In this thesis, several orthosteric and allosteric agonists are presented for the newly discovered hydroxy-carboxylic acid (HCA) receptor 2, and their in vivo activity or in vitro structure... Show moreIn this thesis, several orthosteric and allosteric agonists are presented for the newly discovered hydroxy-carboxylic acid (HCA) receptor 2, and their in vivo activity or in vitro structure-activity relationships are described. The literature on HCA receptors was also thoroughly reviewed, providing some insight into the future of this receptor family as drug targets. The anti-cancer drug N6-(2-isopentenyl)adenosine (IPA) was shown to be a specific ligand for the adenosine A3 receptor, and its antiproliferative effect seems to be mediated by this receptor at low concentrations. A ligand discovery screen for orphan receptor GPR88 was performed, in which over 4000 compounds were tested. Show less
In dit proefschrift wordt onderzoek beschreven waarin een aantal door lipiden gereguleerde genen op bepaalde witte bloedcellen (macrofagen) zijn onderzocht voor nieuwe behandelmethoden ter... Show moreIn dit proefschrift wordt onderzoek beschreven waarin een aantal door lipiden gereguleerde genen op bepaalde witte bloedcellen (macrofagen) zijn onderzocht voor nieuwe behandelmethoden ter voorkoming of behandeling van atherosclerose (slagaderverkalking). Dit wordt gedaan met behulp van de beenmergtransplantatie techniek, waarmee specifiek witte bloedcellen __ waaronder ook macrofagen __ worden vervangen. De in het proefschrift beschreven genen die met behulp van de beenmergtransplantatietechniek zijn onderzocht zijn: ATP-binding cassette transporter (ABC)A1, ABCG1, apolipoproteine (apo)E, en adipose triglyceride lipase (ATGL). Deze genen worden gereguleerd door lipiden en spelen een belangrijke rol in de lipiden homeostase van cellen. Allereerst bleek dat ABCA1 en apoE in macrofagen op verschillende wijze een beschermende werking hebben met betrekking tot atherosclerose, en dat ze gezamenlijk ontstekingsremmend werken. In overeenstemming met deze resultaten bleken ABCG1 en apoE in macrofagen geheel onafhankelijk van elkaar een beschermende rol te spelen in de ontwikkeling van atherosclerose. Afwezigheid van ATGL __ verantwoordelijk voor de afbraak van vetten - in macrofagen leidde verrassenderwijs tot een vermindering van atherosclerose. De afwezigheid van ABCA1 bleek te beschermen tegen een acute hartaanval. Daarnaast bleek dat macrofaag ABCA1 veranderingen in de milt teweegbrengt, maar dat dit geen gevolgen heeft voor de ontwikkeling van atherosclerose. Show less
Although the extracellular matrix (ECM) is the key determinant of the mechanical behavior and stability of tissue, remarkably little is known on this tissue component. Most biomedical research on... Show moreAlthough the extracellular matrix (ECM) is the key determinant of the mechanical behavior and stability of tissue, remarkably little is known on this tissue component. Most biomedical research on the human aorta focuses on biochemical analysis of tissues or the properties of specific cells in the aorta. We show that a physics-based approach can yield important complementary insight. By measuring the mechanical response of the ECM by AFM and imaging it with multi-photon microscopy, we show that the spatial organization of the network structure of collagen fibers plays an important role. First we show how aneurysms, a local dilatation of the arterial wall, are caused by profound defects in collagen network. The collagen fibers in het healthy aorta are organized in a loose braiding of collagen ribbons, while the aneurysmatic tissue show dramatically altered collagen architectures with loss of the collagen knitting. Evaluation by AFM shows how this altered network could explain the failure of the tissue. In a follow-up study, we examine the effects of enzymatic digestion of the ECM of the aortic wall. By starting with real tissue and selectively removing different elements, we are able to measure the contribution of the different constituents of the ECM to the mechanical properties of the whole tissue. We also show how the content of neutrophils is able to mimic the observed change in mechanical response from a healthy aorta to an aneurysm. Finally we will show first results on the disease of atherosclerosis, another common vascular disease. The collagen structure of the cap changes during the growth of the atherosclerotic plaque and we discuss its mechanical implications. This study gives key insights in the failure mechanism of two common pathologies and provides biomedical researchers a new, physics-oriented view to organs, with implications for the study of wound healing, myocardial infarction and cancer cell migration. Show less
Overgewicht en obesitas kunnen leiden tot insulineresistentie (type 2 diabetes mellitus) en hyperlipidemie, een risicofactor voor atherosclerose (aderverkalking). Obesitas gaat ook gepaard met de... Show moreOvergewicht en obesitas kunnen leiden tot insulineresistentie (type 2 diabetes mellitus) en hyperlipidemie, een risicofactor voor atherosclerose (aderverkalking). Obesitas gaat ook gepaard met de ontwikkeling van een chronische ontsteking in vetweefsel en lever. Met dit promotieonderzoek laten we met behulp van onderzoek in muizen zien dat ontsteking een belangrijke rol speelt in het metabolisme en transport van vetten. We bekijken ook welk effect dit heeft op de ontwikkeling van atherosclerose en type 2 diabetes. In het eerste deel van dit promotieonderzoek laten we zien dat ontsteking een belangrijke rol speelt in vetmetabolisme en atherosclerose. De ontstekingsremmer aspirine zorgde voor een verlaging van de hoeveelheid vet in het bloed. Activatie van een onsteking in de lever leidde juist tot een verhoging van vet in het bloed, wat de ontwikkeling van atherosclerose in de vaatwand verergerde. In het tweede deel van dit promotieonderzoek bestuderen we het belang van het inflammasoom/caspase-1 complex (betrokken bij ontstekingsprocessen) in obesitas, insulineresistentie en vetmetabolisme. We laten zien dat muizen die een deel van dit eiwit-complex missen, beschermt zijn tegen de ontwikkeling van obesitas en insulineresistentie. Het inflammasoom/caspase-1 complex lijkt daarmee een potentieel target voor de behandeling van obesitas, insulineresistentie en type 2 diabetes. Show less
The aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical... Show moreThe aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical strategies for the stabilization of an AAA. Such an approach could reduce the need for elective surgery and endovascular repair. It has repeatedly been shown that AAA progression and rupture is related to the failure of collagen in the aortic wall. Yet the exact mechanism underlying this failure remains unknown. Furthermore, the precise mechanism of activation of collagenases and their inflammatory mediators that are responsible for the collagen turnover of AAA are unknown. In this thesis we attempt to determine how collagen metabolism is balanced in aneurysmal diseases and contribute to the knowledge which collagenases and inflammatory mediators are involved in the destruction of the collagen network in AAA disease. Moreover, we evaluate some of the effects of doxycycline on the proteases and inflammatory mediators in AAA. Analyses showed that doxycycline inhibits specific MMPs and inflammatory pathways that are involved in the collagen balance and aneurysm growth. Together, these observations provide a rationale for a randomized clinical trial studying the effect of doxycycline on aneurysm growth. Show less
The aim of the thesis was to develop metabolic analytical platforms for static and dynamic measurements that could answer biological questions for in vitro and in vivo animal models in the area of... Show moreThe aim of the thesis was to develop metabolic analytical platforms for static and dynamic measurements that could answer biological questions for in vitro and in vivo animal models in the area of lipid research. Gene profiling together with the transcriptome and metabolome data was used in combination with the LC/MS analytical platform. In terms of the analytical platforms developed, the focus was on high resolution LC/MS but not limited, as amalgamation with other platforms such as gradient gel electrophoresis (GGE) and fast protein liquid chromatography (FPLC) were explored in more detail to investigate the lipid composition of lipoprotein particles. These analytical strategies were applied to different lipid modulating biological targets as a mean to obtaining a more detailed and characteristic phenotype description directing decisions in drug search during the drug discovery process on the basis of the analytical results obtained. Additionally, the utilization of metabolic tracers was investigated further to probe dynamic changes in the biological target and animal models in question Show less
Atherosclerosis is the underlying cause of most cardiovascular diseases. The evidence to support a cholesterol-atherosclerosis link has been revealed in the past three decades. There is a growing... Show moreAtherosclerosis is the underlying cause of most cardiovascular diseases. The evidence to support a cholesterol-atherosclerosis link has been revealed in the past three decades. There is a growing consensus that therapeutic lowering of plasma VLDL- and LDL-cholesterol levels and raising of HDL-cholesterol level will reduce the risk of cardiovascular incidence. This dissertation is dedicated to the regulation of lipid metabolism pathways, both in plasma and liver, and its subsequent effects on atherosclerotic lesion progression and regression. The first part of the thesis focuses on the hepatic lipid metabolism and the pharmaceutical interventions in the liver. The second part of the thesis focuses on the concept of atherosclerotic lesion regression, shedding insights in the role of LXR activation and application of mouse models in regression studies. In Chapter 8, the results obtained from all the experiments mentioned above are summarized and discussed with respect to the implications of these studies for future investigations. Show less
Non-invasive imaging plays an increasingly important role in the diagnosis and risk stratification of coronary artery disease. Several techniques such as stress echocardiography and myocardial... Show moreNon-invasive imaging plays an increasingly important role in the diagnosis and risk stratification of coronary artery disease. Several techniques such as stress echocardiography and myocardial perfusion imaging have become available to assess cardiac function and myocardial perfusion. With the arrival of multi-slice computed tomography coronary angiography (CTA), non-invasive imaging of coronary anatomy has also become possible. CTA is a relatively new imaging technique; the objective of the thesis is therefore to explore the value of CTA for diagnosis and risk stratification of CAD in patients presenting with suspected and known CAD, in order to further define its role in clinical practice. The results of this thesis show that CTA provides important diagnostic information relative to existing non-invasive imaging strategies. In addition the detailed anatomic information obtained using CTA was shown to provide important prognostic information. CTA supplies complementary information to existing non-invasive imaging techniques, and has the potential to provide a more patient tailored approach to patient management. What remains to be determined is how CTA and non-invasive functional imaging should be integrated into clinical practice. Show less
Excessive accumulation of cholesterol by macrophage-derived foam cells is one of the characteristic features of atherosclerotic lesion development. Macrophages not only play an important role in... Show moreExcessive accumulation of cholesterol by macrophage-derived foam cells is one of the characteristic features of atherosclerotic lesion development. Macrophages not only play an important role in the initiation of the early atherosclerotic lesion, during further progression of the lesions macrophages also contribute to the formation of a necrotic core, thereby affecting the stability of the atherosclerotic plaque. Especially in the initiation of atherosclerosis the balance between cholesterol influx and efflux in macrophages is of prime importance. This balance is maintained by scavenger receptors and ATP-binding cassette (ABC) transporters, which are key mediators for macrophage cholesterol homeostasis as they facilitate the influx and efflux of lipids. Macrophages are incapable of limiting the uptake of cholesterol by scavenger receptors, including scavenger receptor class A (SR-A) and CD36. Therefore, prevention of lipid accumulation in macrophages largely depends on cholesterol efflux pathways, mainly mediated by ABC transporters. Gaining more knowledge on macrophage lipid homeostasis is of prime importance for the development of new therapeutic strategies to prevent atherosclerotic lesion development or induce regression of existing lesions. The aim of the studies described in this thesis was investigation of the role of several ABC transporters and SR-BI in (macrophage) lipid metabolism and atherogenesis. Show less
Een effectieve diagnose voor hart- en vaatziekten kan op dit moment pas gesteld worden als de ziekte zich al in een vergevorderd stadium bevindt of als er klinische symptomen (beroerte) zijn... Show moreEen effectieve diagnose voor hart- en vaatziekten kan op dit moment pas gesteld worden als de ziekte zich al in een vergevorderd stadium bevindt of als er klinische symptomen (beroerte) zijn opgetreden. Tijdens mijn promotieonderzoek heb ik in samenwerking met de farmaceutische industrie (Guerbet) aandacht besteed aan het synthetiseren en valideren van kleine eiwitten die specifiek binden en opgenomen worden door receptoren waarvan aangetoond is dat deze verhoogd tot expressie komen of een specifieke rol spelen in atherosclerose. Dit heeft geleid tot de synthese van 2 kleine eiwitten (PP1 en NP31) die specifiek gericht zijn tegen respectievelijk de scavenger receptor en de CD40 receptor. De scavenger receptor komt verhoogd tot expressie op macrofagen en zorgt voor de verwijdering van slecht cholesterol uit de bloedbaan en vaatwand. De CD40 receptor speelt een belangrijke rol bij de initiatie en in standhouding van de ontstekingsreactie bij atherosclerose. Het onderzoek beschreven in dit proefschrift geeft nieuwe inzichten in mogelijke toepassingen van synthetisch eiwitten die specifiek binden aan receptoren die belangrijk zijn tijdens de ontwikkeling van hart- en vaatziekten. De verschillende synthetische liganden kunnen gezien worden als potenti_le kandidaat-eiwitten voor verbeterde beeldvormingtechnieken van atherosclerotische plaques. Show less
The studies described in this thesis show that inflammation and CETP are both important factors in lipid metabolism and atherosclerosis. In the first part of this thesis we showed that high dietary... Show moreThe studies described in this thesis show that inflammation and CETP are both important factors in lipid metabolism and atherosclerosis. In the first part of this thesis we showed that high dietary cholesterol can induce hepatic inflammation via disturbed cholesterol homeostasis and ER stress, revealing new targets for the treatment of metabolic inflammation. Next, we demonstrated that intervention in both systemic and vascular inflammation can reduce atherosclerosis progression and/ or induce regression, highlighting the importance of developing drugs targeting the inflammatory component of atherosclerotic disease. In the second part of this thesis we showed that CETP inhibition per se may be anti-atherogenic, but that combination therapy of the CETP inhibitor torcetrapib with atorvastatin may have obscured its atheroprotective effect. Furthermore, we showed that the VLDL-increasing effect of CETP largely explains its atherogenic effect, at least in APOE*3-Leiden.CETP mice, and that CETP inhibition may negatively affect lesion stability. Our data suggest that CETP inhibition may not be the most optimal strategy to increase HDL-C levels and thereby reduce atherosclerosis. We anticipate that strategies improving HDL functionality, rather than raising the HDL level, are more likely to effectively reduce CVD. Show less
In this thesis the role of several apoptosis regulating proteins in the development of atherosclerosis and atherosclerotic plaque stability is investigated. Apoptosis of different cell types in... Show moreIn this thesis the role of several apoptosis regulating proteins in the development of atherosclerosis and atherosclerotic plaque stability is investigated. Apoptosis of different cell types in atherosclerotic plaques, such as macrophages and smooth muscle cells may inhibit or promote plaque development or stability depending on the stage of atherosclerosis. As many of these apoptosis regulating proteins also display immune-modulating features, we have particularly investigated effects of modulation of apoptosis regulating proteins on plaque and systemic inflammation. We performed a number of studies in mouse models of atherosclerosis. First gene expression profiles of stable and unstable atherosclerotic plaques were compared in order to identify genes or pathways that are associated with plaque vulnerability. We further developed transgenic mice partially or wholly lacking genes involved in apoptosis and/or inflammation such as Bcl-2 family members and focal adhesion kinase, both systemically or in the leukocyte subset. The studies described in this thesis show amongst other things that Bim and Mcl-1, both members of the Bcl-2 family of apoptosis regulators, regulate specific cell death and inflammatory processes relevant to atherosclerosis. Show less
Atherosclerosis is a chronic inflammatory disease of the vasculature in which both a disturbed lipid metabolism and inflammatory immune responses against several self-antigens are involved. In this... Show moreAtherosclerosis is a chronic inflammatory disease of the vasculature in which both a disturbed lipid metabolism and inflammatory immune responses against several self-antigens are involved. In this thesis we have explored the effectiveness of DC-immunotherapy in atherosclerosis. We have used different strategies to target the immune component in different stages of atherosclerosis. First we used DCs as a vaccination strategy to induce a protective antibody response trough the injection of oxLDL-pulsed DCs or to target NKT cells by the injection of OCH-pulsed DCs. Next we assessed the potential of DC-immunotherapy in a model of established atherosclerosis. We also evaluated the effects of a disturbed TGF-_ signaling in DCs and the subsequent effects on atherosclerosis by using ApoE-/- which have a dysfunctional TGF-__ Receptor II under the CD11c promoter. Next, we were interested in the effect of foam-cell formation on the antigen-presenting capacity of DCs and macrophages. Therefore we studied the effect of oxLDL-loading on antigen uptake and antigen presentation by DCs and macrophages. Finally, by depleting or inducing Tregs we investigated the potential role of regulatory T cells in a mouse model for aneurysm formation. Show less
The studies described in this thesis focus on gene therapeutic strategies to target pathological vascular wall remodeling after PT(C)A or bypass surgery. Inflammatory processes and extracellular... Show moreThe studies described in this thesis focus on gene therapeutic strategies to target pathological vascular wall remodeling after PT(C)A or bypass surgery. Inflammatory processes and extracellular proteases, both activated by mechanical and vascular injury caused by these interventions, are thought to contribute largely to the development of post-angioplasty restenosis and vein graft disease. Therefore, viral and non-viral gene therapy techniques were used in these studies to deliver genes encoding protective as well as inhibiting proteins in order to modulate the inflammatory cascade (i.e. IL-10 and the MCP-1/CCR-2 pathway) in the first part of this thesis and the plasminogen activator and MMP-system in the second part. Finally, the expression of several involving genes was blocked locally by RNA interference techniques in the last part of this thesis. The possibilities and effects of these gene therapy applications were studied in cell cultures, in a human saphenous vein organ culture model and in two mouse models of restenosis and vein graft disease. Altogether, these studies provided more insight into the pathophysiology of post-interventional remodeling and several potential therapeutic strategies were assessed. Show less
The aim of this thesis was to explore the relation between visceral obesity and the accompanying metabolic disturbances, systemic inflammation and the atherosclerotic process. A newly developed... Show moreThe aim of this thesis was to explore the relation between visceral obesity and the accompanying metabolic disturbances, systemic inflammation and the atherosclerotic process. A newly developed magnetic resonance vessel wall imaging technique was implemented in phenotyping patients and as a therapeutic endpoint in a randomised controlled setting. A three step approach was chosen for this purpose. First, the magnetic resonance black blood vessel wall imaging technique at the magnetic field strength of 3 Tesla was developed and validated. Secondly, phenotyping of viscerally obese subjects was performed with special attention for the role of systemic inflammation and atherosclerosis. Finally, in the setting of a randomised controlled trial, the impact of reducing visceral obesity and systemic inflammation with lifestyle intervention and rosiglitazone treatment (PPARg agonist) on the progression of atherosclerosis was assessed. Show less
The research described in this thesis consist of 2 parts: the first part involves studies on the influence of chemokines in cardiovascular disease. Chemokines are inflammatory proteins which play a... Show moreThe research described in this thesis consist of 2 parts: the first part involves studies on the influence of chemokines in cardiovascular disease. Chemokines are inflammatory proteins which play a pivotal role in atherosclerosis and myocardial ischemia. We identify 3 chemokines (CCL3, CCL5 and CCL18) whose levels are not only elevated during myocardial ischemia, but are also predictive of future cardiovascular events. Further studies focus on the individual role of CCL18 as well as CCL3 in atherogenesis and atherosclerotic plaque destabilization. The first is seen to recruit T-lymphocytes and the latter neutrophil granulocytes into the plaque, possibly augmenting plaque growth and destabilization. The second part focuses on the effect of gene modulation on vascular function. It start of with a study on the influence of aging in our atherosclerotic plaque mouse model. Additional genetic microarray revealed the Quaking gene as a possible modulator of atherosclerosis. This observation is further explored in studies which show a link between Quaking genetic polymorphisms and an enhanced risk of developing in-stent restenosis following percutaneous coronary intervention. This is partly mediated by disturbed vascular smooth cell function. Finally, the MEF2 gene is studied for its role in myocardial infarction as genetic mutations in the MEF2A gene are associated with enhanced risk for a myocardial infarction. In a mouse model, we show that this is primarily due to decreased endothelial cell function, leading to plaque erosion. Show less
Cardiovascular disease (CVD) is a major cause of mortality and morbidity in the Western world. CVD is mainly caused by atherosclerosis, for which dyslipidemia, characterized by high a plasma level... Show moreCardiovascular disease (CVD) is a major cause of mortality and morbidity in the Western world. CVD is mainly caused by atherosclerosis, for which dyslipidemia, characterized by high a plasma level of (very) low density lipoprotein ((V)LDL) and a low plasma level of high density lipoprotein (HDL), is a major risk factor. To reduce the risk to develop CVD, drugs aimed at correcting dyslipidemia by lowering (V)LDL are currently the first choice of treatment. Albeit that these drugs lower (V)LDL-C very efficiently (up to ~40%), and generally result in a slight increase in HDL-C, they only prevent a fraction of all cardiovascular events (~30%). Therefore new therapeutic strategies to reduce cardiovascular events more efficiently are necessary. Since HDL is has been attributed multiple protective effects in atherosclerosis by its role in reverse cholesterol transport and its anti-inflammatory and anti-oxidative properties, HDL-raising therapy is currently considered as a promising strategy to further reduce CVD risk. In this thesis, the mechanisms underlying the HDL-raising effects of the classical lipid-lowering drugs fenofibrate, atorvastatin and niacin were elucidated. Furthermore, the effects of potential novel HDL-raising strategies, including torcetrapib, PXR agonism and apoCI, on HDL metabolism were addressed. For these studies, we used the APOE*3-Leiden.CETP (E3L.CETP) transgenic mouse, a valuable model for human-like lipoprotein metabolism Show less
In summary, in this thesis it becomes clear that the intrauterine environment created by the mother during pregnancy not only has beneficial effects on the developing embryo / fetus. Although it is... Show moreIn summary, in this thesis it becomes clear that the intrauterine environment created by the mother during pregnancy not only has beneficial effects on the developing embryo / fetus. Although it is too early to draw definite conclusions, the first results of this research line show that maternal apoE-deficiency, in contrast to maternal Ldlr-deficiency, adversely affects the offspring, not only in late fetal stages but also in adult life. Our data indicate that the inflammatory status of the mother and the lack of maternal apoE itself may attribute to the increased cardiovascular disease risk observed in the adult offspring. Hypercholesterolemia and oxidative stress possibly play a more regulatory role. In a first attempt to elucidate the underlying mechanism we show that maternal apoE-deficiency leads to changes in the histone triple-methylation modifications in the vascular wall of the offspring. Thi s can be considered an important lead that needs to be investigated further. It does not mean, however, that we are close to complete elucidation of the underlying mechanism. A lot of research is needed to accomplish this and it is needed. Why? The fact that a hit so early in life exerts negative effects on cardiovascular disease risk in adulthood is worrisome. If we could succeed in elucidating the exact role of epigenetics in this process and are able to translate these data to the human situation, possibly we could reduce the incidence of cardiovascular disease. Show less
Current non-invasive detection of coronary artery disease (CAD) is based on demonstration of ischemia using stress-rest imaging: this is an indirect way of identifying CAD by demonstration of the... Show moreCurrent non-invasive detection of coronary artery disease (CAD) is based on demonstration of ischemia using stress-rest imaging: this is an indirect way of identifying CAD by demonstration of the hemodynamic consequences rather than direct visualization of the obstructive lesions in the coronary arteries. Multi-slice computed tomography (MSCT) has recently emerged as an extremely rapidly developing non-invasive imaging modality, which allows anatomical imaging of the coronary arteries, or non-invasive coronary angiography. In addition, total plaque burden, plaque morphology and (to some extent) plaque constitution can be assessed by MSCT. The technique also provides information on resting left ventricular systolic function, and possibly resting perfusion. Ideally, stress function and perfusion should also be evaluated, since this would allow detection of ischemia and would complete the picture on CAD. However, this is not routinely performed, since sequential acquisitions are associated with high radiation doses and thus pose a limitation for cardiovascular applications of MSCT. It is anticipated that, with reduction in radiation, MSCT may become an important player in the diagnostic and prognostic workup of patients with known or suspected CAD. Show less
In this thesis we aimed to expand our knowledge on the pathophysiological aspects of the metabolic syndrome in transgenic mice. The metabolic syndrome involves multiple aspects and has a major... Show moreIn this thesis we aimed to expand our knowledge on the pathophysiological aspects of the metabolic syndrome in transgenic mice. The metabolic syndrome involves multiple aspects and has a major impact on cardiovascular diseases. In the first part of thesis the role of PAI-1 in the development of insulin resistance will addressed. This part will also focus on the mechanism of plasma PAI-1 clearance. In the second part of this thesis, the roles of LRP in atherosclerosis and LPL activity in lipid metabolism are addressed. In this thesis we showed the PAI-1 catabolism is facilitated by a RAP-sensitive mechanism other than LRP, LDLR and VLDLR. The increased plasma PAI-1 levels observed in insulin resistance and obesity is not explained by impaired clearance of PAI-1. The increased plasma PAI-1 levels might be an epiphenomenon of the chronic inflammatory state of insulin resistance or obesity. Furthermore, alternative pathways other than the traditional lipoprotein receptors are involved in the regulation of plasma cholesterol and triglyceride levels. The development of atherosclerosis is multi-factorial in which the balance between the antiand pro-inflammatory processes plays a central role. Macrophage LRP might be one of the features that control this balance. Inflammation not only promotes to the development of atherosclerosis, but might also be involved in the processes that restore the damaged vascular wall. Show less
