Apolipoprotein AI as Therapy for Atherosclerosis: Does the Future of Preventive Cardiology Include Weekly Injections of the HDL Protein?

ApoAI, HDL cholesterol, and the atheroma. A. Under physiological conditions, the production rate of apoAI is the main determinant of HDL cholesterol levels, and both correlate well with the extent of cholesterol efflux from peripheral cells. The macrophage cluster in the atheroma is depicted as an example. B. The most common reason for low HDL is reduced production or increased elimination of lipid poor apoAI, resulting in impaired cholesterol efflux from peripheral cells. C. The apoAI_Milano reduces HDL through increased catabolism of mature HDL. This is not associated with vascular deterioration because the production rate of apoAI is normal and its ability to collect cellular cholesterol is increased. D. A strategy based on increasing the amount and availability of normal apoAI in the vessel wall results in vascular benefits without any changes in plasma HDL cholesterol levels (see text for details).