Lipoproteins and Immune Modulation: Implications for Cardiovascular Health - A Narrative Literature Review

Abstract

This review synthesizes current knowledge regarding the roles of major lipoproteins, High-Density Lipoprotein (HDL), Low-Density Lipoprotein (LDL), and Chylomicrons, in modulating immune responses and their implications for cardiovascular health. HDL is primarily anti-atherogenic, mediating reverse cholesterol transport (RCT) and exerting anti-inflammatory effects through the modulation of Toll-like Receptor (TLR) pathways and cholesterol efflux in immune cells. Under chronic inflammatory states or diseases such as atherosclerosis and autoimmunity, HDL function becomes impaired, leading to pro-inflammatory properties through changes in its composition and reduced antioxidant capacity. Additional to HDL, LDL also changes to an atherogenic lipoprotein through modifications and promotes foam cell formation as well as stimulation of both innate and adaptive immune responses, including the activation of macrophages, inflammasomes, and generation of immune complexes that drive vascular inflammation. Chylomicrons, beyond their role in dietary fat transport, participate in immune modulation through interactions with endotoxin lipopolysaccharide (LPS), influencing both the absorption and clearance of LPS and thus affecting inflammatory tone, especially in conditions like obesity and diabetes. The immunomodulatory effects of lipoproteins affect the development and progression of cardiovascular diseases. Modified HDL, LDL, and chylomicrons alter innate and adaptive immune pathways within the arterial wall, contributing to chronic vascular inflammation, plaque instability, and thrombosis. Dysfunctional or pro-inflammatory variants of these lipoproteins enable immune activation and heighten the risk of atherosclerosis. Further research in this field, in particular regarding detailed mechanisms of the interaction between lipoproteins and the immune system, could enable new therapeutic approaches for the prevention and treatment of cardiovascular diseases. Additionally, an improved assessment of lipoprotein quality as opposed to lipoprotein quantity could be relevant for individual risk assessment and targeted interventions.

Date of Award	2026
Original language	English
Awarding Institution	Medical University Graz
Supervisor	Susanne Sattler (Supervisor) & Michael Holzer (Co-supervisor)