Beyond cholesterol: linking the conformation of apolipoprotein B to atherogenesis.

Purpose of review: This review integrates recent structural and biochemical insights into apolipoprotein B (apoB) containing lipoproteins to highlight how factors beyond cholesterol levels contribute to atherosclerosis.

Recent findings: 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.

Summary: 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.