Abnormal protein tyrosine phosphorylation in fibroblasts from hyperapobetalipoproteinemia subjects

Treatment of dyslipidemia in children and adolescents

The early lesions of atherosclerosis begin in childhood, and are related to antecedent cardiovascular disease risk factors. Environmental and genetic factors such as diet, obesity, exercise, and certain inherited dyslipidemias influence the progression of such lesions. The identification of youth at risk for atherosclerosis includes an integrated assessment of these predisposing factors. Treatment starts with a diet low in total and saturated fat and cholesterol, the use of water-soluble fiber and plant sterols, weight control, and exercise. Drug therapy, for example, with inhibitors of hydroxymethylglutaryl CoA reductase, bile acid sequestrants, and cholesterol absorption inhibitors, can be considered in those with a positive family history of premature coronary artery disease and a low-density lipoprotein cholesterol above 160 mg/dL, after dietary and hygienic measures. Candidates for drug therapy often include those with familial hypercholesterolemia, familial combined hyperlipidemia, the metabolic syndrome, polycystic ovarian syndrome, type I diabetes, and the nephrotic syndrome. We review the safety and efficacy of dietary and drug therapy, and propose an updated diagnostic and therapeutic algorithm that includes the metabolic syndrome. The early identification and treatment of youth with dyslipidemias is likely to retard the atherosclerotic process.

Clinical relevance of the biochemical, metabolic, and genetic factors that influence low-density lipoprotein heterogeneity

Traditional risk factors for coronary artery disease (CAD) predict about 50% of the risk of developing CAD. The Adult Treatment Panel (ATP) III has defined emerging risk factors for CAD, including small, dense low-density lipoprotein (LDL). Small, dense LDL is often accompanied by increased triglycerides (TGs) and low high-density lipoprotein (HDL). An increased number of small, dense LDL particles is often missed when the LDL cholesterol level is normal or borderline elevated. Small, dense LDL particles are present in families with premature CAD and hyperapobetalipoproteinemia, familial combined hyperlipidemia, LDL subclass pattern B, familial dyslipidemic hypertension, and syndrome X. The metabolic syndrome, as defined by ATP III, incorporates a number of the components of these syndromes, including insulin resistance and intra-abdominal fat. Subclinical inflammation and elevated procoagulants also appear to be part of this atherogenic syndrome. Overproduction of very low-density lipoproteins (VLDLs) by the liver and increased secretion of large, apolipoprotein (apo) B-100-containing VLDL is the primary metabolic characteristic of most of these patients. The TG in VLDL is hydrolyzed by lipoprotein lipase (LPL) which produces intermediate-density lipoprotein. The TG in intermediate-density lipoprotein is hydrolyzed further, resulting in the generation of LDL. The cholesterol esters in LDL are exchanged for TG in VLDL by the cholesterol ester tranfer proteins, followed by hydrolysis of TG in LDL by hepatic lipase which produces small, dense LDL. Cholesterol ester transfer protein mediates a similar lipid exchange between VLDL and HDL, producing a cholesterol ester-poor HDL. In adipocytes, reduced fatty acid trapping and retention by adipose tissue may result from a primary defect in the incorporation of free fatty acids into TGs. Alternatively, insulin resistance may promote reduced retention of free fatty acids by adipocytes. Both these abnormalities lead to increased levels of free fatty acids in plasma, increased flux of free fatty acids back to the liver, enhanced production of TGs, decreased proteolysis of apo B-100, and increased VLDL production. Decreased removal of postprandial TGs often accompanies these metabolic abnormalities. Genes regulating the expression of the major players in this metabolic cascade, such as LPL, cholesterol ester transfer protein, and hepatic lipase, can modulate the expression of small, dense LDL but these are not the major defects. New candidates for major gene effects have been identified on chromosome 1. Regardless of their fundamental causes, small, dense LDL (compared with normal LDL) particles have a prolonged residence time in plasma, are more susceptible to oxidation because of decreased interaction with the LDL receptor, and enter the arterial wall more easily, where they are retained more readily. Small, dense LDL promotes endothelial dysfunction and enhanced production of procoagulants by endothelial cells. Both in animal models of atherosclerosis and in most human epidemiologic studies and clinical trials, small, dense LDL (particularly when present in increased numbers) appears more atherogenic than normal LDL. Treatment of patients with small, dense LDL particles (particularly when accompanied by low HDL and hypertriglyceridemia) often requires the use of combined lipid-altering drugs to decrease the number of particles and to convert them to larger, more buoyant LDL. The next critical step in further reduction of CAD will be the correct diagnosis and treatment of patients with small, dense LDL and the dyslipidemia that accompanies it.

Novel genes for familial combined hyperlipidemia

Familial combined hyperlipidemia (FCHL) is a complex genetic disorder of unknown etiology. Recently, 'modifier' genes of the FCHL phenotype, such as the apolipoprotein AI-CIII-AIV gene cluster and LPL, have been identified in several populations. A 'major' gene for FCHL has been identified in a Finnish isolate which maps to a region syntenic to murine chromosome 3 where a locus for combined hyperlipidemia has been identified. We review these and other recent studies which indicate that FCHL is genetically heterogeneous.

Differential effect of genistein on the stimulation of cholesterol production by basic protein II in normal and hyperapoB fibroblasts

We studied further the basis for the abnormal effect of human serum basic protein II (BP II) on cholesterol production in hyperapobetalipoproteinemia (hyperapoB) fibroblasts and whether this effect involves protein tyrosine kinase phosphorylation (TKP). Genistein, a specific inhibitor of TKP was used as a probe. Compared with normal cells, BP II stimulated significantly the cellular mass of total cholesterol (6.4-fold), unesterified cholesterol (3.6-fold), and esterified cholesterol (6.7-fold) in hyperapoB fibroblasts. The addition of genistein to BP II in hyperapoB cells markedly inhibited these abnormal stimulatory effects of BP II on cell sterol mass. In normal cells, the addition of genistein to BP II produced an opposite effect: a marked stimulation in the mass of total (5.5-fold) and esterified (18.3-fold) cholesterol and a decrease in unesterified cholesterol (3.4-fold). These effects of genistein on the formation of cellular cholesterol by BP II were both time and concentration dependent. The inhibition of the stimulatory effect of BP II on cholesterol production by genistein in hyperapoB cells may be mediated through 3-hydroxy 3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme of cholesterol biosynthesis, since the rate of incorporation of [14C]acetate, but not [3H]mevalonate, into unesterified cholesterol was decreased by genistein in the hyperapoB cells. When the mass of cell total cholesterol in the cells treated with BP II was subtracted from those treated with BP II plus genistein, a negative number was produced in each of the six hyperapoB cell lines, while each of the normal cell lines retained a positive number. The mean difference for the mass of total cholesterol between the hyperapoB and normal fibroblasts under these conditions was 128.2 nmol/mg cell protein, a difference that was separated by >3 SD. This study supports further the tenet that there is a defect in the response of hyperapoB cells to BP II and that this defect results in an abnormality in cholesterol metabolism that appears mediated through a protein TKP-mediated process.