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Kahaly GJ, Dolman PJ, Wolf J, Giers BC, Elflein HM, Jain AP, Srinivasan A, Hadjiiski L, Jordan D, Bradley EA, Stan MN, Eckstein A, Pitz S, Vorländer C, Wester ST, Nguyen J, Tucker N, Sales-Sanz M, Feldon SE, Nelson CC, Hardy I, Abia-Serrano M, Tedeschi P, Janes JM, Xu J, Vue P, Macias WL, Douglas RS. Proof-of-concept and Randomized, Placebo-controlled Trials of an FcRn Inhibitor, Batoclimab, for Thyroid Eye Disease. J Clin Endocrinol Metab 2023; 108:3122-3134. [PMID: 37390454 PMCID: PMC10655547 DOI: 10.1210/clinem/dgad381] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
CONTEXT Inhibition of the neonatal fragment crystallizable receptor (FcRn) reduces pathogenic thyrotropin receptor antibodies (TSH-R-Ab) that drive pathology in thyroid eye disease (TED). OBJECTIVE We report the first clinical studies of an FcRn inhibitor, batoclimab, in TED. DESIGN Proof-of-concept (POC) and randomized, double-blind placebo-controlled trials. SETTING Multicenter. PARTICIPANTS Patients with moderate-to-severe, active TED. INTERVENTION In the POC trial, patients received weekly subcutaneous injections of batoclimab 680 mg for 2 weeks, followed by 340 mg for 4 weeks. In the double-blind trial, patients were randomized 2:2:1:2 to weekly batoclimab (680 mg, 340 mg, 255 mg) or placebo for 12 weeks. MAIN OUTCOME Change from baseline in serum anti-TSH-R-Ab and total IgG (POC); 12-week proptosis response (randomized trial). RESULTS The randomized trial was terminated because of an unanticipated increase in serum cholesterol; therefore, data from 65 of the planned 77 patients were analyzed. Both trials showed marked decreases in pathogenic anti-TSH-R-Ab and total IgG serum levels (P < .001) with batoclimab. In the randomized trial, there was no statistically significant difference with batoclimab vs placebo in proptosis response at 12 weeks, although significant differences were observed at several earlier timepoints. In addition, orbital muscle volume decreased (P < .03) at 12 weeks, whereas quality of life (appearance subscale) improved (P < .03) at 19 weeks in the 680-mg group. Batoclimab was generally well tolerated, with albumin reductions and increases in lipids that reversed upon discontinuation. CONCLUSIONS These results provide insight into the efficacy and safety of batoclimab and support its further investigation as a potential therapy for TED.
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Affiliation(s)
- George J Kahaly
- Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 3N9, Canada
| | - Jan Wolf
- Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Bert C Giers
- Department of Ophthalmology, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Heike M Elflein
- Department of Ophthalmology, Johannes Gutenberg University (JGU) Medical Center, 55131 Mainz, Germany
| | - Amy P Jain
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ashok Srinivasan
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - David Jordan
- Department of Ophthalmology, University of Ottawa Eye Institute, Ottawa, ON K1H 8L6, Canada
| | | | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Anja Eckstein
- Department of Ophthalmology, University Hospital Essen, 45147 Essen, Germany
| | - Susanne Pitz
- Department of Ophthalmology, Orbitazentrum, Bürgerhospital Frankfurt, 60318 Frankfurt, Germany
| | - Christian Vorländer
- Department of Endocrine Surgery, Bürgerhospital Frankfurt, 60318 Frankfurt, Germany
| | - Sara T Wester
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - John Nguyen
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV 26506, USA
| | - Nancy Tucker
- Toronto Retina Institute, Toronto, ON M5T 3L9, Canada
| | - Marco Sales-Sanz
- Department of Ophthalmology, University Hospital Ramon y Cajal, 28034 Madrid, Spain
| | - Steven E Feldon
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, NY 14642, USA
| | - Christine C Nelson
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI 48105, USA
| | - Isabelle Hardy
- Department of Ophthalmology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | | | | | | | - Jing Xu
- Immunovant, Inc., New York, NY 10018, USA
| | - Peter Vue
- Immunovant, Inc., New York, NY 10018, USA
| | | | - Raymond S Douglas
- Department of Ophthalmology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Ultra-Rare Disorder in a Young Girl with Lipodystrophy: Analbuminemia. Indian J Pediatr 2021; 88:723. [PMID: 33905091 DOI: 10.1007/s12098-021-03729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
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3
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D'Addato S, Fogacci F, Cicero AFG, Palmisano S, Baronio F, Biagi C, Borghi C. Severe hypercholesterolaemia in a paediatric patient with congenital analbuminaemia. Nutr Metab Cardiovasc Dis 2019; 29:316-317. [PMID: 30639253 DOI: 10.1016/j.numecd.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/25/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S D'Addato
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - F Fogacci
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy.
| | - A F G Cicero
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - S Palmisano
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - F Baronio
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | - C Biagi
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | - C Borghi
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
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Suppressa P, Carbonara C, Lugani F, Campagnoli M, Troiano T, Minchiotti L, Sabbà C. Congenital analbuminemia in a patient affected by hypercholesterolemia: A case report. World J Clin Cases 2019; 7:466-472. [PMID: 30842957 PMCID: PMC6397822 DOI: 10.12998/wjcc.v7.i4.466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital analbuminemia (CAA) is a very rare disorder. Our data describes the clinical features and laboratory results of a new case established by mutation analysis of the albumin gene in a 39-year-old woman presenting with hypercholesterolemia. Our findings contribute to shed light on the molecular genetics of the disorder and confirm that safe and well tolerated hypocholesterolemic treatment with atorvastatin may be administered in dislipidemic patient with CAA in order to reduce their cardiovascular risk.
CASE SUMMARY Our patient presented with a history of hypercholesterolemia and referred asthenia and heaviness in both legs. She was born from healthy and non-consanguineous parents and her development was normal. She had not familiarity for early cardiovascular disease, and did not report personal history of hypertension, chronic kidney or liver diseases. Clinical laboratories results showed critically reduced value of albumin whereas other serum proteins were elevated. Main causes of hypoalbuminemia (proteinuria, inflammatory state and insufficient hepatic synthesis) were ruled out by normal procedures and laboratory tests. So the hypothesis of a CAA was tested through mutation analysis of the albumin gene that revealed a homozygous CA deletion in exon 12, at nucleotide positions c1614-1615. This finding brought to the diagnosis of CAA. Currently the patient receives Atorvastatin 20 mg od and undergoes clinical and laboratory follow-up every six months. She never needed albumin infusions.
CONCLUSION Our experience shows how treatment with atorvastatin may be safely administered and well tolerated in patients affected by CAA.
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Affiliation(s)
- Patrizia Suppressa
- Department of Internal Medicine and Rare Disease Centre, University Hospital of Bari, Bari 70124, Italy
| | - Concetta Carbonara
- Department of Medicine, University of Bari, School of Medicine, Bari 70124, Italy
| | - Francesca Lugani
- Laboratory of Molecular Nephrology, Istituto Giannini Gaslini, IRCCS, Genova 16148, Italy
| | - Monica Campagnoli
- Department of Molecular Medicine, University of Pavia, Pavia 27100, Italy
| | - Teresa Troiano
- Department of Clinical Pathology, University Hospital of Bari, Bari 70124, Italy
| | - Lorenzo Minchiotti
- Department of Molecular Medicine, University of Pavia, Pavia 27100, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, Geriatric Unit and Rare Disease Center, "Aldo Moro" University, Bari 70125, Italy
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5
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Crook MA. Analbuminaemia: clinical features and associated hypercholesterolaemia. Ann Clin Biochem 2016; 53:525-6. [DOI: 10.1177/0004563216657841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- MA Crook
- Department of Clinical Biochemistry, University Hospital Lewisham, London, UK
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Gianazza E, Miller I, Palazzolo L, Parravicini C, Eberini I. With or without you — Proteomics with or without major plasma/serum proteins. J Proteomics 2016; 140:62-80. [DOI: 10.1016/j.jprot.2016.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 03/31/2016] [Accepted: 04/02/2016] [Indexed: 12/26/2022]
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Roopenian DC, Low BE, Christianson GJ, Proetzel G, Sproule TJ, Wiles MV. Albumin-deficient mouse models for studying metabolism of human albumin and pharmacokinetics of albumin-based drugs. MAbs 2015; 7:344-51. [PMID: 25654695 PMCID: PMC4623309 DOI: 10.1080/19420862.2015.1008345] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Serum albumin is the major determinant of blood colloidal osmotic pressure acting as a depot and distributor of compounds including drugs. In humans, serum albumin exhibits an unusually long half-life mainly due to protection from catabolism by neonatal Fc receptor (FcRn)-mediated recycling. These properties make albumin an attractive courier of therapeutically-active compounds. However, pharmaceutical research and development of albumin-based therapeutics has been hampered by the lack of appropriate preclinical animal models. To overcome this, we developed and describe the first mouse with a genetic deficiency in albumin and its incorporation into an existing humanized FcRn mouse model, B6.Cg-Fcgrt(tm1Dcr) Tg(FCGRT)32Dcr/DcrJ (Tg32). Albumin-deficient strains (Alb(-/-)) were created by TALEN-mediated disruption of the albumin (Alb) gene directly in fertilized oocytes derived from Tg32 mice and its non-transgenic background control, C57BL/6J (B6). The resulting Alb(-/-) strains are analbuminemic but healthy. Intravenous administration of human albumin to Tg32-Alb(-/-) mFcRn(-/-) hFcRn(Tg/Tg)) mice results in a remarkably extended human albumin serum half-life of ∼24 days, comparable to that found in humans, and in contrast to half-lives of 2.6-5.8 d observed in B6, B6-Alb(-/-) and Tg32 strains. This striking increase can be explained by the absence of competing endogenous mouse albumin and the presence of an active human FcRn. These novel albumin-deficient models provide unique tools for investigating the biology and pathobiology of serum albumin and are a more appropriate rodent surrogates for evaluating human serum albumin pharmacokinetics and albumin-based compounds.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- FcRn, neonatal Fc receptor
- HDL, high-density lipoprotein
- HSA, human serum albumin
- IgG, immunoglobulin G
- LDH, low-density-lipoprotein
- MSA, mouse serum albumin
- TALEN
- TALEN, transcription activator-like effector nuclease
- albumin
- albumin-conjugates
- analbuminemia
- hFcRn, human FcRn
- human serum albumin
- hypoalbuminemia
- mouse model
- neonatal Fc receptor
- pharmacokinetics
- transgenic
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8
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Lopez MF, Krastins B, Sarracino DA, Byram G, Vogelsang MS, Prakash A, Peterman S, Ahmad S, Vadali G, Deng W, Inglessis I, Wickham T, Feeney K, Dec GW, Palacios I, Buonanno FS, Lo EH, Ning M. Proteomic signatures of serum albumin-bound proteins from stroke patients with and without endovascular closure of PFO are significantly different and suggest a novel mechanism for cholesterol efflux. Clin Proteomics 2015; 12:2. [PMID: 25678897 PMCID: PMC4305391 DOI: 10.1186/1559-0275-12-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/23/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The anatomy of PFO suggests that it can allow thrombi and potentially harmful circulatory factors to travel directly from the venous to the arterial circulation - altering circulatory phenotype. Our previous publication using high-resolution LC-MS/MS to profile protein and peptide expression patterns in plasma showed that albumin was relatively increased in donor samples from PFO-related than other types of ischemic strokes. Since albumin binds a host of molecules and acts as a carrier for lipoproteins, small molecules and drugs, we decided to investigate the albumin-bound proteins (in a similar sample cohort) in an effort to unravel biological changes and potentially discover biomarkers related to PFO-related stroke and PFO endovascular closure. METHODS The method used in this study combined albumin immuno-enrichment with high resolution LC-MS in order to specifically capture and quantify the albumin-bound proteins. Subsequently, we measured cholesterol and HDL in a larger, separate cohort of PFO stroke patients, pre and post closure. RESULTS The results demonstrated that a number of proteins were specifically associated with albumin in samples with and without endovascular closure of the PFO, and that the protein profiles were very different. Eight proteins, typically associated with HDL were common to both sample sets and quantitatively differently abundant. Pathway analysis of the MS results suggested that enhanced cholesterol efflux and reduced lipid oxidation were associated with PFO closure. Measurement of total cholesterol and HDL in a larger cohort of PFO closure samples using a colorimetric assay was consistent with the proteomic predictions. CONCLUSIONS The collective data presented in this study demonstrate that analysis of albumin-bound proteins could provide a valuable tool for biomarker discovery on the effects of PFO endovascular closure. In addition, the results suggest that PFO endovascular closure can potentially have effects on HDL, cholesterol and albumin-bound ApoA-I abundance, therefore possibly providing benefits in cardioprotective functions.
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Affiliation(s)
- Mary F Lopez
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | - Bryan Krastins
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | | | - Gregory Byram
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | | | - Amol Prakash
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | - Scott Peterman
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | - Shadab Ahmad
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | - Gouri Vadali
- Thermo Scientific BRIMS, 790 Memorial Dr, Cambridge, MA 02139 UK
| | - Wenjun Deng
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ignacio Inglessis
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Tom Wickham
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Kathleen Feeney
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - G William Dec
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Igor Palacios
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ferdinando S Buonanno
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Eng H Lo
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - MingMing Ning
- Clinical Proteomics Research Center and Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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9
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Del Ben M, Angelico F, Loffredo L, Violi F. Treatment of a patient with congenital analbuminemia with atorvastatin and albumin infusion. World J Clin Cases 2013; 1:44-48. [PMID: 24303462 PMCID: PMC3845927 DOI: 10.12998/wjcc.v1.i1.44] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 01/24/2013] [Accepted: 02/06/2013] [Indexed: 02/05/2023] Open
Abstract
Congenital analbuminemia is a rare autosomic recessive inherited disorder characterized by low plasma albumin and hypercholesterolemia, which may increase cardiovascular risk. Patients are essentially asymptomatic, apart from ease of fatigue, minimal ankle oedema and hypotension. There is no accepted strategy for safely treating both hypercholesterolemia and analbuminemia in order to eventually decrease the atherosclerotic risk. We report a case of congenital analbuminemia (1.0 g/dL)
in a 38-year-old male with hypercholesterolemia (range: 406-475 mg/dL) and severe arterial dysfunction [no brachial artery flow-mediated dilation (FMD)]. Long-term, cholesterol-lowering treatment with atorvastatin was associated with the appearance of peripheral edema. Two-months of infusion with albumin improved FMD (7%) and reduced serum cholesterol (273 mg/dL), supporting the hypothesis of a compensatory role of hypercholesterolemia. Statin treatment, together with periodical albumin infusions, may contribute to the safe reduction of cardiovascular risk.
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10
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Stein C, Kling L, Proetzel G, Roopenian DC, de Angelis MH, Wolf E, Rathkolb B. Clinical chemistry of human FcRn transgenic mice. Mamm Genome 2011; 23:259-69. [DOI: 10.1007/s00335-011-9379-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/17/2011] [Indexed: 12/31/2022]
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Babin PJ, Gibbons GF. The evolution of plasma cholesterol: direct utility or a "spandrel" of hepatic lipid metabolism? Prog Lipid Res 2008; 48:73-91. [PMID: 19049814 DOI: 10.1016/j.plipres.2008.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 11/06/2008] [Accepted: 11/07/2008] [Indexed: 02/07/2023]
Abstract
Fats provide a concentrated source of energy for multicellular organisms. The efficient transport of fats through aqueous biological environments raises issues concerning effective delivery to target tissues. Furthermore, the utilization of fatty acids presents a high risk of cytotoxicity. Improving the efficiency of fat transport while simultaneously minimizing the cytotoxic risk confers distinct selective advantages. In humans, most of the plasma cholesterol is associated with low-density lipoprotein (LDL), a metabolic by-product of very-low-density lipoprotein (VLDL), which originates in the liver. However, the functions of VLDL are not clear. This paper reviews the evidence that LDL arose as a by-product during the natural selection of VLDL. The latter, in turn, evolved as a means of improving the efficiency of diet-derived fatty acid storage and utilization, as well as neutralizing the potential cytotoxicity of fatty acids while conserving their advantages as a concentrated energy source. The evolutionary biology of lipid transport processes has provided a fascinating insight into how and why these VLDL functions emerged during animal evolution. As causes of historical origin must be separated from current utilities, our spandrel-LDL theory proposes that LDL is a spandrel of VLDL selection, which appeared non-adaptively and may later have become crucial for vertebrate fitness.
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Affiliation(s)
- Patrick J Babin
- Université Bordeaux 1, Génomique et Physiologie des Poissons, UMR NuAGe, 33405 Talence, France
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12
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Computational lipidology: predicting lipoprotein density profiles in human blood plasma. PLoS Comput Biol 2008; 4:e1000079. [PMID: 18497853 PMCID: PMC2361219 DOI: 10.1371/journal.pcbi.1000079] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 04/04/2008] [Indexed: 01/14/2023] Open
Abstract
Monitoring cholesterol levels is strongly recommended to identify patients at risk for myocardial infarction. However, clinical markers beyond "bad" and "good" cholesterol are needed to precisely predict individual lipid disorders. Our work contributes to this aim by bringing together experiment and theory. We developed a novel computer-based model of the human plasma lipoprotein metabolism in order to simulate the blood lipid levels in high resolution. Instead of focusing on a few conventionally used predefined lipoprotein density classes (LDL, HDL), we consider the entire protein and lipid composition spectrum of individual lipoprotein complexes. Subsequently, their distribution over density (which equals the lipoprotein profile) is calculated. As our main results, we (i) successfully reproduced clinically measured lipoprotein profiles of healthy subjects; (ii) assigned lipoproteins to narrow density classes, named high-resolution density sub-fractions (hrDS), revealing heterogeneous lipoprotein distributions within the major lipoprotein classes; and (iii) present model-based predictions of changes in the lipoprotein distribution elicited by disorders in underlying molecular processes. In its present state, the model offers a platform for many future applications aimed at understanding the reasons for inter-individual variability, identifying new sub-fractions of potential clinical relevance and a patient-oriented diagnosis of the potential molecular causes for individual dyslipidemia.
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Rosipal S, Debreová M, Rosipal R. A speculation about hypercholesterolemia in congenital analbuminemia. Am J Med 2006; 119:181-2. [PMID: 16443434 DOI: 10.1016/j.amjmed.2005.10.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 10/20/2005] [Indexed: 01/14/2023]
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14
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Prinsen BHCMT, de Sain-van der Velden MGM. Albumin turnover: experimental approach and its application in health and renal diseases. Clin Chim Acta 2004; 347:1-14. [PMID: 15313137 DOI: 10.1016/j.cccn.2004.04.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2004] [Revised: 03/31/2004] [Accepted: 04/01/2004] [Indexed: 11/15/2022]
Abstract
Plasma albumin is an important protein in the human body and is responsible for transport and binding of many molecules. Furthermore, it is involved in mediating blood volume and colloid osmotic pressure (COP). As hypoalbuminemia occurs, as is the case in a number of clinical disorders, adaptation mechanisms may be involved. Serum albumin concentration is the net result of physiological processes like synthesis and catabolism. Measurement of one of these processes can provide therefore a more dynamic insight into the adaptation mechanism of albumin metabolism in relation to an underlying disease than would be obtained by changes in albumin concentration alone. This review highlights several studies over the past years that have contributed to knowledge of albumin metabolism. A short introduction is given for synthesis, formation and catabolism of albumin, after which an overview is given on how to measure albumin turnover including a general approach. Finally, albumin metabolism focused on patients with renal diseases will be discussed.
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Affiliation(s)
- Berthil H C M T Prinsen
- Department of Metabolic and Endocrine Diseases, University Medical Center Utrecht, HP KC 02.069.1, Lundlaan 6, Box 85090, 3508 AB Utrecht, The Netherlands.
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Koot BGP, Houwen R, Pot DJ, Nauta J. Congenital analbuminaemia: biochemical and clinical implications. A case report and literature review. Eur J Pediatr 2004; 163:664-70. [PMID: 15300429 DOI: 10.1007/s00431-004-1492-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Accepted: 05/27/2004] [Indexed: 12/25/2022]
Abstract
UNLABELLED Congenital analbuminaemia was diagnosed in a small-for-gestational-age neonate presenting with placental and body oedema, an unusual presentation of this rare autosomal recessive disorder. A review of 39 reported cases in the literature shows that the clinical symptoms are always remarkably mild and that the diagnosis is rarely made in infancy. The absence of albumin appears to be partly counterbalanced by high levels of non-albumin proteins and circulatory adaptations. However, congenital analbuminemia can have important complications: lipodystrophy and hypercholesterolaemia, possibly leading to atherosclerosis. Other possible complications reported in literature are hypercoagulability, osteoporosis, respiratory tract infections, intrauterine growth retardation and intrauterine death. Moreover, albumin-binding drugs should be used with caution. CONCLUSION Congenital analbuminaemia is a rare disorder with remarkably mild signs and symptoms at all ages. Although often thought to be innocent, this disorder may have important clinical complications.
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Affiliation(s)
- Bart G P Koot
- Department of Paediatrics, St. Franciscus Gasthuis and Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands,
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16
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Monks J, Neville MC. Albumin transcytosis across the epithelium of the lactating mouse mammary gland. J Physiol 2004; 560:267-80. [PMID: 15297572 PMCID: PMC1665199 DOI: 10.1113/jphysiol.2004.068403] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2004] [Accepted: 07/29/2004] [Indexed: 12/20/2022] Open
Abstract
Murine milk contains 18 mg ml(-1) serum albumin, a concentration equal to that in the serum of the lactating mouse. We examined cellular transport using in vivo methods in the mouse. At steady state the specific activity of (125)I-albumin injected into the blood stream was equal in plasma and whey, confirming that milk albumin is extra-mammary in origin. Fluorescent albumin crossed the gland from basolateral surface to lumen via cytoplasmic vesicles, but was not transported in the apical to basal direction. Albumin was segregated from transferrin at the basal surface of the epithelial cells and did not colocalize with either caveolin-1 or -2. Vesicular transport was not disrupted by filipin providing additional evidence that, unlike the vascular endothelium, caveoli are not involved. Cytoplasmic albumin was localized to vesicles containing IgA and transport was disrupted by agents that interfere with clathrin-mediated endocytosis. Together, these findings provide evidence that albumin is transported across the mammary epithelium by the same pathway as immunoglobulin. The possibility that the massive transfer of albumin into mouse milk is mediated by fluid phase transport is considered.
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Affiliation(s)
- Jenifer Monks
- Department of Physiology and Biophysics, Room 2802-2, Box C240, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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Prinsen BHCMT, Kaysen GA, Klomp LWJ, de Boer J, Barrett PHR, Thornalley PJ, Battah S, Berger R, Rabelink TJ, de Sain-van der Velden MGM. Idiopathic hypoalbuminemia explained by reduced synthesis rate and an increased catabolic rate. Clin Biochem 2002; 35:545-53. [PMID: 12493583 DOI: 10.1016/s0009-9120(02)00357-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the contribution of albumin synthetic and catabolic rates to steady state levels in a patient with idiopathic hypoalbuminemia. METHODS Using L-[1-(13)C] valine, both FSR (fractional synthesis rate) as well as FCR (fractional catabolic rate) were studied. Human albumin cDNA analysis and determination of the exact albumin mass by electrospray mass spectrometry were performed. RESULTS Compared with controls, plasma albumin concentration in the patient was reduced (6.7 vs. 37.0 +/- 2.6 g/L). Albumin FSR (= FCR in steady state) was increased compared to controls. The ASR (absolute synthesis rate) of albumin was decreased based on the enrichment in plasma valine and KIV, but estimated to be normal based on VLDL apoB100 at plateau compared to controls. Direct estimation of albumin FCR rejected the latter. No mutation was found in the transcribed region of albumin gene. The exact mass of albumin (66.493 Da) was not different from controls. CONCLUSION The hypoalbuminemia was a result of accelerated clearance of albumin from plasma in addition to defective albumin synthesis. This study also shows that the chosen method of the precursor pool could lead to misinterpretation of data in hepatic protein synthesis.
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Affiliation(s)
- Berthil H C M T Prinsen
- Department of Vascular Medicine and Metabolism, University Medical Center, Utrecht, The Netherlands.
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18
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Burnett JR, Barrett PHR. Apolipoprotein B metabolism: tracer kinetics, models, and metabolic studies. Crit Rev Clin Lab Sci 2002; 39:89-137. [PMID: 12014529 DOI: 10.1080/10408360208951113] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The study of apolipoprotein (apo) B metabolism is central to our understanding of lipoprotein metabolism. However, the assembly and secretion of apoB-containing lipoproteins is a complex process. Specialized techniques, developed and applied to in vitro and in vivo studies of apoB metabolism, have provided insights into the mechanisms involved in the regulation of this process. Moreover, these studies have important implications for understanding both the pathophysiology as well as the therapeutic options for the dyslipidemias. The purpose of this review is to examine the role of apoB in lipoprotein metabolism and to explore the applications of kinetic analysis and multicompartmental modeling to the study of apoB metabolism. New developments and significant advances over the last decade are discussed.
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Affiliation(s)
- John R Burnett
- Department of Core Clinical Pathology and Biochemistry, Royal Perth Hospital, University of Western Australia, Australia.
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19
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Smith A. Homeostasis of heme in health and disease: current aspects of the structural biology of heme-protein interactions and of gene regulation. DNA Cell Biol 2002; 21:245-9. [PMID: 12042064 DOI: 10.1089/104454902753759663] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Maugeais C, Ouguerram K, Frénais R, Maugère P, Charbonnel B, Magot T, Krempf M. Effect of low-density lipoprotein apheresis on kinetics of apolipoprotein B in heterozygous familial hypercholesterolemia. J Clin Endocrinol Metab 2001; 86:1679-86. [PMID: 11297603 DOI: 10.1210/jcem.86.4.7428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The acute reduction of low-density lipoprotein (LDL) cholesterol obtained by LDL-apheresis allows the role of the high level of circulating LDL on lipoprotein metabolism in heterozygous familial hypercholesterolemia (heterozygous FH) to be addressed. We studied apolipoprotein B (apoB) kinetics in five heterozygous FH patients before and the day after an apheresis treatment using endogenous labeling with [(2)H(3)]leucine. Compared with younger control subjects, heterozygous FH patients before apheresis showed a significant decrease in the fractional catabolic rate of LDL (0.24 +/- 0.08 vs. 0.65 +/- 0.22 day(-1); P < 0.01), and LDL production was increased in heterozygous FH patients (18.9 +/- 7.0 vs. 9.9 +/- 4.2 mg/kg.day; P < 0.05). The modeling of postapheresis apoB kinetics was performed using a nonsteady state condition, taking into account the changing pool size of very low density lipoprotein (VLDL), intermediate density lipoprotein, and LDL apoB. The postapheresis kinetic parameters did not show statistical differences compared with preapheresis parameters in heterozygous FH patients; however, a trend for increases in fractional catabolic rate of LDL (0.24 +/- 0.08 vs. 0.35 +/- 0.09 day(-1); P = 0.067) and the production of VLDL (13.7 +/- 8.3 vs. 21.9 +/- 1.6 mg/kg.day; P = 0.076) was observed. These results suggested that the marked decrease in plasma LDL obtained a short time after LDL-apheresis is able to stimulate LDL receptor activity and VLDL production in heterozygous FH.
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Affiliation(s)
- C Maugeais
- Centre de Recherche en Nutrition Humaine, Hôtel Dieu, 44093 Nantes Cedex 01, France
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21
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Sakai T, Jin FY, Kamanna VS, Kashyap ML. Albumin inhibits apolipoprotein AI and AII production in human hepatoblastoma cell line (Hep G2): additive effects of oleate-albumin complex. Atherosclerosis 2000; 149:43-9. [PMID: 10704613 DOI: 10.1016/s0021-9150(99)00292-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the role of multiple humoral agents (such as plasma albumin, glucose, hormones etc.) are implicated in lipoprotein metabolism, the mechanism of action of these agents on various steps of the synthesis and secretion of lipoproteins and apolipoproteins (protein moieties of lipoproteins) are not completely understood. Specifically, the hepatocellular mechanisms of the effect of albumin and fatty acids on apolipoprotein (apo) AI and AII [major proteins of high density lipoproteins (HDL)] synthesis and secretion are not known. Using human hepatoblastoma cells (Hep G2) as an in vitro model system, this study examined the effect of albumin and fatty acids on the synthesis, secretion, and the steady-state mRNA expression of apo AI and AII. The data indicated that the incubation of Hep G2 cells with albumin, dose-dependently, inhibited apo AI and AII accumulation (secretion) in the media, de novo synthesis, and the steady-state mRNA expression. Albumin did not alter total protein synthesis; thus the effect of albumin appeared to be specific for the synthesis and secretion of apo AI and apo AII. Free fatty acids (FFA) are transported by albumin and diseases characterized by enhanced FFA mobilization (e.g. diabetes mellitus) are associated with low HDL levels. Studies were therefore performed to examine the effect of albumin-bound-oleic acid on apo AI and apo AII production. The results showed that the albumin-oleate complex further increased the inhibitory effects of albumin on apo AI and apo AII production. These data suggest how HDL metabolism may be affected at the hepatocellular level by alterations in plasma albumin concentrations and/or fatty acid mobilization in clinical situations characterized by altered HDL levels.
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Affiliation(s)
- T Sakai
- Department of Veterans Affairs Healthcare System, Cholesterol Research Center, 5901 E. Seventh Street (111GE), Long Beach, CA 90822, USA
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22
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Noto D, Barbagallo CM, Cascio AL, Cefalù AB, Cavera G, Caldarella R, Marino G, Travali S, Cutaia I, Maringhini S, Notarbartolo A, Averna M. Lipoprotein(a) levels in relation to albumin concentration in childhood nephrotic syndrome. Kidney Int 1999; 55:2433-9. [PMID: 10354292 DOI: 10.1046/j.1523-1755.1999.00489.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is a lipoprotein consisting of a low-density lipoprotein (LDL) particle linked to a polymorphic glycoprotein, apoprotein(a) [apo(a)]. Prior studies have reported high Lp(a) levels in the nephrotic syndrome, but it is still controversial whether this is due to the degree of hypoalbuminemia or proteinuria. METHODS To investigate a model of nephrotic syndrome in the absence of renal failure, we studied a group of 84 children in different clinical stages of the disease for a period of five years. We evaluated the direct relationships between lipoproteins, including Lp(a), and/or plasma albumin and proteinuria. RESULTS Lp(a) levels were significantly higher in the subjects with the active disease compared with patients in remission, and were also significantly different when subjects were ranked by albumin quartiles. Multiple regression analysis revealed that Lp(a) levels were inversely correlated with apo(a) isoform size and plasma albumin levels but not with the proteinuria/creatinine clearance ratio. Among subjects in complete remission, Lp(a) levels were different in patients with albumin levels below or above the fifth percentile. After the improvement of the clinical stage of the disease, the Delta% variation of albumin levels was related to the Delta% of apoB and LDL cholesterol (LDL-C), but not with the Delta% variation of Lp(a), whereas the Delta% variation of LDL-C was, in turn, related to the Delta% of Lp(a) levels. CONCLUSIONS These results suggest that in the childhood nephrotic syndrome, the increased Lp(a) levels are mainly related to hypoalbuminemia, probably through a mechanism involving apoB overproduction, which leads to an increased number of LDL particles to be converted into Lp(a).
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Affiliation(s)
- D Noto
- Department of Internal Medicine, University of Palermo, Palermo, Italy
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Maugeais C, Ouguerram K, Krempf M, Magot T. Kinetic study of apo B100 containing lipoprotein metabolism using amino acids labeled with stable isotopes: methodological aspects. Clin Chem Lab Med 1998; 36:739-45. [PMID: 9853798 DOI: 10.1515/cclm.1998.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Kinetic disturbances of lipoprotein metabolism are important to know for a better understanding of lipid diseases or effects of drugs. These kinetic aspects were previously studied with radioactive tracers. The ethical concerns related to these tracers can be now overcome at a reasonable cost with the new development of small bench top mass spectrometers and the increased production of stable isotope tracers. In this review, we will discuss some methodological aspects related to stable isotope tracers and the analysis of the data with non-compartmental or compartmental models.
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Affiliation(s)
- C Maugeais
- Centre de Recherche en Nutrition Humaine, Hôtel Dieu, Nantes, France
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Millar JS, Packard CJ. Heterogeneity of apolipoprotein B-100-containing lipoproteins: what we have learnt from kinetic studies. Curr Opin Lipidol 1998; 9:197-202. [PMID: 9645501 DOI: 10.1097/00041433-199806000-00003] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Apolipoprotein B-100-containing lipoprotein assembly is dependent on the successive addition of triglyceride by microsomal transfer protein. Assembly may end at this point and the lipoprotein secreted or it may continue with the bulk addition of triglyceride by an unknown transfer process. These steps are independently regulated and result in the secretion of a spectrum of apolipoprotein B-100-containing particles. The production of small, dense LDL is determined by the type of VLDL secreted by the liver. Large, triglyceride-rich VLDL1 results in the formation of small, dense LDL through triglyceride exchange and subsequent hydrolysis. Small, dense LDL are cleared from plasma relatively slowly and tend to accumulate in the circulation where they exert their atherogenic effects.
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Affiliation(s)
- J S Millar
- Department of Pathological Biochemistry, Glasgow Royal Infirmary, UK
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Abstract
The bile acid concentrations in the serum, liver, bile, intestines, and feces of 3- and 19-mon-old male and female Nagase analbuminemic (NA) rats were compared with those in Sprague-Dawley (SD) rats. There was no significant difference in the bile acid levels between NA and SD rats. However, increased biosynthesis and pool size of cholic acid (CD) derivatives and decreased levels of chenodeoxycholic acid (CDCA) derivatives (increased CA/CDCA ratio) were detected in male NA rats as compared to SD rats. The CA/CDCA ratio in female NA rats was not different from that in their SD counterparts. There were no significant differences between NA and SD rats in the biliary bile flow, bile acid levels in the small and large intestines, fecal bile acid excretion, bile acid concentration in the portal and systemic circulation, and in the pool size of bile acids. The blood lipid concentrations were significantly higher in the NA rats than in the SD rats. The hepatic levels of lipids were not significantly different between the two rat strains. In conclusion, this study showed that metabolism of bile acids in NA rats is not significantly affected, and that the hypercholesterolemia observed in these strains is not related to abnormalities of bile acid metabolism.
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Affiliation(s)
- A Kambe
- Third Department of Internal Medicine, Mie University School of Medicine, Japan
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