Enzymatic modification of APOB within the endothelium causes lipoprotein retention, leading to oxidation, macrophage attraction, and atherosclerosis development.

“What can happen is that APOB molecule or that APOB protein can be enzyatically modified into a proteoglycan. Basically enzymes inside the inima can act on that apo and that causes that that enzyatic modification causes that LDL or VLDLDL or whatever particle it is to be retained inside the inima. Once retained that causes an oxidation. Oxidation can increase on those lipoproteins that can attract macrofasages as you pointed out the immune response. those macrofasages begin to engulf some of these aggregate that that these LDL particles can start to clump together or VLDLDL particles or whatever particle they start to clump together in a process called aggregation. macrofasages infiltrate inflammation trying to again repair this. But those macrofasages then engulfing them. This produces foam cells and over time you also get more I think the smooth muscle starts to thicken as well. And this is eventually what's leading to s kind of this closing of the blood vessel.”