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Lipid signatures of unstable atheromas: fossils or a step toward personalized lipidomics-metabolomics?

Atherosclerosis is a disease of the vasculature, characterized by the retention of low-density lipoprotein and the accumulation of peripheral blood leukocytes in the arterial intima.1 The role of the innate immune system in the progression of atherosclerosis is now widely recognized, and although several inflammatory cell types infiltrate atherosclerotic plaques, it is undisputed that macrophages accumulate excess lesional lipid and transform into inflammatory foam cells that fail to egress from the lesion.1–3 The ensuing inflammatory sequelae is self-perpetuating, perhaps resulting from a failure to resolve the local inflammatory response within the vessel wall, which drives the evolution of fatty streaks to a more complex lesion characterized by extensive lesion remodeling, cellular necrosis in the lesion core, and fibrous cap formation.1,4,5

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Acute myocardial infarction and stroke are the primary clinical manifestations of atherosclerosis, which result primarily from plaque rupture, thrombus formation, and subsequent ischemic injury.6 For plaque rupture to occur, the protective collagen-rich fibrous cap must be disrupted by matrix-degrading enzymes and other inflammatory mediators. Exposure of the plaque promotes thrombus formation by the release of numerous soluble mediators, such as tissue factor and thromboxane A2.4,7 Plaque rupture by means of angioplasty also initiates intracoronary generation of leukotrienes and lipoxins, which are enhanced with aspirin treatment.8 The intraluminal presence of soluble mediators can affect vascular reactivity and performance.

Because atherosclerosis is one of the most prominent diseases of our time, there is a critical need to identify early markers and local mediators of the dynamic lesion remodeling process so that new therapeutics can be developed to prevent atherogenesis and plaque rupture. Many research teams have taken on the task to identify such local mediators and assign the role of diverse lipid …