Cited by 1,014Atherosclerosis and Cardiovascular DiseasesCholesterol and Lipid MetabolismLipoproteins and Cardiovascular Health

Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. Intimal accumulation of low density lipoprotein and its oxidation precede monocyte recruitment into early atherosclerotic lesions.

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Napoli, C, D'Armiento, F P, Mancini, F P, Postiglione, A, Witztum, J L, Palumbo, G, Palinski, W·1997·Journal of Clinical Investigation

Abstract

To determine whether oxidized LDL enhances atherogenesis by promoting monocyte recruitment into the vascular intima, we investigated whether LDL accumulation and oxidation precede intimal accumulation of monocytes in human fetal aortas (from spontaneous abortions and premature newborns who died within 12 h; fetal age 6.2+/-1.3 mo). For this purpose, a systematic assessment of fatty streak formation was carried out in fetal aortas from normocholesterolemic mothers (n = 22), hypercholesterolemic mothers (n = 33), and mothers who were hypercholesterolemic only during pregnancy (n = 27). Fetal plasma cholesterol levels showed a strong inverse correlation with fetal age (R = -0.88, P < 0.0001). In fetuses younger than 6 mo, fetal plasma cholesterol levels correlated with maternal ones (R = 0.86, P = 0.001), whereas in older fetuses no such correlation existed. Fetal aortas from hypercholesterolemic mothers and mothers with temporary hypercholesterolemia contained significantly more and larger lesions (758,651+/-87,449 and 451,255+/-37,448 micron2 per section, respectively; mean+/-SD) than aortas from normocholesterolemic mothers (61,862+/-9,555 micron2; P < 0.00005). Serial sections of the arch, thoracic, and abdominal aortas were immunostained for recognized markers of atherosclerosis: macrophages, apo B, and two different oxidation-specific epitopes (malondialdehyde- and 4-hydroxynonenal-lysine). Of the atherogenic sites that showed positive immunostaining for at least one of these markers, 58.6% were established lesions containing both macrophage/foam cells and oxidized LDL (OxLDL). 17.3% of all sites contained only native LDL, and 13.3% contained only OxLDL without monocyte/ macrophages. In contrast, only 4.3% of sites contained isolated monocytes in the absence of native or oxidized LDL. In addition, 6.3% of sites contained LDL and macrophages but few oxidation-specific epitopes. These results demonstrate that LDL oxidation and formation of fatty streaks occurs already during fetal development, and that both phenomena are greatly enhanced by maternal hypercholesterolemia. The fact that in very early lesions LDL and OxLDL are frequently found in the absence of monocyte/macrophages, whereas the opposite is rare, suggests that intimal LDL accumulation and oxidation contributes to monocyte recruitment in vivo.

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  • Oxidative modification of lipoproteins has been observed in human fetal arterial samples before signs of inflammation such as macrophage infiltration appear.

    “oxidative modification of lipoproteins has been observed in arterial samples from human fetuses even before signs of inflammation, such as macrophage infiltration, are present17.”

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  1. Lillie, R.D. 1965. Histopathologic techniques and practical histochemis- try. McGraw Hill, New York.

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Authors
Napoli, C., D'Armiento, F. P., Mancini, F. P., Postiglione, A., Witztum, J. L., Palumbo, G., & Palinski, W.
Affiliations
  • University of Naples Federico II (IT)
  • University of California San Diego (US)
Venue
Journal of Clinical Investigation
Published
1997-12-01
Volume
100
Issue
11
Pages
2680-2690
ISSN
0021-9738 (ISSN-L)
OpenAlex
W2095282566
Cited by
1,014
References
59
Citations by year
2026: 17 · 2025: 17 · 2024: 21 · 2023: 44 · 2022: 32 · 2021: 34 · 2020: 31 · 2019: 29 · 2018: 32 · 2017: 31 · 2016: 40 · 2015: 42 · 2014: 32 · 2013: 42 · 2012: 41
FWCI
7.98
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
Funders
  • Università degli Studi di Napoli Federico II
  • Regione Campania
  • Consiglio Nazionale delle Ricerche
  • National Institutes of Health (5p50hl014197-25)
  • National Heart, Lung, and Blood Institute (HL 14197, HL65989)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
Keywords
fatty streak formation, fetal aorta, maternal hypercholesterolemia, oxidized LDL, low-density lipoprotein, monocyte recruitment, atherosclerosis, macrophages, foam cells, malondialdehyde, 4-hydroxynonenal, pregnancy, atherogenesis, preterm infants, miscarriage
MeSH terms
Adult, Aldehydes, Aorta, Apolipoproteins B, Arteriosclerosis, Cholesterol, Female, Fetal Diseases, Humans, Hypercholesterolemia, Lipoproteins, Macrophages, Malondialdehyde, Pregnancy, Pregnancy Complications, Hematologic, Lipid Peroxidation

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