An hypothesis for the immunopathogenesis of atherosclerosis.

According to the textbooks, oxidative processes transform low density lipoprotein (LDL) to an atherogenic moiety. Oxidized LDL contains potentially harmful constituents that induce inflammatory responses in endothelial cells, smooth muscle cells and macrophages. The oxidation hypothesis, born 20 years ago through the work of Steinberg and colleagues [Steinberg et al. 1989], forms the basis for current discussions on the pathogenesis of atherosclerosis [Glass and Witztum 2000, Lusis 2000]. In the clinical setting, however, a puzzle relates to the failure of antioxidants to prevent and cure coronary heart disease; we here allude to just the most recent study [Brown et al. 2001]. More unobtrusively, experimental observations accumulating over the past years have laid the foundation for an alternative view on atherogenesis that will be outlined here.