Abstract-Treatment of human aortic endothelial cells (EC) with minimally oxidized LDL (or minimally modified LDL, MM-LDL) produces a specific pattern of endothelial cell activation distinct from that produced by LPS, tumor necrosis factor-␣, and interleukin-1, but similar to other agents that elevate cAMP. The current studies focus on the signal transduction pathways by which MM-LDL activates EC to bind monocytes. We now demonstrate that, in addition to an elevation of cAMP, lipoxygenase products are necessary for the MM-LDL response. [1][2][3] Exposure of EC to the major cytokines, tumor necrosis factor-␣ (TNF-␣) and interleukin-1 (IL-1), and lipopolysaccharide (LPS) increased transcription of intracellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin, adhesion molecules that promote both neutrophil and monocyte binding. 4,5 In contrast, MM-LDL selectively stimulates EC to bind monocytes but not neutrophils 2 by an alternatively spliced variant of fibronectin 6 and without increasing expression levels of ICAM-1, VCAM-1, or E-selectin. 3 We have previously demonstrated that treatment of EC with MM-LDL caused a rapid increase in cAMP that was necessary for the induction of monocyte binding by MM-LDL. 1 We also found that other agents that increase cAMP, including cholera toxin, pertussis toxin, and dibutyryl cAMP, had a similar effect to MM-LDL; these agents stimulated monocyte but not neutrophil binding to EC without increasing expression of ICAM-1, VCAM-1, and E-selectin. 1 Taken together these observations suggest that MM-LDL and cytokines activate distinct signal transduction pathways. These separate pathways may determine the differences between acute inflammation mediated by neutrophils and chronic inflammation mediated by monocytes.To elucidate the signal transduction mechanisms by which MM-LDL activates the endothelium, we have examined the role of lipoxygenase (LO) metabolites in the actions of MM-LDL. The LO pathway was investigated because several