Abstract-Oxidative modification of low density lipoprotein (LDL) appears to play an important role in atherogenesis.Although the precise mechanisms of LDL oxidation in vivo are unknown, several lines of evidence implicate myeloperoxidase and reactive nitrogen species, in addition to ceruloplasmin and 15-lipoxygenase. Myeloperoxidase generates a number of reactive species, including hypochlorous acid, chloramines, tyrosyl radicals, and nitrogen dioxide. Key Words: low density lipoproteins Ⅲ myeloperoxidase Ⅲ reactive nitrogen species Ⅲ vitamin C Ⅲ vitamin E T he hypothesis that oxidative stress plays an important role in the pathogenesis of atherosclerosis has gained considerable support. Although there are many determinants in the development of an atherosclerotic lesion, substantial in vitro evidence links LDL oxidation to potentially atherogenic processes at the molecular and cellular level. 1-3 However, the in vivo mechanism(s) of the initiation and progression of LDL oxidation is presently unclear and is a topic of much research. The most relevant information concerning this mechanism has come from immunohistochemical and biochemical analyses of animal and human atherosclerotic lesions and lipoproteins extracted from these lesions. Ceruloplasmin, 15-lipoxygenase, myeloperoxidase (MPO), and inducible (in addition to endothelial) nitric oxide synthase (NOS) have been found in animal and human lesions and can cause or contribute to LDL oxidation in vitro. 2,4 -10 With respect to a role for ceruloplasmin in in vivo LDL oxidation, specific markers of metal ion-catalyzed protein damage are not elevated in early or intermediate lesions, in contrast to advanced lesions. 9,11 Immunohistochemical detection of aldehyde-modified LDL in human and animal lesions 12,13 also has been used as evidence for metal ionmediated oxidation; however, the specificity of antibodies raised against aldehyde-modified or copper-oxidized LDL has been questioned, because these can cross-react with LDL modified by hypochlorous acid (HOCl). 14 Therefore, it appears unlikely that ceruloplasmin and other sources of redoxactive metal ions contribute significantly to LDL oxidation in vivo during the early stages of atherosclerotic lesion development.The role of 15-lipoxygenase in LDL oxidation and atherogenesis is controversial, because the mechanism by which the intracellular enzyme "seeds" extracellular LDL with hydroperoxides is unclear. 15,16 Furthermore, there is limited evidence for the presence of 15-lipoxygenase-modified lipids in lesions, because only small increases in the S/R enantiomeric ratio of lipid hydro(pero)xides were detected. 17,18 Nevertheless, immunohistochemical studies have demonstrated the presence of 15-lipoxygenase in macrophage-rich regions of human and rabbit atherosclerotic lesions, 19,20 and epitopes of oxidized LDL colocalize with 15-lipoxygenase. 20 Interestingly, cholesterol-fed transgenic rabbits overexpressing the human 15-lipoxygenase gene in macrophages develop significantly less atherosclerosis than do the...