Objective
Oxidative stress and oxidized high-density lipoprotein (oxHDL) are implicated as risk factors for cardiovascular disease (CVD) in systemic lupus erythematosus (SLE). Yet, how HDL is oxidized and rendered dysfunctional in SLE remains unclear. Neutrophil extracellular traps (NETs), which are elevated in lupus, possess oxidant-generating enzymes including myeloperoxidase (MPO), NADPH oxidase (NOX) and nitric oxide synthase (NOS). We hypothesized that NETs mediate HDL oxidation, impairing cholesterol efflux capacity (CEC).
Methods
Control and lupus plasma MPO levels and CEC activity were examined; 3-chlorotyrosine (MPO-specific) and 3-nitrotyrosine (derived from reactive nitrogen species) were quantified in human HDL. Multivariable linear models estimated and tested differences between groups. HDL was exposed to NETs from control and lupus neutrophils in the presence or absence of MPO, NOX, NOS inhibitors and chloroquine. Murine HDL oxidation was quantified after NET inhibition in vivo.
Results
SLE subjects displayed higher MPO levels and diminished CEC. SLE HDL had higher 3-nitrotyrosine and 3-chlorotyrosine content, with site-specific oxidation signatures on apoA1. Experiments with human and murine NETs confirmed that chlorination is mediated by MPO and NOX, and nitration by NOS and NOX. Lupus mice treated with the NET-inhibitor Cl-amidine displayed significantly decreased oxHDL. Chloroquine inhibited NET formation in vitro.
Conclusion
Active NOS, NOX and MPO within NETs significantly modify HDL, rendering the lipoprotein proatherogenic. As NET formation is enhanced in SLE, these findings support a novel role for NET-derived lipoprotein oxidation in SLE-associated CVD and identify additional proatherogenic roles of neutrophils and putative protective roles of antimalarials in autoimmunity.