Obstructive sleep apnea (OSA), a condition that affects a quarter of the Western adults,
triples the risk for cardiovascular diseases and increases all-cause mortality. Intermittent
hypoxia (IH) during transient cessation of breathing in OSA leads to endothelial
inflammation, a key step in the initiation and progression of cardiovascular disease.
However, the mechanisms that mediate IH-induced endothelial inflammation remain unclear and,
consequently, no targeted therapy is available for vascular manifestations of OSA. Using
endothelial cells (ECs) freshly harvested from OSA patients, they study team has identified
impaired complement inhibition as an initial stimulus for endothelial inflammation in IH,
thereby linking for the first time complement activation to vascular risk in OSA. The
investigators found that a major complement inhibitor cluster of differentiation (CD59), a
plasma membrane protein that inhibits the formation of the terminal complement membrane
attack complex (MAC) and protects host cells from complement injury, is internalized from the
EC surface in OSA patients. Consequent MAC deposition initiates endothelial inflammation in
IH. Importantly, the investigators showed that IH does not significantly affect inflammation
in ECs in the absence of complement, suggesting that complement activation has an essential
role in endothelial inflammation in OSA. Interestingly, internalization of CD59 in IH appears
to be cholesterol-dependent and statins prevent MAC deposition on ECs in IH in a
CD59-dependent manner, suggesting a novel therapeutic strategy to reduce vascular risk in
OSA. This led the study team to hypothesize that IH-induced cellular cholesterol accumulation
reduces complement inhibition via increased internalization of CD59 from the EC surface
leading to increased MAC deposition, and that treatment of OSA with continuous positive
airway pressure (CPAP) and/or statins reverses endothelial dysfunction by restoring
complement inhibition.