1. Introduction
Atherosclerosis is the main cause of morbidity and mortality in the Western world. It is a multifactorial chronic inflammatory disease that involves a complex interaction of circulating cells and blood factors with the blood vessels. The disease starts with endothelial dysfunction that leads to accumulation of oxidized lipids in the artery wall [
1,
2]. Lipid oxidation plays a central role in atherogenesis [
3] by inducing a pro-inflammatory phenotype in the arterial wall that underlies the development and progression of atherosclerosis [
4].
High-density lipoprotein (HDL) is an established protective factor against atherosclerosis due to its ability to mediate reverse cholesterol transport as well as anti-oxidative, anti-inflammatory, and endothelial protective functions [
4,
5,
6]. HDL can inhibit endothelial cell adhesion molecules, such as vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin that enable monocytes to bind at the sites of developing atherosclerosis [
7]. HDL can remove peroxidized lipids from LDL and subsequently reduce them in a reaction with methionine residues of apolipoprotein A1 (APOA1) [
8]. Lipid-free APOA1 can also remove lipid peroxide molecules from low density lipoprotein (LDL) [
9]. Reconstituted HDL containing only APOA1 and phospholipids, inhibits LDL oxidation like the native HDL3b and HDL3c particles do [
8]. Other HDL-associated lipoproteins and enzymes, including paraoxonase 1 (PON1), have also been implicated in HDL’s anti-oxidative, anti-inflammatory, and endothelial protective functions [
10,
11].
Studies over the last decade have significantly expanded our knowledge regarding the natural substrates of PON1 and their role in human disease. Other studies have shown that the protective function of PON1 in human health is due to the ability of PON1 to affect the expression of genes involved in anti-oxidative and anti-inflammatory processes. These studies are discussed in the present review, highlighting the involvement of reduced PON1 expression/activity in the pro-oxidative, pro-atherogenic, pro-amyloidogenic, and pro-cancerogenic phenotypes.
2. Hydrolytic activities of the PON1 enzyme
PON1, a hydrolytic enzyme that requires calcium for activity, is expressed in the liver, kidney, colon [
12], brain [
13,
14,
15], and circulates attached to HDL in the blood. It is a minor HDL protein with potential clinical significance. Proteomic studies revealed that HDL particles carrying PON1, are enriched in several other important proteins such as A2M, ALB, CLU, IGHG1, IGLC2, PROS1, and TF [
16]. The
PON1 gene is located on the long arm of chromosome 3 in the
PON cluster together with
PON2 and
PON3 genes. Its polymorphic variants include
PON1-Q192R [
17] that involves the glutamine (Q) to arginine (R) change at position 192 of the amino acid sequence of the PON1 protein and affects its hydrolytic activity. Historically, the hydrolytic activity of PON1 has been assayed with non-natural substrates such as the organophosphate paraoxon (for which the PON1 enzyme has been named) and phenyl acetate [
18] (
Figure 1).
Studies of homocysteine (Hcy) metabolism have led to the discovery that PON1 is responsible for enzymatic hydrolysis of Hcy-thiolactone to Hcy (
Figure 1) in human serum, thus identifying the first natural substrate of PON1 [
19]. Hcy-thiolactone, a cyclic chemically reactive thioester, is a product of Hcy editing by methionyl-tRNA synthetase during protein biosynthesis [
20,
21,
22].
PON1 is the only Hcy-thiolactone hydrolyzing enzyme in the human blood [
19,
39]. The Hcy-thiolactonase activity of the PON1 enzyme shows an interindividual variability of over 10-fold [
23,
24], similar to the interindividual variability in the paraoxonase activity [
17]. This variability is mostly due to polymorphisms in the human
PON1 gene [
17]. For example,
PON1-192RR variant exhibits high activity while
PON1-192QQ variant has low activity towards Hcy-thiolactone [
23] and paraoxon [
17]. In contrast,
PON1-Q192R polymorphism has an opposite effect on the arylesterase activity: the
PON1-192RR variant exhibits low arylesterase activity while PON1-192QQ variant has high arylesterase activity [
16,
25,
26,
27,
28]. Individuals who have the low activity
PON1-192QQ polymorphic variant produce significantly more Hcy-thiolactone than those who have the high activity
PON1-192RR polymorphic variant [
25].
Low PON1 expression/activity is accompanied by increased oxidative stress and predicts adverse outcomes in cardiovascular disease (CVD) [
27,
29], diabetes [
30,
31], neurological disease [
32], and cancer [
33]. This has been suggested to be due to the mediation by PON1 of anti-oxidative and anti-inflammatory effects of HDL [
34,
35]. Many other HDL components have also been shown to mediate the anti-oxidative activity of HDL [
10,
11,
36], including APOA1, which accounts for 70% of HDL protein mass [
36] and anti-apoptotic activity [
37] and for most of the HDL anti-oxidative activity [
8]. Accumulating evidence suggests that influence of PON1 on oxidative stress and inflammation is indirect rather than direct [
38].
Hcy-thiolactone is harmful because it reacts with ε-amino group of protein lysine residues, forming
N-homocysteinylated-proteins, which impairs protein’s structure and function [
22]. Hydrolytic detoxification of Hcy-thiolactone by PON1 is beneficial because it prevents protein damage by
N-homocysteinylation [
19,
23,
39]. For example, serum from donors with
PON1-LL55/RR192 genotype hydrolyzed Hcy-thiolactone (
Figure 2A) to Hcy (
Figure 2B) faster and afforded better protection from protein
N-homocysteinylation than serum from donors with the
PON1-MM55/QQ192 genotype (
Figure 2C). Notably, PON1 in rabbit serum hydrolyzed Hcy-thiolactone (
Figure 2A) even faster and afforded much better protection from protein
N-homocysteinylation than any human serum (
Figure 2C).
In a large randomized clinical trial, urinary Hcy-thiolactone was associated with myocardial infarction in coronary artery disease patients [
40]. In a mouse and cellular models of Alzheimer’s disease (AD), Hcy-thiolactone promoted the accumulation of amyloid beta (Aβ) by inhibiting autophagy [
15]. Hcy-thiolactone can promote the progression to AD by upregulating amyloid precursor protein (APP), which results in increased generation of Aβ [
15].
The involvement of Hcy-thiolactone in disease can also be explained by its ability to impair protein structure/function
via N-homocystinylation of protein lysine residues [
22]. For example,
N-homocysteinylation of fibrinogen by Hcy-thiolactone, which impairs lysis of fibrin clots
in vitro [
41], explains the association of Hcy-thiolactone with impaired lysis of fibrin clots
in vivo in humans (manifested by longer time of fibrinolysis) as we have recently shown in a large randomized controlled trial [
42].
Enzymological studies
in vitro led to a contention that the lactonase activity is a native physiological activity of PON1, but no physiological evidence was provided [
43,
44]. Other studies repeated this contention by stating that the lactonase activity is “the established native physiological activity of PONs” [
45] even though no physiological evidence supporting such statement has been reported either. A study that attempted to identify endogenous lipophilic lactones as possible
in vivo substrates for PON1 in human serum, found none [
46]. Possible involvement of PON1 in metabolism of endogenous lipophilic lactones
in vivo as proposed in refs [
43,
44] remains to be proven.
Nevertheless, recent findings showed that some phenyl-γ-valerolactones (PVLs), phase 2 metabolites derived from dietary flavan-3-ols, are substrates for PON1 and PON3
in vivo [
47]. Flavan-3-ols constitute the main class of polyphenolic bioactive compounds present in the food and beverages such as tea, pome fruits, cocoa products, and berries. Large-scale randomized clinical trials show that flavan-3-ol intake was associated with beneficial cardiovascular effects [
48] but had no effect on cognition [
49]. After intake, flavan-3-ols are catabolized by gut microbiota to PVLs and phenyl-γ-valeric acids (PVAs), which enter the circulation and are distributed throughout the human body [
50]. After intraperitoneal administration of 5-(3′,4′-dihydroxyphenyl)-
γ-valerolactone (
γVL), the sulfated form of
γVL was detected in the brain while
γVL aglycon was not detected [
51]. In TNF-α stimulated human brain primary microvascular endothelial cells, 5-(4′-hydroxyphenyl)-
γ-valerolactone-3′-sulfate and 5-(4′-hydroxyphenyl)-
γ-valerolactone-3′-
O-glucuronide were biologically active at low nanomolar concentrations and influenced the expression of genes involved in biological pathways such as cell adhesion, cytoskeleton organization, focal adhesion, signaling pathways, pathways regulating endothelial permeability, and interaction with immune cells [
52]. However, it is not known whether corresponding PVAs (i.e., products of PVLs hydrolysis by PON1) can also influence gene expression.
In human serum,
γVL was rapidly hydrolyzed to the corresponding
γ-substituted valeric acid (
γVA) by PON1 and PON3 (t
1/2 = 9.8 min) (
Figure 3B) [
47]. The hydrolysis was prevented by treatments with EGTA (calcium chelator and an inhibitor of PON1) or with heat (
Figure 3A). Km was 269 μM (
Figure 3C), way above sub micromolar
γVL concentrations in humans [
50]. Some but not all, phase II metabolites (sulfated or glucuronidated
γVL) were also hydrolyzed by PON1/PON3 in serum. In general, conjugated
γVLs were worse substrates of PON than unconjugated
γVL. Additional conjugations of
γVL significantly reduced or prevented the hydrolysis of
γVL metabolites by PON. Another polyphenol-derived lactone, enterolactone, was not a substrate [
47].
In contrast to the established influence of PON1 genotype on the hydrolysis of Hcy-thiolactone [
23,
39], the EPIC-Norfolk sub-cohort study found that the sum of urinary conjugated
γVLs was not influenced by
PON1 genotype (
Q192R, rs662 in the coding region; -162A/G rs705381 in the promoter region) in males but there was a small effect in females [
47]. These findings suggest that
PON1 genotype has a minor sex-dependent effect on the hydrolysis of conjugated
γVLs; this, however, remains to be examined in future studies.
4. PON1 Has no Intrinsic Anti-oxidant Activity: Don’t Waste Clean Thoughts on Dirty Enzymes
PON1 has been stated to hydrolyze oxidized lipids and thus to promote atheroprotective effects, e.g., refs [
27,
87], which incorrectly implies that PON1 has an intrinsic anti-oxidant function. That PON1 has the ability to hydrolyze oxidized lipids was originally proposed by a study that reported the ability of purified native human PON1 to inhibit copper-induced oxidation of LDL in an in vitro assay that quantified lipo-peroxides and TBARS [
88].
The availability of an assay for a biological event in a cell-free system usually facilitates studies of its molecular mechanism. Indeed, this assay has been used in many in vitro studies using purified native (e.g., refs. [
89,
90,
91,
92]) and recombinant [
93,
94] PON1 preparations. Unfortunately, these and other studies in the PON1 field did not follow the maxim “don’t waste clean thoughts on dirty enzymes” attributed by Arthur Kornberg in his ‘ten commandments of enzymology’ [
95] to Efraim Racker, a pioneer in the enzymology of oxidative phosphorylation [
96].
Some labs did not replicate the finding that purified PON1 protects LDL from oxidation [
44,
97] while those that did [
98,
99,
100] went on to corrected themselves by showing in a more rigorous and well-controlled studies that their earlier findings were due to PAF-AH contamination in PON1 preparations and that PAF-AH-free that PON1 does not protect lipoproteins from oxidation nor hydrolyze oxidized lipids [
44,
101,
102]. Rigorously purified PON1, or plasma from an individual with a mutation in the
PAF-AH gene, did not hydrolyze PAF nor the oxidized phospholipids from oxLDL [
97].
One study purported to show that purified PON1 was capable of hydrolyzing PAF. In that study [
103], purified PON1 preparations were tested by western blotting (20 μg) and amino acid sequencing (50 μg, or about 1 nmol PON1) and found not to have any detectable PAF-AH contamination. However, such evidence does not exclude PAF-AH contamination, considering that as little as 5 to 10 ng of PAF-AH (undetectable by western blotting and not sufficient for sequencing) is sufficient to account for all the phospholipase activity in purified PON1 preparations [
97]. In fact, other labs have shown that purified PON1 has no phospholipase A2-like activity toward PAF or pro-atherogenic oxidized phospholipids and that PAF-AH is the sole phospholipase A2 of HDL [
97,
101]. Rigorously purified PON1, or plasma from an individual with a mutation in the
PAF-AH gene, did not hydrolyze PAF nor the oxidized phospholipids from oxLDL [
97].
Although Aviram et al. [
93] and Liu et al. [
94] reported that PON1, PON2, and PON3 protect LDL from oxidative modification, Draganov et al. found no protection [
44]. Recombinant human PON1 was expressed from a baculovirus vector in insect cells and purified. When PON1 hydrolytic activity and a putative anti-oxidant activity were monitored during PON1 purification, the two activities did not co-purify at any stage and in any of the preparations. The putative anti-oxidant activity was shown to be associated with a low mass contaminant and the detergent used in PON1 purification [
44]. That putative anti-oxidant activity in PON1 preparations was associated with the detergent present in these preparations was confirmed by another lab that also showed that anti-oxidant activity was not associated with hydrolytic PON1 activities such as arylesterase and lactonase, or with phospholipase activity [
101]. Unfortunately, it appears that many other laboratories didn’t seem bother to control their PON1 preparations for contaminants.
Studies that examined contribution of individual protein components to the ability of HDL to inhibit LDL oxidation showed that APOA1 is the major anti-oxidant protein in HDL [
10]. APOA1 is also the major factor responsible for the protection of human endothelial cells from oxLDL-induced apoptosis, accounting for 70% of HDL antiapoptotic activity [
37]. APOA1 is one of the two phosphatidylcholine peroxide reducing enzymes isolated from human plasma (the other is glutathione peroxidase) [
104]. APOA1 is essential for HDL structure and for activation of the HDL-associated enzymes PON1 and LCAT [
105]. Two methionine residues in APOA1 (Met112, Met148) are oxidized to sulfoxides during reduction of lipid peroxides to redox-inactive hydroxides [
106,
107]. Reconstituted HDL containing only purified APOA1, and phospholipids (palmitoyloleoyl phosphatidylcholine at a molar ratio of 1.0/77.1) has the capacity to inhibit LDL oxidation like that of native normolipidemic small, dense HDL3b and 3c isolated from normal human plasma. Oxidation of APOA1 Met residues in HDL3 incubated with oxLDL is accompanied by concomitant reduction of lipid peroxides to lipid hydroxides [
8].
To assess a role of HDL-associated enzymes, such as PON1, PAF-AH, and LCAT, in oxLDL inactivation, HDL3 was pretreated with inhibitors such as DFP that inhibits the 3 enzymes, Pefabloc that inhibits only PAF-AH, or EDTA that inhibits only PON1, and then incubated with oxLDL. As expected, pretreatment significantly reduced the activities of LCAT (by 50%), PAF-AH (by 90%), and PON1 (by 99%). In contrast, the capacity of HDL3 to inactivate lipid peroxides in oxLDL or to delay LDL oxidation was not affected. None of the inhibitors impaired the capacity of HDL3 to delay the accumulation of conjugated dienes in LDL [
8]. Two earlier studies have also reported that inactivation of PON1 activity by EDTA did not affect the anti-oxidant activity of HDL3 [
108] or PON1 preparations [
91] in the copper-induced LDL oxidation assay. These findings do not support the contention that paraoxonase activity inhibits the formation of 'minimally oxidized' LDL by hydrolyzing biologically active oxidized phospholipids [
9,
89].