While simvastatin inhibited the enzyme HMGCoA-reductase, punicalagin, β-sitosterol, and PJ inhibited macrophage cholesterol biosynthesis downstream to mevalonate. Simvastatin (15μg/mL) also modestly decreased macrophage ROS formation by 11%. In the presence of punicalagin (15 or 30μM), however, a remarkable further inhibition was noted (by 61% or 79%, respectively).Although β-sitosterol alone showed some pro-oxidant activity, the combination of simvastatin, β-sitosterol, and punicalagin clearly demonstrated

a remarkable 73% reduction in ROS production. Similarly, simvastatin + PJ decreased the extent of ROS formation by up to 63%. These results suggest that PJ consumption Inhibitors,research,lifescience,medical by hypercholesterolemic patients together with treatment Inhibitors,research,lifescience,medical with a low dose of statins could lead to attenuation of macrophage foam cell formation and atherogenesis in these patients. CONCLUSIONS Pomegranate fruit click here polyphenols protect against lipid peroxidation in serum by direct interaction of pomegranate polyphenols with LDL, or indirectly by increasing serum PON1 stability (HDL association), as well as its catalytic activities, resulting in the hydrolysis of lipid peroxides. Moreover, PJ has a remarkable effect on macrophage Inhibitors,research,lifescience,medical and lesion atherogenicity. Pomegranate juice consumption decreased oxidative stress in macrophages and in atherosclerotic lesions,

and the extent of Ox-LDL uptake by macrophages. This could be a direct antioxidant effect of PJ, or an indirect effect, by increasing HDL-associated PON1 as well as cellular PON2. Interestingly, Inhibitors,research,lifescience,medical the lesion cholesterol levels were decreased after PJ consumption. This could be related to the reduction in Ox-LDL uptake by macrophages, to PJ/PON1-induced inhibition of cholesterol biosynthesis, and to PON1 stimulation of HDL-mediated Inhibitors,research,lifescience,medical cholesterol efflux from arterial macrophages. All these antioxidative and anti-atherogenic effects of pomegranate polyphenols were clearly demonstrated

in vivo, in humans (healthy subjects, CAS patients, as well as diabetic patients).The preferred pomegranate product in terms of biological potency and consequent health benefits is PJ from the whole fruit (including the peel). Since the combination of antioxidants that exists in PJ can provide a wider most range of free radical scavenging capacities than an individual antioxidant, clinical and nutritional studies in humans should be directed towards the use of combinations of several types of dietary antioxidants, as well as combinations of flavonoids together with other nutritional antioxidants, such as vitamin E or carotenoids. In addition, PJ can be beneficially used in combination with low-dose statins in hypercholesterolemic patients. Finally, it is also important to identify populations suitable for antioxidant treatment, as antioxidants treatment may be beneficial only in subjects who are under excess oxidative stress.