Influence of intravenous lipid emulsions on cholesterol homeostasis

Effect of medium/ω-6 long chain triglyceride-based emulsion on leucocyte death and inflammatory gene expression

Lipid emulsion (LE) containing medium/ω-6 long chain triglyceride-based emulsion (MCT/ω-6 LCT LE) has been recommended in the place of ω-6 LCT-based emulsion to prevent impairment of immune function. The impact of MCT/ω-6 LCT LE on lymphocyte and neutrophil death and expression of genes related to inflammation was investigated. Seven volunteers were recruited and infusion of MCT/ω-6 LCT LE was performed for 6 h. Four volunteers received saline and no change was found. Blood samples were collected before, immediately afterwards and 18 h after LE infusion. Lymphocytes and neutrophils were studied immediately after isolation and after 24 and 48 h in culture. The following determinations were carried out: plasma-free fatty acids, triacylglycerol and cholesterol concentrations, plasma fatty acid composition, neutral lipid accumulation in lymphocytes and neutrophils, signs of lymphocyte and neutrophil death and lymphocyte expression of genes related to inflammation. MCT/ω-6 LCT LE induced lymphocyte and neutrophil death. The mechanism for MCT/ω-6 LCT LE-dependent induction of leucocyte death may involve changes in neutral lipid content and modulation of expression of genes related to cell death, proteolysis, cell signalling, inflammatory response, oxidative stress and transcription.

Inclusion of 10% fish oil in mixed medium-chain triacylglycerol-long-chain triacylglycerol emulsions increases plasma triacylglycerol clearance and induces rapid eicosapentaenoic acid (20:5n-3) incorporation into blood cell phospholipids

BACKGROUND

Lipolysis of a fish oil (FO) emulsion is much slower than that of a soybean [long-chain triacylglycerol (LCT)] emulsion; in contrast, emulsions containing medium-chain triacylglycerol (MCT) are efficiently hydrolyzed by lipoprotein lipase.

OBJECTIVES

We questioned whether incorporating 10% FO in a mixed MCT-LCT emulsion would affect plasma triacylglycerol clearance and provide efficient delivery of n-3 polyunsaturated fatty acids to cells and tissues.

DESIGN

This prospective crossover study was conducted in 8 normolipidemic subjects with the use of the hypertriglyceridemic clamp model and compared plasma triacylglycerol clearance of a lipid emulsion (5:4:1) made of 50% MCT, 40% LCT, and 10% FO (wt:wt:wt) to a control (5:5) preparation with 50% MCT and 50% LCT. Subjects were daily infused for 5 h, over 4 consecutive days. Fatty acyl pattern was daily measured in plasma phospholipids as well as in leukocyte and platelet phospholipids.

RESULTS

Inclusion of 10% FO in mixed emulsion particles enhanced plasma clearance of infused triacylglycerols (18%; P < 0.0001). The faster elimination of the 5:4:1 emulsion appears related to an enhanced uptake of remnant particles rather than to faster intravascular lipolysis. Each infusion of 5:4:1 raised the eicosapentaenoic acid (C20:5n-3) concentration in blood cell phospholipids to reach a 7-fold enrichment in platelets and a >2-fold enrichment in leukocytes after 4 infusions. In contrast, the docosahexaenoic acid (C22:6n-3) concentration remained unchanged in blood cell phospholipids.

CONCLUSIONS

Infusion of a mixed emulsion with MCTs, soy LCTs, and FO is associated with efficient plasma triacylglycerol clearance and results in rapid incorporation of C20:5n-3 but not C22:6n-3 in leukocyte and platelet phospholipids.

Metabolism of defined structured triglyceride particles compared to mixtures of medium and long chain triglycerides intravenously infused in dogs

The present study aimed to determine whether including medium-chain fatty acids (MCFA) in specifically designed structured triglycerides (STG) with a MCFA in sn-1 and sn-3 positions and a long-chain (LC) FA in sn-2 position (MLM) would lead to different effects on plasma lipids and FA distribution into plasma and tissue lipids by comparison to a mixture of separate MCT and LCT molecules (MMM/LLL). The fatty acid (FA) composition was comparable in both lipid emulsions. Lipids were infused over 9h daily, in 2 groups of dogs (n = 6 each), for 28 days as a major component (55% of the non-protein energy intake) of total parenteral nutrition (TPN). Blood samples were obtained on specific days, before starting and just before stopping TPN. The concentration of plasma lipids was measured before starting and before stopping TPN on days 1, 2, 3, 4, 5, 8, 10, 12, 16 and 28. Biopsies were obtained from liver, muscle and adipose tissue 15 days before starting, and again on the day following cessation of TPN. In addition, the spleen was removed after the TPN period. FA composition in plasma and tissue lipids was analysed by gas liquid chromatography in different lipid components of plasma and tissues. No differences in either safety or tolerance parameters were detected between both lipid preparations. A lower rise of plasma TG (P < 0.05) was observed during MLM infusion, indicating a faster elimination rate of MLM vs MMM/LLL emulsion. In spite of the differences of TG molecules which would be assumed to affect the site of FA delivery and metabolic fate, FA distribution in phospholipids (PL) of hepatic and extrahepatic tissues did not substantially differ between both emulsions.

Lipoprotein metabolism during and after a 6-h infusion ofMCT/LCT vs LCT emulsion in man

We studied, in man, the intravascular metabolism of two lipid emulsions differing in their triglyceride (TG) fatty acid pattern. One emulsion was composed exclusively of soy bean long-chain triglycerides (LCT), the other of a mixture containing a (1:1, wt:wt) ratio of medium-chain triglycerides (MCT) and LCT (MCT/LCT). Both emulsions contained 10% TG and 1.2% of the same egg yolk phospholipid emulsifier. Six healthy volunteers received both emulsions, in random order, at a rate of 0.2 g TG/kg.h for 6 h. An interval of 2 weeks separated the tests. Although the MCT/LCT emulsion provided 39% more TG molecules than the pure LCT emulsion, plasma TG increased to similar levels, indicating a faster elimination of MCT/LCT. The rise of plasma non esterified fatty acids was greater with MCT/LCT (P < 0.001). LDL-TG enrichment was higher with MCT/LCT (P < 0.025) while net transfer of TG to HDL was similar with both emulsions. Cholesteryl ester (CE) enrichment in the 'VLDL' fraction (largely composed of emulsion particles) was markedly less during MCT/LCT than LCT infusions (P < 0.01). CE enrichment of the 'VLDL' fraction persisted up to 6 h after cessation of both lipid infusions. In conclusion, TG from MCT/LCT emulsion appear to be eliminated faster than LCT during an in vivo infusion in man. In accordance with our previous in vitro data, MCT/LCT infusion was associated with a higher transfer of TG to LDL and in a reverse manner, with a lesser acquisition of CE by emulsion particles as compared to LCT infusion.

Plasma lipoprotein pattern during long-term home parenteral nutrition with two lipid emulsions

Hypertriglyceridemia induced by short-term lipid infusions causes redistribution of neutral lipid components between endogenous lipoproteins and emulsion particles. To determine whether such redistribution occurs over a long-term infusion period and affects lipoprotein pattern, we studied seven patients with inflammatory bowel disease who received cyclic home parenteral nutrition for two consecutive periods of 3 months with two different lipid emulsions. During each period, they received in random order either an emulsion composed exclusively of soy-derived long-chain triglycerides (LCTs) or another emulsion containing an equal weight:weight mixture of long- and medium-chain triglycerides (MCTs/LCTs). Both emulsions contained 20 triglycerides (TGs) and 1.2 phospholipids. Lipids provided 50 of nonprotein energy. Blood samples were taken once a week, 1 hour before the end of infusion (during) and again after a 6- to 8-h lipid-free interval (baseline). During infusion, there was a moderate increase of plasma TGs and phospholipids and a slight decrease of plasma esterified cholesterol (CE) and free cholesterol. Most of the plasma TGs increase occurred in the very-low-density lipoprotein fraction (containing both emulsion particles and the endogenous very-low-density lipoprotein), but there was also an increase of TGs content in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) that was more pronounced with MCTs/LCTs. Acquisition by exogenous particles of CE transferred from LDL and HDL was significant for the LCT emulsion only. Although no change was observed in plasma lipid concentration of baseline samples during 3 months of home parenteral nutrition, some modifications were observed in the composition of lipoprotein fractions demonstrating a redistribution of lipid components.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of essential fatty acid contents of lipid emulsions on erythrocyte polyunsaturated fatty acid composition in patients on long-term parenteral nutrition

The effect of the long-term intravenous infusion of 2 lipid emulsions, differing in essential fatty acid (EFA) content, on fatty acid pattern of red blood cell (RBC) was investigated in 5 patients with inflammatory bowel disease. They were randomly assigned to receive daily intravenous infusion of either a soybean emulsion or a mixed medium-chain triacyl-glycerols (MCT): soybean emulsion, followed by the other, each for a period of 3 months. The soybean emulsion contained exclusively long-chain triacylglycerols (LCT) with 54% of C18:2n-6 and 6% of C18:3n-3. The mixed emulsion consisted of a 50:50 (w:w) mixture of soybean LCT and MCT, providing half the amount of the same EFA compared to LCT emulsion. The same phospholipid emulsifier was used in both preparations. Infusion of LCT for a 3 month period modified RBC fatty acid pattern as follows: 18:2n-6 increased, 20:4n-6 decreased as well as n-6:n-3 ratio. By contrast, infusion of MCT/LCT did not alter RBC fatty acids, and even tended to correct a pattern altered by the previous LCT infusion. The study demonstrates that soybean LCT provides an excess of C18: 2n-6 which affects the balance between RBC fatty acids in adult patients. Decreasing the intake of C18:2n-6 and C18: 3n-3, by using a mixed MCT/LCT emulsion, appears more appropriate for keeping a balanced pattern.