Atherogenic hyperlipoproteinemia. The cellular and molecular biology of plasma lipoproteins altered by dietary fat and cholesterol

Apolipoprotein E: receptor binding properties

The E apoprotein plays a central role in lipoprotein metabolism. It is a key protein determinant responsible for the recognition of lipoproteins by specific lipoprotein receptors. Structure-function studies are providing insights into the normal function of this apoprotein in cholesterol homeostasis and into the clinical abnormalities resulting from the occurrence of specific mutants.

The cellular pathobiology of atherosclerosis in 1983

Atherosclerosis is a dynamic process in which a number of stimuli to arterial lipid deposition, cell proliferation and cell death, and the synthesis of fiber and matrix proteins by modulated smooth muscle cells are the major factors which can vary to control to process. The circulating levels and interaction of lipoproteins, the integrity of the endothelium, the heart rate and the height of the blood pressure and many incompletely understood arterial wall factors all appear to affect these components. Although there are many unanswered questions, it is clear that immense progress has been made in the past 25 years in developing a reasonable understanding of the cellular pathobiology of the atherosclerotic process. The momentum of this progress is such as to project a very promising future in which the molecular pathology of atherogenesis will be understood well enough to permit prevention, retardation and more effective regression of the dangerous advanced plaque.

Pantethine reduces plasma cholesterol and the severity of arterial lesions in experimental hypercholesterolemic rabbits

Pantethine (P), a coenzyme A precursor, was administered to cholesterol-fed rabbits (0.5% cholesterol diet + 1% pantethine) for 90 days. At the end of treatment, plasma total cholesterol levels were reduced 64.7% and the HDL/total cholesterol ratio increased in P-treated animals; a significant rise of the apo A-I/A-II ratio was detected in HDL. VLDL lipid and protein levels were, on the other hand, reduced by P. The cholesterol-ester content of both liver and aortic tissues was not significantly affected by P. Although the total aortic area with evident plaques was reduced only 18.2%, the microscopical examination of sections from the major vessels of P-treated animals, showed a reduction in the severity of lesions, both in the aorta and in the coronary arteries. These findings suggest that P, in addition to significantly lowering plasma cholesterol levels in rabbits on an experimental diet, may modify lipid deposition in major arteries, possibly by affecting lipoprotein composition and/or exerting an arterial protective effect.

New mutants of apolipoprotein E associated with atherosclerotic diseases but not to type III hyperlipoproteinemia

We analyzed the heterogeneity of apo E in very low density lipoprotein from 58 hyperlipidemic subjects with or without atherosclerosis, 69 patients with ischemic heart disease, and 100 apparently healthy individuals. Apo E gene frequencies in the group of healthy individuals were comparable with those in German and American populations. The distribution of six common apo E phenotypes in the groups of hyperlipidemia and ischemic heart disease was similar to that in the healthy group. In addition to the three major isoforms of apolipoprotein E (apo E-4, E-3, and E-2) and the new one (apo E-5) which was recently found in this laboratory, we have discovered an additional series of components, which showed themselves as at least three bands on an isoelectric focusing gel in the region of E-VII through E-V, in four patients with hyperlipidemia and atherosclerosis. The new series of apo E components, named apo E-Suita, was identical with the ordinary apo E in its interaction with heparin-Sepharose gel and with anti-apo E antibody. The most basic component of apo E-Suita (E-VII) was the unsialylated form and other components (E-VI and E-V), the sialylated forms. Family studies revealed that apo E-Suita was determined by inheritance of a new apo E allele located at the same locus as the hitherto known apo E components. Apo E-5 and apo E-Suita isoproteins had isoelectric points more basic than apo E-3, the parent type, by two and four units of charge, respectively. While the apo E-Suita isoprotein had the same molecular weight as ordinary major apo E isoproteins, the molecular weight of the apo E-5 isoprotein was approximately 1,500-2,000 lower than the other apo E isoproteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The incidence of abnormal apo E components, including apo E-5 and apo E-Suita, was high among patients with hyperlipidemia and ischemic heart disease (7:127), while we could not find such components among 100 healthy individuals. Moreover, five of seven patients with the abnormal apo E had overt atherosclerotic disease. The findings suggest that these kinds of apolipoprotein mutation are closely related to the development of atherosclerosis.

Uptake of apolipoprotein E-containing high density lipoproteins by hepatic parenchymal cells

Cholesterol-enriched, apolipoprotein E-containing high density lipoproteins (apo E HDLc), which were isolated from the plasma of cholesterol-fed dogs by using agarose column chromatography or ultracentrifugation, possessed essentially identical biochemical and metabolic characteristics. Radioiodinated (125I) apo E HDLc isolated by either method gave identical rates of clearance from the plasma, i.e., greater than 50% of the injected dose was cleared from the plasma within 5 to 10 minutes, principally by the liver. Detailed studies localizing apo E HDLc uptake to specific cell types within the liver were performed in both normal and cholesterol-fed rats. The validity of using the canine apo E HDLc in the rat was supported by observations of marked similarities in plasma clearance, i.e., a rapid acute phase of disappearance, and a near-quantitative hepatic uptake of lipoproteins in both species. Canine apo E HDLc (fluorescently labeled with 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine), which were injected into normal rats, appeared to be taken up primarily by parenchymal cells, as determined by fluorescence microscopy. Light microscopic autoradiography also revealed that the uptake of 125I apo E HDLc was principally carried out by parenchymal cells in rat liver. Likewise, the uptake of apo E HDLc by the liver of cholesterol-fed rats was extensively localized to parenchymal cells. An in situ, single-pass perfusion of a lobule of the liver of a normal dog with iodinated and fluorescently labeled apo E HDLc confirmed that the uptake of the lipoproteins was principally carried out by parenchymal cells. The plasma clearance of apo E HDLc by hepatic parenchymal cells, even in cholesterol-fed animals in which the apo B,E (LDL) receptors were markedly down-regulated (undetectable), suggests that the apo E receptor, presumably the remnant receptor, is localized in the parenchymal cells.

Isolation and DNA sequence of full-length cDNA and of the entire gene for human apolipoprotein AI--discovery of a new genetic polymorphism in the apo AI gene

We have isolated full-length cDNA clones for apolipoprotein AI from a human fetal liver cDNA library made in the vector lambda gt10. One such clone, pBL13AI, was 965 nucleotides long and contained the entire preproapolipoprotein AI sequence, in addition to 86 nucleotides of 5' untranslated region and 75 nucleotides of the 3' untranslated region. The complete structure of this clone is presented. Furthermore, we have obtained a 20-kb genomic fragment from a human genomic library, encompassing the entire apo AI gene. Sequence analysis of the gene shows that the coding region is interrupted by three introns of 197, 187, and 588 bp, respectively. Digestion of the DNA of various individuals with the endonuclease Msp I revealed a new restriction site polymorphism in the apo AI gene.

Studies of hypercholesterolemia in the nonhuman primate. I. Changes that lead to fatty streak formation

Morphologic studies resulting from events that occur during the development of the lesions of atherosclerosis were studied in chronic, diet-induced hypercholesterolemia in a series of nonhuman primates. Within 12 days of hypercholesterolemia in Macaca nemestrina, monocytes became adherent to the surface of the endothelium. These monocytes appeared to migrate subendothelially, accumulate lipid, and become lipid-laden macrophages (foam cells). Within a month, a "serofibrinous insudate" formed together with variable numbers of subendothelial lipid-laden macrophages. By the second month, foam cells increased in number, often in multilayers, to form a fatty streak. Concomitantly, the luminal surface of the arteries became increasingly irregular due to the subendothelial accumulation of foam cells. Numerous monocytes continued to attach to the endothelial surface over the fatty streaks, and many of them appeared to enter the intima and participate in the growth of the fatty streaks. Lipid-laden smooth muscle cells appeared in small numbers and formed two to four layers between the macrophages and the internal elastic lamella at 2 to 3 months. During the third month of hypercholesterolemia, endothelial cell continuity over the lipid-laden macrophages became interrupted, exposing the underlying foam cells to circulating blood. Foam cells were then readily observed in whole blood smears, suggesting that many of the lipid-laden macrophages leave the intima and enter the circulation. After 4 months, significant endothelial denudation was found in the iliac artery and many exposed macrophages were covered by adherent platelets in the form of a mural thrombus. Thus, the early components of atherosclerosis induced by chronic hypercholesterolemia centered around the monocyte-macrophage and its interaction with endothelium in the induction of the fatty streak. Subsequent changes that lead to macrophage-smooth muscle interactions, platelet-macrophage interactions, and platelet-endothelial interactions appeared to set the stage for the development of more advanced proliferative lesions.

Correlations of aortic histology with gross aortic atherosclerosis and metabolic measurements in diabetic and nondiabetic Macaca nigra

We studied the aortic histology of 28 Macaca nigra males and females, from 6 to more than 20 years old, normal and manifesting various degrees of spontaneous diabetes. Correlations of several metabolic and hormonal indicators of diabetes severity with gross and microscopic findings in the aortas demonstrated direct associations with the severity of atherosclerosis. Mild to relatively severe aortic lesions were present. These monkeys showed many changes similar to those observed in medium and large arteries of diabetic humans. Intimal proliferation, prominent extracellular fibers as part of the intimal thickening, and lipid deposition--mostly in extracellular locations--were particularly evident. Significant relationships were observed when glucose clearance, insulin secretion, and fasting glucose levels were correlated with all aortic microscopic findings. Cholesterol concentrations had no correlation with the histological state of the aortas, and triglyceride levels correlated only with aortic lipid content and intimal thickness. Aortic pathologic changes increased with age; diabetics had significantly greater changes than nondiabetics. Macaca nigra can be useful in the study of how diabetes affects the development of atherosclerosis without the influence of an atherogenic diet.

Dyslipoproteinemia and xanthomatosis

The cutaneous markers associated with dyslipoproteinemia are reviewed in the context of the current view of lipid and lipoprotein metabolism. The utility of determining the plasma levels of lipoproteins and certain apoproteins in children or adults with xanthomas or xanthelasma is discussed. We hope that early identification and appropriate treatment of such patients will reduce the morbidity and mortality from the two major complications of dyslipoproteinemia--atherosclerotic cardiovascular disease and pancreatitis.

[Antihypertensive therapy and lipid metabolism]

Hypertension, hyperlipidaemia and cigarette smoking are major risk factors in coronary heart disease. Since many antihypertensive drugs alter plasma lipid levels it is a subject of current discussion that these agents may increase associated coronary risk and therefore offset the beneficial effects of lowering blood pressure. The purpose of this paper is to review clinical and experimental data in the literature on the influence of data in the literature on the influence of antihypertensive drugs on lipid metabolism. The thiazides hydrochlorothiazide and chlorthalidone cause an elevation of plasma triglycerides and very low density lipoprotein (VLDL) but have little effect on total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL). The unspecific beta-blockers, e.g. propranolol, do not affect total cholesterol and LDL but increase total triglycerides and VLDL and decrease HDL. The changes of plasma lipids and lipoproteins caused by cardio-selective beta-blockers, e.g. atenolol and metoprolol, and unspecific beta-blockers with intrinsic sympathomimetic activity (ISA), e.g. oxprenolol and pindolol, appear to be qualitatively similar but less pronounced. The alpha 1-blocker prazosin reduces total triglycerides and slightly lowers total cholesterol. The concentration of VLDL plus LDL decreases while HDL may increase. Only very few studies have been reported on the effects of other antihypertensive drugs, e.g. clonidine, hydralazine, on plasma lipids. Several experimental studies reveal that antihypertensive agents exert direct effects on triglyceride and cholesterol metabolism. Although the pathophysiological mechanisms and the significance of the alterations of lipid metabolism induced by antihypertensive drugs are not yet clear, the following guidelines for the clinical use of these agents are recommended: (1) before initiating drug treatment in hypertensive patients, blood lipid levels should be measured to exclude a preexisting hyperlipidaemia, (2) during long-term therapy with antihypertensive agents, lipoprotein fractions should be controlled in order to reconsider the therapeutic regime if major alterations of blood lipid levels are observed.

Receptor binding activity of high-density lipoproteins containing apoprotein E from abetalipoproteinemic and normal neonate plasma

The receptor binding properties of lipoproteins derived from neonates and abetalipoproteinemic patients were examined. Compared to normal adults, the neonate plasma contained reduced cholesterol levels, with only 40% of the total cholesterol transported in the low-density lipoproteins (LDL). When compared at equal cholesterol concentrations, however, the total neonate lipoproteins (d less than 1.21) were as effective as adult d less than 1.21 lipoproteins in stimulating cholesteryl ester formation in cultured human fibroblasts. Analysis of the neonate lipoproteins explained their enhanced ability to deliver cholesterol to the cells via LDL (apoprotein B,E) receptors: the neonate d = 1.02-1.063 fraction contained, in addition to LDL, alpha 2-migrating, apoprotein E-rich high-density lipoproteins (HDL1), which were isolated by Geon-Pevikon electrophoresis. In binding studies performed with human fibroblasts at 4 degrees C, the neonate HDL1 were 14-fold more effective than either neonate or adult human LDL in displacing 125I-LDL from apo-B,E receptors. The neonate HDL (d = 1.063-1.21) contained a subfraction rich in apo-E and apo(E-A-II), which was isolated by heparin-Sepharose chromatography. This fraction was also active in displacing 125I-LDL from the receptors on cultured fibroblasts. Apoprotein E-containing HDL subclasses, similar to those described in the blood of neonates, were present in the d less than 1.063 and d = 1.063-1.21 lipoprotein fractions of patients with abetalipoproteinemia. These HDL with apo-E were enriched in cholesterol and were as effective as normal LDL in competing with 125I-LDL for apo-B,E receptor-mediated binding, internalization, and degradation. When incubated with cultured human fibroblasts, the HDL with apo-E from the abetalipoproteinemic subjects increased the cholesteryl ester mass three- to fourfold. These studies suggest that neonates and abetalipoproteinemic subjects may depend (at least in part) upon lipoproteins containing apo-E to deliver cholesterol to various tissues via the LDL (apo-B,E) receptor.

Analysis and lipoprotein lipase activation capacity of plasma lipoproteins isolated from atherosclerosis-susceptible White Carneau pigeon and atherosclerosis-resistant Show Racer pigeon

The lipoprotein composition and apoprotein composition of the major lipoprotein fraction (high density lipoprotein) were compared in White Carneau and Show Racer plasma. The capacity of the plasma and lipoproteins to activate the triacylglycerol hydrolyzing activity of lipoprotein lipase in vitro was compared in the two strains of birds and found to be identical in each case. It appears unlikely that differences in lipoprotein composition or tissue lipoprotein lipase activity will be reflected in the flux rates of lipoproteins in the two strains which have different susceptibilities to atherosclerosis.

A comparison of the composition and catabolism in vitro of porcine very low density lipoprotein subfractions prepared by gel exclusion and heparin-affinity chromatography

A comparison of the subfractions prepared from porcine plasma very low density lipoproteins by gel exclusion and heparin-Sepharose affinity chromatography revealed that the smallest and largest particles had the highest affinity for the glycosaminoglycan and had the highest ratio of apolipoprotein E to apolipoprotein CII. When the rates of triglyceride hydrolysis catalysed by lipoprotein lipase were compared for the subfractions the results were consistent with the view that apolipoprotein E may play a role in facilitating the catabolism of very low density lipoprotein triglyceride in the presence of glycosaminoglycan.

Musculoskeletal disorders in patients with hyperlipidaemia

We have assessed the nature and significance of musculoskeletal disorders in 166 patients with the commonly encountered forms of hyperlipidaemia attending a lipid clinic. The incidence of musculoskeletal disorders was determined by questionnaire to the patients, inquiries to general practitioners, and a review of hospital records. To ensure the sensitivity of these methods a series of negatively responding cases were seen and examined; none had identifiable musculoskeletal disease. Eight males with type IV hyperlipidaemia had recurrent acute attacks of gout. The only other musculoskeletal disorder possibly attributable to an association with hyperlipidaemia was a transient polyarthritis in 3 patients. This was inflammatory, recurrent, but nondeforming, and involved the small joints of the hand. It did not require any specific therapy or lead to disability. We suggest that, while we have confirmed the association of type IV hyperlipidaemia and gout, there is little evidence for clinically significant arthritis being associated with other commonly presenting forms of hyperlipidaemia, although we accept that the rarely met homozygous familial hypercholesterolaemia may also be complicated by a crystal arthropathy due to the presence of crystalline cholesterol in joints.

Apolipoprotein and size heterogeneity in human umbilical cord blood low density lipoproteins

Neonatal umbilical cord blood plasma low density lipoproteins (LDL, d = 1.019-1.063 g/ml) were subfractionated by density gradient ultracentrifugation into seven fractions (from 1.024 to 1.062 g/ml); the bulk of the LDL mass was in a density region of 1.034-1.042 g/ml. Apolipoprotein B by 10% SDS-polyacrylamide gel electrophoresis varied inversely with density, with only trace amounts present in the most dense fraction. The distribution of apolipoprotein B molecular weight forms was assessed by both 3% SDS-polyacrylamide gel electrophoresis and relative aminoacyl mass determination. Lower molecular weight forms of apolipoprotein B (B74 and B26) increased relative to apolipoprotein B100 with increasing density, ranging from undetectable in fraction 1 to apolipoproteins B26 and B74 comprising 30% of the total mass of apolipoprotein B in fraction 6. No apolipoprotein B48 was detectable in the LDL. Apolipoprotein E as determined by both SDS-polyacrylamide gel electrophoresis and radioimmunoassay increased with density with a maximum (14% of the protein) in the most dense fraction, fraction 7. Apolipoprotein A-I by SDS-polyacrylamide gel electrophoresis increased with increasing density and was the major apolipoprotein in fraction 7. Electron microscopic analysis revealed spherical particles whose diameters decreased with increasing density, ranging from 28.6 nm in the top fraction (fraction 1) to 15.6 nm in the bottom fraction (fraction 7). Gradient gel electrophoresis revealed that most of the fractions contained several different sized particles. The bottom fraction (fraction 7), enriched in apolipoproteins E and A-I, had a unique, poorly defined peak at 14.6 nm on gradient gel electrophoresis and showed a tendency to pack hexagonally upon electron microscopy. The unusual composition and apolipoprotein distribution in neonatal LDL fractions suggests that the LDL in the neonate are metabolically very diverse.

Cholesteryl ester accumulation in mouse peritoneal macrophages induced by beta-migrating very low density lipoproteins from patients with atypical dysbetalipoproteinemia

The d < 1.006 lipoproteins of patients in a kindred with atypical dysbetalipoproteinemia induced marked cholesteryl ester accumulation in mouse peritoneal macrophages. The affected family members had severe hypercholesterolemia and hypertriglyceridemia, xanthomatosis, premature vascular disease, the apo-E3/3 phenotype, and a predominance of cholesterol-rich beta-very low density lipoproteins (beta-VLDL) in the d < 1.006 fraction. When incubated with mouse peritoneal macrophages, the d < 1.006 lipoproteins or beta-VLDL from the affected family members stimulated cholesteryl [(14)C]oleate synthesis 15- to 30-fold above that caused by normal, control d < 1.006 lipoproteins (VLDL). The ability of the beta-VLDL to stimulate macrophage cholesteryl ester accumulation was greatly reduced as a consequence of treatment with hypolipidemic agents, which specifically reduced the concentration of beta-VLDL. Two important differences were noted in a comparison of the beta-VLDL from these atypical dysbetalipoproteinemic subjects with that of classic E2/2 dysbetalipoproteinemics: (a) the beta-VLDL from the atypical subjects were severalfold more active in stimulating cholesteryl ester accumulation in macrophages, and (b) both the intestinal and hepatic beta-VLDL from the atypical subjects were active. The triglyceriderich, alpha(2)-migrating VLDL from the affected family members constituted <10% of the d < 1.006 fraction and were similar to normal VLDL in that they did not stimulate cholesteryl ester synthesis in the macrophages. Several lines of evidence indicate that the macrophage accumulation of cholesteryl esters was induced by a receptor-mediated uptake process and that the beta-VLDL were bound by a specific beta-VLDL receptor. First, the uptake and degradation of the lipoproteins and the induction of cholesteryl ester formation displayed qualities of high affinity, saturable kinetics. Second, the uptake and degradation process was inhibited when the lysyl residues of the beta-VLDL apoproteins were modified by reductive methylation. Third, the beta-VLDL from the affected subjects competed with diet-induced canine (125)I-beta-VLDL for the same cell surface receptors, but did not compete with chemically modified low density lipoproteins. Finally, the receptor-mediated uptake of these beta-VLDL resulted in lysosomal degradation of the lipoproteins, which could be prevented by incubating the cells with chloroquine. Normal, triglyceride-rich VLDL were also degraded when incubated with the macrophages, but they were not degraded by the same receptor-mediated process responsible for the degradation of the beta-VLDL of the patients. The degradation of the VLDL was not abolished by reductive methylation of the lipoproteins or by treatment of the cells with choloroquine. These studies demonstrate that the beta-VLDL from subjects with atypical dysbetalipoproteinemia are taken up by macrophages via the same receptor-mediated process responsible for the uptake of diet induced beta-VLDL. The accelerated vascular disease seen in these patients may be the result of high concentrations of beta-VLDL capable of binding to and delivering large quantities of cholesterol to macrophages and converting them into cells resembling the foam cells of atherosclerotic lesions.

Influence of diet on high-density lipoproteins

Evidence of a relation between diet and high-density lipoprotein (HDL) levels in humans comes from numerous cross-sectional and experimental studies. Evaluation of data from cross-sectional nutrition and health surveys sometimes yields different results for men and women but usually demonstrates positive correlations of HDL cholesterol levels with total energy intake, alcohol consumption, dietary cholesterol and total and animal fat, and negative correlations of HDL with dietary carbohydrates (simple sugars) and, in some instances, plant fats. Short-term dietary manipulation produced confirmatory evidence of a causal relation between diet and HDL with regard to several of these factors; however, there are few long-term data. The underlying mechanisms as well as the relation of HDL manipulation to cardiovascular health are still to be defined, particularly because the functions and fates of the HDL molecule may vary according to its composition and turnover, which are not reflected by the HDL cholesterol concentration. Furthermore, some relations between diet and HDL may only be the result of other metabolic consequences of dietary change, for instance, triglyceride metabolism and other lipoproteins. Although there is consistent evidence that a high HDL cholesterol level is indicative of a low risk of coronary heart disease in industrialized populations, evidence is inconclusive that manipulation of HDL leads to an alteration of risk.

Atherosclerosis: pathology, pathogenesis, and role of risk factors

Atherosclerosis is a complex disease that represents the end product of the interaction of many different causative agents. Those that originate external to the arterial wall usually are called primary risk factors. Many other influences, the secondary risk factors, modulate the primary factors. The penetrance of the secondary factors is variable. They can have a major effect in some people but not in others. The idea of risk factor is important because it provides the conceptual framework upon which to build an intervention program for prevention of atherosclerosis. The development of atherosclerosis can be viewed as a two-step process (Table 2). The first is injury to the arterial wall. The second is response to injury. The primary risk factors can be regarded as the injurious agents. Examples are factors causing endothelial damage, influx of plasma lipoproteins, toxic products of smoking, hemodynamic injury of hypertension, and perhaps microvascular injury from diabetes mellitus. The response to injury represents typical pathologic changes--proliferation of smooth muscle cells, mononuclear infiltration, phagocytosis of products of injury, secretion of connective tissue elements, neovascularization, and necrosis. Regulation of these latter processes is poorly understood and is a worthy subject for future research. Modulation of the primary injurious factors through alteration of secondary risk factors is currently the only significant approach to prevention of atherosclerosis. Future investigation may provide more direct ways to prevent or retard atherogenesis, either by more effective modification of primary factors or by reducing the magnitude of response to these factors.

Lecithin:cholesterol acyltransferase-mediated modification of discoidal peripheral lymph high density lipoproteins: possible mechanism of formation of cholesterol-induced high density lipoproteins (HDLc) in cholesterol-fed dogs

Peripheral lymph high density lipoproteins (HDL) of the cholesterol-fed dog differ in a number of characteristics from plasma HDL of the same animal. Their high content of free cholesterol, phospholipid, apoprotein E, and apoprotein A-IV, their greater heterogeneity in size, and the presence of many discoidal particles suggest that a portion of lymph HDL is assembled within the interstitial fluid. The present experiments demonstrate that the endogenous lecithin:cholesterol acyltransferase (LCAT) activity of whole peripheral lymph of the cholesterol-fed dog is far less (less than 1%) than that found in the plasma of the same animal (0.3 nmol/hr per ml versus 40.6 nmol/hr per ml). Addition of partially purified LCAT to whole lymph induced many changes in the chemical composition of peripheral lymph lipoproteins. After incubation with LCAT, the free cholesterol and phospholipid contents of lymph HDL decreased, from 17% to 12% and from 46% to 33%, respectively, whereas cholesteryl ester content increased from 7% to 13%. These changes were accompanied by a mass transfer of apoprotein E and cholesterol to the p less than 1.05 g/ml fraction, the complete disappearance of the discoidal particles, and a decrease in size heterogeneity of lymph HDL. These results suggest that, in the cholesterol-fed dog, cholesterol efflux into the interstitial spaces may occur in the absence of significant LCAT activity. Furthermore, our studies suggest that the subsequent reaction between lymph HDL and LCAT within the vascular compartment leads to the generation of apoprotein E and cholesteryl ester-rich cholesterol-induced HDL.

Racial differences in plasma high-density lipoproteins in patients receiving hemodialysis. A possible mechanism for accelerated atherosclerosis in white men

Among 346 nondiabetic patients receiving long-term hemodialysis, cardiovascular mortality was higher in white than in black men (P less than 0.02) but was similar between black and white women, despite the higher incidence of nephrosclerosis in black men and women (59 and 58 per cent vs. 8 and 10 per cent, respectively; P less than 0.0001). There were significant racial differences in plasma lipid and apoprotein levels in a subset of 100 of these patients. The white men had higher levels of plasma triglyceride and lower levels of high-density-lipoprotein (HDL) cholesterol, apoprotein A-I, and apoprotein A-II than black men; concentrations of HDL, apoprotein A-I, and apoprotein A-II were also lower in white than in black women. The distribution of the HDL subfractions HDL2, HDL3, and HDL3D, as determined by zonal ultracentrifugation, was normal in black and abnormal in white men receiving hemodialysis. HDL2 concentrations were higher in black than in white men by both zonal analysis (P less than 0.05) and polyanionic precipitation of the HDL subfractions (P less than 0.01). The distributions and concentrations of HDL2 and HDL3L were similar in black and white women. Thus, there are marked racial differences in HDL in male patients receiving hemodialysis. The abnormalities in HDL and the hypertriglyceridemia in the white men may explain their high rate of cardiovascular mortality.

Turbidimetric kinetic method for serum low density lipoprotein quantitation

A turbidimetric kinetic fixed-time method for the rapid determination of serum low density lipoprotein (LDL) has been developed. It is based on specifically precipitating this lipoprotein with the use of a combination of heparin, Ca2+, EDTA and lipase. The method has been adapted to the Eppendorf spectrum line photometer and to the ENI Gemsaec centrifugal analyzer. It yielded satisfactory results with regard to linearity and precision. The values agreed closely to those obtained by conventional procedures for LDL-cholesterol and LDL-apolipoprotein B. The predictive value of this new method for the assessment of the individual risk of vascular disease remains to be proven by clinical and epidemiological studies.

Independent pathways for secretion of cholesterol and apolipoprotein E by macrophages

Cholesterol-loaded macrophages secrete cholesterol and apolipoprotein E. The current studies show that this secretion occurs by two independent pathways. In the absence of serum, the cells secrete apolipoprotein E, but not cholesterol. In the presence of monensin (an inhibitor of protein secretion), the cells secrete cholesterol, but little apolipoprotein E. After secretion, apolipoprotein E and cholesterol associate with high-density lipoprotein to form a particle that can deliver cholesterol to the liver by receptor-mediated endocytosis. We conclude that apolipoprotein E does not function to remove cholesterol from macrophages but rather to participate in "reverse cholesterol transport."

Lipid nephrotoxicity in chronic progressive glomerular and tubulo-interstitial disease

It is hypothesised that chronic progressive kidney disease may be mediated by abnormalities of lipid metabolism. A series of self-perpetuating secondary events follows an initial glomerular injury. Increased glomerular basement membrane permeability leads to loss of lipoprotein lipase activators, resulting in hyperlipidaemia. Circulating low-density lipoprotein binds with glycosaminoglycans in the glomerular basement membrane and increases its permeability. Filtered lipoprotein accumulates in mesangial cells and stimulates them to proliferate and produce excess basement membrane material. The proximal tubular cells metabolise some of the filtered lipoprotein and the remainder are altered on passage down the nephron. Luminal apoprotein precipitates, initiating or aggravating tubulo-interstitial disease, if the intraluminal pH is close to the isoelectric point of the apoprotein. The hypothesis offers new approaches to the study of chronic progressive kidney disease by proposing a major pathogenetic role for lipid abnormalities.

Binding properties of high-density lipoprotein subfractions and low-density lipoproteins to rabbit hepatocytes

Primary cultures of rabbit hepatocytes which were preincubated for 20 h in a medium containing lipoprotein-deficient serum subsequently bound, internalized and degraded 125I-labeled high-density lipoproteins2 (HDL2). The rate of degradation of HDL2 was constant in incubations from 3 to 25 h. As the concentration of HDL2 in the incubation medium was increased, binding reached saturation. At 37 degrees C, half-maximal binding (Km) was achieved at a concentration of 7.3 micrograms of HDL2 protein/ml (4.06 X 10(-8)M) and the maximum amount bound was 476 ng of HDL2 protein/mg of cell protein. At 4 degrees C, HDL2 had a Km of 18.6 micrograms protein/ml (1.03 X 10(-7)M). Unlabeled low-density lipoproteins (LDL) inhibited only at low concentrations of 125I-labeled HDL2. Quantification of 125I-labeled HDL2 binding to a specific receptor (based on incubation of cells at 4 degrees C with and without a 50-fold excess of unlabeled HDL) yielded a dissociation constant of 1.45 X 10(-7)M. Excess HDL2 inhibited the binding of both 125I-labeled HDL2 and 125I-labeled HDL3, but excess HDL3 did not affect the binding of 125I-labeled HDL3. Preincubation of hepatocytes in the presence of HDL resulted in only a 40% reduction in specific HDL2 receptors, whereas preincubation with LDL largely suppressed LDL receptors. HDL2 and LDL from control and hypercholesterolemic rabbits inhibited the degradation of 125I-labeled HDL2, but HDL3 did not. Treatment of HDL2 and LDL with cyclohexanedione eliminated their capacity to inhibit 125I-labeled HDL2 degradation, suggesting that apolipoprotein E plays a critical role in triggering the degradative process. The effect of incubation with HDL on subsequent 125I-labeled LDL binding was time-dependent: a 20 h preincubation with HDL reduced the amount of 125I-labeled LDL binding by 40%; there was a similar effect on LDL bound in 6 h but not on LDL bound in 3 h. The binding of 125I-labeled LDL to isolated liver cellular membranes demonstrated saturation kinetics at 4 degrees C and was inhibited by EDTA or excess LDL. The binding of 125I-labeled HDL2 was much lower than that of 125I-labeled LDL and was less inhibited by unlabeled lipoproteins. The binding of 125I-labeled HDL3 was not inhibited by any unlabeled lipoproteins. EDTA did not affect the binding of either HDL2 or HDL3 to isolated liver membranes. Hepatocytes incubated with [2-14C]acetate in the absence of lipoproteins incorporated more label into cellular cholesterol, nonsaponifiable lipids and total cellular lipid than hepatocytes incubated with [2-14C]acetate in the presence of any lipoprotein fraction. However, the level of 14C-labeled lipids released into the medium was higher in the presence of medium lipoproteins, indicating that the effect of those lipoproteins was on the rate of release of cellular lipids rather than on the rate of synthesis.

Effect of neurotensin on specific activity of plasma cholesterol following intravenous administration of cholesterol-4-14C

In order to investigate the source of the additional circulating cholesterol in hypercholesterolemia induced by neurotensin (NT), 12.5 pmol/100 g body weight NT was injected into the tail veins of rats which received by the same route 1 X 10(6) dpm/100 g body weight cholesterol-4-14C 24 hours earlier. Fifteen minutes later the concentration of the labeled plasma cholesterol was the same in the treated animals and in the controls. However, specific activity of plasma cholesterol significantly decreased in rats that received NT, while it remained unchanged in the controls. These data suggest that the additional circulating cholesterol after the intravenous administration of NT was either newly formed or originated in some tissue where equilibrium between endogenous and exogenous cholesterol has not yet been established.