SUMMARY The influence of homologous high density lipoprotein (HDL) and low density lipoprotein (LDL) and of whole hypercholesterolemic serum on the esterification of oleic acid and cholesterol was studied in rhesus monkey arterial smooth muscle cells. Whole hypercholesterolemic serum and isolated LDL stimulated cholesterol esterification as much as 10-fold using either cholesterol-1,2-3 H or oleate-l-14 C as substrate. At the same concentrations of cholesterol, HDL stimulated cholesterol esterification to a lesser extent, to a maximum of 3-fold. Associated with the stimulation of cholesterol esterification by LDL or whole hypercholesterolemic serum was a greater than 10-fold increase in the cholesteryl ester content of the arterial smooth muscle cells.Esterification to cholesterol reached a maximum after 8-12 hours of culture with either hypercholesterolemic serum or LDL. The stimulation of esterification was specific for esterification to cholesterol because there was little change in incorporation of fatty acid into triglycerides and phospholipids. These studies provide further evidence that a major consequence of the interaction of plasma LDL with the cellular elements of the arterial wall is a stimulation of cholesterol esterification. These studies, coupled with the observation that cholesteryl esters, more than any other single component, increase in the atherosclerotic artery, suggest an important role of a stimulation in cholesterol esterification in the pathogenesis of atherosclerosis.THERE NOW IS considerable information available describing the metabolic changes that occur in atherosclerotic arterial tissue.1 These include a number of alterations in the metabolism of proteins, carbohydrates, and lipids within the atherosclerotic artery. Although all of these metabolic changes contribute to the final expression of the disease, it is difficult to know which of them play a primary role in the initiation of the atherosclerotic lesion and which are results of the disease.The fact that cholesteryl esters accumulate within the atherosclerotic artery has been recognized for some time.
2As has been shown, an increase in arterial cholesteryl ester content is one of the first changes to occur in the arterial wall in experimentally produced atherosclerosis. This suggests that an alteration of cholesteryl ester metabolism may play a role in the initial events in the pathogenesis of atherosclerosis.3 Consistent with this hypothesis is the fact that a stimulation of cholesterol esterification can be demonstrated in arterial tissue prior to the appearance of grossly visible atherosclerotic lesions. Although cholesterol esterification appears to be one of the first metabolic parameters altered in the development of the atherosclerotic lesion, the actual mechanism of this stimulation is unclear. Considerable evidence suggests that it may result from the interaction of circulating plasma lipoproteins with the cellular elements of the arterial wall.3 "' To study the influence of a single component, such