Altered HDL subclasses in endogenous hypertriglyceridemia are not affected by weight reduction

Reduction of body weight is commonly used to decrease the plasma lipids of patients with primary endogenous hypertriglyceridemia, but the effects of stabilized weight reduction on lipoprotein compositions and distribution are not well known. Since lipoprotein structures are perhaps as important in normal and abnormal metabolism and atherogenesis as are the levels of lipoproteins, we examined the effects of weight loss on the plasma concentrations, compositions, and ultracentrifugal flotation properties of plasma lipoproteins. Nine patients (eight males, one female) with endogenous hypertriglyceridemia and low high-density lipoprotein (HDL)-cholesterol levels who were approximately 130% of ideal body weight were studied during two dietary periods (basal and low weight). Subjects consumed an isocaloric diet for 5 weeks consisting of approximately 15% protein, approximately 45% carbohydrate, approximately 40% fat, approximately 500 mg/d cholesterol, P/S ratio 0.43 (basal), followed by a hypocaloric diet of the same composition, which was eaten for 16 to 52 weeks, until the desired weight was lost (9.6 +/- 3.6 kg). Then patients continued to eat a diet of the same composition lower in calories but sufficient in quantity to maintain their new lower body weights for the final 5 weeks (low-weight period). The last weeks of the basal and the low-weight periods were spent in a metabolic ward. Thus, high and low body weights were known to be stable for at least 5 weeks. Fasting (12 to 14 hours) plasma total triglycerides decreased in all patients (from 328 +/- 204 mg/dL at basal to 185 +/- 77 mg/dL at low weight, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Microrheologic investigation of erythrocyte deformability in diabetes mellitus

This study was undertaken to determine whether diabetes alters the viscoelastic properties of erythrocytes. The oldest and youngest 10% fractions of circulating red cells were separated by centrifugation of freshly drawn blood obtained from ten diabetics with disease of one to 20 years' duration and from an equal number of age- and sex-matched control subjects. Cells from each fraction were suspended in phosphate-buffered saline, and their rheologic behavior was examined in a rheoscope. The elongation of cells, the percentage of cells that tank-treaded in response to shear stress, tank-treading frequency, and the rate of recovery of cell shape upon cessation of shear stress were determined in the oldest and youngest 10% of cells for diabetics as well as for controls. All four parameters were virtually identical for diabetics and controls. Additional aliquots of cells were taken for assessment of nonenzymatic glucosylation of hemoglobin and cell membrane protein. The absence of any measurable difference in rheologic behavior of cells from diabetic and control subjects, despite substantial differences in nonenzymatic glucosylation of hemoglobin and cell membrane proteins, suggests that the magnitude of glucosylation observed in these cellular constituents does not alter the viscoelastic properties of the cells. The implication of these observations is that microvascular complications of diabetes are not attributable to altered deformability of red cells.

Age-related changes in deformability of human erythrocytes

The present study was designed to further the characterization of age-related changes in the deformability of human erythrocytes. The top (approximately young) and bottom (approximately old) 10% fractions of density-separated red cells from ten normal donors were subjected to graded levels of shear stress in a rheoscope. Measurements were made of steady-state elongation (cells tank treading in a state of dynamic equilibrium) and the time course of shape recovery following abrupt cessation of shear. In parallel with the rheologic experiments, several physical and chemical properties were assayed to determine correlates of mechanical properties. These included mean cell volume, mean corpuscular hemoglobin concentration, type A1 hemoglobin, glucosylation of membrane proteins, and membrane phospholipid and protein concentration. The microrheologic observations revealed that only about 90% of the old cells retained their capacity to tank tread. However, the tank-treading cells elongated less than their younger counterparts at corresponding levels of shear stress, thus demonstrating a reduced level of deformability. Further analysis of the data indicates that increases in membrane viscosity and elastic modulus along with a significant loss in excess surface area contribute to the limitation of the ability of the older cells to change shape.

Abnormal cell-interactive properties of low-density lipoproteins isolated from patients with chronic renal failure

Patients with renal failure on maintenance hemodialysis have accelerated rate of atherosclerosis. This, and the fact that chemically modified low-density lipoproteins (LDL) have a better capacity than native LDL to stimulate cholesteryl ester accumulation within macrophages in the vessel wall, led us to examine the possibility that some alteration in apo-LDL may take place in chronically uremic patients. We isolated LDL (d = 1.019 - 1.063 g/mL) from 18 patients with chronic renal failure and from 13 normolipidemic controls and compared the interactive properties of the different LDL preparations with cultured fibroblasts. Our results show that "uremic" LDL associates less, is degraded less, and has diminished ability to stimulate cholesteryl ester formation in fibroblasts when compared to normal LDL. LDL carbamylated in vitro showed interactive properties with fibroblasts similar to those of uremic LDL. Uremic LDL was not taken up by scavenger receptors present on rat peritoneal macrophages, similarly to normal LDL. However, the decrease in uptake by fibroblasts of uremic LDL may increase the residence time of these particles within the subendothelial region of the vessel wall, ultimately resulting in increased atherogenicity. Carbamylation of lysine residues of apoB in vivo, abnormal catabolism of LDL due to the absence of functional renal tissue, or triglyceride enrichment of LDL are among the possible explanations for the abnormal properties of uremic LDL.

Effect of exercise of the lower limbs on the non-exercised biceps brachii muscle

The electrophysiological pattern of fatigue of the biceps brachii (BB) muscle before and after bicycle leg exercise (LE), was evaluated in 12 healthy volunteers. In healthy people, the onset of isometric contraction is initiated by smaller motor units with briefer durations and higher spike frequencies. With the progression of contraction and muscular fatigue, electromyographic decrease in frequency and an increased spike duration occur. In our study, these findings were presented in subjects at the Final Value (FV) of electromyography before and after LE. In 8 subjects, the Initial Value (IV) of spike duration was longer after LE and a decrease in the frequency of electromyography was found in 9 of the 12 subjects. The changes in these two parameters at the onset of the BB contraction after LE may be due to the existence of an electrophysiological transfer effect. Eight subjects sustained the isometric BB contraction longer after LE than before LE. This may be explained by a diverting activity or other factors. Venous lactic acid was measured in 7 subjects and showed an increase after LE. No definite correlation between electromyographic changes and lactic acid was found.

The interaction of carbamylated low-density lipoprotein with cultured cells. Studies with human fibroblasts, rat peritoneal macrophages and human monocyte-derived macrophages

We determined the effects of various degrees of chemical modification of low-density lipoprotein (LDL) on its interaction with receptors present on human fibroblasts, human monocyte-derived macrophages and rat peritoneal macrophages. We isolated LDL (d = 1.019-1.063 g/ml) and carbamylated different numbers of lysine residues and tested its cell-interactive properties, including binding, degradation, and stimulation of [3H]oleate incorporation into cholesteryl oleate. Small carbamylation of LDL (approximately 1-2% of lysine residues) resulted in a reduced ability (70-80% of control) to displace 125I-labeled LDL from fibroblast receptors. Modification of 12.5-25% of lysine residues resulted in a marked increase in the ability of LDL to interact with scavenger receptors and an almost total loss in the ability to interact with apolipoprotein B-E receptors. Acetylated LDL and malondialdehyde-modified LDL inhibited competitively the degradation of 125I-carbamylated LDL by human macrophages. Thus, the extent of modification plays an important role in recognition of modified LDL by scavenger receptors. There also seems to be a range of modification over which LDL is not yet recognized by the scavenger receptor, but its interaction with the apolipoprotein B-E receptor is markedly reduced. This perhaps explains how a small in vivo modification of LDL can result in an increase in residence time of LDL in the subendothelial tissue which can lead to further local interactions, ultimately increasing the atherogenicity of the LDL particle.

Effect of probucol on the composition of lipoproteins and on VLDL apoprotein B turnover

We studied the effect of probucol on lipoprotein composition and VLDL apo B turnover. In 7 hypercholesterolemic subjects, probucol therapy lowered mean total cholesterol, HDL cholesterol and HDL triglycerides, raised LDL triglycerides and did not change LDL cholesterol. LDL cholesterol:LDL triglycerides mass ratios fell. In all 6 subjects studied by rate-zonal ultracentrifugation, the flotation rate of LDL decreased. The isolated LDL were depleted of cholesteryl esters relative to protein. Thus, there were changes in the physical and chemical properties of LDL. All 6 subjects had reductions in HDL2, with variable changes in HDL3 on zonal ultracentrifugation. Probucol did not cause significant alterations in VLDL apo B turnover in 4 patients. The results suggest that the alterations in HDL probably are not related to changes in the flux of VLDL plasma, but rather may be due to direct effects of the drug on HDL production or catabolism.

Increases in dietary cholesterol and fat raise levels of apoprotein E-containing lipoproteins in the plasma of man

Previous studies from this laboratory have determined that diets containing the usual amounts of fat to which are added 750-1500 mg/day cholesterol elevate the plasma cholesterol concentration by variable amounts, depending upon the ratio of polyunsaturated to saturated fatty acids (P/S ratio) of the diet. Diets with P/S ratios of 0.25-0.4 are accompanied by elevations of low density lipoprotein (LDL) cholesterol, whereas diets with a P/S ratio of 2.5 produce no significant changes in cholesterol levels. On the low P/S ratio diets, the structure, composition, and interaction with cultured fibroblasts of LDL are not significantly changed. Plasma high density lipoprotein (HDL) cholesterol levels remain constant, but HDL2 increase relative to HDL3. In the present study, not only dietary cholesterol but also total dietary fat was altered. Six normal young men were fed a basal diet consisting of 18% protein, 51% carbohydrate, and 30% fat, containing 250 mg/day cholesterol. After 2 weeks, an experimental diet consisting of 18% protein, 42% carbohydrate, and 39% fat, containing 1760 mg/day cholesterol, was fed for 4 weeks. The P/S ratios of both diets were about 0.4. Plasma samples were taken twice during each dietary period from 12- to 14-h-fasted subjects and analyzed for their contents of lipoprotein lipids. Plasma levels of LDL and HDL cholesterol increased by 30 and 13 mg/dl, respectively; total and very low density lipoprotein (VLDL) triglyceride concentrations were unaltered. The plasma concentrations of apoproteins (apo) B, E. and A-I, but not A-II, were elevated. Plasma samples also were studied by zonal ultracentrifugation, gel permeation column chromatography, and Pevikon electrophoresis. Although on zonal ultracentrifugation the total concentrations of LDL were increased, the flotation properties and chemical compositions of LDL were not changed. By contrast, HDL2 and HDL3L concentrations increased, and HDL2 became enriched with cholesteryl esters. On gel permeation chromatography, with the subjects on the basal diet, plasma cholesterol eluted in two peaks, corresponding to LDL and HDL. The sizes of the peaks increased on the experimental diet. ApoE eluted in two peaks: one at the leading edge of LDL (corresponding to VLDL or IDL) and the other in the area between LDL and HDL, corresponding to HDLC. On the experimental diet, the apoE peak between LDL and HDL increased. On Pevikon electrophoresis apoE migrated between the LDL and HDL bands. This apoE peak was increased on the experimental diet. These findings suggest that increasing the concentrations of both dietary cholesterol and total fat can increase the levels of plasma LDL, HDL2, and HDLC in fasting normal subjects. Thus, the concentrations of some putatively atherogenic as well as antiatherogenic lipoproteins increased in plasma, and the apparent paradox between the epidemiological and metabolic behaviors of some lipoproteins remains. Clearly, more work is needed to resolve the roles of various lipoproteins in plasma in atherosclerosis.

Lipoprotein levels in morbidly obese patients with massive, surgically-induced weight loss

Abnormalities in lipoprotein metabolism are among the risk factors for atherosclerotic cardiovascular disease frequently present in patients with morbid obesity. We have examined the effects of dietary restriction induced by gastric bypass surgery on plasma lipoprotein levels in 22 morbidity obese patients. Operation induced weight loss in all patients. Postoperatively (12 +/- 7 mo), triglycerides decreased from 146.4 +/- 67 (mean +/- S.D. before operation) to 104 +/- 44 mg/dl (p less than 0.01), total cholesterol decreased from 187 +/- 52 to 166 +/- 39 mg/dl (p less than 0.025), LDL cholesterol levels decreased from 119 +/- 42 to 104 +/- 36 mg/dl (p less than 0.038), and HDL cholesterol levels increased from 40.1 +/- 10.1 to 45.2 +/- 9.5 mg/dl (p less than 0.012). HDL cholesterol to LDL cholesterol ratio increased from 0.37 +/- 0.13 to 0.48 +/- 0.21 (p less than 0.01). The results of apo A-1, A-2 and B determinations (n = 12) paralleled the changes in lipoprotein levels. Apo A1/Apo A2 ratio increased suggesting an increase in the concentration of HDL2. We conclude that weight loss following gastric bypass surgery is associated with favorable changes in lipoprotein metabolism which may help prevent or delay the development of atherosclerotic cardiovascular disease. The mechanism responsible for the lipoprotein changes remains to be determined.

Antigenic mapping of human low density lipoprotein with monoclonal antibodies

Monoclonal anti-LDL antibodies were produced in a mouse spleen-myeloma system and purified by affinity chromatography on insolubilized low density lipoprotein (LDL). Five antibodies with different specificities could be distinguished by their immunoreactivities with chemically modified LDL preparations, and by their competition for binding to LDL. One of the antibodies inhibited the binding of (125)I-labeled LDL to the apoB,E receptors of cultured human fibroblasts. The same degree of inhibition was achieved using isolated Fab fragments. This antibody may bind to an antigenic site located near the cellular binding site of LDL-apoB.-Tikkanen, M. J., R. Dargar, B. Pfleger, B. Gonen, J. M. Davie, and G. Schonfeld. Antigenic mapping of human low density lipoprotein with monoclonal antibodies.

The effect of short-term feeding of a high carbohydrate diet on HLD subclasses in normal subjects

Plasma HDL concentrations are effected by several perturbations, including certain dietary manipulations. In this study we have examined the effects of a one week ingestion of an isocaloric, fat-free, high-carbohydrate diet (CHO greater than 80% of calories) and the concentrations and compositions of plasma HDL subclasses. Eleven healthy normolipidemic volunteers (6 females, 5 males) took part in this study. Blood samples for lipoprotein analysis were drawn before and at the end of the dietary period and analyzed for lipoprotein lipid and apoprotein concentrations. Lipoproteins also were characterized by zonal ultracentrifugation. Our results show the following significant changes at the end of the dietary period: plasma concentrations of VLDL-TG, VLDL-cholesterol and total VLDL mass increased, whereas plasma concentrations of LDL-cholesterol, LDL mass and HDL-cholesterol and HDL mass, decreased. Plasma concentrations of apoprotein A1 decreased (from 133.3 +/- 7.7 to 108.1 +/- 8.6; mean +/- S.E.M., p less than 0.0004), and apoprotein A2 concentrations remained unchanged. This resulted in a drop in plasma ratio of ApoA1/ApoA2 (p less than 0.03). Since it has been shown that ApoA1/ApoA2 ratio is higher in HDL2 than HDL3, we examined the concentrations of these two subfractions, employing rate-zonal ultracentrifugation for their isolation. One week of ingestion of the study diet was followed by consistent decreases in HDL2 mass (from 84 +/- 15 to 44 +/- 16 mg/dl, mean +/- S.E.M.), with inconsistent changes in HDL3 mass, (from 254 +/- 18 to 222 +/- 13 mg/dl) resulting in significant decreases in HDL2/HDL3 mass ratio. Lipid analyses of these subfractions did not demonstrate major compositional changes. The alterations noted could be due to decreased HDL production, at least in part, but alterations in the interconversions of lipoproteins also could have played a role. The falls in HDL2 on a diet which should be "antiatherogenic" illustrate the difficulty of assessing the atherogenicity of any given diet solely by the changes it produces in the levels of circulating lipoproteins.

Nonenzymatic glycosylation of low density lipoproteins in vitro. Effects on cell-interactive properties

Atherosclerosis occurs at an accelerated rate in patients with diabetes mellitus. Since some proteins undergo nonenzymatic glycosylation in diabetic patients and because certain chemical modifications of low density lipoproteins produced alterations in their interactions with certain cultured cells, a fact that may be relevant to atherogenesis, we investigated the effect of in vitro glycosylation on cell-related properties of low density lipoproteins. Glycosylation was carried out by incubating LDL (1-10 mg LDL-protein/ml) with glucose (0-100 mM) in 0.5 M phosphate buffer, pH 8.0, at 37 degrees C. The amount of glucose incorporated into LDL after 1-2 wk of incubation was estimated to be in the range of 1-10 mol/mol LDL-protein. Amino acid analysis of glycosylated LDL showed that glucose was covalently bound to lysine residues. In studies with cultured human fibroblasts, glycosylated LDL was internalized and degraded significantly less than control LDL, in proportion to the estimated degree of glycosylation (12% of control for the most extensively glycosylated LDL). Glycosylation of LDL also impaired significantly its ability to stimulate cholesteryl ester synthesis by cultured fibroblasts. Glycosylated LDL did not stimulate cholesteryl ester synthesis in rat peritoneal macrophages. If glycosylation of LDL occurs in diabetic patients, some pathophysiologic consequences related to the increased incidence of atherosclerosis in these patients may result.

Recovery after muscular fatigue in hemiparesis

Setchenov showed in 1903 that the amount of work he could perform with his right arm after a pause, during which he had worked with his nonfatigued left arm was greater than if he had rested passively between bouts. Asmussen and Mazin have shown that recuperation after local muscle fatigue was influenced by a central nervous factor. In this paper 10 stroke patients were examined and the muscular activity of the deltoid was measured by means of EMG. The intact deltoid behaved according to Setchenov's observation. In 4 patients the diverting activity did not have any beneficial effect on the paretic muscle. It is assumed that in some of the stroke patients the brain damage affects the facilitatory centers which are needed for the recuperation after muscular fatigue.