Low Density Lipoprotein Aggregation Research Articles

Effect of arterial curvature on hemodynamics and mass transport.

Atherosclerotic lesions develop preferentially at certain sites in the human arterial system, such as the inner wall of curved segments and the outer wall of bifurcations. Local wall shear stress (WSS) and concentration of low density lipoprotein (LDL) have been identified as two important factors contributing to these lesions. To determine if a connection exists between arterial curvature and the formation of atherosclerosis. A set of 3-D vessel models with different bend angles was constructed. By comparing blood flow, WSS, and LDL aggregation, the influence of bend curvature on atherosclerotic lesions was assessed. Upon increasing arterial bending, low WSS regions were formed at the outer wall of the junction between straight and curved segments, as well as the inner wall of curved segments. However, high LDL concentrations only appeared at the inner wall of the bend region. A connection between secondary flow and LDL concentration was observed; high LDL concentration regions had stronger secondary flow. Higher water infiltration velocity could enhance LDL aggregation, while blood non-Newtonian properties, by easing secondary flow, diminished its aggregation. Under the same flow rate, a larger bend angle increased flow resistance, lowered WSS, and increased LDL surface concentrations, thus indicating an increased risk of atherosclerosis.

Study on effect of salting process on egg yolk plasma using AF4 combined with ATR-FTIR and DSC

In this work, the effect of salting method (i.e. immersing method and paste coating method) and salting time on egg yolk plasma was studied. Asymmetrical flow field-flow fractionation (AF4) combined with attenuated total reflectance-fourier transform infrared spectroscopy (ATR-FTIR) was employed for monitoring low density lipoprotein (LDL) aggregation in salted egg yolk plasma. AF4 provides a size-based separation of the major components of egg yolk plasma. ATR-FTIR allows determining the secondary structure of protein such as intermolecular β-sheet structure which is an indicator of protein aggregation. By combining the results from AF4 and ATR-FTIR, it was clearly demonstrated that salting process results in the formation of LDL aggregates. Furthermore, the LDL size distributions of a variety of egg yolk plasmas were obtained based on AF4 theory. Results reveal that the size distribution of LDL in duck egg yolk plasma is broader than that in hen egg yolk plasma. The protein thermal stability of salted egg yolk plasma was investigated using differential scanning calorimetry (DSC). It was found that salting process enhances the thermal stability of egg yolk plasma. The results show that AF4 combined with ATR-FTIR and DSC is a promising approach towards better understanding of protein aggregation.

Angiotensin II induces the aggregation of native and oxidized low-density lipoprotein.

Modifications of low-density lipoprotein (LDL), such as oxidation and aggregation, and angiotensin (Ang) peptides are involved in the pathogenesis of atherosclerosis. Here, we investigated the relationship between one of the Ang peptides, AngII, and two LDL modifications, oxidation and aggregation. Using polyacrylamide gel electrophoresis and aggregation assays, we noted that AngII markedly induced the aggregation of LDL and oxidized LDL (Ox-LDL), and bound to both the aggregated and non-aggregated forms. In contrast, a peptide (AngIII) formed by deletion of N-terminal Asp of AngII induced the aggregation of Ox-LDL but not LDL. From tyrosine fluorescence measurements, we noted that AngII interacted with two major lipid components in LDL and Ox-LDL, phosphatidylcholine (PC) and oxidized PC, while AngIII interacted with oxidized PC, but not with PC and lysophosphatidylcholine. Moreover, results from thiobarbituric acid-reactive substances assay proved that AngII did not induce oxidation of LDL. These results suggest that AngII can be involved in the pathogenesis of atherosclerosis by binding to LDL and Ox-LDL-especially to the major lipid components, PC and oxidized PC-followed by inducing the aggregation of LDL and Ox-LDL and that the N-terminal Asp of AngII is important for the binding and aggregation specificity of LDL and Ox-LDL.

Study on external factors affecting egg yolk plasma by asymmetrical flow field-flow fractionation

In this work, the ability of asymmetrical flow field-flow fractionation (AF4) coupled with UV–vis, multiangle light scattering (MALS), and quasi-elastic light scattering (QELS) (AF4-UV-MALS-QELS) for monitoring aggregation of components of egg yolk plasma was evaluated. The effect of external factors (i.e., pH, storage conditions, freezing and heat treatments) on the egg yolk plasma was studied. The results reveal that the aggregation mechanism of components of egg yolk plasma during heat and freezing treatment is different. The results suggest that the low density lipoproteins (LDLs) in egg yolk plasma undergo a ‘clusters-fusion-gel’ process under heat treatment at pH10. The alkaline conditions promote the formation of LDL aggregates. Also, storage conditions play a role in the formation of LDL aggregates. It was found that the hen eggs stored for 7days at room temperature contain less aggregate than those stored at 4°C for the same period. The combination of AF4 with online MALS-QELS provided conformational information in terms of the shape and size distribution of LDL aggregates. AF4-UV-MALS-QELS was proved to be a rapid and gentle method for the separation and characterization of egg yolk plasma aggregates.

Thermal stability of human plasma electronegative low-density lipoprotein: A paradoxical behavior of low-density lipoprotein aggregation

Low-density lipoprotein (LDL) aggregation is central in triggering atherogenesis. A minor fraction of electronegative plasma LDL, termed LDL(−), plays a special role in atherogenesis. To better understand this role, we analyzed the kinetics of aggregation, fusion and disintegration of human LDL and its fractions, LDL(+) and LDL(−). Thermal denaturation of LDL was monitored by spectroscopy and electron microscopy. Initially, LDL(−) aggregated and fused faster than LDL(+), but later the order reversed. Most LDL(+) disintegrated and precipitated upon prolonged heating. In contrast, LDL(−) partially retained lipoprotein morphology and formed soluble aggregates. Biochemical analysis of all fractions showed no significant degradation of major lipids, mild phospholipid oxidation, and an increase in non-esterified fatty acid (NEFA) upon thermal denaturation. The main baseline difference between LDL subfractions was higher content of NEFA in LDL(−). Since NEFA promote lipoprotein fusion, increased NEFA content can explain rapid initial aggregation and fusion of LDL(−) but not its resistance to extensive disintegration. Partial hydrolysis of apoB upon heating was similar in LDL subfractions, suggesting that minor proteins importantly modulate LDL disintegration. Unlike LDL(+), LDL(−) contains small amounts of apoA-I and apoJ. Addition of exogenous apoA-I to LDL(+) hampered lipoprotein aggregation, fusion and precipitation, while depletion of endogenous apoJ had an opposite effect. Therefore, the initial rapid aggregation of LDL(−) is apparently counterbalanced by the stabilizing effects of minor proteins such as apoA-I and apoJ. These results help identify key determinants for LDL aggregation, fusion and coalescence into lipid droplets in vivo.

Inhibitory effect of ilexpernoside C from Ilex pernyi on aggregated LDL-induced foam cells formation

The aggregation of macrophage-derived foam cells on vascular wall is considered to be a main cause of atherosclerosis. In the present study, we evaluated the inhibitory effect of the compound ilexpernoside C (IC1) extracted from Ilex pernyi (Aquifoliaceae) on foam cell formation in THP-1 macrophages cells which were induced by low density lipoproteins aggregates (LDL aggregates). Results showed that IC1 could significantly inhibit the formation of foam cells. The analysis on related receptors of foam cells indicated that IC1 could significantly decrease the expression of low density lipoprotein-related receptor 1(LRP1). Therefore, these findings indicated that IC1 inhibited the formation of foam cells by inhibiting endocytosis of macrophages, thus it may act as a potential anti-atherosclerotic agent.

Study on aggregation behavior of low density lipoprotein in hen egg yolk plasma by asymmetrical flow field-flow fractionation coupled with multiple detectors

In this study, asymmetrical flow field-flow fractionation (AF4) coupled online with UV, multiangle light scattering (MALS), and fluorescence (FS) detectors (AF4–UV–MALS–FS) was employed for separation and characterization of egg yolk plasma. AF4 provided separation of three major components of the egg yolk plasma i.e. soluble proteins, low density lipoproteins (LDL) and their aggregates, based on their respective hydrodynamic sizes. Identification of LDL was confirmed by staining the sample with a fluorescent dye, Nile Red. The effect of carrier liquids on aggregation of LDL was investigated. Collected fractions of soluble proteins were characterized using sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS–PAGE). Moreover, the effect of heat and enzymatic treatment on egg yolk plasma was investigated. The results suggest that enzymatic treatment with phospholipase A2 (PLA2) significantly enhances the heat stability of LDL. The results show that AF4–UV–MALS–FS is a powerful tool for the fractionation and characterization of egg yolk plasma components.

Apolipoprotein J protects against LDL aggregation

Aim: Apolipoprotein J (apoJ) is an extracellular chaperone involved in the quality control system against protein unfolding and aggregation. A minor part of apoJ is transported in blood bound to low-density lipoproteins (LDL), but its role is poorly understood. Since LDL aggregation is considered the initial event triggering atherosclerosis, our aim was to determine the role of apoJ bound to LDL.

Misfolding of Apoprotein B-100, LDL Aggregation and 17-β -estradiol in Atherogenesis

The long quest for a missing mechanistic rationale accounting for the correlation between plasma cholesterol levels and cardiovascular disease (CVD) has been focused on various possible modifications of low density lipoprotein (LDL), turning this physiological cholesterol carrier into a damaging agent able to trigger atherogenesis and later the onset of the disease. In addition to the debated oxidized LDL (oxLDL), a modified LDL with a misfolded apoprotein B-100, called electronegative LDL(-) for its negative charge due to an increased amount of free fatty acids, is commonly present in plasma. LDL(-) is generated by the action of secretory calcium dependent phospholipase A2. LDL(-) primes LDL aggregation and amyloid formation according to mechanisms very similar to those observed in other misfolding diseases. The LDL particle aggregates recall the structure and size of the subendothelial lipid droplets described in early atherogenesis and elicit a powerful inflammatory response. The use of 17-β-estradiol (E2) confirmed that the suggested atherogenicity of LDL (-) is mostly dependent on the misfolded character of its apoprotein. E2 binding to the apoprotein of native LDL, through a specific and saturable receptor, inhibits misfolding phenomenon despite an unaffected production of LDL (-) by phospholipase A2, ultimately preventing LDL aggregation. The apoprotein misfolding in LDL(-) emerges as a possible significant trigger mechanism of atherogenesis. Potential implications for the development of novel therapeutic approaches might be hypothesized in perspective. The existing evidence is discussed and reported in this review.

Evaluation of the effects of weak and moderate static magnetic fields on the characteristics of human low density lipoprotein in vitro

It has been suggested that exposure to electromagnetic fields may be a risk factor for cardiovascular disease in humans. Low density lipoprotein (LDL) modifications such as peroxidation and aggregation have been implicated in the pathogenesis of atherosclerosis. The present study investigated the effects of weak (0.125-0.5 mT) and moderate (1-4 mT) static magnetic fields (SMFs) on LDL oxidation, aggregation and zeta potential in vitro. Our results demonstrated that magnetic flux densities of 0.25 and 0.5 mT decreased, and magnetic flux densities of 3 and 4 mT increased the zeta potential and LDL oxidation in comparison with the control samples. All doses of SMFs increased the LDL aggregation in a time- and dose-dependent manner. It is concluded that SMFs can alter the susceptibility of LDL to oxidation and this alteration is dependent on the applied magnetic flux density. The SMF, in addition to its role in the production and stabilization of free radicals and promotion of lipid peroxidation, may influence the metabolism of lipoproteins and their interaction with other molecules such as apolipoproteins, enzymes and receptors through the alteration of the LDL zeta potential and its particles tendency to aggregation.

Characterization of secretory sphingomyelinase activity, lipoprotein sphingolipid content and LDL aggregation in ldlr−/− mice fed on a high-fat diet

The propensity of LDLs (low-density lipoproteins) for aggregation and/or oxidation has been linked to their sphingolipid content, specifically the levels of SM (sphingomyelin) and ceramide. To investigate this association in vivo, ldlr (LDL receptor)-null mice (ldlr−/−) were fed on a modified (atherogenic) diet containing saturated fats and cholesterol. The diet led to significantly elevated SM content in all serum lipoproteins. In contrast, ceramide increased only in the LDL particles. MS-based analyses of the lipid acyl chain composition revealed a marked elevation in C16:0 fatty acid in SM and ceramide, consistent with the prevalence of palmitic acid in the modified diet. The diet also led to increased activity of the S-SMase [secretory SMase (sphingomyelinase)], a protein that is generated by ASMase (acid SMase) and acts on serum LDL. An increased macrophage secretion seemed to be responsible for the elevated S-SMase activity. ASMase-deficient mice (asm−/−/ldlr−/−) lacked S-SMase activity and were protected from diet-induced elevation in LDL ceramide. LDL from asm−/−/ldlr−/− mice fed on the modified diet were less aggregated and oxidized than LDL from asm+/+/ldlr−/− mice. When tested in vitro, the propensity for aggregation was dependent on the SM level: only LDL from animals on modified diet that have high SM content aggregated when treated with recombinant S-SMase. In conclusion, LDL-SM content and S-SMase activity are up-regulated in mice fed on an atherogenic diet. S-SMase mediates diet-induced changes in LDL ceramide content and aggregation. S-SMase effectiveness in inducing aggregation is dependent on diet-induced enrichment of LDL with SM, possibly through increased hepatic synthesis.

Pluronic Block Copolymers Inhibit Low Density Lipoprotein Self‐Association

Little is known about exogenous inhibitors of low-density lipoprotein (LDL) aggregation. The search for nontoxic and bioavailable inhibitors of LDL aggregation is of interest, especially considering that the suppression of the aggregation of LDL might represent a therapeutic approach. We hypothesized that amphiphilic copolymers of propylene oxide and ethylene oxide, the so-called Pluronic block copolymers, can be used to influence the aggregation of LDL. In this work we used Pluronic® P85, L61 and F68. A comparative study of the effects of Pluronic block copolymers with various hydrophilic-lipophilic properties on the aggregation process of LDL showed that Pluronic copolymers with strong hydrophobic properties (P85 and L61) at concentrations close to or greater than the respective critical concentration of micelle formation inhibited the aggregation process of LDL; however, the "hydrophilic" Pluronic F68 had no effect on the aggregation of LDL at any concentration. Thus, the study demonstrated for the first time that Pluronic® block copolymers inhibit LDL self-association. The possibility of modulating the aggregation of LDL by various Pluronic copolymers can be regarded as a prerequisite in the creation of new types of anti-atherosclerotic drugs.

Abstract 323: Dietary Saturated Fat Increases the Susceptibility of Low-Density Lipoprotein to Aggregation by Sphingomyelinase

Early steps in the development of atherosclerosis are characterized by accumulation of extracellular aggregated low density lipoprotein (LDL) particles in the arterial intima. Sphingomyelinase (SMase), an intimal enzyme that hydrolyses sphingomyelin on the surface monolayer of LDL particles, is particularly effective in inducing LDL aggregation. In this study, we analyzed individual differences in SMase-induced LDL aggregation with the aim of identifying specific lipid components of LDL that can be linked with their susceptibility for aggregation. For this purpose we isolated plasma LDL from 100 randomly selected subjects participating in the Finnish Health 2000 Health Examination Survey. LDL aggregation was analyzed by measuring the size of LDL aggregates with dynamic light scattering during their modification by human recombinant sphingomyelinase. Large variations were observed in the aggregation lag phase between the different LDL donors. In particular, LDL from some donors expressed rapid aggregation potential, whereas LDL from other donors was very resistant to aggregation. Large aggregates (>1000 nm) were observed in 13 of the LDL samples after incubation for 2 h in the presence of SMase and the size of the aggregates plateaued at about 4500 nm, the first samples reaching this size after incubation for 3 h. In four out of the 100 samples only very small aggregation was observed and LDL particles had an average size <350 nm after incubation for 6 h. The intake of saturated fat was found to correlate positively with increased susceptibility for LDL aggregation ( p ≤0.005 ) . Thus, LDL isolated from butter-using donors aggregated faster than LDL derived from vegetable oil -using donors. Lipidomic analysis demonstrated that LDL particles with the highest susceptibility for aggregation had a larger number of saturated fatty acids in their surface phospholipids when compared with that of the aggregation-resistant LDL particles. This study provides novel insights of the influence of dietary fats on LDL atherogenicity.

Oxidation of low-density lipoprotein by iron at lysosomal pH: implications for atherosclerosis.

Low-density lipoprotein (LDL) has recently been shown to be oxidized by iron within the lysosomes of macrophages, and this is a novel potential mechanism for LDL oxidation in atherosclerosis. Our aim was to characterize the chemical and physical changes induced in LDL by iron at lysosomal pH and to investigate the effects of iron chelators and α-tocopherol on this process. LDL was oxidized by iron at pH 4.5 and 37 °C and its oxidation monitored by spectrophotometry and high-performance liquid chromatography. LDL was oxidized effectively by FeSO4 (5–50 μM) and became highly aggregated at pH 4.5, but not at pH 7.4. The level of cholesteryl esters decreased, and after a pronounced lag, the level of 7-ketocholesterol increased greatly. The total level of hydroperoxides (measured by the triiodide assay) increased up to 24 h and then decreased only slowly. The lipid composition after 12 h at pH 4.5 and 37 °C was similar to that of LDL oxidized by copper at pH 7.4 and 4 °C, i.e., rich in hydroperoxides but low in oxysterols. Previously oxidized LDL aggregated rapidly and spontaneously at pH 4.5, but not at pH 7.4. Ferrous iron was much more effective than ferric iron at oxidizing LDL when added after the oxidation was already underway. The iron chelators diethylenetriaminepentaacetic acid and, to a lesser extent, desferrioxamine inhibited LDL oxidation when added during its initial stages but were unable to prevent aggregation of LDL after it had been partially oxidized. Surprisingly, desferrioxamine increased the rate of LDL modification when added late in the oxidation process. α-Tocopherol enrichment of LDL initially increased the rate of oxidation of LDL but decreased it later. The presence of oxidized and highly aggregated lipid within lysosomes has the potential to perturb the function of these organelles and to promote atherosclerosis.

Mechanistic roles of lipoprotein lipase and sphingomyelinase in low density lipoprotein aggregation

The initiation of atherosclerosis involves retention of colloidal atherogenic lipoproteins, primarily low density lipoprotein (LDL), in the arterial intima. This retention occurs when LDL binds to smooth muscle cell extracellular matrix (SMC ECM), and is enhanced by lipoprotein lipase (LpL) and sphingomyelinase (Smase). Here we use a fluorescence assay and dynamic light scattering to study the individual and combined effects of these two enzymes on LDL aggregation. Our results show: (1) LpL is self-sufficient to induce LDL aggregation with aggregate sizes up to ∼400 nm; (2) Smase induces LDL aggregation due to generation of ceramide and subsequent hydrophobic interactions; (3) Smase hydrolysis of LpL-induced LDL aggregates does not cause further aggregation and results in a ∼3-fold diminished production of ceramide, while LpL treatment of Smase-induced aggregates does enhance aggregation; (4) The simultaneous addition of LpL and Smase causes increased variability in aggregation with final sizes ranging from 50 to 110 nm. Our data suggest a new proatherogenic function for LpL, namely, bridging between LDL particles causing their aggregation and consequently enhanced retention by SMC ECM. The mechanism of LpL-and-Smase-mediated LDL aggregation and binding to SMC ECM provides specific points of intervention to design novel effective antiatherogenic therapeutics.

Effects of phospholipase A2 and its products on structural stability of human LDL: relevance to formation of LDL-derived lipid droplets

Hydrolysis and oxidation of LDL stimulate LDL entrapment in the arterial wall and promote inflammation and atherosclerosis via various mechanisms including lipoprotein fusion and lipid droplet formation. To determine the effects of FFA on these transitions, we hydrolyzed LDL by phospholipase A(2) (PLA(2)), removed FFA by albumin, and analyzed structural stability of the modified lipoproteins. Earlier, we showed that heating induces LDL remodeling, rupture, and coalescence into lipid droplets resembling those found in atherosclerotic lesions. Here, we report how FFA affect these transitions. Circular dichroism showed that mild LDL lipolysis induces partial β-sheet unfolding in apolipoprotein B. Electron microscopy, turbidity, and differential scanning calorimetry showed that mild lipolysis promotes LDL coalescence into lipid droplets. FFA removal by albumin restores LDL stability but not the protein conformation. Consequently, FFA enhance LDL coalescence into lipid droplets. Similar effects of FFA were observed in minimally oxidized LDL, in LDL enriched with exogenous FFA, and in HDL and VLDL. Our results imply that FFA promote lipoprotein coalescence into lipid droplets and explain why LDL oxidation enhances such coalescence in vivo but hampers it in vitro. Such lipid droplet formation potentially contributes to the pro-atherogenic effects of FFA.

Size-selective uptake of colloidal low density lipoprotein aggregates by cultured white blood cells

This paper illustrates how principles of colloid science are useful in studying atherosclerosis. Accumulation of foam cells in the arterial intima is a key step in atherogenesis. The extent of foam cell formation is enhanced by low density lipoprotein (LDL) aggregates, and we have previously shown that the size of sphingomyelinase (Smase)-hydrolysis-induced aggregates depends directly on the concentration of ceramide generated in the LDL phospholipid monolayer, mediated by the hydrophobic effect. Here, we focus on the effect of LDL aggregate particle sizes on their subsequent uptake by macrophages. Our data show the first direct measurement of uptake as a function of aggregate size and the first direct comparison of uptake after Smase-catalyzed and vortex-mixing-mediated aggregation. Vortex-mixed aggregates with radii 20–77 nm showed maximal uptake ∼118 μg sterol/mg protein at a 53 nm intermediate size, consistent with a mathematical model describing competition between aggregate surface area and volume. Smase-treated aggregates with radii 25–211 nm also showed maximal uptake at an intermediate size, ∼58 μg sterol/mg protein for 132 nm particles, and fit a modified model that incorporated ceramide concentration expressed as aggregate size. This study shows that particle size is significant and composition may also be a factor in LDL uptake.

Homocystinuria, Arteriosclerosis, Methylmalonic Aciduria, and Methyltransferase Deficiency: A Key Case Revisited

The original case of Cb1 C disease with homocystinuria, cystathioninuria, methylmalonic aciduria, and hypomethioninemia was reexamined because of its importance in the discovery of the homocysteine theory of arteriosclerosis. The vascular lesions in the case consist of proliferative fibrous intimal plaques and focal necrosis of the artery wall, which are attributed to effects of excess homocysteine thiolactone on aggregation of low-density lipoproteins (LDL) and on respiration of endothelial cells. Atrophic, metaplastic, and dysplastic changes within the gastric mucosa are attributed to effects of excess homocysteine thiolactone on synthesis of keratin, sulfomucins, and nucleoproteins within affected cells. The case illustrates how investigation of an inborn error of metabolism illuminates pathophysiological disease processes, normal metabolic pathways, and important aspects of cellular function.

Effect of Sphingomyelinase-Mediated Generation of Ceramide on Aggregation of Low-Density Lipoprotein

This study addresses the response-to-retention hypothesis, which states that the subendothelial retention of atherogenic lipoproteins is the necessary and sufficient condition for the initiation of atherosclerosis. Here we focus on the relationship between the generation of ceramide in the low-density lipoprotein (LDL) phospholipid monolayer and the resulting aggregation of LDL particles. This study provides the first measurement of neutral, Mg (2+)-dependent Sphingomyelinase (Smase)-mediated ceramide formation from LDL-sphingomyelin and does so for a range of enzyme concentrations (0-0.22 units Smase/mL). The kinetics of ceramide generation was measured using a fluorescence assay for the above enzyme concentrations with a fixed substrate concentration (0.33 mg LDL/mL). The kinetics of LDL aggregate formation was measured by dynamic light scattering (DLS, method of cumulants) for identical enzyme concentrations. Ceramide concentration profiles were fit with a modification of the Michaelis-Menten model ( k a = 1.11 x 10 (-1) microM (-1) min (-1), k -a = 6.54 x 10 (2) microM (-1) min (-1), k 1 = 3.33 x 10 (1) microM (-1) min (-1), k -1 = 1.41 x 10 (-2) min (-1), k cat = 8.05 x 10 (1) min (-1), K M = 2.418 microM, k deact = 4.66 x 10 (-2) microM (-1) min (-1)) that accounts for the effects of enzyme attachment to the LDL monolayer and for deactivation of Smase due to product inhibition. LDL aggregation is described by a mass action model as explained in previous studies. A key result of this work is the finding that LDL aggregate size depends directly on ceramide concentration and is independent of enzyme concentration. This study demonstrates how principles of colloid science are relevant to important biomedical problems.

Low density lipoprotein misfolding and amyloidogenesis

In early atherogenesis, subendothelial retention of lipidic droplets is associated with an inflammatory response-to-injury, culminating in the formation of foam cells and plaque. Low density lipoprotein (LDL) is the main constituent of subendothelial lipidic droplets. The process is believed to occur following LDL modification. Searching for a modified LDL in plasma, electronegative LDL [LDL(-)] was identified and found to be associated with major risk biomarkers. The apoprotein in LDL(-) is misfolded, and we show here that this modification primes the aggregation of native LDL, conforming to the typical pattern of protein amyloidogenesis. After a lag phase, whose length depends on LDL(-) concentration, light scattering and atomic force microscopy reveal early exponential growth of intermediate globules, which evolve into fibrils. These globules are remarkably similar to subendothelial droplets in atheromatous lesions and different from those produced by oxidation or biochemical manipulation. During aggregation, ellipticity and tryptophan fluorescence measurements reveal a domino-style spread of apoprotein misfolding from LDL(-) to all of the LDL. Computational analysis of the apoprotein primary sequence predicts an unstable, aggregation-prone domain in the regulatory alpha2 region. Apoprotein misfolding well represents an LDL modification able to transform this cholesterol carrier into a trigger for a response-to-injury in the artery wall.