (ECs) cultured in medium containing either [3H]thymidine, [3H]mevalonolactone or 45Ca(2+) to determine how the plasma from the patients influences cell growth and function. We found that less [3H]thymidine (P<0.05), less [3H]mevalonolactone (P<0.05) and more 45Ca(2+) (P<0.001) was incorporated into ECs cultured in the plasma from 36 patients with 83+/-4% stenosis than from the 36 controls. When synthetic 7beta-hydroxycholesterol, cholesterol 5beta,6beta-epoxide, cholesterol 5alpha,6alpha-epoxide and 7-ketocholesterol were added to the plasma from the controls, the influx of 45Ca(2+) into ECs then equaled that in the plasma of patients. The enhanced incorporation of 45Ca(2+) into the ECs cultured in the plasma both from the patients and from controls with added synthetic oxysterols substantiates in vitro the hypothesis that oxysterols increase the influx of calcium into cells. These data indicated that an excess of oxysterols in the plasma of the patients was cytotoxic to the cultured cells.

The relationship of oxidized lipids to coronary artery stenosis

A total of 1200 patients with angina were cardiac catheterized establishing that 63% had 70-100% stenosis, 12% had 10-69% stenosis of one or more of their coronary arteries and 25% had microvascular angina listed as 0% stenosis. Prior to catheterization 10 ml of blood was drawn and the plasma subjected to analysis for the concentration of cholesterol, lipid peroxides (LPX), total antioxidant capacity (TAOC), fibrinogen (FB), ceruloplasmin (CP) and activation of polymorphonuclear leukocytes (PMNLs). Comparisons were made to non-smoking controls without angina. Significant differences in LPX were found between the patients with 0 and 10-69% stenosis (P<0.001), with 10-69 and 70-100% stenosis (P<0.001), and with 0 and 70-100% stenosis (P<0.001). Under 70 years of age there was a significant difference in LPX between patients with all levels of stenosis and age and sex matched controls (P<0.001). Differences in the mean plasma cholesterol concentration for different levels in the degree of stenosis were not significant, indicating that LPX provided consistent data on the severity of stenosis while the plasma cholesterol concentration did not. Compared with controls an increase in activation of PMNLs (P<0.01), an increase in concentration of both FB and CP (P<0.01) and a decrease in total antioxidant capacity were noted in the plasma of catheterized patients. In summary the concentration of oxidation products rather than the concentration of cholesterol in the plasma identified stenosis in cardiac catheterized patients.

Effect of trans fatty acids on calcium influx into human arterial endothelial cells

BACKGROUND

A recent task force of The American Society for Clinical Nutrition and American Society for Nutritional Sciences recommended in a position paper on trans fatty acids that models be developed to assess the effects of changes in fat intake on disease risk.

OBJECTIVE

The objective was to investigate, using human arterial endothelial cells as a model, the influence of trans fatty acids and magnesium on cell membrane composition and on calcium influx into arterial cells, a hallmark of atherosclerosis.

DESIGN

Endothelial cells were cultured for 3 d in media with high (adequate) or low (inadequate) amounts of magnesium plus various concentrations of trans,trans linoelaidic; cis,cis linoleic; trans elaidic; oleic; or stearic acids. The cells were then harvested and the fatty acid composition and the amount of (45)Ca(2+) incorporated into the cell was determined.

RESULTS

The percentage of fatty acids incorporated into the endothelial cells was proportional to the amount added to the culture medium. Adequate magnesium was crucial in preventing calcium influx into endothelial cells. Without an adequate amount of magnesium in the culture medium, linoelaidic and elaidic acids, even at low concentrations, increased the incorporation of (45)Ca(2+) into the cells, whereas stearic acid and oleic acid did not (P < 0.05).

CONCLUSION

Our model indicated that a diet inadequate in magnesium combined with trans fat may increase the risk of calcification of endothelial cells.

The levels of bilirubin may be related to an inflammatory condition in patients with coronary heart disease

In agreement with previous reports, we found that the bilirubin level is significantly lower in the blood of patients with coronary heart disease (CHD) than in age and sex matched controls. However, we found that the level of bilirubin in the blood seemed to be an age-dependent phenomenon and closely related to the activation of leukocytes. In 1,000 cardiac catheterized patients from Urbana. USA suffering from CHD, the level of blood bilirubin was found to be lower than in age and sex-matched controls. The same results were obtained on 300 patients with acute ischemia from three hospitals from Bucharest, Romania. The activation of polymorphonuclear leukocytes increased in the catheterized patients, as well in Romanian patients. An activation of leukocytes triggered by a chronic inflammatory process may increase the lysis of erythrocytes. The erythrocytes of patients with 100% stenosis exhibited a higher rate of in vitro lysis in the presence of activated leukocytes and homocysteine. The increased hemolysis may trigger the activation and removal of the resulting bilirubin from blood. Such a mechanism may depend on the liver clearing function. This function had decreased in catheterized patients over 60 years of age, but had accelerated in younger patients. An individual variation in liver function may explain the widespread bilirubin levels in the blood of patients suffering from CHD.

The accentuating effect of low magnesium concentration on cholestane-3 beta, 5 alpha, 6 beta-triol-induced decrease of LDL uptake by cultured endothelial cells

The effects of cholestane-3 beta, 5 alpha, 6 beta-triol (TriolC) and/or low magnesium on uptake, internalization, surface binding and degradation of 125I-LDL were investigated in cultured endothelial cells. TriolC (at a level of 1 microgram/ml and higher) or magnesium (at a level of 188 microM and lower) in cultured medium decreased significantly the uptake, internalization, surface binding and degradation of 125I-LDL. When TriolC and low magnesium were combined, the significant inhibitions of uptake, internalization, surface binding and degradation of 125I-LDL were also observed although by themselves at these levels (TriolC lower than 1 microgram/ml and magnesium higher than 188 microM) they had no obvious effects. Our work suggests that a combination of low magnesium and TriolC have additive inhibitive effects on uptake, internalization, surface binding and degradation of 125I-LDL.

Influence of low magnesium concentrations in the medium on the antioxidant system in cultured human arterial endothelial cells

Using cultured human endothelial cells, we investigated the contribution of concentrations of magnesium to the antioxidant system and oxidative stress. Cells were cultured at decreasing magnesium levels (569, 380, 190 and 95 microM) for 72 h. We then measured the amount of released hydrogen peroxide (H2O2) from the cells, the consumption of exogenous H2O2, the intracellular reduced glutathione (GSH) and the oxidized glutathione (GSSG) contents and the activities of glutathione reductase and catalase. Magnesium at a level of 949 microM was used as a control. The effect of magnesium deficiency on cellular membrane permeability was determined by measurement of the amount of [14C] amino acid mixture released from the cells. The results showed that during 72 h of magnesium-deficient treatment, the H2O2 release from the cells gradually increased and consumption of exogenous H2O2 was enhanced during the first 48 h of treatment. GSH content gradually decreased but GSSG was not affected. The activity of glutathione reductase was first stimulated and then inhibited. Catalase activity was gradually reduced. [14C]Amino acid mixture release from the cells continuously increased. We suggest that magnesium deficiency affected the intracellular antioxidant system in cultured endothelial cells.

Hydrogenated fat high in trans monoenes with an adequate level of linoleic acid has no effect on prostaglandin synthesis in rats

Our study was designed to determine whether hydrogenated fat high in trans monoenes concentration affected prostaglandin synthesis. Corn oil (CO), butter (B), hydrogenated vegetable oil (HF) and coating fat (CF) were used in this study. These fats were fed to rats for 10 wk at 10 g/100 g diet. The phospholipid (PL) fatty acid content of platelets, aorta and heart was determined by gas liquid chromatography, and the in vitro aorta production of prostacyclin (PGI2) from exogenous or endogenous arachidonic acid (AA) was measured using the radioimmuno-assay (RIA) method. Serum thromboxane B2 (TXB2) released by platelets as thromboxane A2 (TXA2) during incubation of whole blood was also measured by this method. In the group fed CF, AA was significantly lower in the PL of aorta, platelet and heart, and the ratio 20:3(n-9)/20:4(n-6) was greater than in the groups fed CO, B or HF, indicating that the group fed CF was essential fatty acid (EFA) deficient. Although AA was significantly lower in the aorta and platelet PL of the group fed HF compared to the group fed CO, that difference did not affect the amounts of PGI2 or TXB2 produced in these groups. The group fed CF had significantly less PGI2 and TXB2 released by aorta and platelets than the other groups. This was the result of the reduced level of AA and the presence of higher amounts of 20:3(n-9) acid in the PL, which might act as a competitive inhibitor for cyclooxygenase. The aortic production of PGI2 from exogenous AA did not differ among the groups indicating that prostaglandin synthetase was not affected by the dietary fat. We conclude that the consumption of hydrogenated fats high in trans 18:1 acids with adequate amount of linoleic acid had no effect on the amount of thromboxane or prostacyclin produced by platelet or aorta in vitro.

Oxysterols and TBARS are among the LDL oxidation products which enhance thromboxane A2 synthesis by platelets

In this study, we compared the effects of normal LDL (nLDL) and oxidized LDL (oxLDL) on thromboxane (TXA2) release by platelets triggered by low concentration of thrombin, and we determined which component of oxLDL is responsible for that activation. After oxidation of LDL with copper sulfate, the small molecular weight fraction (< 10 kDa) which was high in TBARS was removed; using Amicon Centriprep-10 concentrator membrane. More than 67% of TBARS in the oxLDL preparation was found in solution while the remaining was covalently attached to the oxLDL particles. OxLDL contained significantly higher levels of oxysterols and TBARS than the nLDL. Platelets preincubated with low concentrations of oxLDL (33-132 micrograms protein/mL) produced significantly higher TXA2 than platelets preincubated with equivalent concentrations of nLDL when triggered with thrombin. Platelets treated with oxLDL also contained significantly higher levels of oxysterols than platelets treated with nLDL. Platelets preincubated with pure cholestanetriol (10 micrograms/mL) contained a high level of cholestanetriol in the membrane, and TXA2 release was significantly increased in these platelets compared to the control platelets. The TBARS in solution also was very potent in enhancing TXA2 release by thrombin-treated platelets. These results indicate that oxysterols and the free TBARS either in solution or covalently attached to the oxLDL particles are partly responsible for the stimulatory effect of oxLDL on TXA2 release by platelets. The present study also showed that this enhancement of TXA2 release was due to activation of phospholipase A2 and to the increase of arachidonic acid liberation from the platelet phospholipids.

Effect of 27-hydroxycholesterol on cellular sphingomyelin synthesis and Ca++ content in cultured smooth muscle cells

The relationships among sphingomyelin synthesis cytosolic free Ca++ level and cytotoxicity in the presence of 27-hydroxycholesterol were investigated by measurement of [methyl-3H] choline incorporation into sphingomyelin, phosphatidylcholine, phosphocholine and cytidine choline 5'-diphosphate, 45Ca++ uptake, cytosolic free Ca++ levels and viable cell numbers. The results indicated that 27-hydroxycholesterol at higher than normal level induced increased [3H] choline incorporation in sphingomyelin accompanied by decreased radioactivity in phosphatidylcholine but did not alter [3H] choline content in phosphocholine and cytidine choline 5'-diphosphate. The increased radioactivity in sphingomyelin by 27-hydroxycholesterol was detected first, followed by detection of the enhanced Ca++ uptake and cytosolic free Ca++. Finally, a decrease in viable cell number occurred. We suggest that the increased transfer from phosphatidylcholine to sphingomyelin by 27-hydroxycholesterol may be related to enhanced cytosolic free Ca++.

Cholesterol metabolism in human umbilical arterial endothelial cells cultured in low magnesium media

Epidemiological and experimental studies have shown that magnesium is closely related to regulation of lipid metabolism, membrane structure and permeability, ion migration through cellular membranes, endocrine hormone and platelet function. The cause of atherosclerosis induced by magnesium deficiency has been suggested to be due to abnormal lipid metabolism, lipid peroxidation, a decrease of prostacycline produced by endothelial cells, and an increase of platelet aggregation. We found that the plasma from cardiac catheterized patients suffering from chest pains contained higher levels of oxysterols than age and sex matched patients free of chest pain. Studies with cultured arterial cells in media deficient in magnesium or containing oxysterols indicated that both magnesium and oxysterols have an important role in lipid metabolism in patients with coronary heart disease.

Effect of cholesterol-rich diets with and without added vitamins E and C on the severity of atherosclerosis in rabbits

Oxysterols as oxidation products of cholesterol are considered an atherogenic factor in the development of atherosclerosis in the arteries of cholesterol-fed rabbits. We compared the atherogenic effects of diets enriched either with 0.5% oxidized cholesterol (OC; characterized by high amounts of oxysterols) or with pure cholesterol (PC). The effects of antioxidant vitamins E and C added to the PC diet were also evaluated in view of their antioxidative properties for lipoproteins and cholesterol and how this could affect the severity of atherosclerosis. Four groups of rabbits were fed the following for 11 wk: 1) a nonpurified stock diet, 2) this stock diet plus 0.5% OC, 3) the stock diet plus 0.5% PC, and 4) the stock diet plus 0.5% PC and 1000 mg vitamin E and 500 mg vitamin C/kg diet (PC + antioxidants). The OC and PC diets were equally hyperlipidemic and hypercholesterolemic. The severity of atherosclerotic lesions was highest with the OC diet and lowest with the PC + antioxidants diet. The plasma oxysterol concentration was proportional to the severity of atherosclerosis in all three groups of cholesterol-fed rabbits. beta-Very-low-density-lipoprotein modification was minimized by vitamins E and C as indicated by its polyacrylamide gel electrophoretic pattern and its increased binding to the rabbit liver membrane in vitro. This study indicated that OC and PC were equally atherogenic but that the addition of antioxidants to the PC diet significantly reduced its severity, even when hypercholesterolemia persisted. This indicated that atherogenesis can result from an excessive accumulation of oxidation products of cholesterol in the plasma.

Antioxidant effects of lovastatin and vitamin E on experimental atherosclerosis in rabbits

The effects of the administration of vitamin E (10 mg/day) plus lovastatin (2 mg/day; group A, n = 10), lovastatin alone (2 mg/day; group B, n = 10), and placebo (group C, n = 10) were compared over 24 weeks in a randomized, single-blind controlled trial. All groups of rabbits received a trans fatty acid (TFA)-rich diet (5-10 g/day) for 36 weeks. Treatment with vitamin E plus lovastatin (group A) and lovastatin (group B) started after 12 weeks of administration of TFA-rich diet was associated with a significant but similar decline in serum cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides in both groups at 36 weeks. Lipid peroxides and diene conjugates showed a significant decline in association with a significant increase in the plasma level of vitamin E in group A rabbits at 36 weeks. However, the lovastatin group B showed a lesser but significant decrease in lipid peroxides and diene conjugates at 36 weeks, indicating that lovastatin may have antioxidant activity. In control group C, the increase in blood lipids and oxidative stress at 36 weeks was much greater than the decrease in groups A and B. After experimental lipid peroxidation at 24 weeks in all of the rabbits, 2 of 10 group B and 3 of 10 group C rabbits died due to coronary thrombosis; there were no deaths in group A. Thus antioxidant therapy with vitamin E can provide protection against death due to free radical stress. Aortic lipids and sudanophilia indicating athorosclorosis were significantly lower in groups A and B than in group C. The atherosclerotic coronary plaque sizes were significantly smaller in group A (18.5 +/- 3.6 microns) than in groups B (41.6 +/- 4.2 microns) and C (85 +/- 6.7 microns). Aortic plaque sizes were also smaller in group A than in group B and C. It is possible that antioxidant therapy with vitamin E, as an adjunct to lipid lowering with lovastatin, can provide additional benefit in the inhibition of oxidative stress and atherosclerosis. The antioxidant activity of lovastatin has not been reported, to our knowledge.

Alterations in serum phosphatidylcholine fatty acyl species by eicosapentaenoic and docosahexaenoic ethyl esters in patients with severe hypertriglyceridemia

A new and sensitive method has been developed to analyze the molecular species of glycerophospholipids. This method was used to examine the effects of hypolipidemic intervention with n-3 fatty acids on the serum phosphatidylcholine species in severely hypertriglyceridemic patients. The drug treated group (n = 19) received 4 g/day of an 85% concentrate of the ethyl esters of eicosapentenoic and docosahexaenoic acids for 6 weeks. Control patients (n = 21) received 4 g/day of ethyl esters of corn oil fatty acids. To evaluate the effects of n-3 fatty acids upon serum phosphatidylcholines (PCs), sera from treated and control patients were analyzed before and after 6 weeks of intervention. PCs isolated from sera were digested with phospholipase C to diglycerides, derivatized with 7-methoxycoumarin-3-carbonyl azide, and analyzed by reverse phase high performance liquid chromatography (HPLC) with fluorescence detection. Pre-intervention serum PC species were, in order of decreasing concentration C16:0,18:2, C16:0,18:1, C18:0,18:2, C16:0,20:1, C16:0,22:0, C18:0,20:4, C16:0,16:0, C18:0,18:1, C18:1,18:2, C16:0,20:5, and C18:1,20:5. In the treated patients, mean increases of 300% in C16:0,20:5 and of 160% in C16:0,22:6 species were observed. There were no significant changes in the molecular species of the serum phosphatidylcholines in the group receiving the corn oil ethyl esters. The cumulative relative percentages for each of the individual fatty acids measured by HPLC were comparable to those determined by gas-liquid chromatography (GLC). In the treated group plasma triglycerides were reduced 26%, while they were increased by 7% in the placebo group. Our data showed that incorporation of eicosapentaenoic and docosahexaenoic acid into the serum PCs occurred within 6 weeks primarily in the C16:0,20:5 and C16:0,22:6 species and were usually accompanied by a reduction in plasma triglyceride.

Bilirubin sensitized photooxidation of human plasma low density lipoprotein

Previous investigations have shown that the bile pigment bilirubin can act as peroxyl radicals scavenger and transition metals trap, but also as a peroxidant, to erythrocyte ghost membranes through 1O2-driven photooxidation. In the present study we examined the changes occurring in the lipoprotein particle following bilirubin-sensitized photooxidation of isolated plasma LDL. The oxidative stress resulted in increased TBA reactivity, diene formation, free cholesterol oxidation, apo B fragmentation and enhanced uptake of the modified particle by the mouse macrophage scavenger receptors as well as the decrease binding to the native B, E-receptor on fibroblasts. The marked increase in TBARS production in D2O-enriched medium and the inhibition of lipid peroxidation of azide is consistent with singlet oxygen involvement in the oxidation process. The apo B-bound Cu2+ appears to become redox active during photooxidation since the presence of EDTA in the reaction mixture greatly reduced protein fragmentation. It was also found that BHT inhibited almost completely the lipid peroxidation, as determined by the TBA reaction but could not totally abolish the formation of 5 alpha-hydroxycholesterol, which is the main product formed by the direct attack of 1O2 on cholesterol. The results of this work strongly suggest that, through photooxidation by light-activated bilirubin, the lipoprotein particle may be modified in the blood stream as well, besides being modified in the well known oxidation site within the arterial wall. Our findings provide the rationale for extending these studies to clinical investigations, which aim at developing strategies for minimizing damage to arterial tissue following phototherapy of hyperbilirubinemic newborns or cancer patients after systemic administration of photosensitizers.

Cholesterol metabolism in human umbilical arterial endothelial cells cultured in low magnesium media

To study the time- and dose-dependent effects of low magnesium on free [H3]cholesterol uptake, [H3]mevalonolactone incorporation into cholesterol, and both of which labelled precursors and [H3]oleic acid incorporations into cholesteryl esters, cultured human umbilical arterial endothelial cells were exposed to experimental media containing decreasing magnesium concentrations at 94, 188, 376 and 564 microM until 48 h. A level of magnesium at 949 microM was used as a control. The results showed that reduced magnesium in the cultured medium led to a decrease in [H3]cholesterol, uptake, an inhibition of the incorporation of [H3]mevalonolactone into cholesterol and a stimulation of the incorporation of [H3]cholesterol, [H3]mevalonolactone and [H3]oleic acid into cholesteryl esters, but the time- and dose-dependent effects of magnesium deficiency were not significant. We suggest that reduced cholesterol uptake and synthesis might contribute to hypercholesterolaemia under a condition of magnesium deficiency, and that enhanced cholesterol esterification might be explained by a stimulated activity of acyl-Coenzyme A: cholesterol O-acyltransferase (ACAT).

The hemolytic activity of homocysteine is increased by the activated polymorphonuclear leukocytes

Homocysteine is an accepted risk factor when its plasma level exceeds the physiological upper limit of 12 mumol/L. We found in vitro that homocysteine is able to lyse the erythrocytes (RBCs) at higher concentrations than 15 mumol/L only when activated polymorphonuclear leukocytes (PMNL) are present. The hemolytic effect of homocysteine was higher in RBCs obtained from cardiac catheterized patients with 100% stenosis of the coronary arteries. Homocysteine was also able to increase the activation in vitro of PMNLs triggered by opsonized zymosan. The hemolytic action of homocysteine was found to be dependent on the ratio of PMNLs to RBCs. This relationship may help to explain the great individual variations in the hemolytic activity noticed in blood obtained from cardiac catheterized patients, and also may explain the mild anemia in some patients suffering from cardiovascular disease.

Cholestane-3 beta, 5 alpha, 6 beta-triol stimulates phospholipid synthesis and CTP-phosphocholine cytidyltransferase in cultured LLC-PK cells

The present study was conducted to examine the effect, if any, of triol on the rate of total or individual phospholipid synthesis by LLC-PK cells in culture. LLC-PK cells were incubated in medium with or without 10 micrograms/ml of 5 alpha-cholestane-3 beta, 5 alpha,6 beta-triol (triol) for 24 h. Triol-treated and control cells were then incubated with medium containing either [14C]glycerol or [32P]phosphate for 1, 6 or 12 hr. In triol-treated cells, the amount of labeled glycerol and [32P]phosphate incorporated into glycerophospholipids and phospholipids (PL), respectively, were higher in triol-treated cells than in control cells, indicating a higher rate of PL synthesis in triol-treated cells. The results also showed that the increase in PL synthesis was higher in magnitude for some PL than others, thus disturbing the ratios among the PL fractions in the cell membrane. CTP-phosphocholine cytidyltransferase activity was greatly enhanced in the cytosolic as well as the particulate fractions of the triol-treated cells, which explains the increase of PC synthesis under triol effect. The rate of [3H]acetate incorporation into the total and free fatty acid fractions was significantly increased in triol-treated cells. The activation of the cytidyl transferase enzyme was related to the enhanced de novo synthesis and cellular uptake of fatty acids in triol-treated cells, which make fatty acids more available in these cells and can upregulate the enzyme. The increased synthesis of phospholipids in the triol cells and the increased level of phospholipid in these cells (as micrograms lipid phosphorus/mg cell protein) observed in our previous study indicate changes in the phospholipid head group composition of the triol cells. These changes can affect several membrane properties and membrane bound enzymes.

Effect of magnesium on secretion of platelet-derived growth factor by cultured human arterial smooth muscle cells

Two conditioned media were prepared by culturing human umbilical artery smooth muscle cells (SMC) in 75 cm2 flasks with minimum essential medium (MEM) under magnesium (Mg) sufficient (900 microM) or deficient (100 microM) conditions for 72 h ([900]- and [100]-MEM), respectively. A third conditioned medium was obtained by adjusting the Mg concentration of half of the [100]-MEM to 900 microM ([100-900]-MEM). SMC in 12-well plates were incubated in one of the three conditioned media and the growth rates of SMC were determined by [3H]-thymidine incorporation and cell counting. The growth rate in [100-900]-MEM was significantly higher than in [900]- and [100]-MEM. When platelet derived growth factor (PDGF) was neutralized by the addition of a mixture of anti-PDGF-AA and -BB antibodies, [3H]-thymidine incorporation in [100-900]-MEM decreased by 23.3 per cent, but only by 7.0 per cent in [900]-MEM. The quantity of PDGF in the Mg-deficient media was greater than in the magnesium-sufficient media at all indicated times, as shown by radioimmunoassay for PDGF-BB or -AB. These results indicate that Mg deficiency increases the secretion of PDGF by SMC.