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van den Berg EH, Flores-Guerrero JL, Gruppen EG, Garcia E, Connelly MA, de Meijer VE, Bakker SJL, Blokzijl H, Dullaart RPF. Profoundly Disturbed Lipoproteins in Cirrhotic Patients: Role of Lipoprotein-Z, a Hepatotoxic LDL-like Lipoprotein. J Clin Med 2022; 11:jcm11051223. [PMID: 35268313 PMCID: PMC8910943 DOI: 10.3390/jcm11051223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 12/17/2022] Open
Abstract
Detailed information regarding lipoprotein concentrations and subfractions in cirrhotic patients before and after orthotopic liver transplantation (OLT) is lacking. Lipoprotein-Z (LP-Z) is a recently characterised abnormal, hepatotoxic free cholesterol-rich low-density lipoprotein (LDL)-like lipoprotein. We determined the lipoprotein profiles, including LP-Z, in cirrhotic patients and OLT recipients and assessed the prognostic significance of LP-Z on the OLT waiting list. We performed analyses in cirrhotic transplant candidates and non-cirrhotic OLT recipients. A population-based cohort was used as reference. The setting was a University hospital. Lipoprotein particle concentrations and subfractions were measured by nuclear magnetic resonance spectroscopy. In the cirrhotic patients (N = 130), most measures of triglyceride-rich lipoproteins (TRL), LDL, and high-density lipoproteins (HDL) were much lower compared to the OLT recipients (N = 372) and controls (N = 6027) (p < 0.01). In the OLT recipients, many lipoprotein variables were modestly lower, but HDL-cholesterol, triglycerides, and TRL and HDL size were greater vs. the control population. LP-Z was measurable in 40 cirrhotic patients and 3 OLT recipients (30.8% vs. 0.8%, p < 0.001). The cirrhotic patients with measurable LP-Z levels had profoundly lower HDL-cholesterol and particle concentrations (p < 0.001), and worse Child Pugh Turcotte classifications and MELD scores. The presence of LP-Z (adjusted for age, sex, and MELD score) predicted worse survival in cirrhotic patients (HR per 1 LnSD increment: 1.11, 95%CI 1.03−1.19, p = 0.003). In conclusion, cirrhotic patients have considerably lower plasma concentrations of all major lipoprotein classes with changes in lipoprotein subfraction distribution. After OLT, these lipoprotein abnormalities are in part reversed. LP-Z is associated with cirrhosis. Its presence may translate in disturbed HDL metabolism and worse survival.
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Affiliation(s)
- Eline H. van den Berg
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-50-3610426
| | - Jose L. Flores-Guerrero
- Department of Nephrology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (E.G.G.); (S.J.L.B.)
| | - Eke G. Gruppen
- Department of Nephrology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (E.G.G.); (S.J.L.B.)
| | - Erwin Garcia
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC 27560, USA; (E.G.); (M.A.C.)
| | - Margery A. Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC 27560, USA; (E.G.); (M.A.C.)
| | - Vincent E. de Meijer
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Stephan J. L. Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (J.L.F.-G.); (E.G.G.); (S.J.L.B.)
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Robin P. F. Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
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