Recent findings have helped to explain the fate of cholesterol enterin
g the arterial wall. LDL can undergo both fusion and aggregation. Thes
e changes may cause increased retention of LDL in lesion connective ti
ssue matrix and LDL uptake by macrophages. In the cornea, apparent fus
ion of LDL occurs in the absence of macrophages. Mast cells may be imp
ortant in LDL fusion, as mast cell-derived proteases can induce fusion
of LDL through proteolysis of apolipoprotein B. LDL in arterial wall
atherosclerotic lesions was found to be sialic acid-poor and ceramide-
enriched. These chemical changes promote LDL aggregation. Processes th
at may function to remove cholesterol from the arterial wall have been
reported. Macrophage-produced apolipoprotein E can mediate macrophage
cholesterol efflux and macrophages can convert cholesterol to 27-oxyg
enated products that macrophages excrete. Alternately, another oxygena
ted sterol, 7-ketocholesterol, impairs macrophage cholesterol efflux.
In addition, mast-cell derived chymase proteolyses HDL and reduces its
capacity to stimulate cholesterol efflux.