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Kazenwadel J, Berezhnoy G, Cannet C, Schäfer H, Geisler T, Rohlfing AK, Gawaz M, Merle U, Trautwein C. Stratification of hypertension and SARS-CoV-2 infection by quantitative NMR spectroscopy of human blood serum. COMMUNICATIONS MEDICINE 2023; 3:145. [PMID: 37845506 PMCID: PMC11081957 DOI: 10.1038/s43856-023-00365-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/12/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Diagnostic approaches like the nuclear magnetic resonance spectroscopy (NMR) based quantification of metabolites, lipoproteins, and inflammation markers has helped to identify typical alterations in the blood serum of COVID-19 patients. However, confounders such as sex, and comorbidities, which strongly influence the metabolome, were often not considered. Therefore, the aim of this NMR study was to consider sex, as well as arterial hypertension (AHT), when investigating COVID-19-positive serum samples in a large age-and sex matched cohort. METHODS NMR serum data from 329 COVID-19 patients were compared with 305 healthy controls. 134 COVID-19 patients were affected by AHT. These were analyzed together with NMR data from 58 hypertensives without COVID-19. In addition to metabolite, lipoprotein, and glycoprotein data from NMR, common laboratory parameters were considered. Sex was considered in detail for all comparisons. RESULTS Here, we show that several differences emerge from previous NMR COVID-19 studies when AHT is considered. Especially, the previously described triglyceride-rich lipoprotein profile is no longer observed in COVID-19 patients, nor an increase in ketone bodies. Further alterations are a decrease in glutamine, leucine, isoleucine, and lysine, citric acid, HDL-4 particles, and total cholesterol. Additionally, hypertensive COVID-19 patients show higher inflammatory NMR parameters than normotensive patients. CONCLUSIONS We present a more precise picture of COVID-19 blood serum parameters. Accordingly, considering sex and comorbidities should be included in future metabolomics studies for improved and refined patient stratification. Due to metabolic similarities with other viral infections, these results can be applied to other respiratory diseases in the future.
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Affiliation(s)
- Jasmin Kazenwadel
- Werner Siemens Imaging Center, Department for Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Georgy Berezhnoy
- Werner Siemens Imaging Center, Department for Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Claire Cannet
- Bruker BioSpin GmbH, Applied Industrial and Clinical Division, Ettlingen, Germany
| | - Hartmut Schäfer
- Bruker BioSpin GmbH, Applied Industrial and Clinical Division, Ettlingen, Germany
| | - Tobias Geisler
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Anne-Katrin Rohlfing
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Trautwein
- Werner Siemens Imaging Center, Department for Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany.
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Chiriacò M, Nesti L, Natali A, Santoro N, Caprio S, Tricò D. Proatherogenic changes in lipoprotein particles associated with a high triglyceride to high-density lipoprotein cholesterol ratio in youths. Obesity (Silver Spring) 2023; 31:1894-1902. [PMID: 37227148 PMCID: PMC10330115 DOI: 10.1002/oby.23767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE A high triglyceride (TG) to high-density lipoprotein cholesterol (HDL) ratio (TG/HDL) predicts atherosclerosis and cardiovascular events. This study examined whether a proatherogenic distribution of plasma lipoprotein subclasses is associated with a high TG/HDL ratio in youths with obesity. METHODS Lipoprotein particle concentration and size were measured by proton nuclear magnetic resonance in a multiethnic cohort of 592 adolescents with overweight/obesity (age 13 ± 3 years, 58% females, BMI z score 2.1 ± 0.8) who were phenotyped with a 3-hour oral glucose tolerance test and abdominal magnetic resonance imaging. RESULTS The highest TG/HDL quartile showed a higher particle concentration of very low-density lipoprotein (VLDL; +178%, p < 0.0001), intermediate-density lipoprotein (+338%, p < 0.0001), and low-density lipoprotein (LDL; +42%, p < 0.0001), compared with the lowest quartile. The prevalence of large VLDL, very small LDL, and small HDL progressively increased across TG/HDL quartiles. The TG/HDL ratio correlated positively with the average particle size of VLDL (r = 0.37, p < 0.0001) and negatively with particle size of both LDL (r = -0.51, p < 0.0001) and HDL (r = -0.69, p < 0.0001). These associations were independent of sex, age, race/ethnicity, body mass, fasting plasma glucose, and insulin sensitivity. CONCLUSIONS In youths with obesity, an elevated TG/HDL ratio is associated with high concentrations of proatherogenic lipoprotein subclasses. This phenotype may explain the increased cardiovascular risk associated with a high TG/HDL ratio.
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Affiliation(s)
- Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Santoro
- Kansas University Medical Center, Kansas City, KS, USA
- Department of Medicine and Health Sciences, “V.Tiberio” University of Molise, Campobasso, Italy
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Yanagi Y, Yu RM, Ahamed W, Yu M, Teo KYC, Tan AC, Cheng CY, Wong TY, Apte RS, Cheung CMG. Serum Cholesterol Efflux Capacity in Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy. OPHTHALMOLOGY SCIENCE 2022; 2:100142. [PMID: 36278032 PMCID: PMC9562377 DOI: 10.1016/j.xops.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022]
Abstract
Purpose To investigate serum cholesterol efflux capacity (the ability of the serum to accept cholesterol) and factors that regulate it using nuclear magnetic resonance-quantified measures of lipoprotein particle composition and size and apolipoproteins metrics in patients with age-related macular degeneration (AMD). Design Case-control study. Participants Four hundred two serum samples from 80 patients with early AMD (eAMD), and 212 patients with neovascular AMD (nAMD), including 80 with typical nAMD (tAMD) and 132 with polypoidal choroidal vasculopathy (PCV), and 110 age- and gender matched control participants. Methods Serum from participants showed cholesterol efflux capacity measured using in vitro cell assays and lipoprotein subfractions measured using nuclear magnetic resonance (Nightingale, Ltd). Associations between cholesterol efflux capacity (measured in percentage) and lipid subfractions were investigated in the patients and control participants. Main Outcome Measures Cholesterol efflux capacity and lipid subfractions in control, eAMD, and nAMD. Associations between HDL subfractions and cholesterol efflux capacity. Results Cholesterol efflux capacity was higher in patients with eAMD (68.0 ± 11.3% [mean ± standard deviation]) and nAMD (75.9 ± 27.7%) than in the control participants (56.9 ± 16.7%) after adjusting for age, gender, and use of lipid-lowering drug (P < 0.0001). Nuclear magnetic resonance lipidomics demonstrated that the mean diameter of HDL was larger both in eAMD (9.96 ± 0.27 mm [mean ± standard deviation]) and PCV (9.97 ± 0.23 mm) compared with that of the control participants (9.84 ± 0.24 mm; P = 0.0001 for both). Among the 28 HDL subfractions, most of the small, medium, and large HDLs, but none of the 7 extra large HDLs fractions, were associated moderately with cholesterol efflux capacity in eAMD and PCV (R = 0.149-0.277). Conclusions Serum cholesterol efflux capacity was increased in eAMD and PCV, but not tAMD, possibly reflecting differential underlying pathophysiologic features of lipid dysregulation in tAMD and PCV. Further studies should be directed toward investigating the diverse biological activities of HDL in AMD, including macular pigment transport, regulation of inflammation, and local cholesterol transport system.
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Key Words
- AMD, age-related macular degeneration
- Age-related macular degeneration
- Cholesterol efflux
- Drusen
- HDL, high-density lipoprotein
- LDL, low-density lipoprotein
- Lipoprotein
- NMR, nuclear magnetic resonance
- PCV, polypoidal choroidal vasculopathy
- Polypoidal choroidal vasculopathy
- RPE, retinal pigment epithelium
- RPMI, Roswell Park Memorial Institute
- SCES, Singapore Chinese Eye Study
- SD, standard deviation
- VLDL, very low-density lipoprotein
- eAMD, early age-related macular degeneration
- nAMD, neovascular age-related macular degeneration
- tAMD, typical neovascular age-related macular degeneration
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Affiliation(s)
- Yasuo Yanagi
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore,Correspondence: Yasuo Yanagi, Singapore Eye Research Institute, 11 Third Hospital Avenue, 168751, Singapore, Republic of Singapore.
| | - Richard M.C. Yu
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Waseem Ahamed
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin Yi Chong Teo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Anna C.S. Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Rajendra S. Apte
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri,Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
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Cho YK, Jung CH. HDL-C and Cardiovascular Risk: You Don't Need to Worry about Extremely High HDL-C Levels. J Lipid Atheroscler 2021; 10:57-61. [PMID: 33537253 PMCID: PMC7838515 DOI: 10.12997/jla.2021.10.1.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yun Kyung Cho
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
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Henson J, Edwardson CL, Davies MJ, Gill JMR, Heaney LM, Khunti K, Ng L, Sattar N, Zaccardi F, Yates T. Physical activity and lipidomics in a population at high risk of type 2 diabetes mellitus. J Sports Sci 2020; 38:1150-1160. [PMID: 32228122 DOI: 10.1080/02640414.2020.1744836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim was to investigate how measurements of the lipidome differ according to the level and intensity of physical activity in a population at high risk of type 2 diabetes (T2DM). A targeted metabolomics platform provided quantitative molecular data on lipid species. Linear regression examined the associations between plasma lipid concentrations, particle size and time spent in objectively measured physical activity intensity domains, in increments of 500 counts per minute (cpm) (up to >4500 cpm (~>5.6METs)). Results are presented as % difference in the concentration (lower/higher) or particle size (smaller/larger) per 10 min of activity within each intensity. Five hundred and nine participants were included. Time spent in the lowest physical activity intensity domain (<500 cpm) was unfavourably associated with VLDL (2%), HDL (-2%) and Apolipoprotein A-1 particle concentrations (-2%) and HDL diameter (-2%). Conversely, time spent in intensities ≥1000 cpm were favourably associated with HDL subclass concentrations; with stronger associations seen at moderate intensities (2000-3999 cpm (~4.5METs)). For Apolipoprotein-B concentration and VLDL particle concentration and size, a negative association was consistently observed at the highest physical activity intensity only. If these associations are causal, HDL subclasses appear sensitive to light-intensities whereas only the high category of physical activity intensity was consistently associated with VLDL subclasses.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre, UK and Diabetes Research Centre, College of Life Sciences, University of Leicester , Leicester, UK
| | - Charlotte L Edwardson
- NIHR Leicester Biomedical Research Centre, UK and Diabetes Research Centre, College of Life Sciences, University of Leicester , Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, UK and Diabetes Research Centre, College of Life Sciences, University of Leicester , Leicester, UK
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow, UK
| | - Liam M Heaney
- School of Sport, Exercise and Health Sciences, Loughborough University , Loughborough, UK
| | - Kamlesh Khunti
- NIHR Applied Research Collaboration (ARC) East Midlands, UK and Diabetes Research Centre, College of Life Sciences, University of Leicester , Leicester, UK
| | - Leong Ng
- NIHR Leicester Biomedical Research Centre, UK and Department of Cardiovascular Sciences, University of Leicester , Leicester, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow, UK
| | - Francesco Zaccardi
- NIHR Leicester Biomedical Research Centre, UK and Diabetes Research Centre, College of Life Sciences, University of Leicester , Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, UK and Diabetes Research Centre, College of Life Sciences, University of Leicester , Leicester, UK
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Charles-Schoeman C, DeMasi R, Valdez H, Soma K, Hwang LJ, Boy MG, Biswas P, McInnes IB. Risk Factors for Major Adverse Cardiovascular Events in Phase III and Long-Term Extension Studies of Tofacitinib in Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2019; 71:1450-1459. [PMID: 31385441 PMCID: PMC6754249 DOI: 10.1002/art.40911] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Tofacitinib is an oral JAK inhibitor for the treatment of rheumatoid arthritis (RA). This study was undertaken to evaluate the risk of major adverse cardiovascular events (MACE) in patients with RA receiving tofacitinib. METHODS Data were pooled from patients with moderately to severely active RA receiving ≥1 tofacitinib dose in 6 phase III and 2 long-term extension studies over 7 years. MACE (myocardial infarction, stroke, cardiovascular death) were independently adjudicated. Cox regression models were used to evaluate associations between baseline variables and time to first MACE. Following 24 weeks of tofacitinib, changes in variables and time to future MACE were evaluated after adjusment for age, baseline values, and time-varying tofacitinib dose. Hazard ratios and 95% confidence intervals were calculated. RESULTS Fifty-two MACE occurred in 4,076 patients over 12,873 patient-years of exposure (incidence rate 0.4 patients with events per 100 patient-years). In univariable analyses of baseline variables, traditional cardiovascular risk factors and glucocorticoid and statin use were associated with MACE risk; disease activity and inflammation measures were not. In subsequent multivariable analyses, baseline age, hypertension, and the total cholesterol to high-density lipoprotein (HDL) cholesterol ratio remained significantly associated with risk of MACE. After 24 weeks of treatment, an increase in HDL cholesterol and a decrease in the total to HDL cholesterol were associated with decreased MACE risk; changes in total cholesterol, low-density lipoprotein (LDL) cholesterol, and disease activity measures were not. Increased erythrocyte sedimentation rates trended with increased future MACE risk. CONCLUSION In this post hoc analysis, after 24 weeks of tofacitinib treatment, increased HDL cholesterol, but not increased LDL cholesterol or total cholesterol, appeared to be associated with lower future MACE risk. Further data are needed to test the cardiovascular safety of tofacitinib.
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Effects of a diet naturally rich in polyphenols on lipid composition of postprandial lipoproteins in high cardiometabolic risk individuals: an ancillary analysis of a randomized controlled trial. Eur J Clin Nutr 2019; 74:183-192. [PMID: 31249395 DOI: 10.1038/s41430-019-0459-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES Plasma lipoprotein composition, especially in the postprandial state, could be relevant for cardiovascular risk and could be influenced by eating habits. This study evaluated the effects of a polyphenol-rich diet on postprandial lipoprotein composition in individuals at high cardiometabolic risk. SUBJECTS/METHODS Seventy-eight individuals with high waist circumference and at least another component of the metabolic syndrome were randomized to either a high-polyphenol (HighP) or low-polyphenol (LowP) diet. Before and after the 8-week intervention, chylomicrons, VLDL1, VLDL2, IDL, LDL, HDL particles, and their lipid concentrations were determined over a 6-h high-fat test meal with high or low-polyphenol content, according to the diet assigned. RESULTS VLDL1 postprandial areas under the curve (AUCs) were lower for cholesterol (Chol) (1.48 ± 0.98 vs. 1.91 ± 1.13 mmol/L × 6 h, M ± SD, p = 0.014) and triglycerides (Tg) (4.70 ± 2.70 vs. 6.02 ± 3.07 mmol/L × 6 h, p = 0.005) after the HighP than after the LowP diet, with no changes in Chol/Tg ratio. IDL Chol AUCs were higher after the HighP than after the LowP diet (1.29 ± 0.77 vs. 1.01 ± 0.51 mmol/L × 6 h, p = 0.037). LDL Tg AUCs were higher after the HighP than after the LowP diet (1.15 ± 0.33 vs. 1.02 ± 0.35 mmol/L × 6 h, p < 0.001), with a lower Chol/Tg ratio (14.6 ± 4.0 vs. 16.0 ± 3.8, p = 0.007). HDL Tg AUCs were lower after the HighP than after the LowP diet (1.20 ± 0.41 vs. 1.34 ± 0.37 mmol/L × 6 h, p = 0.013). CONCLUSIONS A high-polyphenol diet reduces the postprandial lipid content of large VLDL and increases IDL cholesterol; it modifies the composition of LDL particles-which become richer in triglycerides, and of HDL-which become instead triglyceride poor. The overall changes in atherogenicity by these effects warrant further investigation on clinical cardiovascular outcomes.
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HDL biogenesis revisited: how desmocollin-1 could sabotage reverse cholesterol transport in the arterial wall. Eur Heart J 2018; 39:1203-1206. [DOI: 10.1093/eurheartj/ehx496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Update on the laboratory investigation of dyslipidemias. Clin Chim Acta 2018; 479:103-125. [PMID: 29336935 DOI: 10.1016/j.cca.2018.01.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 01/08/2023]
Abstract
The role of the clinical laboratory is evolving to provide more information to clinicians to assess cardiovascular disease (CVD) risk and target therapy more effectively. Current routine methods to measure LDL-cholesterol (LDL-C), the Friedewald calculation, ultracentrifugation, electrophoresis and homogeneous direct methods have established limitations. Studies suggest that LDL and HDL size or particle concentration are alternative methods to predict future CVD risk. At this time there is no consensus role for lipoprotein particle or subclasses in CVD risk assessment. LDL and HDL particle concentration are measured by several methods, namely gradient gel electrophoresis, ultracentrifugation-vertical auto profile, nuclear magnetic resonance and ion mobility. It has been suggested that HDL functional assays may be better predictors of CVD risk. To assess the issue of lipoprotein subclasses/particles and HDL function as potential CVD risk markers robust, simple, validated analytical methods are required. In patients with small dense LDL particles, even a perfect measure of LDL-C will not reflect LDL particle concentration. Non-HDL-C is an alternative measurement and includes VLDL and CM remnant cholesterol and LDL-C. However, apolipoprotein B measurement may more accurately reflect LDL particle numbers. Non-fasting lipid measurements have many practical advantages. Defining thresholds for treatment with new measurements of CVD risk remain a challenge. In families with genetic variants, ApoCIII and lipoprotein (a) may be additional risk factors. Recognition of familial causes of dyslipidemias and diagnosis in childhood will result in early treatment. This review discusses the limitations in current laboratory technologies to predict CVD risk and reviews the evidence for emergent approaches using newer biomarkers in clinical practice.
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Lappegård KT, Kjellmo CA, Ljunggren S, Cederbrant K, Marcusson-Ståhl M, Mathisen M, Karlsson H, Hovland A. Lipoprotein apheresis affects lipoprotein particle subclasses more efficiently compared to the PCSK9 inhibitor evolocumab, a pilot study. Transfus Apher Sci 2018; 57:91-96. [PMID: 29398508 DOI: 10.1016/j.transci.2018.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/31/2017] [Accepted: 01/03/2018] [Indexed: 12/22/2022]
Abstract
Lipoprotein apheresis and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are last therapeutic resorts in patients with familial hypercholesterolemia (FH). We explored changes in lipoprotein subclasses and high-density lipoprotein (HDL) function when changing treatment from lipoprotein apheresis to PCSK9 inhibition. We measured the levels of low-density lipoprotein (LDL) and HDL particle subclasses, serum amyloid A1 (SAA1), paraoxonase-1 (PON1) activity and cholesterol efflux capacity (CEC) in three heterozygous FH patients. Concentrations of all LDL particle subclasses were reduced during apheresis (large 68.0 ± 17.5 to 16.3 ± 2.1 mg/dL, (p = 0.03), intermediate 38.3 ± 0.6 to 5.0 ± 3.5 mg/dL (p = 0.004) and small 5.0 ± 2.6 to 0.2 ± 0.1 mg/dL (p = 0.08)). There were non-significant reductions in the LDL subclasses during evolocumab treatment. There were non-significant reductions in subclasses of HDL particles during apheresis, and no changes during evolocumab treatment. CEC was unchanged throughout the study, while the SAA1/PON1 ratio was unchanged during apheresis but decreased during evolocumab treatment. In conclusion, there were significant reductions in large and intermediate size LDL particles during apheresis, and a non-significant reduction in small LDL particles. There were only non-significant reductions in the LDL subclasses during evolocumab treatment.
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Affiliation(s)
- Knut Tore Lappegård
- Division of Internal Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | | | - Stefan Ljunggren
- Occupational and Environmental Medicine Center, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | | | | | - Helen Karlsson
- Occupational and Environmental Medicine Center, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anders Hovland
- Division of Internal Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
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Kjellmo CA, Karlsson H, Nestvold TK, Ljunggren S, Cederbrant K, Marcusson-Ståhl M, Mathisen M, Lappegård KT, Hovland A. Bariatric surgery improves lipoprotein profile in morbidly obese patients by reducing LDL cholesterol, apoB, and SAA/PON1 ratio, increasing HDL cholesterol, but has no effect on cholesterol efflux capacity. J Clin Lipidol 2018; 12:193-202. [DOI: 10.1016/j.jacl.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/24/2017] [Accepted: 10/11/2017] [Indexed: 11/27/2022]
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Martinez LO, Genoux A, Ferrières J, Duparc T, Perret B. Serum inhibitory factor 1, high-density lipoprotein and cardiovascular diseases. Curr Opin Lipidol 2017; 28:337-346. [PMID: 28504983 DOI: 10.1097/mol.0000000000000434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The atheroprotective properties of HDL are supported by epidemiological and preclinical research. However, the results of interventional trials paradoxically indicate that drugs increasing HDL-cholesterol (HDL-C) do not reduce coronary artery disease (CAD) risk. Moreover, Mendelian randomization studies have shown no effect of HDL-C-modifying variants on CAD outcome. Thus, the protective effects of HDL particles are more governed by their functional status than their cholesterol content. In this context, any successful clinical exploitation of HDL will depend on the identification of HDL-related biomarkers, better than HDL-C level, for assessing cardiovascular risk and monitoring responses to treatment. RECENT FINDINGS Recent studies have enlightened the role of ecto-F1-ATPase as a cell surface receptor for apoA-I, the major apolipoprotein of HDL, involved in the important metabolic and vascular atheroprotective functions of HDL. In the light of these findings, the clinical relevance of ecto-F1-ATPase in humans has recently been supported by the identification of serum F1-ATPase inhibitor (IF1) as an independent determinant of HDL-C, CAD risk and cardiovascular mortality in CAD patients. SUMMARY Serum IF1 measurement might be used as a novel HDL-related biomarker to better stratify risk in high-risk populations or to determine pharmacotherapy.
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Affiliation(s)
- Laurent O Martinez
- aInstitut National de la Santé et de la Recherche Médicale (INSERM), UMR 1048, Institute of Metabolic and Cardiovascular Diseases bUniversity of Toulouse, UMR1048, Paul Sabatier University cService de Biochimie, Pôle biologie, Hôpital de Purpan, CHU de Toulouse dDepartment of Cardiology, Toulouse Rangueil University Hospital eINSERM UMR 1027, Department of Epidemiology, Toulouse University School of Medicine, Toulouse, France
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Dubé MP, de Denus S, Tardif JC. Pharmacogenomics to Revive Drug Development in Cardiovascular Disease. Cardiovasc Drugs Ther 2016; 30:59-64. [PMID: 26768480 DOI: 10.1007/s10557-015-6637-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Investment in cardiovascular drug development is on the decline as large cardiovascular outcomes trials require considerable investments in time, efforts and financial resources. Pharmacogenomics has the potential to help revive the cardiovascular drug development pipeline by providing new and better drug targets at an earlier stage and by enabling more efficient outcomes trials. This article will review some of the recent developments highlighting the value of pharmacogenomics for drug development. We discuss how genetic biomarkers can enable the conduct of more efficient clinical outcomes trials by enriching patient populations for good responders to the medication. In addition, we assess past drug development programs which support the added value of selecting drug targets that have established genetic evidence supporting the targeted mechanism of disease. Finally, we discuss how pharmacogenomics can provide valuable evidence linking a drug target to clinically relevant outcomes, enabling novel drug discovery and drug repositioning opportunities.
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Affiliation(s)
- Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada. .,Faculty of Medicine, Université de Montréal, Montreal, Canada.
| | - Simon de Denus
- Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada. .,Faculty of Medicine, Université de Montréal, Montreal, Canada.
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Genoux A, Lichtenstein L, Ferrières J, Duparc T, Bongard V, Vervueren PL, Combes G, Taraszkiewicz D, Elbaz M, Galinier M, Nassar B, Ruidavets JB, Perret B, Martinez LO. Serum levels of mitochondrial inhibitory factor 1 are independently associated with long-term prognosis in coronary artery disease: the GENES Study. BMC Med 2016; 14:125. [PMID: 27553421 PMCID: PMC4994300 DOI: 10.1186/s12916-016-0672-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Epidemiological and observational studies have established that high-density lipoprotein cholesterol (HDL-C) is an independent negative cardiovascular risk factor. However, simple measurement of HDL-C levels is no longer sufficient for cardiovascular risk assessment. Therefore, there is a critical need for novel non-invasive biomarkers that would display prognostic superiority over HDL-C. Cell surface ecto-F1-ATPase contributes to several athero-protective properties of HDL, including reverse cholesterol transport and vascular endothelial protection. Serum inhibitory factor 1 (IF1), an endogenous inhibitor of ecto-F1-ATPase, is an independent determinant of HDL-C associated with low risk of coronary artery disease (CAD). This work aimed to examine the predictive value of serum IF1 for long-term mortality in CAD patients. Its informative value was compared to that of HDL-C. METHOD Serum IF1 levels were measured in 577 male participants with stable CAD (age 45-74 years) from the GENES (Genetique et ENvironnement en Europe du Sud) study. Vital status was yearly assessed, with a median follow-up of 11 years and a 29.5 % mortality rate. Cardiovascular mortality accounted for the majority (62.4 %) of deaths. RESULTS IF1 levels were positively correlated with HDL-C (r s = 0.40; P < 0.001) and negatively with triglycerides (r s = -0.21, P < 0.001) and CAD severity documented by the Gensini score (r s = -0.13; P < 0.01). Total and cardiovascular mortality were lower at the highest quartiles of IF1 (HR = 0.55; 95 % CI, 0.38-0.89 and 0.50 (0.28-0.89), respectively) but not according to HDL-C. Inverse associations of IF1 with mortality remained significant, after multivariate adjustments for classical cardiovascular risk factors (age, smoking, physical activity, waist circumference, HDL-C, dyslipidemia, hypertension, and diabetes) and for powerful biological and clinical variables of prognosis, including heart rate, ankle-brachial index and biomarkers of cardiac diseases. The 10-year mortality was 28.5 % in patients with low IF1 (<0.42 mg/L) and 21.4 % in those with high IF1 (≥0.42 mg/L, P < 0.02). CONCLUSIONS We investigated for the first time the relation between IF1 levels and long-term prognosis in CAD patients, and found an independent negative association. IF1 measurement might be used as a novel HDL-related biomarker to better stratify risk in populations at high risk or in the setting of pharmacotherapy.
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Affiliation(s)
- Annelise Genoux
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, UMR 1048, Toulouse, France
- Université de Toulouse, UMR1048, Toulouse, France
- CHU Toulouse, Toulouse University Hospital, Service de Biochimie, Pôle biologie, Hôpital de Purpan, Toulouse, France
| | - Laeticia Lichtenstein
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, UMR 1048, Toulouse, France
- Université de Toulouse, UMR1048, Toulouse, France
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, Inserm, Université de Toulouse, CHU Toulouse, UMR1027, Toulouse, France
- CHU Toulouse, Toulouse University Hospital, Fédération de Cardiologie, Toulouse, France
| | - Thibaut Duparc
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, UMR 1048, Toulouse, France
- Université de Toulouse, UMR1048, Toulouse, France
| | - Vanina Bongard
- Department of Epidemiology, Health Economics and Public Health, Inserm, Université de Toulouse, CHU Toulouse, UMR1027, Toulouse, France
| | - Paul-Louis Vervueren
- Department of Epidemiology, Health Economics and Public Health, Inserm, Université de Toulouse, CHU Toulouse, UMR1027, Toulouse, France
- CHU Toulouse, Toulouse University Hospital, Fédération de Cardiologie, Toulouse, France
| | - Guillaume Combes
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, UMR 1048, Toulouse, France
- CHU Toulouse, Toulouse University Hospital, Service de Biochimie, Pôle biologie, Hôpital de Purpan, Toulouse, France
| | - Dorota Taraszkiewicz
- CHU Toulouse, Toulouse University Hospital, Fédération de Cardiologie, Toulouse, France
| | - Meyer Elbaz
- CHU Toulouse, Toulouse University Hospital, Fédération de Cardiologie, Toulouse, France
| | - Michel Galinier
- CHU Toulouse, Toulouse University Hospital, Fédération de Cardiologie, Toulouse, France
| | - Bertrand Nassar
- CHU Toulouse, Toulouse University Hospital, Service de Biochimie, Pôle biologie, Hôpital de Purpan, Toulouse, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, Inserm, Université de Toulouse, CHU Toulouse, UMR1027, Toulouse, France
| | - Bertrand Perret
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, UMR 1048, Toulouse, France
- Université de Toulouse, UMR1048, Toulouse, France
- CHU Toulouse, Toulouse University Hospital, Service de Biochimie, Pôle biologie, Hôpital de Purpan, Toulouse, France
| | - Laurent O Martinez
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, UMR 1048, Toulouse, France.
- Université de Toulouse, UMR1048, Toulouse, France.
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Ditah C, Otvos J, Nassar H, Shaham D, Sinnreich R, Kark JD. Small and medium sized HDL particles are protectively associated with coronary calcification in a cross-sectional population-based sample. Atherosclerosis 2016; 251:124-131. [DOI: 10.1016/j.atherosclerosis.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 01/21/2023]
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Short-term isocaloric fructose restriction lowers apoC-III levels and yields less atherogenic lipoprotein profiles in children with obesity and metabolic syndrome. Atherosclerosis 2016; 253:171-177. [PMID: 27451002 DOI: 10.1016/j.atherosclerosis.2016.06.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/23/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Dietary fructose may play a role in the pathogenesis of metabolic syndrome (MetS). In a recently published study of obese children with MetS, we showed that isocaloric fructose restriction reduced fasting triglyceride (TG) and LDL-cholesterol (LDL-C). In these ancillary analyses, we tested the hypothesis that these effects were also accompanied by improved quantitative and qualitative changes in LDL and HDL subclasses and their apolipoproteins; as well as change in VLDL, particularly apoC-III. METHODS Obese children with MetS (n = 37) consumed a diet that matched self-reported macronutrient composition for nine days, with the exception that dietary fructose was reduced from 11.7 ± 4.0% to 3.8 ± 0.5% of daily calories and substituted with glucose (in starch). Participants underwent fasting biochemical analyses on Days 0 and 10. HDL and LDL subclasses were analyzed using the Lipoprint HDL and LDL subfraction analysis systems from Quantimetrix. RESULTS Significant reductions in apoB (78 ± 24 vs. 66 ± 24 mg/dl) apoC-III (8.7 ± 3.5 vs. 6.5 ± 2.6 mg/dl) and apoE (4.6 ± 2.3 vs. 3.6 ± 1.1 mg/dl), all p < 0.001) were observed. LDL size increased by 0.87 Å (p = 0.008). Small dense LDL was present in 25% of our cohort and decreased by 68% (p = 0.04). Small HDL decreased by 2.7% (p < 0.001) and large HDL increased by 2.4% (p = 0.04). The TG/HDL-C ratio decreased from 3.1 ± 2.5 to 2.4 ± 1.4 (p = 0.02). These changes in fasting lipid profiles correlated with changes in insulin sensitivity. CONCLUSIONS Isocaloric fructose restriction for 9 days improved lipoprotein markers of CVD risk in children with obesity and MetS. The most dramatic reduction was seen for apoC-III, which has been associated with atherogenic hypertriglyceridemia.
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Gutiérrez OM, Judd SE, Irvin MR, Zhi D, Limdi N, Palmer ND, Rich SS, Sale MM, Freedman BI. APOL1 nephropathy risk variants are associated with altered high-density lipoprotein profiles in African Americans. Nephrol Dial Transplant 2015; 31:602-8. [PMID: 26152403 DOI: 10.1093/ndt/gfv229] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/22/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Two independent coding variants in the apolipoprotein L1 gene (APOL1), G1 and G2, strongly associate with nephropathy in African Americans; associations with cardiovascular disease are more controversial. Although APOL1 binds plasma high-density lipoproteins (HDLs), data on APOL1 risk variant associations with HDL subfractions are sparse. METHODS Two APOL1 G1 single nucleotide polymorphisms and the G2 insertion/deletion polymorphism were genotyped in 2010 Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study participants with nuclear magnetic resonance spectroscopy-based lipoprotein subfraction measurements. Linear regression was used to model associations between numbers of APOL1 G1/G2 risk variants and HDL subfractions, adjusting for demographic, clinical and ancestral covariates. RESULTS Female sex and higher percentage of African ancestry were positively associated with the number of APOL1 G1/G2 risk alleles. In the unadjusted analysis, mean (standard error) small HDL concentrations (μmol/L) for participants with zero, one and two G1/G2 risk alleles were 19.0 (0.2), 19.7 (0.2) and 19.9 (0.4), respectively (P = 0.02). Adjustment for age, sex, diabetes and African ancestry did not change the results but strengthened the statistical significance (P = 0.004). No significant differences in large or medium HDL, very low-density lipoprotein or low-density lipoprotein particle concentrations were observed by APOL1 genotype. CONCLUSIONS Greater numbers of APOL1 G1/G2 risk alleles were associated with higher small HDL particle concentrations in African Americans. These results may suggest novel areas of investigation to uncover reasons for the association between APOL1 risk variants with adverse outcomes in African Americans.
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Affiliation(s)
- Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Degui Zhi
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nita Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholette D Palmer
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Michèle M Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, USA
| | - Barry I Freedman
- Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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