Validation of an incompletely coupled two-compartment nonrecycling catenary model for turnover of liver and plasma triglyceride in man

Metabolism of Triglyceride-Rich Lipoproteins

Triglycerides are critical lipids as they provide an energy source that is both compact and efficient. Due to its hydrophobic nature triglyceride molecules can pack together densely and so be stored in adipose tissue. To be transported in the aqueous medium of plasma, triglycerides have to be incorporated into lipoprotein particles along with other components such as cholesterol, phospholipid and associated structural and regulatory apolipoproteins. Here we discuss the physiology of normal triglyceride metabolism, and how impaired metabolism induces hypertriglyceridemia and its pathogenic consequences including atherosclerosis. We also discuss established and novel therapies to reduce triglyceride-rich lipoproteins.

Fatty liver disrupts glycerol metabolism in gluconeogenic and lipogenic pathways in humans

It is a challenge to assess metabolic dysregulation in fatty liver of human patients prior to clinical manifestations. Here, we recruited obese, but otherwise healthy, subjects to examine biochemical processes in the liver with simple triglyceride accumulation using stable isotopes and NMR analysis of metabolic products in blood. Intrahepatic triglycerides were measured using ¹H magnetic resonance spectroscopy, and volunteers received ²H₂O and [U-¹³C₃]glycerol orally, followed by a series of blood draws. NMR analysis of plasma triglycerides and glucose provided detailed information about metabolic pathways in patients with simple hepatic steatosis. Compared with subjects with low hepatic fat, patients with hepatic steatosis were characterized by the following: lower ¹³C enrichments in the glycerol backbones of triglycerides (i.e., TG-[¹³C]glycerol), higher [U-¹³C₃]glycerol metabolism through the tricarboxylic acid (TCA) cycle, delayed gluconeogenesis from [U-¹³C₃]glycerol, and less flexibility in adjusting supporting fluxes of glucose production upon an oral load of glycerol. In summary, simple hepatic steatosis was associated with enhanced [U-¹³C₃]glycerol metabolism through pathways that intersect the TCA cycle and delayed gluconeogenesis from glycerol.

Novel insights on interactions between folate and lipid metabolism

Folate is an essential B vitamin required for the maintenance of AdoMet-dependent methylation. The liver is responsible for many methylation reactions that are used for post-translational modification of proteins, methylation of DNA, and the synthesis of hormones, creatine, carnitine, and phosphatidylcholine. Conditions where methylation capacity is compromised, including folate deficiency, are associated with impaired phosphatidylcholine synthesis resulting in non-alcoholic fatty liver disease and steatohepatitis. In addition, folate intake and folate status have been associated with changes in the expression of genes involved in lipid metabolism, obesity, and metabolic syndrome. In this review, we provide insight on the relationship between folate and lipid metabolism, and an outlook for the future of lipid-related folate research.

A novel method for measuring intestinal and hepatic triacylglycerol kinetics

This study aimed to 1) develop a method that completely separated hepatic (VLDL1, VLDL2) and intestinal [chylomicron (CM)] lipoproteins and 2) use the method to measure triacylglycerol (TAG) kinetics in these lipoproteins in the fed and fasting state in healthy subjects, using intravenous [²H₅]glycerol as the tracer. An immunoaffinity method that completely separated hepatic and intestinal particles using sequential binding to three antibodies to apolipoprotein B-100 (apoB-100) was established and validated. Six healthy volunteers were studied in a fasted and continuous feeding study (study 1). Five additional healthy volunteers were studied in a continuous feeding study that included an oral [¹³C₃]glycerol tripalmitin tracer (study 2). In both studies, an intravenous bolus of [²H₅]glycerol was administered to label TAG in hepatic and intestinal lipoproteins. In both feeding studies there was sufficient incorporation of the [²H₅]glycerol tracer into the exogenous lipoproteins to enable isotopic enrichment to be measured. In study 2, the oral tracer enrichment in VLDL1 was <5% of CM enrichment 150 min after tracer administration, demonstrating negligible contamination of VLDL1 with apoB-48. Western blotting showed no detectable apoB-100 in CMs. VLDL1 and VLDL2 TAG fractional catabolic rate (FCR) did not differ between feeding and fasting (study 1). There was no difference between CM and VLDL1 TAG FCR in both fed studies. In fed study 2, 47% of the total TAG production rate (CM + VLDL1) was from CM. This methodology may be a useful tool for understanding the abnormalities in postprandial TAG kinetics in metabolic syndrome and type 2 diabetes.

The removal of exogenous triglycerides in haemorrhagic hyperlipidaemia in rabbits

Bleedings (15 ml/day/kg b.wt.) on two consecutive days caused a threefold increase in plasma triglycerides (TG) in rabbits. Both in normal and in haemorrhagic rabbits the elimination of injected TGs (fat emulsion) was exponential, the fractional removal rate in the haemorrhagic group being slower than normal. In order to rule out the possible effect of the TG pool in haemorrhagic rabbits and the possible changes in endogenous TGs during the test, the TGs were fractionated by the polyvinylpyrolidone density gradient method. Again, both in normal and in haemorrhagic rabbits the elimination of exogenous TGs was exponential, the removal rate of haemorrhagic animals being retarded. Accordingly, the changes in endogenous TGs were negligible. The results are regarded as indicative of an elimination defect as one factor in the pathogenesis of haemorrhagic hyperlipidaemia.

Stable isotope-labeled tracers for the investigation of fatty acid and triglyceride metabolism in humans in vivo

Understanding lipid metabolism and its regulation requires information on the rates at which lipids are produced within the body, absorbed (dietary lipids) into the body, transported within the body, and utilized by various tissues. This article focuses on the use of stable isotope-labeled tracers for the quantitative evaluation of major pathways of fatty acid and triglyceride metabolism in humans in vivo. Adipose tissue lipolysis and free fatty acid appearance in plasma, fatty acid tissue uptake and oxidation, and hepatic very low-density lipoprotein triglyceride secretion are among the metabolic pathways that can be studied by using stable isotope labeled tracers, and will be discussed in detail. The methodology has been in use for many years and is constantly being refined. A variety of tracers and analytical approaches are available and can be used; knowing the advantages, assumptions, and limitations of each is essential for the planning of studies and the interpretation of data, which can provide unique insights into human lipid metabolism.

Overproduction of very low-density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome

Insulin resistance is a key feature of the metabolic syndrome and often progresses to type 2 diabetes. Both insulin resistance and type 2 diabetes are characterized by dyslipidemia, which is an important and common risk factor for cardiovascular disease. Diabetic dyslipidemia is a cluster of potentially atherogenic lipid and lipoprotein abnormalities that are metabolically interrelated. Recent evidence suggests that a fundamental defect is an overproduction of large very low-density lipoprotein (VLDL) particles, which initiates a sequence of lipoprotein changes, resulting in higher levels of remnant particles, smaller LDL, and lower levels of high-density liporotein (HDL) cholesterol. These atherogenic lipid abnormalities precede the diagnosis of type 2 diabetes by several years, and it is thus important to elucidate the mechanisms involved in the overproduction of large VLDL particles. Here, we review the pathophysiology of VLDL biosynthesis and metabolism in the metabolic syndrome. We also review recent research investigating the relation between hepatic accumulation of lipids and insulin resistance, and sources of fatty acids for liver fat and VLDL biosynthesis. Finally, we briefly discuss current treatments for lipid management of dyslipidemia and potential future therapeutic targets.

Fatty liver, insulin resistance, and dyslipidemia

After recently being recognized as a feature of the metabolic syndrome, fatty liver has evolved as a key player in the pathogenesis of dyslipidemia. Development of nonalcoholic fatty liver disease comes from an imbalance between the influx and production of fatty acids and the use of fatty acids for oxidation or secretion as very low density lipoprotein (VLDL) triglycerides. Previously, we have shown a strong relationship between increased liver fat and overproduction of large VLDL particles. We observed recently that in patients with high liver fat, insulin was unable to regulate VLDL production. The result is increased concentrations of VLDL particles in the circulation. Consequently, changes are seen in the metabolism of other lipoproteins that interact with VLDL particles, the net result being decreased high-density lipoprotein cholesterol and increased formation of small, dense low-density lipoprotein. In this article, we review recent findings on the development of fatty liver and its role in the diabetic dyslipidemia pathogenesis.

Thematic review series: Patient-Oriented Research. Free fatty acid metabolism in human obesity

Adipose tissue lipolysis provides circulating FFAs to meet the body's lipid fuel demands. FFA release is well regulated in normal-weight individuals; however, in upper-body obesity, excess lipolysis is commonly seen. This abnormality is considered a cause for at least some of the metabolic defects (dyslipidemia, insulin resistance) associated with upper-body obesity. "Normal" lipolysis is sex-specific and largely determined by the individual's resting metabolic rate. Women have greater FFA release rates than men without higher FFA concentrations or greater fatty acid oxidation, indicating that they have greater nonoxidative FFA disposal, although the processes and tissues involved in this phenomenon are unknown. Therefore, women have the advantage of having greater FFA availability without exposing their tissues to higher and potentially harmful FFA concentrations. Upper-body fat is more lipolytically active than lower-body fat in both women and men. FFA released by the visceral fat depot contributes only a small percentage of systemic FFA delivery. Upper-body subcutaneous fat is the dominant contributor to circulating FFAs and the source of the excess FFA release in upper-body obesity. We believe that abnormalities in subcutaneous lipolysis could be more important than those in visceral lipolysis as a cause of peripheral insulin resistance. Understanding the regulation of FFA availability will help to discover new approaches to treat FFA-induced abnormalities in obesity.

Thematic review series: Patient-Oriented Research. Recent advances in liver triacylglycerol and fatty acid metabolism using stable isotope labeling techniques

Isotopic measurement of biosynthetic rates of lipids in VLDL particles has long posed difficult technical problems. In this review, key methodologic issues and recent technical advances are discussed. A common problem for all biosynthetic measurements is the requirement to measure isotopic labeling of the true intracellular biosynthetic precursor pool. Two techniques that address this problem for lipid biosynthesis, and that are applicable to humans, have been developed-the combinatorial probability method (or mass isotopomer distribution analysis) and (2)H(2)O incorporation. The theoretical basis and practical application of these methods, both of which involve mass spectrometry, are described. Issues relevant to specific lipid components of VLDL, such as differences in the labeling of the various particle lipids (phospholipid, cholesterol, etc.), and the contribution of an intrahepatic cytosolic triacylglycerol (TG) storage pool to VLDL-TG are discussed. In summary, advances in stable isotope-mass spectrometric techniques now permit accurate measurement of liver-TG synthesis and flux. In vivo regulation of the synthesis, assembly, and secretion of VLDL-TG in humans is thereby accessible to direct investigation. Patient-oriented research in conditions such as dyslipidemia and hepatic steatosis is made feasible by these scientific advances.

Measuring VLDL-triglyceride turnover in humans using ex vivo-prepared VLDL tracer

There has been more interest in VLDL-triglyceride (TG) kinetics during the last decade. Unfortunately, robust measurement methods are elaborate and not readily available. Here, we describe a method using unique, ex vivo labeling of the fatty acid moiety of VLDL-TG followed by intravenous bolus infusion in the same person. We found that plasma disappearance of ex vivo-labeled VLDL-TG was comparable to that of in vivo-labeled VLDL-TG and that turnover rates can be safely estimated from the log linear decay of VLDL-TG specific activity. We found minor labeling of the plasma FFA (oleate) pool, which was largely attributable to coinfusion of free [14C]triolein; VLDL-TG did not contribute substantially to the plasma FFA pool. The plasma decay curve of VLDL-TG was not affected by the presence of tracer in the FFA pool, provided that the data from 2 h after the VLDL tracer bolus infusion was used. The FFA contamination problem was circumvented by minor modification of the VLDL-TG tracer preparation. The approach we describe should expand the opportunity to study processes that cannot be assessed if the FFA precursor pool is labeled. This method for VLDL-TG tracer preparation can allow measurement of VLDL turnover, tissue uptake of VLDL-TG, and oxidation of VLDL-TG.

A mathematical model of fatty acid metabolism and VLDL assembly in human liver

The lipid composition of very-low-density lipoprotein (VLDL) in plasma is crucial for human health. A pre-requisite for the alteration of VLDL composition is a co-ordinated understanding of the complex interactions in VLDL assembly. In order to determine the potential effects of changes in substrate availability on VLDL lipid composition, we constructed, parameterized and evaluated a mechanistic mathematical model of the biosynthesis of triglycerides, phospholipids, and cholesterol esters and the assembly of VLDL in human hepatocytes. Using published data on human liver metabolism, the model was also used to provide insight into the complex process of lipid metabolism and to estimate the affinities of different liver enzymes for different fatty acids (FA). For example, we found that Delta6-desaturase is 19 times more selective for C18:3n-3 than C18:2n-6, stearoyl-CoA-desaturase is 2.7 times more selective for C18:0 than C16:0, Delta5-desaturase desaturates C20:4n-3 preferentially over C20:3n-6 and FA elongase preferentially elongates C18:3n-6. The model was also used to predict the plasma free fatty acid (FFA) composition required to generate a prescribed change in plasma lipoprotein FA composition. Furthermore, the model was tested against a published human feeding trial that investigated the effect of changes in dietary FA composition on human plasma lipid FA composition. The model is a useful tool for predicting the effect of changes in plasma FFA composition on plasma lipoprotein lipid FA composition.

Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of excess liver triacylglycerol (TAG), inflammation, and liver damage. The goal of the present study was to directly quantify the biological sources of hepatic and plasma lipoprotein TAG in NAFLD. Patients (5 male and 4 female; 44 +/- 10 years of age) scheduled for a medically indicated liver biopsy were infused with and orally fed stable isotopes for 4 days to label and track serum nonesterified fatty acids (NEFAs), dietary fatty acids, and those derived from the de novo lipogenesis (DNL) pathway, present in liver tissue and lipoprotein TAG. Hepatic and lipoprotein TAG fatty acids were analyzed by gas chromatography/mass spectrometry. NAFLD patients were obese, with fasting hypertriglyceridemia and hyperinsulinemia. Of the TAG accounted for in liver, 59.0% +/- 9.9% of TAG arose from NEFAs; 26.1% +/- 6.7%, from DNL; and 14.9% +/- 7.0%, from the diet. The pattern of labeling in VLDL was similar to that in liver, and throughout the 4 days of labeling, the liver demonstrated reciprocal use of adipose and dietary fatty acids. DNL was elevated in the fasting state and demonstrated no diurnal variation. These quantitative metabolic data document that both elevated peripheral fatty acids and DNL contribute to the accumulation of hepatic and lipoprotein fat in NAFLD.

Why Syndrome X? From Harold Himsworth to the insulin resistance syndrome

Although the concept of Syndrome X was introduced in the Banting Medal address of 1988 (Reaven, 1988), the notion that led to its genesis had started approximately 50 years earlier. In this short history, an attempt will be made to trace the two paths of scientific discovery that were formally merged in New Orleans in 1988 to form the scientific foundation of Syndrome X. In addition, the developments in the last 16 years that have led from the notion of Syndrome X to the broader concept of an Insulin Resistance Syndrome (IRS) will be briefly summarized.

Measuring very low density lipoprotein-triglyceride kinetics in man in vivo: how different the various methods really are

PURPOSE OF REVIEW

The purpose of this article is to briefly outline the methods that are currently available for the determination of very low density lipoprotein-triglyceride (VLDL-TG) kinetics in man in vivo.

RECENT FINDINGS

A number of novel methodologies have been developed over the years for quantifying VLDL-TG production, clearance, and turnover rates. Besides the splanchnic arteriovenous balance technique, tracer methods with radioactive and, more recently, stable isotopes have been widely used. Most of the latter approaches utilize an isotopically labelled substrate, such as glycerol, fatty acid or acetate, which is eventually incorporated into a VLDL-TG moiety, and monitor the time course of change in specific activity or enrichment. A procedure of in vivo labelling of VLDL-TG with stable isotopes and use of the labelled VLDL-TG as a tracer has also been described in man. There is, however, considerable variability in estimates of VLDL-TG kinetics obtained by the various techniques, which cannot be readily attributed to normal physiological variation. Still, a large part of this discrepancy may be related to differences in VLDL-TG pool size within the normal range, which seem to account for approximately 40-50% of the total variance in VLDL-TG kinetics in both men and women.

SUMMARY

Several methods are available for quantifying VLDL-TG kinetics in man in vivo, varying in the selection of tracer, mode of administration and sampling, and data analysis. These inherent features, along with different pool sizes, result in multifold variable estimations of VLDL-TG kinetic parameters.

Stable isotope tracer dilution for quantifying very low-density lipoprotein-triacylglycerol kinetics in man

BACKGROUND & AIM

A number of approaches have been employed in the past to measure very low-density lipoprotein (VLDL) triacylglycerol (TG) kinetics in humans in vivo, varying in the selection of tracer and mode of administration. All, however, make use of labeled TG precursors and more or less complicated mathematical models to derive the kinetic parameters of interest. The aim of the present study was to develop a conceptually straightforward method, based on the traditional tracer infusion technique, for quantifying VLDL-TG production rates in man using stable isotopes.

METHOD

Our approach involves ingestion of [U-13C3]glycerol to endogenously label the glycerol in VLDL-TG, plasmapheresis, isolation of the newly 13C-labeled VLDL from plasma, and administration within the next 2-3 days via a primed constant autologous reinfusion. This procedure produces enough tracer for a priming dose plus 2-3 h of infusion. In the physiological conditions examined (basal and hyperglycemic states, fat- and carbohydrate-rich diets), with almost 3-fold ranging VLDL-TG pool sizes, a steady state in plasma VLDL-TG glycerol tracer-to-tracee ratio was readily achieved within 2 h. Consequently, calculations are made according to the isotope dilution principle, thus avoiding assumptions implicit in more complicated models.

CONCLUSION

The stable isotope VLDL-TG tracer dilution method offers an alternative and reliable tool for the determination of endogenous VLDL-TG kinetics in man under a variety of metabolic states.

The rise of the plasma lipid concentration elicited by dietary sodium chloride restriction in Wistar rats is due to an impairment of the plasma triacylglycerol removal rate

Studies in humans have indicated that dietary salt restriction raises plasma levels of total cholesterol (TC) and triacylglycerols (TAG). In order to explain the mechanisms involved, a rat experimental model was developed consisting of chronic feeding ad libitum isocaloric diets with variable sodium chloride contents. Rates of synthesis of plasma TAG were measured either as the increase of plasma TAG after blocking its removal from plasma by the intra-arterial pulse infusion of Triton-WR 1339, or as the plasma rate of incorporation of [(14)C]-oleic acid [(14)C]-TAG. Plasma TAG removal rate was determined by the intra-arterial pulse infusion of a lipid emulsion. Severe salt restriction increased the plasma concentrations of TAG (71%) and of TC (10%). This result was not due to modification of the rate of synthesis of plasma TAG but was attributed to a 55% slower rate of removal of the TAG-containing lipoproteins. An increased plasma non-esterified fatty acid concentration, probably due to a salt restriction-related insulin resistance, may have impaired the activity of the enzyme lipoprotein lipase.

Metabolic complications of obesity. Pathophysiologic considerations

Given a specific research interest in human fatty acid metabolism, this article focuses primarily on the evidence surrounding the hypothesis that dysregulation of the fuel release function of fat cells (lipolysis) is an important contributing factor to the health hazards of obesity.

Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms

Current trends in health promotion emphasize the importance of reducing dietary fat intake. However, as dietary fat is reduced, the dietary carbohydrate content typically rises and the desired reduction in plasma cholesterol concentrations is frequently accompanied by an elevation of plasma triacylglycerol. We review the phenomenon of carbohydrate-induced hypertriacylglycerolemia, the health effects of which are among the most controversial and important issues in public health nutrition today. We first focus on how seminal observations made in the late 1950s and early 1960s became the basis for subsequent important research questions and areas of scientific study. The second focus of this paper is on the current knowledge of biological mechanisms that contribute to carbohydrate-induced hypertriacylglycerolemia. The clinical rationale behind mechanistic studies is this: if carbohydrate-induced hypertriacylglycerolemia shares a metabolic basis with endogenous hypertriacylglycerolemia (that observed in subjects consuming high-fat diets), then a similar atherogenic risk may be more likely than if the underlying metabolic mechanisms differ. The third focus of the paper is on both the positive metabolic changes that occur when high-carbohydrate diets are consumed and the potentially negative health effects of such diets. The review concludes with a summary of some important research questions that remain to be addressed. These issues include the level of dietary carbohydrate that induces carbohydrate-induced hypertriacylglycerolemia, whether the phenomenon is transient or can be avoided, whether de novo lipogenesis contributes to the phenomenon, and what magnitude of triacylglycerol elevation represents an increase in disease risk.

Effects of lovastatin therapy on very-low-density lipoprotein triglyceride metabolism in subjects with combined hyperlipidemia: evidence for reduced assembly and secretion of triglyceride-rich lipoproteins

We have previously reported decreased production rates of the major apolipoprotein B (apoB)-containing lipoproteins, very-low-density lipoproteins (VLDL), and low-density lipoproteins (LDL) in patients with combined hyperlipidemia (CHL) during treatment with lovastatin. In the present study, we determined the effects of lovastatin therapy on VLDL triglyceride (TG) metabolism. Plasma VLDL turnover was determined in six CHL patients, before and during lovastatin therapy. 3H-triglyceride-glycerol-specific activity data derived from injection of 3H-glycerol were analyzed by compartmental modeling. The effects of lovastatin on VLDL TG metabolism were compared with those previously determined on VLDL apoB metabolism in these subjects. Lovastatin therapy was associated with decreased concentrations of VLDL TG in five of six patients and decreased VLDL apoB concentrations in all six. VLDL TG production rates (PR) decreased in five patients, with the mean for the group decreasing from 14.1 +/- 7.1 to 10.3 +/- 4.0 mg/kg/h (P less than .05). VLDL apoB PR also decreased in five patients, with the mean decreasing from 21.8 +/- 20.3 to 12.2 +/- 9.0 mg/kg/d (P = .11). Changes in VLDL TG concentrations during lovastatin treatment were correlated with changes in VLDL apoB concentrations (r = .74, P = .09) and in VLDL TG PR (r = .91, P = .01). Changes in VLDL TG PR were also related to changes in VLDL apoB PR (r = .62, P = NS). There were no consistent changes in the fractional catabolic rates of either VLDL TG or VLDL apoB during lovastatin therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Triglyceride-rich lipoprotein metabolism during acute hyperinsulinemia in hypertriglyceridemic humans

Chronic endogenous hyperinsulinemia is associated with increased rates of triglyceride production in humans. The effect of acute exogenous hyperinsulinemia on triglyceride production was studied in seven hypertriglyceridemic men before and during six hours of hyperinsulinemic-euglycemic clamping, and in two men before and during six hours of hyperinsulinemic-hyperglycemic clamping. Apparent triglyceride production rates were assessed qualitatively by examining the rate of decline of 3H-glycerol-labeled plasma triglyceride specific activity in the preclamp period, and again when a new steady state had occurred, during the final three hours of the clamp. During the euglycemic (91.2 +/- 3.0 mg glucose/dL plasma) clamps, plasma insulin levels were increased by 700% (0.76 +/- 0.12 to 5.3 +/- 0.29 ng/mL, P less than .001) and plasma glucagon levels decreased by 19%, compared with baseline. The apparent triglyceride production rate did not increase in five of six men during the euglycemic-hyperinsulinemic clamp, or in either man during the hyperglycemic-hyperinsulinemic clamp. During the clamp period the triglyceride declined in the plasma by 23.4 +/- 3.1%; and the apolipoprotein B by 10.5 +/- 1.5%. Hyperinsulinemia with euglycemia was also associated with a decline in the ratio of triglyceride to apolipoprotein B in the triglyceride-rich lipoproteins. This was more pronounced in very low density lipoprotein (VLDL) than in intermediate density lipoprotein (IDL). In this study, hyperinsulinemia led to a decrease in the plasma glucagon concentration. This decrease was positively correlated with the decrease in the slope of the triglyceride specific activity v time curve. Hence, the changes in triglyceride production were not due to an increase in plasma glucagon concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Very low density lipoprotein metabolism in diabetes mellitus

The concentration of VLDL and their major lipid, triglyceride, are regulated at many levels from the initial availability of the substrates needed for their synthesis all the way to the function of the enzymes and receptors involved in their removal from plasma. It should be clear from this review that in diabetes mellitus metabolic derangements resulting from the absolute lack of insulin or from resistance to the actions of insulin can affect VLDL triglyceride metabolism at any or all of these regulatory points. The outcome of this interplay between diabetes and VLDL metabolism is the common occurrence of elevated plasma VLDL and triglyceride concentrations in individuals with both Type 1 and Type 2 diabetes mellitus. Mildly elevated plasma levels of triglycerides are nearly universal in diabetics; more significant hypertriglyceridemia can be the consequence of either metabolic decompensation or the concomitant inheritance of a familial pattern of hyperlipoproteinemia. The combination of the latter two situations usually presents with as severe hypertriglyceridemia. Although deregulation can occur at many points, the most common abnormality associated with hypertriglyceridemia in human diabetes appears to be overproduction of VLDL triglycerides. Increased rates of synthesis of VLDL apoB may also be a common consequence of diabetes. The basis for this belief is the accumulated data from kinetic studies in humans and in experimental models of diabetes in rats. Although the latter may also demonstrate defects in catabolism when insulin deficiency is severe, catabolic abnormalities appear to be uncommon as the primary force in the development of hypertriglyceridemia in humans. Finally, despite the complexity of the systems regulating VLDL metabolism and the many metabolic abnormalities that may be present in diabetic subjects, it appears that reduction of the hyperglycemia by means of dietary or pharmacologic interventions is associated with normalization of the rates of synthesis and catabolism of the VLDL and their triglycerides. In view of the probable atherogenecity of VLDL, particularly in individuals with diabetes, such intervention must be aimed at both plasma glucose and lipid concentrations.

Effect of ileal exclusion on kinetics of very low density lipoprotein triglycerides in familial hypercholesterolemia

Plasma lipoproteins, VLDL triglyceride kinetics, and bile acid and cholesterol synthesis were measured in 21 patients heterozygous for familial hypercholesterolemia with (n = 11) or without (n = 10) ileal bypass. LDL cholesterol and apoprotein B concentrations were lower, and cholesterol and bile acid synthesis, the VLDL triglyceride/cholesterol ratio, and the HDL cholesterol concentration were higher in the operated than the control patients. The VLDL triglyceride production rate was increased in the operated normotriglyceridemic patients by about 65%, whereas the fractional catabolism of VLDL triglycerides and the calculated VLDL cholesterol transport were similar in the operated and control groups. VLDL triglyceride production was not correlated with cholesterol or bile acid synthesis. The VLDL triglyceride concentration was positively correlated with the production and negatively with the fractional catabolism of VLDL triglycerides. In unoperated normotriglyceridemic patients the VLDL triglyceride production was positively correlated with LDL cholesterol (r = 0.69, p less than 0.05), LDL triglyceride (r = 0.84, p less than 0.01) and LDL apoprotein B (r = 0.80, p less than 0.01) concentrations, and with the LDL triglyceride/apoprotein B (r = 0.72, p less than 0.05) and LDL triglyceride/cholesterol (r = 0.68, p less than 0.05) ratios. None of these correlations was significant in the operated patients. We conclude that in heterozygous familial hypercholesterolemia VLDL triglyceride level depends on both VLDL triglyceride synthesis and catabolism, LDL level is proportionate to VLDL triglyceride production in the unoperated patients but not in the patients with ileal bypass, ileal exclusion results in an increase in the production rate of VLDL triglycerides in normotriglyceridemic patients but otherwise VLDL triglyceride production is poorly associated with cholesterol and bile acid synthesis, ileal exclusion may induce hepatic secretion of triglyceride-rich VLDL.

The methodology of compartmental modeling as applied to the investigation of lipoprotein metabolism

The statements to this point only give a cursory review of the beginning (20 years) of the kinetic approach to the classification of lipoproteins and subsystems which are involved in their synthesis and metabolism. At the present time the following partial list of theoretical findings expressed through model building can be made for the lipid and lipoprotein field: A cascade process of delipidation for VLDL exists and the rate of this process is decreased in subjects with hyperlipoproteinemia. ApoC recycles between VLDL and HDL in response to the dynamics of the delipidation cascade. New synthesis of apoB first appears with newly synthesized VLDL. VLDL apoB synthesis decreased in hyperlipidemic states examined. Multiple synthesis pathways exist for the triglyceride moiety of VLDL as determined by the transit time of a precursor through the conversion pathway. Thus the isotopic precursor methods now yield the same results as the more invasive techniques. Kinetic heterogeneity of VLDL, IDL, LDL, and HDL has been established. Kinetic heterogeneity for apoA-I, apoA-II, apoB, apoC-2 and apoC-3 have been established. The presence of direct pathways for IDL and LDL synthesis have been established. Irreversible loss of apoC from HDL has been predicted using models. Synthesis of apoC has been found to be invariant in hyperlipoproteinemic states studied. Hepatic cholesterol compartments associated with the formation of bile acids and biliary cholesterol derive a majority of their cholesterol from newly synthesized and lipoprotein-free cholesterol. More than 85% of the free cholesterol in the beta-lipoproteins cycles directly through the HDL. Free cholesterol recycles between HDL and tissue pools and between HDL and beta-lipoproteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolism of the apolipoprotein B-containing lipoproteins

This chapter was designed to describe the approaches one can take to study the metabolism of the apoB-containing particles in vivo. The focus has been to blend (1) what is the current tracer kinetics analysis methodology and (2) what are the current experimental protocols being used into a total picture so that the experimentalist wishing to perform such studies may have a better perspective of the strong points and pitfalls of this important experimental tool. Hence, these points have been summarized from the point of view of what caveats are associated with each methodology. Recognition of these is essential to avoid reaching potentially erroneous conclusions. More important, attention has been focused on the realization that certain methodologies can be chosen depending upon what questions are being asked. Finally, areas where future development is needed in order to proceed to the next level of understanding are pointed out in the context of using tracer kinetic analysis as an integral part of a total experimental design.

Triglyceride-lowering effect of marine polyunsaturates in patients with hypertriglyceridemia

Twenty male patients with primary hypertriglyceridemia were treated for 4 weeks with daily supplements (15 g) of oil, which provided approximately 6 g of polyunsaturated fatty acid (PUFA) either of fish or of vegetable origin. Total plasma cholesterol concentrations were unaffected, but both types of supplement increased high density lipoprotein-3 (HDL3) cholesterol concentrations. The fish, but not the vegetable, oil supplement led to a decrease in plasma triglyceride concentrations. Very low density lipoprotein (VLDL), fatty acid composition, and VLDL triglyceride kinetics were subsequently studied in five patients (four male, one female) before and after 4 weeks of therapy with 15 g of the same fish oil. The fish oil led to increases in the proportion of eicosapentaenoic acid in both the VLDL triglyceride and phospholipid fractions, but the increase was greater in the latter. In contrast, the proportion of docosahexanoic acid was increased only in the VLDL triglycerides. The decrease in plasma triglyceride concentrations that occurred with fish-oil therapy was accompanied by a reduction in the absolute catabolic rate of VLDL triglyceride, implying a concomitant change in synthetic rate; the fractional catabolic rate of VLDL triglyceride was unaltered. It is suggested that polyunsaturated fatty acids of marine origin may be therapeutically useful for hypertriglyceridemia.

Elimination of lipofundin S during the intravenous fat tolerance test in patients with low, medium, and high fasting triglyceride concentrations

The intravenous fat tolerance test with Lipofundin S (0.5 ml of 20% emulsion/kg body weight) was performed in 22 male nondiabetic patients. According to their fasting triglycerides (TG), the patients were arranged into three groups: low (less than 2.8 mmol/liter), medium (2.8-5.7 mmol/liter), and high (greater than 5.7 mmol/liter) concentrations. Fractional elimination rates of injected Lipofundin S decreased from 11.08 in low TG to 4.57%/min in high TG; they were positively correlated with fasting levels of high-density lipoprotein cholesterol but negatively with those of TG. The same pattern of correlations was observed with fractional catabolic rates of endogenous TG as measured after injection of tritium-labeled glycerol. The intravenous Lipofundin S load effected transient TG and free fatty acid elevations which were delayed in high TG. The elimination mechanisms of injected Lipofundin S and of endogenous TG are compared.

Impaired catabolism of very low-density lipoprotein-triglyceride in a family with primary hypertriglyceridemia

In this report, kinetic studies of plasma very low-density lipoprotein-triglyceride (VLDL-TG) were examined in five brothers (three affected and two unaffected) from a family with primary hypertriglyceridemia. Synthesis and catabolism of VLDL-TG were studied by in vivo labelling of plasma TG with 3H-glycerol, and multicompartmental analysis of the plasma die-away curves. Results of the kinetic studies revealed the following information: (1) one brother, who had the highest plasma TG level and was obese, had both overproduction and a reduced fractional catabolic rate (FCR) of VLDL-TG; (2) second brother, who had moderate hypertriglyceridemia, had a low FCR and high-normal synthesis of VLDL-TG; (3) a third, who had only mildly elevated TG, had a low FCR and normal synthesis of VLDL-TG; and (4) the two normolipidemic brothers had neither overproduction nor decreased FCR of VLDL-TG. The composition of the soluble apoproteins of VLDL was normal. The apoprotein E phenotypes were E4/3 in four brothers, and E3/2 in the fifth. We have reached the following conclusions regarding this family: (1) the common kinetic abnormality of VLDL-TG metabolism in the hypertriglyceridemic brothers was a low clearance of VLDL-TG; (2) impaired catabolism of VLDL could not be explained by the apoprotein C or E patterns; and (3) the most severe hypertriglyceridemia occurred when the decreased FCR was present in conjunction with VLDL-TG overproduction due to obesity. Thus, a moderate defect in catabolism of plasma TG appears to be responsible for one familial form of primary hypertriglyceridemia.

Very low density lipoprotein triglyceride kinetics during hepatic lipase suppression by estrogen. Studies on the physiological role of hepatic endothelial lipase

The exact role of the heparin-releasable hepatic endothelial lipase has remained controversial. It has been suggested that it acts in concert with lipoprotein lipase in the step-wise delipidation of triglyceride-rich lipoproteins. On the other hand, there is evidence indicating that high density lipoprotein2 is the preferred substrate for hepatic lipase. Here, it is shown that a moderate (27%) suppression of hepatic lipase activity by estrogen did not impair removal of 3H-labeled very low density lipoproteins (VLDL) triglycerides, suggesting that this enzyme is not a major regulator of VLDL catabolism under physiological circumstances.

Effects of dietary substitution of mixed amino acids for glucose on the splanchnic metabolism of plasma triglycerides, cholesterol, carbohydrates, and amino acids in conscious fed baboons

Splanchnic metabolism was studied in the fed state during prolonged constant intravenous administration of tracer amounts of [9,10]-3H palmitic acid and the calculated isocaloric intraduodenal administration (13 mg/min X kg body wt0.75) of either (1) glucose, (2) 15% mixed amino acids and 85% glucose or (3) 45% mixed amino acids and 55% glucose to conscious, restrained female baboons that had been maintained on a similar diet (supplemented in essential nutrients) for the previous 9 days. Secretion of plasma triglycerides from the splanchnic region was quantified from splanchnic flow and radiochemical measurements of transsplanchnic gradients of 3H-labeled free fatty acids and triglycerides. Mean splanchnic secretion of plasma triglycerides increased significantly as the proportion of dietary calories derived from amino acids was varied from 0 to 15 to 45% (mean values 1.1 +/- 0.1, 2.6 +/- 0.2 and 4.2 +/- 0.3 mumol/min kg body wt0.75, respectively, p less than 0.05). Increased triglyceride secretion was attributable to both significantly higher rates of esterification of free fatty acids taken up in the splanchnic region to triglycerides released into hepatic venous blood plasma (mean values 10 +/- 1, 16 +/- 2 and 34 +/- 5%, respectively) and to significantly higher rates of secretion of triglycerides derived from precursors other than free fatty acids. Higher intake of amino acids was also associated with both higher plasma concentrations of cholesterol and higher values for hepatic oxidation of cholesterol to bile acids.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of anesthesia or restraint on triacylglycerol turnover in the rat

A comparison of triacylglycerol metabolism was made among anesthetized, restrained and unanesthetized-unrestrained rats. The method utilized for the comparison was the determination of triacylglycerol turnover following the intravenous injection of [3H]glycerol. Peak appearance of triacyl[3H]glycerol was 25 min in unanesthetized-unrestrained rats but 35 and 45 min in restrained and anesthetized rats, respectively. Using serial plasma triacylglycerol determinations as an index of steady-state in all three groups, it was found that only the anesthetized and unanesthetized-unrestrained animals could be used for kinetic analysis. In these two animal preparations, apparent fractional catabolic rates were calculated and found to be lower in anesthetized (0.014 min-1) compared to unanesthetized-unrestrained animals with chronic indwelling cannulas (0.029 min-1). Apparent total catabolic rates, calculated from the plasma triacylglycerol mass and estimated plasma volume, were reduced by 50% in anesthetized animals. It is concluded that wide differences in triacylglycerol metabolism exist in these rat preparations which should be considered in the interpretation of future studies. The unanesthetized-unrestrained rat model may represent the closest approximation to the normal physiologic state.

Effects of moderate increases in dietary polyunsaturated: saturated fat on plasma triglyceride and cholesterol levels in man

1. The effects of two isoenergetic diets differing only in the values for polyunsaturated: saturated fat (P:S values of 0.2 v. 2.0) were studied in twenty adult human volunteers. 2. A period of 14 d on the high P:S diet failed to produce significant changes in fasting triglyceride levels, though there were individual variations. On the other hand, fasting cholesterol levels dropped by 10% (P less than 0.005). High-density-lipoprotein-cholesterol concentrations were not influenced by changes in the P:S value. 3. Investigations into the mechanism by which changes in the P:S value might affect plasma triglyceride values revealed no consistent effects on very-low-density-lipoprotein kinetics, insulin secretion, insulin sensitivity or free fatty acid concentrations. 4. The results of this study suggest that the largest increase in dietary P:S values that is likely to be obtained on a long-term basis may have only a small effect on plasma triglyceride and cholesterol concentrations.

Combined deficiency of apolipoprotein C-II and lipoprotein lipase in familial hyperchylomicronemia

The underlying pathophysiological defect was studied in four siblings with familial hyperchylomicronemia. Deficiency of apolipoprotein C-II and E-3 was identified. In addition, these subjects had markedly decreased LPL activity in postheparin plasma. Addition of normal plasma to the assay as source for apoC-II enhanced LPL activity only to a limited extent. In contrast with previously reported patients with apoC-II deficiency, a far less pronounced effect of intravenous infusion of normal plasma was seen in one of the siblings, probably due to the combined deficiency of apoC-II and LPL. Plasma VLDL-TG turnover rate was not decreased in one of the siblings with apoC-II and LPL deficiency, suggesting different metabolic pathways for chylomicrons and VLDL. Family study confirmed an autosomal recessive mode of inheritance both for apoC-II and for apoE-3 deficiency. The mode of inheritance for LPL deficiency could not be established exactly.

Integrated regulation of very low density lipoprotein triglyceride and apolipoprotein-B kinetics in man: normolipemic subjects, familial hypertriglyceridemia and familial combined hyperlipidemia

Turnover kinetics of triglycerides (TG) and apolipoprotein-B (apo-B) of plasma very low density lipoprotein (VLDL) and their relationship to plasma VLDL composition and VLDL apo-B conversion to low density lipoprotein (LDL) were determined in age and weight-matched groups of normolipemic (NL) healthy subjects, patients with familial combined hyperlipidemia (FCHL) and patients with familial hypertriglyceridemia (FHTG). In NL subjects, a significant correlation as observed between VLDL TG or VLDL apo-B turnover rate and its circulating mass, suggesting that the plasma level of VLDL was determined by the secretion rate of VLDL TG and apo-B. The positive significant correlation between VLDL TG and apo-B also suggests that the production of these moieties was integrated at the synthetic and/or secretory sites to maintain the ratio of TG to apo-B in plasma VLDL. In moderately obese NL subjects, proportionate increases in VLDL TG and apo-B turnover rates resulted in enhanced secretion of VLDL particles. Both groups with genetic hypertriglyceridemia had increased VLDL TG and VLDL apo-B turnover rates. This increase accounted for the increase in circulating VLDL TG and apo-B mass. In patients with FCHL, turnover rates of VLDL TG and apo-B were equally increased, hence, the ratios between major VLDL constituents were within normal limits. On the other hand, the increase in VLDL TG turnover in patients with FHTG was disproportionately greater than that of apo-B resulting in a higher ratio of TG to other VLDL components. In NL subjects, approximately 72% of VLDL apo-B released into plasma was converted to LDL. This conversion correlated positively with VLDL apo-B turnover rate and inversely with VLDL TG turnover rate. Formation of LDL from VLDL was significantly greater in the obese individuals. In FCHL, conversion of VLDL to LDL represented the major pathway for VLDL apo-B catabolism. The increased VLDL apo-B load was predominantly catabolized to LDL. The greater increase in VLDL TG turnover relative to apo-B in FHTG, on the other hand, resulted in a smaller fraction of VLDL apo-B recovered in LDL, most of the VLDL apo-B being removed via a pathway that did not involve this conversion. We conclude that the composition and metabolic fate of plasma VLDL may be greatly influenced by the secretion rates of VLDL TG and apo-B. If VLDL conversion to LDL and the subsequent catabolism of the latter provides a major route for delivery of cholesterol ester to peripheral tissues, then the increased LDL production in FCHL compared to FHTG may account for a higher cardiovascular risk.

Hyperinsulinemia in patients with low fractional catabolic rate of triglycerides

In non-diabetic persons whose serum triglyceride (TG) concentrations ranged from normal to very high levels, endogenous TG turnover was measured using the radioglycerol method of Farquhar and coworkers. Insulin, FFA, and glucose concentrations were estimated during an oral glucose tolerance test. Stimulated insulin levels were correlated positively to TG concentrations and absolute TG turnover rates, and negatively to fractional TG catabolic rates. FFA concentrations had similar relationships, also in non-insulin-dependent diabetics. A more detailed analysis showed that elevated insulin and FFA levels - as an expression of peripheral insulin resistance - are typical finding in the kind of patients whose fractional TG catabolic rate is low [less than or equal to 0.210 (h-1)], irrespective of actual serum TG concentration. Our data do not suggest a stimulatory role of insulin for TG production.

Impaired plasma triglyceride clearance as a feature of both uremic and posttransplant triglyceridemia

After accurate plasma volume calculation, endogenous plasma very-low-density-lipoprotein (VLDL)-triglyceride turnover rates were measured in 20 undialyzed patients with chronic renal failure (CRF) and in 16 renal transplant recipients with stable graft function. When kinetic criteria were based on a group of healthy subjects (Vmax = 36.7 mumoles/hr/kg), it was clear that, on the whole, CRF patients had a reduced capacity for VLDL-triglyceride removal (Vmax = 14.0 mumoles/hr/kg), as did graft recipients (Vmax = 19.5 mumoles/hr/kg). In transplant recipients with impaired graft function, however, extremes of both under removal and over production of VLDL-triglycerides were observed. In CRF, defective clearance was accompanied by a reduction in postheparin lipoprotein and hepatic lipase activities, although there was no statistical relationship. Enzyme activities were not reduced, however, after transplantation, and the metabolic factors responsible for defective clearance were not clearly identified.

Lipoprotein-lipase action determining plasma high density lipoprotein cholesterol level in adult normolipaemics

In a series of healthy normolipaemic, adult subjects, plasma triglyceride turnover, heparin-releasable lipoprotein lipase (LPL), and plasma HDL cholesterol were determined. Strong correlations were found to exist between the fractional removal rate of plasma triglycerides (FTR) or LPL as one variable and HDL cholesterol as the other, whereas the triglyceride turnover rate (TR) did not correlate with HDL cholesterol. It is concluded that lipoprotein lipase action is largely responsible for the formation of HDL cholesterol in the blood stream.

Very low density lipoprotein metabolism in domestic pigs

Patterns of triacylglycerol (TG) turnover in plasma and liver, and the hepatic secretion of very density lipoprotein triacylglycerol (VLDL TG) into the circulation, have been studied in young Large White female pigs, using i.v. tracer [1,3-14C]- and [2-3H]glycerol. Serial measurements were made of plasma [14C]glycerol and [14C]glucose and of liver TG and plasma VLDL TG specific activities. In other studies VLDL TG obtained from a donor pig was reinjected into recipient animals to measure the early disappearance (dilution) of VLDL TG. Multicompartmental analysis revealed a mean rate of hepatic TG turnover somewhat slower than the rate of VLDL TG turnover, suggesting that almost all of the hepatic TG turnover was due to secretion of VLDL TG, and that the intestine probably contributed an appreciable part of the newly synthesized plasma VLDL TG. The t1/2 of reinjected VLDL TG, whether prepared by the most rapid possible techniques and reinjected immediately or stored for several days, was approximately 10 min. This was much faster than the t1/2 of the falling limb of the plasma VLDL TG curve seen after injection of labelled glycerol (t1/2 approximately 2 H). Thus, in these respects, the pig resembled all other species studied rather than human subjects as described by Farquhar et al.

Kinetic bases of the primary hyperlipidaemias: studies of apolipoprotein B turnover in genetically defined subjects

Autologous 131I-labelled very low density lipoprotein (VLDL) and 125I-labelled low density lipoprotein (LDL) were injected into seven normal subjects and into forty-three hyperlipidaemic patients, classified into groups on the basis of family studies and clinical findings, to quantitate VLDL and LDL apolipoprotein B kinetics. In normal subjects, mean VLDL-B peptide synthetic rate was 15 . 1 mg kg-1 day-1, mean LDL-B peptide synthetic rate 7 . 7 mg kg-1 day-1 and mean LDL-B fractional catabolic rate (FCR) 0 . 31 day-1. In heterozygous familial hypercholesterolaemia (n = 14) VLDL-B peptide production was normal in patients with normal triglyceride levels; in those with high triglyceride levels there was either VLDL overproduction or a catabolic defect. LDL-B peptide synthetic rates ranged from high normal to increased (8 . 5--18 . 0 mg kg-1 day-1) and LDL-B peptide FCR values were markedly reduced (0 . 14--0 . 28 day-1) confirming the presence of a defect in LDL catabolism but indicating over-production as well. In familial combined hyperlipidaemia (n = 11) VLDL-B peptide production ranged from normal to elevated (13 . 9--44 . 4 mg kg-1 day-1, mean 23 . 8 mg kg-1 day-1) correlating with the VLDl triglyceride level (i.e. with the phenotypic expression of the disorder). LDL-B peptide production ranged from high normal to markedly increased (8 . 9--19 . 5 mg kg-1 day-1, mean 12 . 2 mg kg-1 day-1) and correlated with LDL cholesterol levels (i.e. the phenotype), (r = +0 . 66, P < 0 . 05). Three patients with unclassified hypercholesterolaemia had increased LDL-B peptide synthetic rates. One patient with remnant hyperlipoproteinaemia (type III) had a high normal VLDL-B peptide synthetic rate, 17 . 3 mg kg-1 day-1, and a strikingly low FCR of VLDL-B. In familial hypertriglyceridaemia (three patients) there was a low VLDL-B peptide FCR. In unclassified hypertriglyceridaemia VLDL over-production was the finding in seven patients but four patients appeared to have catabolic defects only. Overall there were significant hyperbolic relationships between VLCL-B peptide FCR and VLDL-B peptide concentration (r = -0 . 78, P < 0 . 001, for the log/log relationship) and between LDL-B peptide FCR and LDL cholesterol (r = -0 . 88, P < 0 . 001 for the log/log relationship.)