{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T17:18:43Z","timestamp":1774286323476,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T00:00:00Z","timestamp":1643414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/17\/16\/32560"],"award-info":[{"award-number":["FS\/17\/16\/32560"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["220572\/Z\/20\/Z"],"award-info":[{"award-number":["220572\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>We aimed to investigate if major vascular surgery induces LDL oxidation, and whether circulating antibodies against malondialdehyde-modified LDL (MDA-LDL) alter dynamically in this setting. We also questioned relationships between these biomarkers and post-operative cardiovascular events. Major surgery can induce an oxidative stress response. However, the role of the humoral immune system in clearance of oxidized LDL following such an insult is unknown. Plasma samples were obtained from a prospective cohort of 131 patients undergoing major non-cardiac vascular surgery, with samples obtained preoperatively and at 24- and 72 h postoperatively. Enzyme-linked immunoassays were developed to assess MDA-LDL-related antibodies and complexes. Adverse events were myocardial infarction (primary outcome), and a composite of unstable angina, stroke and all-cause mortality (secondary outcome). MDA-LDL significantly increased at 24 h post-operatively (p &lt; 0.0001). Conversely, levels of IgG and IgM anti-MDA-LDL, as well as IgG\/IgM-MDA-LDL complexes and total IgG\/IgM, were significantly lower at 24 h (each p &lt; 0.0001). A smaller decrease in IgG anti-MDA-LDL related to combined clinical adverse events in a post hoc analysis, withstanding adjustment for age, sex, and total IgG (OR 0.13, 95% CI [0.03\u20130.5], p &lt; 0.001; p value for trend &lt;0.001). Major vascular surgery resulted in an increase in plasma MDA-LDL, in parallel with a decrease in antibody\/complex levels, likely due to antibody binding and subsequent removal from the circulation. Our study provides novel insight into the role of the immune system during the oxidative stress of major surgery, and suggests a homeostatic clearance role for IgG antibodies, with greater reduction relating to downstream adverse events.<\/jats:p>","DOI":"10.3390\/antiox11020271","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T01:41:59Z","timestamp":1643420519000},"page":"271","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Depletion of Homeostatic Antibodies against Malondialdehyde-Modified Low-Density Lipoprotein Correlates with Adverse Events in Major Vascular Surgery"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1431-2200","authenticated-orcid":false,"given":"Adam","family":"Hartley","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London W12 0NN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magapu","family":"Pradeep","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4330-8972","authenticated-orcid":false,"given":"Victor","family":"Van den Berg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Centre, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameer Hamid Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan Ali","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Allaf","sequence":"additional","affiliation":[{"name":"Department of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikhail","family":"Caga-Anan","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London W12 0NN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1011-7440","authenticated-orcid":false,"given":"Joseph","family":"Shalhoub","sequence":"additional","affiliation":[{"name":"Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK and Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W2 1NY, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Koenig","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum M\u00fcnchen, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany and DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Lazarettstra\u00dfe 36, 80636 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2304-6434","authenticated-orcid":false,"given":"Michael","family":"Fisher","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Trust and Royal Liverpool and Broadgreen NHS Trust, Liverpool L14 3PE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorian O.","family":"Haskard","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London W12 0NN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4119-5193","authenticated-orcid":false,"given":"Ramzi Y.","family":"Khamis","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London W12 0NN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.5551\/jat1973.22.4_257","article-title":"Mechanisms of endothelial cell injury induced by oxidatively modified LDL","volume":"22","author":"Naito","year":"1994","journal-title":"J. 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