Antibody E06 and the Role of Oxidized Phospholipids in Atherogenesis and Inflammation

Oxidized phospholipids (OxPL) are generated at sites of oxidative stress and tissue injury, where they function as prototypic danger-associated molecular patterns that trigger inflammation, cell death, and tissue remodeling. The natural IgM antibody E06, and derivative formats such as E06-scFv, recognize the phosphocholine epitope on OxPL but not on native phospholipids, providing powerful tools to probe the biology of OxPL across cardiovascular and noncardiovascular disease. In this review, we summarize experimental and translational evidence implicating OxPL as mediators of atherogenesis, myocardial ischemia-reperfusion injury, nonalcoholic steatohepatitis and hepatocellular carcinoma, bone loss, lung fibrosis and acute lung injury, sepsis, neuroinflammation, and pain. In multiple murine models, genetic or passive approaches that express or deliver E06-based constructs neutralize OxPL, attenuate inflammation, improve tissue function, and reduce lesion burden, establishing OxPL as an actionable driver rather than a passive byproduct of oxidative stress. We further highlight how E06 has been leveraged to develop sensitive immunoassays for OxPL on apoB-containing lipoproteins and on Lp(a) (lipoprotein[a]; OxPL-apo[a]). These biomarkers consistently associate with incident and recurrent cardiovascular events and link OxPL biology to human lipoprotein metabolism, particularly the preferential enrichment of OxPL on Lp(a). We review emerging data on how established and novel therapies, including statins, PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, lipoprotein apheresis, and Lp(a)-targeted antisense and RNA-based agents, modulate OxPL, and discuss how these interventions may help test the OxPL hypothesis in outcomes trials. Finally, we outline key challenges and opportunities for translating OxPL-directed strategies to the clinic, including issues of specificity, immunogenicity, timing, and patient selection. Collectively, these insights position OxPL and its selective neutralization by E06-like antibodies as a unifying mechanism and promising therapeutic target across diverse inflammatory and cardiometabolic diseases.