👤 Martina B Lorey

BACKGROUNDIcosapent ethyl (IPE), an ethyl ester of eicosapentaenoic acid (EPA), reduces cardiovascular disease (CVD), but the mechanism remains elusive. We examined the effect of IPE supplementation on lipoprotein subclasses, lipidomes, and pro-atherogenic properties.METHODSUsing 3 independent metabolomic platforms, we examined the effect of high-dose IPE supplementation for 28 days on fatty acid profiles, lipoprotein subclasses, lipidomes, and pro-atherogenic properties in normolipidemic volunteers (n = 38).RESULTSIPE supplementation increased lipoprotein EPA on average 4-fold within 7 days, returning to baseline after a 7-day washout. Notably, the incorporation displayed marked interindividual variance, negatively correlating with baseline levels. We identified persistent participant-specific lipoprotein fingerprints despite uniform IPE-induced lipidome remodeling across all lipoprotein classes. This remodeling resulted in reductions in saturated, monounsaturated, and n-6 polyunsaturated fatty acids, resulting in reduced clinical risk markers, including triglyceride, remnant cholesterol, and apolipoprotein B (apoB) levels and 10-year CVD risk score. Of the pro-atherogenic properties tested, IPE significantly reduced apoB lipoprotein binding to proteoglycans, which correlated with lower apoB particle concentration, cholesterol content, and specific lipid species in LDL, including phosphatidylcholine 38:3 previously associated with CVD.CONCLUSIONThese findings highlight IPE's rapid, uniform remodeling of lipoproteins and reduced proteoglycan binding, likely contributing to previously observed CVD risk reduction. Persistent interindividual lipidome signatures underscore the potential for personalized therapeutic approaches in atherosclerotic CVD treatment.TRIAL REGISTRATIONNCT04152291.FUNDINGJenny and Antti Wihuri Foundation, Research Council of Finland, Sigrid Jusélius Foundation, Finnish Foundation for Cardiovascular Research, Emil Aaltonen Foundation, Ida Montin Foundation, Novo Nordisk Foundation, Finnish Cultural Foundation, and Jane and Aatos Erkko Foundation. Show less

This review integrates recent structural and biochemical insights into apolipoprotein B (apoB) containing lipoproteins to highlight how factors beyond cholesterol levels contribute to atherosclerosis. Emerging evidence demonstrates that the atherogenic potential of apoB-containing lipoproteins varies substantially both between and within lipoprotein classes. Recent studies using high-resolution cryo-electron microscopy, crosslinking mass spectrometry, and computational modeling reveal that even subtle differences in lipoprotein composition, particle size, and lipid spatial organization can significantly alter the conformation and dynamic behavior of apoB on the particle surface. These conformational shifts influence a variety of lipoprotein characteristics such as the stability of the particle, their ability to interact with receptors and enzymes, and their proatherogenic potential as measured by the propensity of lipoproteins to bind to proteoglycans of the arterial wall or to undergo modification and aggregation. In this review, we discuss how novel structural and functional information can refine our understanding of the distinct properties of apoB-containing lipoproteins and their role in atherosclerosis and lipid accumulation. Understanding of the specific features related to the proatherogenic behavior of the lipoproteins helps in understanding the complexities of atherogenesis and cardiovascular risk beyond cholesterol. Show less