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Atherosclerosis is a degenerative disease characterized by lesions that develop in the wall of large- and medium-sized arteries due to the accumulation of low-density lipoproteins (LDLs) in the intima. A growing bulk of evidence suggests that cholesterol oxidation products, known as oxysterols, and the aldehyde 4-hydroxy-2-nonenal (HNE), the major pro-atherogenic components of oxidized LDLs, significantly contribute to atherosclerotic plaque progression and destabilization, with eventual plaque rupture. The involvement of certain members of the protein convertase subtilisin/kexin proteases (PCSKs) in atherosclerosis has been recently hypothesized. Among them, PCSK6 has been associated with plaque instability, mainly thanks to its ability to stimulate the activity of matrix metalloproteinases (MMPs) involved in extracellular matrix remodeling and to enhance inflammation. In U937 promonocytic cells and in human umbilical vein endothelial cells, an oxysterol mixture and HNE were able to up-regulate the level and activity of PCSK6, resulting in MMP-9 activation as demonstrated by PCSK6 silencing. Inflammation, enhanced by these lipid oxidation products, plays a key role in the up-regulation of PCSK6 activity as demonstrated by cell pretreatment with NS-398, with epigallocatechin gallate or with acetylsalicylic acid, all with anti-inflammatory effects. For the first time, we demonstrated that both oxysterols and HNE, which substantially accumulate in the atherosclerotic plaque, up-regulate the activity of PCSK6. Of note, we also suggest a potential association between PCSK6 activity and MMP-9 activation, pointing out that PCSK6 could contribute to atherosclerotic plaque development.

A growing bulk of evidence suggests that cholesterol oxidation products, known as oxysterols, are potentially involved in the pathogenesis of major chronic diseases, including atherosclerosis, Alzheimer's disease, and inflammatory bowel disease. Oxysterols are involved in various key steps of these complex processes, mainly thanks to their ability to act through up-regulation of oxidative stress, inflammation, and cell toxicity. This review summarizes the current knowledge of the effects induced by these compounds on cells, after their accumulation in the arterial wall, brain, and intestine. This evidence might help to develop innovative strategies to counteract the progression of these chronic inflammatory human diseases.

Alzheimer's disease (AD) is a gradually debilitating disease that leads to dementia. The molecular mechanisms underlying AD are still not clear, and at present no reliable biomarkers are available for the early diagnosis. In the last several years, together with oxidative stress and neuroinflammation, altered cholesterol metabolism in the brain has become increasingly implicated in AD progression. A significant body of evidence indicates that oxidized cholesterol, in the form of oxysterols, is one of the main triggers of AD. The oxysterols potentially most closely involved in the pathogenesis of AD are 24-hydroxycholesterol and 27-hydroxycholesterol, respectively deriving from cholesterol oxidation by the enzymes CYP46A1 and CYP27A1. However, the possible involvement of oxysterols resulting from cholesterol autooxidation, including 7-ketocholesterol and 7β-hydroxycholesterol, is now emerging. In a systematic analysis of oxysterols in post-mortem human AD brains, classified by the Braak staging system of neurofibrillary pathology, alongside the two oxysterols of enzymatic origin, a variety of oxysterols deriving from cholesterol autoxidation were identified; these included 7-ketocholesterol, 7α-hydroxycholesterol, 4β-hydroxycholesterol, 5α,6α-epoxycholesterol, and 5β,6β-epoxycholesterol. Their levels were quantified and compared across the disease stages. Some inflammatory mediators, and the proteolytic enzyme matrix metalloprotease-9, were also found to be enhanced in the brains, depending on disease progression. This highlights the pathogenic association between the trends of inflammatory molecules and oxysterol levels during the evolution of AD. Conversely, sirtuin 1, an enzyme that regulates several pathways involved in the anti-inflammatory response, was reduced markedly with the progression of AD, supporting the hypothesis that the loss of sirtuin 1 might play a key role in AD. Taken together, these results strongly support the association between changes in oxysterol levels and AD progression., Highlights • Changes in brain oxysterol levels may influence AD progression. • Oxysterol accumulation in the brain may amplify neuroinflammation. • SIRT-1 loss during AD progression may favor neuroinflammation. • Oxysterols and SIRT-1 might be useful markers for early AD diagnosis.

Cholesterol oxidation products such as oxysterols are considered critical factors in the atherosclerotic plaque formation since they induce oxidative stress, inflammation and apoptotic cell death. 27-hydroxycholesterol (27-OH) is one of the most represented oxysterols in atherosclerotic lesions. We recently showed that relatively low concentrations of 27-OH generated a strong survival signaling through an early and transient increase of cellular ROS level, that enhanced MEK-ERK/PI3K-Akt phosphorylation, in turn responsible of a sustained quenching of ROS production. It remains to identify the link between ERK/Akt up-regulation and the consequent quenching effect on ROS intracellular level that efficiently and markedly delay the pro-apoptotic effect of the oxysterol. Here we report on the potent activation of Nrf2 redox-sensitive transcription factor by low micromolar amount of 27-OH added to U937 promonocytic cells. The 27-OH-exerted induction of Nrf2 and subsequently of the target genes, HO-1 and NQO-1, was proved to be: (i) dependent upon the activation of ERK and Akt pathways, (ii) directly responsible for the quenching of intracellular oxidative stress and by this way (iii) ultimately responsible for the observed oxysterol-induced pro-survival response. (C) 2015 Elsevier Inc. All rights reserved.

Cholesterol oxidation products, termed oxysterols, have been shown to be more reactive than unoxidized cholesterol, possessing marked pro-inflammatory and cytotoxic effects in a number of cells and tissues. Oxysterols, absorbed with the diet as products of cholesterol auto-oxidation, have recently been suggested to potentially interfere with homeostasis of the mucosal intestinal epithelium, by promoting and sustaining irreversible damage. However, the treatment of colon cancer cells with a diet-compatible mixture of oxysterols does not elicit the same responses than individual components added to the cells at the same concentrations at which they are present in the mixture. Sixty μM oxysterol mixture showed a slight pro-apoptotic effect on human colon cancer CaCo-2 cell line, evaluated in terms of caspase-3 and caspase-7 activation; conversely, 7α-hydroxycholesterol, 7β-hydroxycholesterol and 5α,6α-epoxycholesterol were identified to be able to induce a significant pro-apoptotic effect if added to cell culture singly; 7β-hydroxycholesterol had stronger action than other compounds. The enhanced production of reactive oxygen species through up-regulation of the colonic NADPH-oxidase isoform NOX1 appeared to be the key event in oxysterol-induced apoptosis in these colon cancer cells. As regards pro-inflammatory effects of oxysterols, IL-8 and MCP-1 were evaluated for their chemotactic activity. Only MCP-1 production was significantly induced by 7β-hydroxycholesterol, as well as by cholesterol and oxysterol mixture. However, oxysterol-induced inflammation appeared to be NOX1-independent, suggesting a secondary role of this enzyme in inducing inflammation in colon cancer cells. A selective cell death induced by specific oxysterols against colon cancer cells, mainly exploiting their ability to activate NOX1 in generating oxidative reactions, might represent a promising field of investigation in colorectal cancer, and might bring new insights on strategies in anticancer therapy.

Pathological accumulation of 27-carbon intermediates or end-products of cholesterol metabolism, named oxysterols, may contribute to the onset and especially to the development of major chronic diseases in which inflammation, but also oxidative damage and to a certain extent cell death, are hallmarks and primary mechanisms of progression. Indeed, certain oxysterols exercise strong pro-oxidant and pro-inflammatory effects at concentrations detectable in the lesions typical of atherosclerosis, neurodegenerative diseases, inflammatory bowel diseases, age-related macular degeneration, and other pathological conditions characterized by altered cholesterol uptake and/or metabolism., Graphical Abstract AAA Research highlights ► Oxysterols are 27-carbon-atom products of enzymatic or non-enzymatic oxidation of cholesterol. ► Oxidative stress is the major non-enzymatic source of oxysterols. ► Oxysterols may in turn amplify oxidative redox imbalance in cells and tissues. ► Pathological accumulation of oxysterols triggers and sustains inflammatory reactions. ► Oxysterol-mediated inflammation is a primary mechanism of progression in major chronic diseases.

The age-related increased impedance in large arteries overloads the senescent heart, and the myocardial phenotype is hypertrophic. Together with qualitative changes observed in the senile heart, this can be responsible for impaired diastolic function. A restricted diet providing adequate nutrient intake, e.g. alternate-day fasting (ADF), has been shown to extend life-span and decrease incidence and progression of age-associated diseases in laboratory rodents, and to ameliorate some metabolic markers of aging in rhesus monkeys and humans. This study reports an age-related increase of some biological and morphological hypertrophy markers in the rat heart, together with increased plasma BNP, a well known marker of heart failure. The tissue modifications might likely be related to hyper-activation of two of the signaling pathways associated with myocardial pathological hypertrophy: ERK1/2 and PI3Kγ. Increased ERK1/2 activation might be in part related to the disturbance of STAT3, with a consequent decrease of SOCS3. In this context, the down-modulation of ERK1/2 and PI3Kγ signaling, together with the restoration of STAT3 activity and SOCS3 content, both observed with ADF, might help to reduce pathological hypertrophy stimuli and to rescue an important cardioprotective pathway, possibly opening new preventive and therapeutic perspectives in age-related heart failure.

Cholesterol and its oxidation products, namely oxysterols, have very recently been shown to potentially interfere with homeostasis of the human digestive tract, by promoting and sustaining irreversible damage of the colonic epithelial layer. This report concerns the strong proinflammatory action that a dietary oxysterol mixture and, to a lesser extent, an identical concentration of unoxidized cholesterol exert on CaCo-2 colonic epithelial cells by up-regulating both expression and synthesis of interleukin 8. The oxysterol mixture and its most effective component, 7β-hydroxycholesterol, are also shown to markedly enhance the expression of key inflammatory and chemotactic cytokines in colonic epithelial cells, more efficiently than unoxidized cholesterol. The sterols' proinflammatory effect seems to be mediated by enhanced activation of NOX1, because it is prevented by pretreatment of the cells with DPI, a selective inhibitor of this oxidase. Importantly, NOX1 hyperactivation by the oxysterol mixture or cholesterol was fully prevented by CaCo-2 cell preincubation with epigallocatechin-3-gallate. Consistently, supplementation with this compound fully protected colonic epithelial cells against overexpression of inflammatory and chemotactic genes induced by the sterols investigated.

With the aim of investigating whether cholesterol oxidation products could contribute to the pathogenesis of the intestinal epithelial barrier dysfunction that occurs in human inflammatory bowel disease (IBD), differentiated versus undifferentiated CaCo-2 cells, an accepted model for human intestinal epithelial cells, were challenged with a dietary-representative mixture of oxysterols. Only differentiated colonic cells were susceptible to the proapoptotic action of the oxysterol mixture, checked both by enzymatic and by morphological methods, mainly because of a very low AKT phosphorylation pathway compared to the undifferentiated counterparts. Enhanced production of reactive oxygen species by a colonic NADPH oxidase hyperactivation seemed to represent the key event in oxysterol-induced up-regulation of the mitochondrial pathway of programmed death of differentiated CaCo-2 cells. These in vitro findings point to the pro-oxidant and cytotoxic potential of cholesterol oxidation products, of both dietary and endogenous origin, as an important mechanism of induction and/or worsening of the functional impairment of enteric mucosa that characterizes IBD.

The aldehyde 4-hydroxynonenal (HNE) is a major end-product of peroxidation of membrane n-6-polyunsaturated fatty acids. Primary reactants for HNE are the amino acids cysteine, histidine and lysine, and quantitatively, proteins and peptides represent the most important group of HNE-targeted biomolecules. HNE-protein adducts actually elude the metabolism of the aldehyde, particularly active in the liver, so that they can be easily detected in the hepatic tissue itself and in peripheral blood, and quantified by using immunoassays. Since consistently detectable in various liver disease processes and well related to the intensity of necro-inflammation, HNE-protein adducts may be considered a particularly good marker of lipid oxidation during liver injury. In addition, the demonstrated adduction reaction of HNE with important signalling proteins strongly suggests a pathogenetic role for this lipid aldehyde in the progression of liver diseases.

Oxysterols, 27-carbon atoms cholesterol oxidation products, are consistently detectable in minimally oxidized low density lipoproteins (oxLDLs) and accumulate in the core of fibrotic plaques. Several oxysterols of pathophysiological interest have been shown to possess many and diverse biochemical activities. In particular, 7-ketocholesterol (7K), a major cholesterol oxide both in oxLDLs and in atherosclerotic lesions, is able to lead vascular cells to apoptosis. Indeed, when 7K is added to cells of the macrophage lineage, in a concentration range actually detectable in hypercholesterolemic patients, a marked apoptotic effect was observed. However, when identical concentrations of 7K are given to the same cells in a mixture with other oxysterols, also detectable in human low density lipoprotein (LDL), cell apoptosis was dramatically reduced. Of note, identical amounts of unoxidized cholesterol did not show any significant pro-apoptotic effect. With the aim to investigate the mechanisms underlying the quenching of 7K-dependent apoptosis by the oxysterol mixture, we found that the combined oxysterol mixture counteracted the ability of 7K given alone to strongly increase the steady-state level of reactive oxygen species (ROS) in macrophages as well as the up-regulation of the pro-apoptotic factor p21 and the triggering of the mitochondria-dependent pathway of apoptosis. Competition among oxysterols, apparently at NADPH oxidase level, diminishes the macrophage ROS production and direct toxicity that is evoked by defined oxysterols, as for instance, 7-ketocholesterol.

Cholesterol oxidation products, termed oxysterols, are increasingly considered of potential interest in the pathogenesis of atherosclerotic lesions. Of dietary or endogenous origin, oxysterols may occur in significant amounts in low density lipoprotein (LDL) particles, especially in hypercholesterolemic subjects. They likely contribute to the uptake of modified LDL by scavenger receptors and some of them finally accumulate in the subintimal space of major arteries; here cholesterol oxides may favor the perpetuation of a chronic inflammatory state, through their ability to trigger irreversible damage of vascular cells with consequent activation of phagocytes. Furthermore, practically all oxysterols of major pathophysiologic interest have been shown to markedly up-regulate expression and synthesis of adhesion molecules, inflammatory cytokines and chemokines. Cholesterol oxidation thus appears to be an important biochemical pathway through which it exerts toxic, inflammatory and finally atherogenic effects.

A still growing bulk of evidence underlies the multifaceted biochemical properties of oxysterols, several of them of clear relevance to human pathophysiology. Taken up by cells through both vesicular and non vesicular ways or often generated intracellularly, oxysterols contribute to modulate the inflammatory response of a given tissue but also cell viability, metabolism and function. The signaling pathways and the transcription factors whose activation they can influence, often through redox-mediated reactions, are quite a number. Moreover, the outcome of the complex network of intracellular reactions promoted by oxysterols appears to be largely dependent upon specific features and dynamic conditions of the cellular and tissue environment but also on their actual concentration in the site of action. Here focus was given to their potential implication in the advanced progression of atherosclerosis, whosehypercholesterolemia is a recognized primary risk factor. A significant contribution to the possible rupture of atherosclerotic plaque could be provided by defined oxysterols, in particular 27-hydroxycholesterol. Indeed, the latter oxysterol was shown in a promonocytic cell line to amplify the inflammatory reaction and activate several pathways leading to a marked up-regulation of metalloproteases, the key enzymes involved in cap matrix degradation and weakening.

Altered cholesterol metabolism in the brain is implicated both in the initiation and in the progression of Alzheimer’s disease (AD), and hypercholesterolemia is a potential risk factor. In particular, oxidized cholesterol, in the form of oxysterols, is believed to be one of the main triggers of AD. Oxysterols can accumulate in the brain, where they can behave as friends or foes: they cause neuron dysfunction and degeneration and contribute to neuroinflammation and amyloidogenesis, but they can also be neuroprotective. One of the main oxysterols most closely involved in AD pathogenesis is 24-hydroxycholesterol (24OH), also called cerebrosterol. The levels of 24OH are markedly reduced in the brain during AD progression, and it is likely that its reduction may accelerate the disease development, considering that it’s known from literature that 24OH may have neuroprotective effects. Moreover, the loss of 24OH proceeds in parallel with the reduction of sirtuin 1 (SIRT1), a deacetylase promoting neuroprotection. We demonstrated that 24OH activates the neuroprotective axis ROS/SIRT1/PGC1a in neuroblastoma cells, thus favoring Tau deacetylation and preventing Tau hyperphosphorylation. Thus, it would be clinically important to prevent the loss of 24OH in the brain, in order to stimulate long upon the expression of SIRT1 with the consequent delay of Tau pathology.

The recent research on the impact that oxidative changes of biolipids could have in pathophysiology serves to explain how free radical–driven reactions not only are considered as mere toxicologic events, but also modulators of cell activity and function. Oxidatively modified low-density lipoproteins are known to affect various cellular processes by modulating various molecular pathways and signaling nuclear transcription. Among the lipid oxidation products detectable in ox-LDLs, and also in the atherosclerotic plaques, 4-hydroxynonenal has been widely investigated. This aldehyde was shown to upregulate AP-1 transcription factor, signaling through the MAP kinase pathway, with eventual nuclear localization and induction of a series of genes. Further, oxidation products of cholesterol and cholesterol esters, in ox-LDL are of similar interest, especially in relation to the pathogenesis of fibrosclerotic lesions of the arterial wall.

The aim of this study was to evaluate a possible relationship between oxidative stress and transforming growth factor β1 (TGFβ1) expression in human colon adenocarcinoma. Crohn's disease, an inflammatory pathology of the intestine often regarded to as precancerous, was also examined. Indices of impaired redox balance were monitored in blood and in bioptic samples from 10 adult patients with adenocarcinoma of the colon and from five patients with Crohn's disease. On tissue samples TGFβ1 mRNA expression was also determined. Ten healthy adults provided normal reference values for plasma indices of oxidative stress, and normal tissue distant from the lesions was used for comparative analysis. Fluorescent adducts with plasma proteins of malonaldehyde (MDA) and 4-hydroxynonenal (HNE) were significantly lower than controls in the plasma from cancer patients and significantly higher in the plasma from Crohn's patients. In adenocarcinoma biopsies, susceptibility to lipid peroxidation processes and TGFβ1 expression were below the relative control; in Crohn's disease, lipid peroxidation and cytokine expression were both above the relative control. The findings obtained suggest the existence of an association between oxidative damage and fibrogenic cytokine expression in the human intestine. Further studies are needed to conclusively prove the correlation between the two events. Copyright © 1997 Elsevier Science Inc.

Oxysterols are a family of 27-carbon molecules originated from cholesterol oxidation and the atherogenic potential of oxysterols is linked to their ability to induce oxidative stress, inflammation and apoptotic cell death. Apparently, these compounds are able to modulate not only pro-apoptotic but also anti-apoptotic signals in targeted cells; however, their anti-apoptotic effect has not been investigated in depth. Hence, we aimed to elucidate the molecular mechanisms underlying the survival signaling elicited by 27-hydroxycholesterol (27-OH) which is the most represented oxysterol in human blood. Using human promonocytic cells (U937) challenged with a relatively low concentration of 27-OH, a strong survival signaling through an early and transient increase of cellular reactive oxygen species (ROS) level, that enhanced MEK-ERK/PI3K-Akt phosphorylation, in turn responsible of a sustained quenching of ROS production was observed. Notably, involvement of antioxidant Nrf2 and its target genes, HO-1 and NQO-1 in this early survival response were shown. It thus appears that Nrf2 is responsible for the quenching of the oxidative imbalance exerted in 27-OH challenged cells. On the other hand, relatively high micromolar amount of 27- OH did not stimulate at all the investigated survival signaling with a constant prooxidant effect. The results of ongoing experiments on the actual role of autophagy in modulating the survival response will be also presented and discussed.The data obtained highlight oxysterols’ ability to promote cell survival that might contribute to the pathogenesis of inflammation-driven chronic diseases such as atherosclerosis.

Hepatoma cells are, at most, moderately sensitive to oxidative stress. An important cause of this lack of sensitivity is the decreased content of polyunsaturated fatty acids in comparison with normal cells. These fatty acids are one cellular target of oxygen radicals, by which they are broken down into several toxic carbonyl compounds. If the membrane phospholipids of tumor cells are enriched with polyunsaturated fatty acids, such as arachidonic acid, they become able to undergo lipid peroxidation in the presence of prooxidants. This effect is studied in the highly deviated Yoshida AH-130 ascites hepatoma and in two rat hepatoma cell lines. In parallel to their increased lipid peroxidation, cells enriched with arachidonic acid and exposed to ascorbic acid/FeSO4 showed lower viability and growth than unenriched ones.