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Review |
From AstraZeneca R&D (E.H.-C., G.C.), Cell Biology and Biochemistry, Mölndal; Wallenberg Laboratory (E.H.-C., G.C., H.P.), Göteborg University, Sweden; and Wihuri Research Institute (K.O., P.K.), Helsinki, Finland.
Correspondence to Eva Hurt-Camejo, Cell Biology and Biochemistry, AstraZeneca, R&D, S-431 83, Mölndal, Sweden. E-mail Eva.Hurt-Camejo{at}astrazeneca.com
| Abstract |
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Key Words: atherosclerosis inflammation cytokines lipases lysophospholipids
| Introduction |
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| The Family of PLA2 |
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Mammalian sPLA2 appears to be implicated in a variety of physiological and pathological processes. These include lipid digestion, release of potent lipid mediators in response to cytokines stimulus,36 cell proliferation,37 control of virus and bacterial infection,38,39 removal of apoptotic or injured cells,40,41 phospholipid repair, lipoprotein catabolism,25,27,42,43 tumorigenesis, and inflammation (for reviews, see Uhl et al44).
| sPLA2-IIA in the Arterial Wall |
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In nonatherosclerotic human arteries, sPLA2-IIA is mainly associated with the smooth muscle cells of the media, whereas in atherosclerotic plaques the enzyme is also found in macrophage-rich regions, in the acellular lipid core of atheromas, and in the extracellular matrix of the diseased intima in association with collagen fibers.15,50 Immunohistochemical studies performed by several research groups show that sPLA2-IIA is found at all stages of atherosclerotic lesion development.15,5055 Cytoplasmic PLA2 (group IV) is also present in atherosclerotic lesions containing macrophages. However, the activity of sPLA2-IIA is more prominent than that of the cytoplasmic enzyme in the same human plaque.52 In summary, immunohistochemical studies show that sPLA2-IIA is present in normal arteries, and that, in early and late atherosclerotic lesions, its extracellular distribution and level of cell expression is increased, suggesting that the enzyme is implicated in atherogenesis.15,52,53
Most studies on sPLA2-IIA expression in vascular cells have been performed with rat smooth muscle cells.56 Although some of these results can be extrapolated to human arterial smooth muscle cells, recent studies suggest that regulation of sPLA2-IIA gene expression is cell- and species-specific.57,58 We reported recently that expression of both sPLA2-IIA mRNA and protein by human arterial smooth muscle cells from the aorta and the coronary and uterine arteries requires conditions that promote cell differentiation in vitro.58 These in vitro results agree with immunohistochemical data showing that, in arteries, the main source of sPLA2-IIA is smooth muscle cells.15,55 Electron microscopy shows that sPLA2-IIA is stored intracellularly inside vesicles close to the smooth muscle cell membrane.50 Cytokines, in vitro, differentially modulate cell secretion and mRNA levels of sPLA2-IIA. Thus, interferon-
(IFN-
) increases the expression of mRNA and sPLA2-IIA protein secretion 2- to 6- fold, and, after addition of IFN-
, this effect lasts up to 48 hours. On the other hand, tumor necrosis factor-
(TNF-
) stimulates sPLA2-IIA secretion for only 4 hours, without detectable changes in mRNA levels. Interestingly, a similar effect of TNF-
is seen in sPLA2-IIA transgenic mice.39,59 Interleukin-10 (IL-10), an anti-inflammatory cytokine, downregulates IFN-
, but not TNF-
, induction of sPLA2-IIA secretion. In contrast to what was reported with rat smooth muscle cells, interleukin-1ß (IL-1ß) is not a strong inducer of sPLA2-IIA in human arterial smooth muscle cells. Colocalization of sPLA2-IIA with the mRNA transcript for IFN-
, IL-1ß, and TNF-
in human atherosclerotic lesions supports a possible in vivo involvement of these cytokines in the regulation of sPLA2-IIA gene expression and protein secretion in atherosclerotic plaques.54
Cytokines acting on tissues may also indirectly regulate the circulating levels of sPLA2-IIA in plasma. SPLA2-IIA is an acute-phase reactant and, in diseases that involve systemic inflammation such as sepsis, rheumatoid arthritis,60 and cardiovascular disease,30,61 its plasma levels are increased. Hepatocytes synthesize and secrete this enzyme in response to cytokines such as IL-6, TNF-
, and IL-1ß,62 but not IFN-
.58 In addition, peritoneal injections of IL-6, TNF-
, and IL-1ß increase plasma levels of sPLA2-IIA in transgenic mice expressing the gene of human sPLA2-IIA.39,59 Together, these data suggest that hepatocytes and arterial smooth muscle cells may contribute to the bulk of circulating sPLA2-IIA in plasma modulated by systemic inflammatory conditions. This hypothesis is illustrated in Figure 1.
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The presence of active sPLA2-IIA in plasma suggests that it may hydrolyze the surface phospholipid monolayer of plasma lipoproteins. A high plasma level of sPLA2-IIA correlates positively with C-reactive protein (CRP) levels and predicts coronary events due to atherosclerosis.28,30,61,63 This association is independent of other established risk factors.28 Furthermore, positive correlations between sPLA2-IIA and soluble adhesion molecules, CRP, and antibody titers to oxidized LDL in plasma of hypercholesterolemic patients were recently reported.64,65 In vitro hydrolysis of LDL phospholipids makes the lipoproteins particles more susceptible to oxidative modification.16,66 Thus, a similar process in plasma may generate oxidation-susceptible LDL and a possible circulating antigen. The clinical studies cited suggest that sPLA2-IIA in plasma may serve as another inflammatory marker for cardiovascular diseases, similar to CRP, serum amyloid A protein (SAA), soluble adhesion molecules, IL-6, and circulating oxidized LDL.67,68
| Possible Atherogenic Actions of sPLA2-IIA |
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In the arterial wall, sPLA2-IIA may exert proatherogenic effects by the three main mechanisms illustrated in Figure 2. First, it may induce release of relatively high concentrations of lipid mediators such as NEFAs, oxidized NEFAs, and lysophospholipids, which may affect the function and properties of vascular cells at sites of apoB-100 lipoprotein accumulation.7,22 Second, sPLA2-IIA may modify apoB-100 lipoproteins to a more atherogenic form by increasing their binding affinity toward proteoglycans and also by making the PLA2-treated lipoproteins more susceptible to further oxidative and enzymatic modifications.16,42,66 Third, the enzyme can also contribute to lipoprotein accumulation by inducing aggregation and fusion of the proteoglycan-bound apoB-100 lipoproteins.31,79,80 Treatment of LDL with sPLA2-IIA in the presence of physiological albumin concentration leads to the formation of small dense LDL particles with increased affinity for glycosaminoglycans and proteoglycans.23 As discussed above, this may take place in the plasma31 or in the arterial wall, where extracellular sPLA2 can hydrolyze the phospholipids on the lipoprotein particles. Because PLA2-treated LDL particles have an increased affinity for extracellular proteoglycans, their residence time in the arterial wall is likely to increase. This provides the possibility for further modifications of these particles. In fact, PLA2-treated LDL particles are more susceptible to lipid peroxidation,66 generation of bioactive phospholipids,26 and hydrolysis by secretory sphingomyelinase.81 In addition, treatment of LDL with PLA2 facilitates sphingomyelinase-induced aggregation and fusion of LDL particles.82 PLA2 can also directly induce aggregation and fusion of LDL particles: treatment of proteoglycan-bound LDL with sPLA2-IIA leads to aggregation and subsequent fusion of the modified LDL particles.24 Interestingly, PLA2 induces fusion of LDL particles only if the particles are bound to glycosaminoglycans either before, during, or after lipolysis.83 The interaction between LDL and glycosaminoglycans can apparently overcome the rigidifying effect of PLA2-induced hydrolysis on LDL particles.79 Thus, it can be hypothesized that if the small dense LDL particles generated by the action of sPLA2-IIA either in plasma or in the arterial intima bind to arterial proteoglycans, this interaction will then trigger aggregation and fusion of the bound LDL particles. Because each aggregate or fused particle contains several copies of apoB-100, it is not surprising that the aggregated/fused particles bind to proteoglycans even more tightly than do the small dense PLA2-treated LDL.82 Moreover, as the modified LDL particles aggregate or fuse, the capacity of arterial proteoglycans to bind LDL increases.24 Thus, aggregation and fusion of LDL particles in the arterial intima are likely to lead to accumulation of LDL-derived lipid particles within the extracellular matrix. Such progressive deposition of lipid within the extracellular matrix of the arterial intima is a central feature of atherogenesis and thus makes the arterial sPLA2-IIA a strong candidate as one of the key enzymes acting in the extracellular space during the development of atherosclerotic lesions. These proatherogenic mechanisms may be potentiated by the colocalization of sPLA2-IIA and apoB-100 lipoproteins with extracellular matrix proteoglycans in the intima. It should be stressed that the total hydrolysis of the phosphoglycerides from one LDL particle may generate more than 500 molecules of lysophospholipids and NEFAs. Thus, at sites of retention of apoB-100 lipoproteins in the arterial intima, NEFAs and lysophospholipids may reach high local concentrations. These bioactive products can induce different proatherogenic cellular processes and cell membrane perturbation. Human arterial smooth muscle cells exposed to albumin-bound NEFAs upregulate the synthesis of matrix proteoglycans.19 This results in a matrix that has a higher affinity for LDL, suggesting the possibility of a noxious cycle in which sPLA2-IIA products from apoB-100 lipoproteins entrapped in the intima trigger matrix changes, which, in turn, lead to further accumulation of lipoproteins. Peroxisome proliferator-activated receptor-
(PPAR-
) agonists oppose this action of NEFAs, suggesting that the improved metabolism of NEFAs downregulates the increase in matrix synthesis in vivo.
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| Molecular Basis and Effects of the sPLA2-IIA Interaction With Arterial Proteoglycans |
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| Other PLA2 Enzymes of Interest in Atherosclerosis |
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There are no studies that could help us to conclude which of these two phospholipases, sPLA2-IIA or the lipoprotein-associated enzyme, has the greater potential for atherogenesis. However, compared with the lipoprotein-associated PLA2, sPLA2-IIA hydrolyzes intact as well as oxidized phospholipids, thus generating NEFAs, oxidized NEFAs, and lysophospholipids from a broader spectrum of substrates. In addition, its expression in the mouse increases the susceptibility to atherosclerosis and its plasma levels predict coronary events in patients with well-defined atherosclerosis. Therefore, sPLA2-IIA may also be a potential target for therapeutic antiatherogenic agents. In vivo studies in models of atherosclerosis with specific inhibitors of each enzyme will be necessary to evaluate their relative relevance for the disease in vivo.
Although not yet directly implicated in arterial disease, the group V and group X sPLA2 enzymes are expressed in macrophages and mast cells (group V) and in spleen and thymus (group X),8991 and a novel sPLA2, group XII, is found in stimulated type 2 helper T cells.92 Therefore, these enzymes may be prominent at sites where macrophages, lymphocytes, and mast cells accumulate in atherosclerotic lesions. Groups V and X are more efficient than sPLA2-IIA in hydrolyzing phosphatidylcholine vesicles and the outer plasma membrane of intact mammalian cells.93 Thus, their capacity to release fatty acids and lysophospholipids, which in turn induce cellular eicosanoid production, may also be higher than that of sPLA2-IIA.90,93 The presence of tryptophan and less basic residues in the interface-binding region of these enzymes appears to contribute to their efficient hydrolysis of cell-membrane phospholipids.34 However, the possible involvement of sPLA2-V, sPLA2-X, and sPLA2-XII and their potential overlapping function with sPLA2-IIA in sustaining a chronic inflammation in atherogenesis remains to be studied.
In addition to the secretory phospholipases mentioned above, an endothelial lipase (EL) was discovered recently.94,95 EL belongs to the family of triglyceride lipases. However, in contrast to other lipases, EL has substantial phospholipase activity and lipoprotein phospholipids are its major substrate.94,95 EL is synthesized by macrophages, and its expression by coronary artery endothelial cells is upregulated by inflammatory cytokines.96 Thus, this enzyme provides the arterial intima with another regulated lipolytic mechanism for local release of fatty acids and lysophospholipids from lipoproteins that may influence atherogenesis.97
| Future Directions |
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| Acknowledgments |
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Received March 12, 2001; accepted July 3, 2001.
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