Summary:Numerous recently published studies demonstrate that, once altered by free radical oxidation, plasma lipoproteins undergo dramatic change, both in the manner in whrch they can interact with cells and in the ways in which they influence cell function. For example, with increasing degrees of oxidation, low-density lipoprotein (LDL) will cease to be recognizable by the LDL receptor and ultimately can become a ligand for "scavenger" receptors on macrophages. Gene expression and production of cemain cytokines and growth factors can be modified through the interaction of oxidized LDL with the cell sources of these potent cell regulators. These discoveries have stimulated the formulation of hypotheses of roles played in vivo by oxidized lipoproteins or their various oxidized lipid moieties in cellular regulation and in various disease processes. Among the more detailed of these hypotheses is a putative sequence in which LDL becomes oxidized and subsequently participates in the various facets of atherosclerotic lesion development, including monocyte recruitment, foam cell formation, vascular cell injury, and cellular proliferation. The evidence supporting this scenario makes a compelling story, one that is fed by reports that certain antioxidants favorably alter the course of vascular lesion development. However, other studies suggest that antioxidants do not inhibit lesion progression or that any alleviation is secondary to lipid lowering. This brief accounting examines some of the more recent studies dealing specifically with the effects of antioxidants on atherosclerosis. There are a number of review articles surveying recent scientific findings related to the role oxidatively modified LDL might play in atherosclerosis.k-3 Brief mention will be made of some of these findings, but the reader is referred to the reviews for deeper background information. The purpose of the current manuscript is to evaluate summarily the interference by exogenous antioxidants in vascular lesion formation. Studies that examined antioxidant-induced plasma lipid or lipoprotein changes, but which did not measure any vascular parameters related to atherosclerosis were, with a few exceptions, omitted.Low-density lipoprotein (LDL) and the other plasma lipoproteins are complexes containing several different lipid classes and dozens of distinct lipids. Comprising LDL, for example, are cholesterol, both free and esterified, triglycerides, several phospholipids, and free fatty acids. The variety of fatty acids in the triglyceride, cholesteryl ester, and phospholipid moieties contributes to the diversity of the resident lipids in LDL. Upon oxidation these dozens of lipids are transformed into an even more heterogeneous mixture, containing numerous newly formed lipids and lipid oxidation products in addition to the pre-existing lipids. Some of these products are sufficiently polar to leave the lipoprotein, others can react with various amino acids residues of the ap~lipoprotein.~.~ With these extensive changes it is perhaps no surprise that u...