Growth of human aortic smooth muscle cells cultured with human serum is retarded when serum lipids are lowered by medroxyprogesterone

Oxidized LDL, glomerular mesangial cells and collagen

Lipid deposits, foam cell collection and accumulation of mesangial matrix components are recognized as early events in the development of focal segmental glomerulosclerosis (FSGS). Studies have suggested that oxidative stress is increased in uremic patients. Oxidized low-density lipoprotein (Ox-LDL) has been identified in the lesions of FSGS. Dietary antioxidants reduced not only the staining intensity of Ox-LDL but also the severity of renal injury in rats with experimental FSGS possibly by making lipoproteins resistant to oxidation. In vitro studies showed that LDL during its incubation with human mesangial cells (HMC) was peroxidatively modified and stimulated alpha1(I), alpha1(III), and alpha1(IV) collagen mRNA expression. Vitamin E, an antioxidant, and antibody against Ox-LDL caused a marked reduction in collagen mRNA stimulated by LDL. These findings suggest that LDL deposited and oxidized in the glomeruli may be implicated in the development of glomerulosclerosis by facilitating excessive mesangial matrix generation.

Involvement of oxidation in LDL-induced collagen gene regulation in mesangial cells

Oxidized low-density lipoprotein (Ox-LDL) is present in the lesions of focal segmental glomerulosclerosis (FSGS), but the role of Ox-LDL in the disease process is not clear. Recent studies have shown that LDL stimulates the type IV collagen mRNA expression in cultured mesangial cells. Thus, we examined whether oxidative stress is responsible for the stimulation of LDL-induced collagen gene expression in cultured human mesangial cells (HMCs). When quiescent HMCs were exposed to serum-free media containing LDL for 48 hours, peroxidation of LDL was induced as shown by the increased production of thiobarbituric acid-reactive substances (TBARS). LDL stimulated the alpha 1 (I), alpha 1 (III), and alpha 1 (IV) mRNA expression in a dose-dependent manner. At a concentration of 200 micrograms/ml, LDL enhanced the levels of alpha 1 (I), alpha 1 (III), and alpha 1 (IV) mRNA by 3.7-, 3.8- and 3.2-fold, respectively, over the levels in the control cells. These transcripts were further increased 5.4-, 6.7-, and 5.9-fold, respectively, by the addition of 500 micrograms/ml of LDL. Cu(2+)-catalyzed Ox-LDL at a concentration of 200 micrograms/ml also stimulated the alpha 1 (I), alpha 1 (III), and alpha 1 (IV) mRNA expression 4.4-, 5.9-, and 2.8-fold, respectively, compared with the control cells. The addition of monoclonal antibody (mAb) OL-10, which recognizes the malondialdehyde (MDA)-modified peptide epitope, or vitamin E (50 microM) to cultured HMC exposed to LDL markedly inhibited the stimulation of collagen gene expression. When HMCs were incubated with MDA (200 microM), alpha 1 (I), alpha 1 (III), and alpha 1 (IV) mRNA levels increased by two- to threefold compared to control cells. Immunohistochemical staining utilizing mAb OL-10 demonstrated the presence of MDA-modified proteins in the cytoplasm of HMC exposed to either LDL or MDA. These results suggest that peroxidative products of LDL stimulate collagen gene expression possibly via modification of proteins, which are responsible for the expression of collagen genes in cultured HMCs. Given that, lipid peroxidation of LDL may be implicated in the development of glomerulosclerosis by facilitating excessive mesangial matrix generation.

Effects of progestogens on haemostasis

Epidemiological data suggested an involvement of the progestogen component in the pathomechanism of venous and arterial diseases during intake of oral contraceptives. The influence of progestogens on haemostasis parameters depend on type and dose of the progestogen, the presence of an estrogen, the route of application, and the duration of use. Treatment of women with progestogen-only preparations caused only minor effects on coagulation and fibrinolysis. Similarly, during hormone replacement therapy with natural estrogens, the additional application of progestogens induced no unfavourable changes on haemostasis. In contrast, the use of ovulation inhibitors resulted in an acceleration of coagulation and fibrinolysis. This is primarily induced by the marked action of ethinylestradiol on hepatic and vascular function. Progestogens with androgenic properties may counteract the estrogen-induced changes in the hepatic synthesis of platelet aggregation and readiness for coagulation. Estrogen and progesterone receptors are localized in endothelial and smooth muscle cells of the vessel wall, but there are differences in the response of veins and arteries to sex steroids. Estrogens and progestogens may influence collagen and elastin synthesis, and the release of vasoactive compounds and of factors controlling fibrinolysis from endothelium. In veins, progestogens may increase distensibility and capacitance resulting in a decreased blood flow. In predisposed women, this may lead to venous stasis and thrombosis. In arteries, progestogens may act as vasoconstrictors, and may enhance vasospasms at sites of injured endothelium which finally may lead to ischemic diseases.

Oestrogens and atherosclerotic vascular disease--lipid factors

Cardiovascular disease remains the major cause of death for postmenopausal women in Western societies. The majority of epidemiological studies indicate that postmenopausal oestrogen replacement therapy is associated with a 50% reduction in the risk of cardiovascular disease, with much of the reduction being mediated by changes in the plasma concentration of cholesterol within high and low density lipoproteins. In addition to favourably influencing the plasma concentration of lipoproteins, oestrogens also influence the complex metabolism of lipoproteins in the arterial wall, helping to impede the formation of the atherosclerotic plaque. Whilst oestrogens alter endothelial function, vascular reactivity and fibrinolysis, these changes are also seen with reduction of LDL cholesterol and may partly reflect the altered concentration of plasma lipoproteins induced by oestrogens. Oral oestrogens have substantially greater favourable effects on LDL and HDL cholesterol than their transdermal counterparts but also result in greater hypertriglyceridaemia. Most progestogens antagonize the beneficial effects of oestrogens on lipoproteins in a dose-dependent manner; however, cyclical use of low doses of progestogens with an oral oestrogen generally retains a net beneficial effect. Lipoprotein levels fluctuate during cyclical therapy, the most adverse changes being noted at the end of the progestogen phase. Lipoprotein concentrations are constant during continuous combined regimens which have the potential for more prolonged exposure to an adverse progestational effect. Despite adverse effects on the lipoprotein profile, animal studies suggest that progestogens do not substantially reverse the beneficial effects of oestrogens on the development of atherosclerosis. Finally, oestrogen therapy may be useful in the management of postmenopausal women with hyperlipidaemia, and also in the secondary prevention of clinical sequelae in women with established atherosclerosis.

Triggerlike stimulation of cholesterol accumulation and DNA and extracellular matrix synthesis induced by atherogenic serum or low density lipoprotein in cultured cells

A 72-hour incubation of cultured cells with blood sera or plasma of patients suffering from coronary heart disease (CHD) with angiographically assessed coronary atherosclerosis caused a threefold to fourfold elevation of intracellular cholesterol. An elevated cholesterol level in the cells precultured with patients' sera was retained several days after the removal of the examined serum from culture. The accumulation of intracellular cholesterol was accompanied by enhanced synthesis of DNA, total protein, collagen, sulfated glycosaminoglycans, and hyaluronic acid. Enhanced DNA and total protein synthesis was retained for at least 9 days after the serum had been removed from culture. The obtained results suggest that the sera of CHD patients possess an atherogenic potential that manifests itself at the arterial cell level in the stable stimulation of atherosclerotic cellular processes: proliferation, lipidosis, and fibrosis. The examined sera of healthy donors were devoid of such an atherogenic potential. The low density lipoprotein (LDL) fraction (density, 1.030-1.050 g/cm3) obtained from an atherogenic serum had the same atherogenic potential as a whole serum. Atherosclerotic alterations in cultured intimal cells caused by atherogenic LDL were retained for at least 3 days after the removal of the lipoprotein from culture. Preincubation of intimal cells with LDL obtained from healthy donors had no effect on the intracellular cholesterol level or the synthesis of DNA and extracellular matrix. One may assume that the atherogenic potential of CHD patients' sera is related to the presence of LDLs that are qualitatively different from the LDL of healthy subjects.