HDL apolipoprotein-related peptides in the treatment of atherosclerosis and other inflammatory disorders.

Elevations of HDL levels or modifying the inflammatory properties of HDL are being evaluated as possible treatment of atherosclerosis, the underlying mechanism responsible for most cardiovascular diseases. A promising approach is the use of small HDL apoprotein-related mimetic peptides. A number of peptides mimicking the repeating amphipathic α-helical structure in apoA-I, the major apoprotein in HDL, have been examined in vitro and in animal models. Several peptides have been shown to reduce early atherosclerotic lesions, but not more mature lesions unless coadministered with statins. These peptides also influence the vascular biology of the vessel wall and protect against other acute and chronic inflammatory diseases. The biologically active peptides are capable of reducing the pro-inflammatory properties of LDL and HDL, likely due to their high affinity for oxidized lipids. They are also capable of influencing other processes, including ABCA1 mediated activation of JAK-2 in macrophages, which may contribute to their anti-atherogenic function. The initial studies involved monomeric 18 amino acid peptides, but tandem peptides are being investigated for their anti-atherogenic and anti-inflammatory properties as they more closely resemble the repeating structure of apoA-I. Peptides based on other HDL associated proteins such as apoE, apoJ and SAA have also been studied. Their mechanism of action appears to be distinct from the apoA-I based mimetics.

The influence of acute phase proteins on murine atherosclerosis.

Atherosclerosis is a chronic inflammatory reaction that is initiated in response to hyperlipidemia and the retention and modification of lipids within the vascular wall. Chronic inflammatory states lead to steady low-level induction of the acute phase reaction and chronic inflammation is associated with elevated cardiovascular disease and atherosclerosis. The acute phase reaction is mediated by cytokines and results in significant changes in the plasma level of several proteins referred to as acute phase proteins. The liver is a major source of these proteins. Several recent studies in humans have shown that levels of acute phase proteins are modified in patients with established cardiovascular disease or are predictors of future disease. Whether these acute phase proteins are a biomarker of inflammation or have a direct role in the development of atherosclerosis is not clear. Murine models of atherosclerosis have been used to address the role of acute phase proteins in atherosclerosis. Modification of the expression level of these proteins has shown that the individual acute phase proteins are either pro-atherogenic or anti-atherogenic. The absence of an overall trend is perhaps not surprising given the complex nature of the acute phase response.