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Ma X, Liao Z, Li R, Xia W, Guo H, Luo J, Sheng H, Tian M, Cao Z. Myocardial Injury Caused by Chronic Alcohol Exposure—A Pilot Study Based on Proteomics. Molecules 2022; 27:molecules27134284. [PMID: 35807529 PMCID: PMC9268295 DOI: 10.3390/molecules27134284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic alcohol exposure can cause myocardial degenerative diseases, manifested as cardiac insufficiency, arrhythmia, etc. These are defined as alcoholic cardiomyopathy (ACM). Alcohol-mediated myocardial injury has previously been studied through metabolomics, and it has been proved to be involved in the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway concerning unsaturated fatty acids biosynthesis and oxidative phosphorylation, which tentatively explored the mechanism of ACM induced by chronic drinking. To further study alcohol-induced myocardial injury, myocardial specimens from a previously successfully established mouse model of ACM were subjected to histological, echocardiographic, and proteomic analyses, and validated by real-time quantitative polymerase chain reaction (qPCR). Results of histopathology and echocardiography showed the hypertrophy of cardiomyocytes, the dilation of ventricles, and decreased cardiac function. Proteomic results, available via ProteomeXchange with identifier PXD032949, revealed 56 differentially expressed proteins (DEPs) were identified, which have the potential to be involved in the KEGG pathway related to fatty acid biosynthesis disorders, lipid metabolism disorders, oxidative stress, and, ultimately, in the development of dilated cardiomyopathy (DCM). The present study further elucidates the underlying effects of myocardial injury due to chronic alcohol intake, laying a foundation for further studies to clarify the potential mechanisms of ACM.
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Affiliation(s)
- Xiaonan Ma
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (X.M.); (Z.L.); (R.L.); (J.L.)
- The Third Clinical Department, China Medical University, Shenyang 110122, China
| | - Zihan Liao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (X.M.); (Z.L.); (R.L.); (J.L.)
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Science, Shenyang 110122, China
| | - Rongxuan Li
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (X.M.); (Z.L.); (R.L.); (J.L.)
- The Third Clinical Department, China Medical University, Shenyang 110122, China
| | - Wei Xia
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (W.X.); (H.G.)
| | - Honghui Guo
- Department of Forensic Analytical Toxicology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (W.X.); (H.G.)
| | - Jiawei Luo
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (X.M.); (Z.L.); (R.L.); (J.L.)
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Science, Shenyang 110122, China
| | - Huaxin Sheng
- Multidisciplinary Neuroprotection Laboratories, Center of Perioperative Organ Protection, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Meihui Tian
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Science, Shenyang 110122, China
- Department of Forensic Genetics and Biology, School of Forensic Medicine, China Medical University, Shenyang 110122, China
- Correspondence: (M.T.); (Z.C.)
| | - Zhipeng Cao
- Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang 110122, China; (X.M.); (Z.L.); (R.L.); (J.L.)
- Liaoning Province Key Laboratory of Forensic Bio-Evidence Science, Shenyang 110122, China
- Correspondence: (M.T.); (Z.C.)
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Chen HM, Lee LC, Hu KY, Tsai WJ, Huang C, Tsay HJ, Liu HK. The application of post-translational modification oriented serum proteomics to assess experimental diabetes with complications. PLoS One 2018; 13:e0206509. [PMID: 30395577 PMCID: PMC6218044 DOI: 10.1371/journal.pone.0206509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/14/2018] [Indexed: 01/01/2023] Open
Abstract
Proteome analysis of serum from type 2 diabetics with complications may lead to the discovery of diagnostic or prognostic biomarkers. To circumvent the principal barrier of serum proteomics, our investigation aimed to evaluate whether a study of post-translational modification enriched serum proteins could be valuable for the discovery of biomarkers or metabolic pathways related to type 2 diabetes pathogenesis. Type 2 diabetes was induced from high-fat diet fed Sprague Dawley rats with streptozotocin injection. Once diabetic status was confirmed, serum samples from either fasted healthy or diabetic rats were pooled and profiled by two-dimensional difference gel electrophoresis or comparative 2D electrophoresis after protein enrichments using immobilized metal ion, concanavalin A, and lentil affinity chromatography, respectively. Differential expressed proteins were identified and the associated networks were established by an Ingenuity Pathway Analysis. As a result, induced rats became severe diabetic and accompanied by hyperlipidemia, fatty liver, and glomerular hypertrophy. There were 3 total, 14 phosphorylated and 23 glycosylated protein targets differentially expressed. Proteins could be linked to HNF4A, HNF1A, and NFκB transcriptional factors and antigen presentation, humoral immune response, and inflammatory response pathways. Predicted organ toxicity in kidney, heart, and liver matched with our histopathological results. In conclusion, post-translational modification based serum protein enrichment could be a valuable approach to enhance the resolution of serum proteomics without depleting potentially valuable abundant proteins. Our results also indicated the potential association of the hepatic secretome and hepatocyte nuclear factors in the pathogenesis of type 2 diabetes and its complications.
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Affiliation(s)
- Han-Min Chen
- Department of Life Science, Fu Jen Catholic University, New Taipei city, Taiwan, ROC
| | - Lin-Chien Lee
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Kuang-Yu Hu
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Jern Tsai
- Division of Chinese Medicine Literature and Informatics, National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan, ROC
| | - Cheng Huang
- Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Earth and Life Sciences, University of Taipei, Taipei, Taiwan, ROC
| | - Hui-Jen Tsay
- Institute of Neuroscience, Brain Research Center, school of life science, National Yang-Ming University, Taipei, Taiwan, ROC
- * E-mail: (HKL); (THJ)
| | - Hui-Kang Liu
- Division of Basic Chinese Medicine, National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan, ROC
- Ph.D. Program in Clinical Drug Development of Chinese Herbal Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- * E-mail: (HKL); (THJ)
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Castro A, Lázaro I, Selva DM, Céspedes E, Girona J, NúriaPlana, Guardiola M, Cabré A, Simó R, Masana L. APOH is increased in the plasma and liver of type 2 diabetic patients with metabolic syndrome. Atherosclerosis 2010; 209:201-5. [DOI: 10.1016/j.atherosclerosis.2009.09.072] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 08/07/2009] [Accepted: 09/25/2009] [Indexed: 11/28/2022]
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Crook M. Apolipoprotein H: Its relevance to cardiovascular disease. Atherosclerosis 2010; 209:32-4. [DOI: 10.1016/j.atherosclerosis.2009.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 11/15/2009] [Accepted: 11/15/2009] [Indexed: 10/20/2022]
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Plasma proteome changes in subjects with Type 2 diabetes mellitus with a low or high early insulin response. Clin Sci (Lond) 2008; 114:499-507. [DOI: 10.1042/cs20070323] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Circulating proteins contribute to the pathogenesis of T2DM (Type 2 diabetes mellitus) in various ways. The aim of the present study was to investigate variations in plasma protein levels in subjects with T2DM and differences in β-cell function, characterized by the EIR (early insulin response), and to compare these protein levels with those observed in individuals with NGT (normal glucose tolerance). Ten subjects with NGT+high EIR, ten with T2DM+high EIR, and ten with T2DM+low EIR were selected from the community-based ULSAM (Uppsala Longitudinal Study of Adult Men) cohort. Plasma protein profiling was performed using SELDI-TOF (surface-enhanced laser-desorption ionization–time-of-flight) MS. In total, nine plasma proteins differed between the three study groups (P<0.05, as determined by ANOVA). The levels of two forms of transthyretin, haemoglobin α-chain and haemoglobin β-chain were decreased in plasma from subjects with T2DM compared with subjects with NGT, irrespective of the EIR of the subjects. Apolipoprotein H was decreased in plasma from individuals with T2DM+high EIR compared with subjects with NGT. Four additional unidentified plasma proteins also varied in different ways between the experimental groups. In conclusion, the proteins detected in the present study may be related to the development of β-cell dysfunction.
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Gao PJ, Piao YF, Liu XD, Qu LK, Shi Y, Wang XC, Yang HY. Studies on specific interaction of beta-2-glycoprotein I with HBsAg. World J Gastroenterol 2003; 9:2114-6. [PMID: 12970918 PMCID: PMC4656686 DOI: 10.3748/wjg.v9.i9.2114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the binding activity of beta-2-glycoprotein I (β2GPI) to hepatitis B surface antigen (HBsAg) and the possible roles of β2GPI in hepatitis B virus (HBV) infection.
METHODS: The rationale of ELISA methods and ELISA-based research method and ligand-blotting technique were used to detect the specific interaction of β2GPI with HBsAg.
RESULTS: With the increase of rHBsAg, the binding of β2GPI to rHBsAg elevated, and these changes had statistic significance. When we added non-biotinlyated β2GPI, the OD value significantly decreased though they still were positively relevant to rHBsAg, suggesting non-biotinlyated β2GPI competed with biotinlyated β2GPI to saturate the binding sites on rHBsAg. Meanwhile BSA was used as negative control to substitute for rHBsAg coating the plates. The results indicated no interaction between β2GPI and BSA, suggesting the affinity of β2GPI to rHBsAg was specific. The ligand blotling indicated that β2GPI might bind to rHBsAg no matter whether it was under reduced condition or not.
CONCLUSION: The binding of β2GPI to HBsAg suggests that β2GPI may be a carrier of HBV and that β2GPI may play important roles in HBV infection.
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Affiliation(s)
- Pu-Jun Gao
- Department of Digestion, 1st Hospital affiliated to Jilin University, Changchun 130021, Jilin Province, China.
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Crook M, Chng SI, Lumb P, Reid F. Serum apolipoprotein H and its relationship to blood pressure, serum lipids, fasting plasma glucose and insulin in normal individuals. Ann Clin Biochem 2001; 38:494-8. [PMID: 11587127 DOI: 10.1177/000456320103800506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Apolipoprotein H (apo H), also known as beta2-glycoprotein 1, has recently become of interest in the field of haemostasis. As apo H is elevated in diabetes mellitus and dyslipidaemia, we wished to test the hypothesis that serum apo H concentration was related to fasting plasma glucose and insulin as well as blood pressure, body mass index, hip/waist ratio and serum lipids in normal individuals. Eighty-one healthy young individuals (46 females and 35 males) were studied. Their age was 20.7 +/- 0.75 years. Serum apo H significantly correlated with fasting plasma glucose (r = 0.24, P = 0.03) and serum LDL cholesterol (r = 0.30, P = 0.006). In the females serum apo H significantly correlated with serum cholesterol concentration (r = 0.30, P = 0.04) and in males with serum HDL cholesterol concentration (r = 0.35, P = 0.04). In multifactorial regression analysis for serum apo H and the other variables for the 81 subjects, only gender and fasting plasma glucose remained statistically significant in the model. Serum apo H concentrations would be expected to increase by 21.7 mg/L for each single mmol/L increase in fasting plasma glucose (95% CI 2.3-41 2), P = 0.029, and to increase by 17.0 mg/L if the gender is male (95% Cl 0.7-332), P= 0.041.
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Affiliation(s)
- M Crook
- Department of Chemical Pathology, Guy's Hospital, London, UK.
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Chen WH, Liu JS. An unusual increase of blood anti-beta 2-glycoprotein-I antibody but not antiphospholipid antibody in cerebral ischemia--a case report. Angiology 2001; 52:149-54. [PMID: 11228090 DOI: 10.1177/000331970105200211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An abnormal increase in anti-beta2-glycoprotein I antibodies (abeta2GPI) is capable of producing thrombosis and the vasculopathy-simulating antiphospholipid antibody (aPL). However, it is rarely described in cerebral ischemia without an association with aPL. The authors report a middle-aged man who experienced recurrent cerebral ischemia and diffuse cerebral stenosis without the apparent traditional cardiovascular risk factor. He was free of antiphospholipid/cofactor syndrome (APCS) and systemic lupus erythematosus (SLE). An increase of blood abeta2GPI was detected in serial measurements. The aPL, Venereal Disease Research Laboratory (VDRL) test, Coombs' test, and antinuclear factor were negative. Activated partial thromboplastin time was normal. This patient is a reminder to consider abeta2GPI in an unexplained recurrent cerebral thrombosis and cerebral artery stenosis even when the typical clinical manifestation or laboratory data of APCS is absent.
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Affiliation(s)
- W H Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwain
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Abstract
Apolipoprotein H is a single chain polypeptide composed of 326 amino acids highly glycosylated. Its carbohydrate content is approximately 19% of the molecular weight. We show that it is rich in sialic acid linked alpha (2-6) to galactose or N-acetylgalactosamine. Sialic acid is not alpha (2-3) linked to galactose. Galactose is beta (1-4) linked to N-acetylglucosamine and beta (1-3) linked to N-acetylgalactosamine. Carbohydrate O-linked chains (mainly sialic acid) are alpha (2-6) linked to galactose or N-acetylgalactosamine. Galactose is also organised in O-linked chains and beta (1-4) linked to N-acetylglucosamine and beta (1-3) linked to acetylgalactosamine. Concanavalin A lectin was used to isolate two groups of apolipoprotein H molecules bearing biantennary and truncated hybrids and high mannose and hybrid oligosaccharides. Apolipoprotein H fails to bind lysine-Sepharose. Our results thus show that it presents truncated hybrid or hybrid-type carbohydrate chains which bear few unmasked mannose residues as a terminal sugar. Biochemical analysis of carbohydrate structures conducted on single isoforms separated through IEF revealed that no specific carbohydrate complex is bound to a single isoform.
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Affiliation(s)
- R Gambino
- Dipartimento di Medicina Interna, Universitá di Torino, Turin, Italy
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Gambino R, Ruiu G, Pagano G, Cassader M. The binding of apolipoprotein H (beta2-Glycoprotein I) to lipoproteins. Prostaglandins Other Lipid Mediat 1999; 57:351-9. [PMID: 10480489 DOI: 10.1016/s0090-6980(99)00010-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Beta2-glycoprotein I has a high affinity for triglyceride-rich particles, activates lipoprotein lipase, and is also defined as an apolipoprotein H. Previous studies have shown that apolipoprotein H is a regular structural component of the major classes of lipoproteins. In view of these findings, we analyzed the interactions of apolipoprotein H with lipoproteins in the fasting plasma of eight normal, seven hypertriglyceridemic, and seven hypercholesterolemic subjects. After rate-zonal, density gradient ultracentrifugation, apolipoprotein H was little distributed among the different density fractions, and most of it was recovered in the last fraction that contained the lipoprotein-free plasma. A small percentage (4-13%) of the apolipoprotein H associated with plasma lipoproteins was detected at the density ranging from 1.090 to 1.225 g/ml. This result means that apolipoprotein H is little associated with lipoproteins.
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Affiliation(s)
- R Gambino
- Dipartimento di Medicina Interna, Universitá di Torino, Italy
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Qushmaq K, Esdaile J, Devine DV. Thrombosis in systemic lupus erythematosus: the role of antiphospholipid antibody. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1999; 12:212-9. [PMID: 10513512 DOI: 10.1002/1529-0131(199906)12:3<212::aid-art9>3.0.co;2-m] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- K Qushmaq
- Department of Medicine, University of British Columbia, Vancouver
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Gambino R, Ruiu G, Pagano G, Cassader M. Apolipoprotein H is not affected by in vitro glycosylation. JOURNAL OF PROTEIN CHEMISTRY 1999; 18:173-7. [PMID: 10333290 DOI: 10.1023/a:1020671821474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Increased nonenzymatic glycosylation of all major classes of apolipoproteins has been demonstrated in diabetes. In this work we deal with the in vitro nonenzymatic glycosylation of apolipoprotein H, whose role in lipid metabolism is still poorly understood and whose levels increase in diabetes. Apolipoprotein H was isolated from human plasma and purified through a combination of affinity chromatography and continuous elution electrophoresis. The in vitro glycosylation was performed by incubating purified apolipoprotein H with high concentration of glucose. Our results indicate that the in vitro nonenzymatic glycosylation has no effect on the physical properties of apolipoprotein H, despite the fact that this apolipoprotein contains a high number of lysine residues. Since the in vitro concentration of glucose was far higher than the levels normally found in diabetic subjects, it is unlikely for apolipoprotein H to become glycosylated in diabetes.
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Affiliation(s)
- R Gambino
- Dipartimento di Medicina Interna, Universita' di Torino, Italy
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Wang SX, Cai GP, Sui SF. The insertion of human apolipoprotein H into phospholipid membranes: a monolayer study. Biochem J 1998; 335 ( Pt 2):225-32. [PMID: 9761718 PMCID: PMC1219773 DOI: 10.1042/bj3350225] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Apolipoprotein H (ApoH) is a plasma glycoprotein isolated from human serum. The interactions of ApoH with lipid membrane were reported to be essential for its physiological and pathogenic roles. In this paper we studied the ability of ApoH to insert into phospholipid membranes using the monolayer approach. The results show that ApoH is surface active and can insert into the lipid monolayers. The insertion ability of ApoH is stronger when a higher content of negatively charged lipids is present in the membrane. The acidic-pH and low-ionic-strength conditions will also enhance ApoH insertion, but these factors may not have much influence on the final insertion ability of ApoH, suggesting that, in the mechanism of ApoH insertion, not only electrostatic forces, but also hydrophobic interactions, are evidently involved. Modification by heat inactivation and reduction/alkylation does not change the critical insertion pressure (pic) of ApoH, suggesting a stable domain, maybe a linear sequence motif, but not the native three-dimensional structure of ApoH, is responsible for its insertion. The extent to which insertion of ApoH into phospholipid membranes may facilitate the 'immune cleaning' of plasma liposomes is discussed.
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Affiliation(s)
- S X Wang
- State Key Laboratory of Biomembrane and Membrane Biotechnology, Department of Biological Sciences and Biotechnology, Tsinghua University, Beijing 100084, People's Republic of China
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Ruiu G, Gambino R, Veglia F, Pagano G, Cassader M. Influence of APOH protein polymorphism on apoH levels in normal and diabetic subjects. Clin Genet 1997; 52:167-72. [PMID: 9377806 DOI: 10.1111/j.1399-0004.1997.tb02538.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Apolipoprotein (apo)H (also known as beta 2 glycoprotein-I) is a glycoprotein synthesized by liver cells and it is present in the blood associated with plasma lipoproteins. APOH displays a genetically determined structural polymorphism: three alleles (APOH*1, APOH*2, APOH*3) at a single locus on chromosome 17 code for different isoforms, and population studies have shown that APOH*2 is the most frequent allele. This paper assesses the relation between APOH phenotypes and plasma apoH levels in a population composed of 278 healthy subjects (243 H2/2, 32 H3/2, 2 H3/3, 1 H2/1; allele frequencies APOH*1 0.002, APOH*2 0.934, APOH*3 0.064) and 245 diabetics (212 H2/2, 30 H3/2, 3 H3/3; allele frequencies APOH*2 0.927 and APOH*3 0.073). Determination of apoH levels by competitive ELISA gave a mean value of 26.3 +/- 9.8 mg/dl for all subjects, 22.6 +/- 7.7 in normals vs 30.6 +/- 10.3 in diabetics (p = 0.0001), and 23.0 +/- 7.9, 19.3 +/- 5.4 and 18.5 +/- 3.5 mg/dl for H2/2, H3/2 and H3/3 in normals and 31.1 +/- 10.1, 28.2 +/- 10.8 and 15.7 +/- 9.0 mg/dl in diabetics, respectively. ANCOVA of the adjusted data revealed a significant difference in apoH levels for the three phenotypes in both the normal subjects (p = 0.01) and the diabetics (p = 0.02). ANCOVA of the whole samples of subjects, controlling for diabetes as well as age, sex and total cholesterol, indicated a substantial effect of phenotype, independent of the other variables (p = 0.0007).
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Affiliation(s)
- G Ruiu
- Department of Internal Medicine, University of Turin, Italy
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