Kinetics of triglyceride turnover of very low density lipoproteins of human plasma

Studies on the turnover of triglyceride and esterified cholesterol in subjects with the nephrotic syndrome

Factors involved in the hyperlipidemia of nephrosis have been studied in seven patients. The turnover of triglyceride was measured in plasma very low density lipoproteins after the injection of glycerol-(14)C. The turnover of esterified cholesterol was measured in whole plasma and in very low density lipoproteins after the injection of mevalonic acid-2-(3)H. Urine protein loss was found to be significantly correlated with the plasma concentrations of triglyceride and free cholesterol, suggesting that increasing loss of protein is associated with the formation of larger lipoproteins. Lactescent plasmas were found in the subjects with the greatest protein loss. The turnover rate of triglyceride tended to be higher among subjects with higher than with lower triglyceride concentrations and was on the average higher than among six normotriglyceridemic subjects. However, there was also evidence for decreased clearance of glyceride from plasma. The hypertriglyceridemia of nephrosis appeared to reflect both increased formation of glyceride and decreased removal of glyceride from plasma. The turnover of esterified cholesterol was significantly higher in whole plasma of nephrotic subjects than in normocholesterolemic nonnephrotic patients. Esterified cholesterol turnover in very low density lipoproteins was raised in the two subjects in whom a major part of total esterified cholesterol was carried in this lipoprotein fraction. These studies were repeated in one subject after remission was induced. The cessation of urinary loss of protein was associated with reductions in the concentrations and turnover of triglyceride and esterified cholesterol. The increased turnover of plasma lipids in nephrosis may reflect the general increase in the formation of protein.

Effects of diet on hepatic triglyceride synthesis

The effects of diet on the rate of triglyceride synthesis by rat liver homogenates was measured. Changes in triglyceride synthesis were correlated with the level of activity of L-alpha-glycerophosphate acyltransferase, the enzyme catalyzing the first specific reaction in hepatic glycerolipid synthesis. Fasting for 48-72 hr depressed the synthesis of triglyceride from L-alpha-glycerophosphate. High carbohydrate diets, fed to rats for 6 days, resulted in increased triglyceride synthesis. Diets high in starch were less effective than high glucose, sucrose, or fructose diets in increasing triglyceride synthesis. Diets high in corn oil did not alter triglyceride synthesis. These studies established the importance of dietary factors in the regulation of hepatic triglyceride synthesis.L-alpha-Glycerophosphate acyltransferase activity was measured after the same dietary changes. Both high carbohydrate and high fat diets resulted in increased enzyme specific activity. Fasting for 72 hr did not decrease activity. Thus, the specific activity of this enzyme did not correlate well with the measured rate of triglyceride synthesis indicating that other factors must participate in the regulation of triglyceride biosynthesis.

Role of insulin in endogenous hypertriglyceridemia

Dietary carbohydrate accentuation of endogenous triglyceride production has been studied in 33 patients. A broad and relatively continuous spectrum of steady-state plasma triglyceride concentrations was produced in 31 of the 33 subjects during 3 wk of a high carbohydrate (fat-free) liquid formula diet. Two patients developed plasma triglyceride concentrations in excess of 2000 mg/100 ml, and these were the only patients we have studied in which carbohydrate induction of hypertriglyceridemia seemed to be associated with a defect in endogenous plasma triglyceride removal mechanisms. In the remaining 31 patients the degree of hypertriglyceridemia was highly correlated with the insulin response elicited by the ingestion of the high carbohydrate formula (P < 0.005). No significant correlation existed between fasting plasma triglyceride concentration and either plasma glucose or free fatty acid concentrations after the high carbohydrate diet, nor was the degree of hypertriglyceridemia related to degree of obesity. It is suggested that hypertriglyceridemia in most subjects results from an increase in hepatic triglyceride secretion rate secondary to exaggerated postprandial increases in plasma insulin concentration.

Tissue lipoprotein lipase in normal individuals and in individuals with exogenous hypertriglyceridemia and the relationship of this enzyme to assimilation of fat

Lipoprotein lipase activity (LLA) was measured in the adipose tissue of six healthy subjects and five members of a family in whom the trait for familial exogenous hypertriglyceridemia was segregating. The lipase activity measured was characteristic of lipoprotein lipase: increased by feeding, dependent on the presence of serum, and inhibited by sodium chloride and protamine sulfate. When compared with lipase activity in healthy individuals, LLA was grossly deficient in two siblings with postabsorptive chylomicronemia and was intermediate in both parents and one sibling, who had normal postabsorptive triglycerides. These findings are compatible with autosomal recessive inheritance. The hormone-sensitive lipolytic enzyme responsible for mobilization of free fatty acids from adipose storage was normal in the hyperlipemic subjects. After a 104-g fat meal, the serum triglyceride increased more in subjects heterozygotic for LLA deficiency than in the healthy subjects, and there was a relatively greater increase in chylomicrons and very low density lipoproteins in the affected individuals. These observations demonstrate the physiologic importance of lipoprotein lipase in removal of these lipoprotein groups and further clarify the differences between endogenous and exogenous hypertriglyceridemia.