Objective-Oxidized low-density lipoprotein (oxLDL)-induced apoptosis of vascular endothelial cells may contribute to plaque erosion and rupture. We aimed to clarify the relationship between the oxLDL-induced calcium signal and induction of apoptotic pathways. Methods and Results-Apoptosis was evaluated by biochemical methods, including studies of enzyme activities, protein processing, release of proapoptotic factors, chromatin cleavage, and especially by morphological methods that evaluate apoptosis/necrosis by SYTO-13/propidium iodide fluorescent labeling. The oxLDL-induced sustained calcium rise activated 2 distinct calcium-dependent mitochondrial apoptotic pathways in human microvascular endothelial cells. OxLDLs induced calpain activation and subsequent Bid cleavage and cytochrome C release, which were blocked by calpeptin. Cyclosporin-A inhibited cytochrome C release, possibly by inhibiting the opening of the mitochondrial permeability transition pore (mPTP). Calcineurin, another cyclosporin-sensitive step, was not implicated, because oxLDLs inhibited calcineurin and FK-506 treatment was ineffective. Cytochrome C release in turn induced caspase-3 activation. In addition, oxLDLs triggered release and nuclear translocation of mitochondrial apoptosis-inducing factor through a mechanism dependent on calcium but independent of calpains, mPTP, and caspases. Conclusions-OxLDL-induced apoptosis involves 2 distinct calcium-dependent pathways, the first mediated by calpain/ mPTP/cytochrome C/caspase-3 and the second mediated by apoptosis-inducing factor, which is cyclosporin-insensitive and caspase-independent. Key Words: calpain Ⅲ caspase Ⅲ mitochondria Ⅲ apoptosis-inducing factor Ⅲ oxidized low-density lipoprotein Ⅲ atherosclerosis A therogenesis is characterized by lipid deposition, a chronic inflammatory response, and chronic wound healing processes. 1,2 Apoptosis may play a role in endothelial cell lining defects, necrotic core formation, or plaque erosion and rupture. [3][4][5] Among the variety of proapoptotic factors present in atherosclerotic plaques, oxidized low-density lipoproteins (oxLDLs) are thought to play a crucial role by concomitantly inducing lipid storage, local inflammation, and toxic events. 4,[5][6][7][8] OxLDLs trigger apoptosis or necrosis of cultured vascular cells 7-9 and may therefore participate in vascular wall injury, plaque erosion/rupture, and subsequent athero-thrombotic events. 4,5 The proapoptotic effects of oxLDLs are mediated through a complex sequence of signaling events that lead to activation of several caspase-dependent or -independent apoptotic pathways. 8,9 Two separate caspase-dependent apoptotic pathways have been implicated in oxLDL-induced apoptosis. 7-9 The extrinsic apoptotic pathway, mediated by death receptors, Fas, and/or tumor necrosis factor receptor (TNFR) and downstream by caspase-8/caspase-3, is involved in oxLDLinduced apoptosis in endothelial cells. 8,10,11 However, a recent report contests this hypothesis. 12 The intrinsic mitochondrial apoptotic pathway, ...