Purpose of review: The differentiation of macrophages into lipid-laden foam cells is central to the development of atherosclerosis. Traditionally, it has been assumed that the uptake of oxidized low-density lipoprotein by macrophage scavenger receptors is largely responsible for this process. However, in light of recent evidence that these mechanisms may not play as large a role as previously thought, alternative mechanisms of foam cell formation are now being explored.
Recent findings: The stimulation of Toll-like receptor (TLR) signalling by bacterial molecules has been shown to promote the accumulation of lipid in macrophages in the form of intracellular inclusions termed 'lipid bodies'. Interactions between TLR-signalling pathways and the liver-X receptor and peroxisome proliferator-activated receptor-γ signalling pathways modulate the formation of lipid bodies in macrophages and thereby cellular accumulation of cholesterol and triglyceride. These pathways appear to involve TLR-mediated regulation of lipid-binding proteins, cellular cholesterol sensors, lipid-body-associated proteins and secreted autocrine factors, but are independent of scavenger receptor or lipoprotein oxidation-dependent pathways.
Summary: TLR stimulation promotes the accumulation of lipid bodies in macrophages and consequently foam cell formation. The pathways responsible for these processes may constitute novel therapeutic targets for atherosclerosis.