Marked changes of lipid levels during puberty in a patient with lipoprotein lipase deficiency

Clinical and biochemical characteristics of a female patient with familial lipoprotein lipase deficiency have been followed in short intervals before and during puberty. The proband is compound heterozygote for two missense mutations in the lipoprotein lipase gene. One mutation occurs in codon 250 (Asp250-->Asn), the other is in codon 410 (Glu410-->Lys). The residual lipoprotein lipase activity in the proband is less than 10% of controls. Before puberty the proband usually presented with moderate isolated hypertriglyceridaemia. During the initial phase of puberty a dramatic increase in the plasma concentration of both cholesterol and triglycerides was observed. During the second half of puberty a reduction of cholesterol but not of triglycerides was noticed.

CONCLUSION

These findings show that the phenotypic expression of familial chylomicronaemia can be modified to a large extent by hormones. Furthermore they demonstrate the need for a closer clinical observation of type I patients during puberty.

Lipoprotein (a) and vascular disease in diabetic patients

In order to assess the potential role of lipoprotein (a) as a risk factor for cardiovascular disease in diabetes mellitus, plasma concentrations were measured in a large group (n = 500) of non-insulin-dependent (NIDDM, n = 355) and insulin-dependent (IDDM, n = 145) patients. Concentrations of lipoprotein (a) were compared in diabetic patients with (n = 153) or without (347) documented vascular disease (ischaemic heart disease, peripheral vascular disease or macroangiopathy). They were significantly higher (p < 0.05) in patients with ischaemic heart disease (mean [interquartile range] 15.5 (5.0-38.0) vs 9.0 (4.5-26.0) mg/dl) or macroangiopathy (13.0 (5.0-38.0) vs 9.0 (4.0-25.0) mg/dl) compared to patients without manifestations of vascular disease. In addition, stepwise logistic regression analysis identified lipoprotein (a) levels > or = 30 mg/dl as being independently associated with the presence of cardiovascular disease. Lipoprotein (a) was an independent risk factor for ischaemic heart disease and macroangiopathy in this group of IDDM and NIDDM patients.

Apolipoprotein E polymorphism as a risk factor for vascular disease in diabetic patients

OBJECTIVE

To examine the prevalence of cardiovascular disease in diabetic patients as a function of apolipoprotein (apo) E polymorphism.

RESEARCH DESIGN AND METHODS

The apo E phenotypes and plasma lipid, lipoprotein, and apo levels were determined for 517 Italian diabetic patients. The prevalence of cardiovascular disease (defined as ischemic heart disease [HD] and/or peripheral vascular disease and/or cerebrovascular disease) was assessed as a function of apo E polymorphism at entry and after 4 years.

RESULTS

The occurrence of vascular disease did not differ significantly between diabetic patients in the various categories of apo E phenotype either at entry into the study or after 4 years. When expressed as a percentage of patients with disease, we observed--for E2, E3, and E4 carriers, respectively--at entry: IHD, 20.0% (n = 14), 21.0% (n = 79), and 21.5% (n = 14); and macroangiopathy, 24.3% (n = 17), 29.3% (n = 110), and 24.6% (n = 16). Apo E polymorphism did not make a significant contribution to multiple logistic regression models designed to identify the factors associated with the occurrence of vascular disease in diabetic patients.

CONCLUSION

Apo E polymorphism and, notably, the apo E4 allele cannot be universally considered as a particular risk factor for cardiovascular disease in diabetic patients.

Characterization of subpopulations of lipoprotein particles isolated from human cerebrospinal fluid

The aim of the present study was to define lipoprotein complexes within cerebrospinal fluid (CSF) in terms of their apolipoprotein composition, using fractionation procedures considered optimal for maintaining lipoprotein structural integrity. Five apolipoproteins were identified, namely apolipoproteins A-I, A-IV, D, E and J. These were differentially distributed amongst lipoprotein particles of which three major subpopulations were identified. CSF-LpAI (20.1 +/- 3.8 nm) was enriched in apolipoprotein A-I and contained the major proportion (> 50%) of apolipoproteins D, E and J. CSF-LpE, of similar size to CSF-LpAI (20.2 +/- 3.1 nm), was composed principally of apolipoprotein E, with minor quantities of apolipoproteins A-I, A-IV, D and J. Elimination of these particles from cerebrospinal fluid by immunoabsorption revealed a third subpopulation of significantly greater diameter (32.0 +/- 6.8 nm). The majority (62%) of apolipoprotein A-IV was also present in this fraction. The study demonstrates the structural and size heterogeneity of lipoproteins in cerebrospinal fluid. This may reflect the lipid transport processes within the central nervous system.

Factors influencing the low density lipoprotein profile in type 2 diabetic patients

The lipoprotein distribution profile was examined in Type 2 (non-insulin-dependent) diabetic patients (n = 52), with particular emphasis on factors influencing low density lipoproteins (LDL). Triglycerides were negatively correlated with LDL-2 (r = 0.34, p < 0.05) and positively correlated with smaller, denser LDL-3 (r = 0.57, p < 0.001). This yielded a highly significant, negative correlation between triglycerides and the LDL-2/LDL-3 mass ratio (r = -0.59, p < 0.001) which is an indication of the presence of smaller LDL particles. Parameters of glycaemic control, in the form of fasting blood sugar and glycated haemoglobin (HbA1c), were also negatively correlated with the LDL-2/LDL-3 mass ratio in univariate analyses; both remained significantly correlated with the mass ratio when corrected for triglycerides. Stepwise multiple regression analysis identified a three-parameter model comprising triglycerides, HbA1c, and high density lipoprotein cholesterol as best defining the variations in the LDL-2/LDL-3 mass ratio (adjusted r2 = 0.52). These observations are consistent with an independent impact of diabetes on the LDL distribution profile and the possibility that the latter may be subjected to multiple pathological influences in diabetic patients.

Quantification of human serum paraoxonase by enzyme-linked immunoassay: population differences in protein concentrations

Paraoxonase is a serum protein bound to high-density lipoproteins (HDLs). The physiological function of the enzyme is unknown, but a role in lipid metabolism has been postulated. To date, studies of the protein have had to rely on measurements of enzyme activity with various substrates. We have developed a highly specific, competitive e.l.i.s.a. using a previously characterized monoclonal antibody. The assay can detect 20 ng of paraoxonase with a working range of 75-600 ng. Intra- and interassay coefficients of variation were 6.5 and 7.9% respectively. Serum concentrations of paraoxonase in healthy subjects from Geneva and Manchester ranged from 25 to 118 micrograms/ml. There were significant differences in mean concentrations between the two groups (Geneva, 79.3 +/- 18.7 micrograms/ml; Manchester, 59.9 +/- 24.1 micrograms/ml: P < 0.001), differences also apparent when subjects were compared according to paraoxonase phenotype. These appeared to be largely a consequence of differences in apolipoprotein A-I concentrations between the two populations, suggesting that HDL particle number may be important in determining serum levels of paraoxonase. Paraoxonase specific activities were also significantly different between the two groups of subjects (Geneva, 2.08 +/- 0.96 units/mg; Manchester, 3.08 +/- 1.73 units/mg: P < 0.001), which may reflect differences in HDL particle composition. The e.l.i.s.a. should furnish the necessary complement to studies of paraoxonase enzymic activity and has already provided evidence for differences with respect to serum levels of the protein both between populations and between phenotypes within populations.

Postprandial lipemia differentially influences high density lipoprotein subpopulations LpAI and LpAI,AII

The behavior of apolipoprotein-defined subpopulations LpAI and LpAI,AII within high density lipoprotein (HDL) subclasses 2 and 3 was analyzed in the postprandial phase after a fat load. For the whole group of subjects, increases in plasma concentrations of HDL, principally due to the influx of lipoprotein surface components, were largely confined to the HDL3 density range and involved LpAI,AII and LpAI. However, the degree of postprandial lipemia influenced the distribution of surface remnants between the subfractions. In subjects with a limited postprandial rise in triglycerides, increased HDL mass was predominantly associated with LpAI,AII, and equally distributed between HDL2 and HDL3. Conversely, subjects with exaggerated postprandial lipemia manifested increased mass primarily within the HDL3 density range, implicating both LpAI,AII and LpAI. Stepwise regression analysis identified a two-variable model, involving LpAI,AII within HDL2 and LpAI within HDL3, as best defining the relationship between postprandial lipemia and the increase in HDL mass. Postprandial increases in triglyceride content were observed for all HDL subfractions, whilst modifications to the core lipid mass ratios were significant only for LpAI,AII. Stepwise regression analysis revealed a significant correlation between postprandial lipemia and the increase in triglyceride concentration only of LpAI,AII within HDL3. The results suggest that postprandial lipemia differentially influences apolipoprotein-defined HDL subfractions. The extent of postprandial lipemia may determine the involvement of different HDL subfractions in postprandial lipoprotein metabolism.

The effect of the gastrointestinal lipase inhibitor, orlistat, on serum lipids and lipoproteins in patients with primary hyperlipidaemia

The effect of orlistat, a nonabsorbed inhibitor of gastric and pancreatic lipases, was examined in patients with primary hyperlipidaemia (serum cholesterol > or = 6.2 mmol.l-1 and triglycerides < or = 5.0 mmol.l-1) not responsive to dietary change alone. In a multicentre, randomised, double-blind study, 103 men and 70 women received 30, 90, 180, or 360 mg or orlistat or placebo for 8 weeks. Total and low-density lipoprotein cholesterol levels were reduced by 4% and 5% with 30 mg orlistat, by 7% and 8% with 90 mg orlistat, by 7% and 7% with 180 mg orlistat and by 11% and 10% with 360 mg orlistat compared to placebo. High density lipoprotein cholesterol levels significantly decreased in the 360 mg orlistat group. Triglyceride levels significantly increased in the placebo group but not in the drug groups. Body weight decreased by 1.2 kg with 360 mg orlistat, despite a weight maintenance diet. Decreases in vitamin E and D levels occurred, although both vitamins remained within the normal range. Adverse effects from the gastrointestinal tract were frequent, but led to discontinuation of therapy in only seven patients. Orlistat is a new therapeutic drug for the treatment of hyperlipidaemia that may be particularly useful among overweight patients. Its potential place in therapy will await long-term studies. Vitamin supplementation should be considered during treatment.

Underexpression of the apolipoprotein E4 isoform in an Italian population

Apolipoprotein (apo) E polymorphism was examined in a population of Italian blood donors. A significantly reduced frequency of the epsilon 4 allele was observed in comparison to a combined Caucasian population. Apo E polymorphism was also associated with significant differences in plasma lipid and lipoprotein levels. Notably, total and low-density lipoprotein cholesterol as well as triglycerides were increased, whereas high-density lipoprotein cholesterol was decreased in carriers of the E4 isoform. This is the first report of a significantly lower frequency of the apo E4 isoform in a European population. The reduced occurrence of an apo E isoform, which is associated with a more atherogenic lipid/lipoprotein profile, may be a contributory factor to the relatively lower incidence of cardiovascular disease in the Italian population.

[Comparison of 2 cholesterol synthesis inhibitors (simvastatin and pravastatin)]

Inhibitors of cholesterol synthesis (HMG-CoA reductase) are the most effective cholesterol-lowering drugs. Comparison of several studies in the literature suggests that simvastatin is approximately twice as effective as pravastatin on a milligram basis. These results are confirmed by the present study, which compares treatment with simvastatin (10 mg/d) with pravastatin (20 mg/d) in the same hypercholesterolemic patients (n = 17). The reduction in LDL cholesterol is the same with twice the dose of pravastatin as with simvastatin (26 +/- 3% vs 27 +/- 2% respectively). The reductions in atherogenic ratios, total cholesterol, HDL cholesterol and ApoB/ApoA1 are similar. Undesirable effects are rare and comparable. The differences between the two inhibitors appear to be on the molecular level, in tissue selectively and regarding in vivo efficacy.

Topical timolol maleate might adversely affect serum lipoproteins

Conflicting observations have been reported about the effects of topically administered timolol maleate on serum lipoproteins. We therefore considered this issue in a series of eight glaucoma patients receiving timolol maleate. Cholesterol and triglycerides were measured in plasma and in low-density lipoproteins (LDL), and high-density lipoproteins (HDL), both before and following three months of treatment. Following the treatment, the mean atherogenic index was increased from 2.72 to 3.38 (p = 0.012). This suggests that the atherogenic index should be determined before and during timolol maleate treatment in high-risk cardiovascular patients.

Gender differences in a type 2 (non-insulin-dependent) diabetic population with respect to apolipoprotein E phenotype frequencies

Apolipoprotein E polymorphism was examined in an Italian population of Type 2 (non-insulin-dependent) diabetic patients. There were significant differences (p < 0.05) in allele frequencies between male and female patients due to an under-representation of the E4 allele in the female group. No differences in allele frequencies were noted when non-diabetic male and female control subjects were compared. Both control groups exhibited similar allele distributions to that of male diabetic patients, but were significantly different (p < 0.05) from female diabetic patients. A closer examination of the female diabetic population revealed that under-representation of the E4 allele was principally confined to patients aged 60 years or older. This subgroup showed a significantly different (p < 0.05) allele frequency profile from control subjects (both men and women) and diabetic men, whereas this was not observed in the younger diabetic women (< or = 59 years). The results are consistent with the suggestion that the E4 allele may be a particular risk factor for female diabetic patients.

Identification of a distinct human high-density lipoprotein subspecies defined by a lipoprotein-associated protein, K-45. Identity of K-45 with paraoxonase

In an attempt to provide immunological tools for subfractionation of high-density lipoproteins (HDL), monoclonal antibodies were raised against HDL complexes. Two clones identified a peptide, provisionally named K-45 (pI 4.5-4.9; molecular mass 45 kDa, range 42-48 kDa), whose plasma distribution and lipoprotein association were fully characterised. Gel filtration localised the peptide to the HDL region of human plasma where it co-eluted with apolipoprotein (apo) A-I, the structural protein of HDL. Complementary studies employing immunoabsorption with anti-(apo A-I) antibodies removed 90% of K-45 from plasma: conversely, anti-(apo A-II) antibodies eliminated only 10% of K-45. Immunoaffinity chromatography on an anti-(K-45) column revealed that the peptide was present in a distinct HDL subsepecies containing three major proteins: K-45, apo A-I and clusterin or apo J. The lipoprotein nature of the bound fraction was indicated by electron microscopy (diameter 9.6 +/- 3.3 nm) and quantification of lipids, the latter showing an unusually high triacyglycerol concentration. Plasma concentrations of K-45 were positively correlated with apo A-I and HDL-cholesterol and negatively correlated with apo B and total cholesterol. Thus, the peptide appears to be linked, directly or indirectly, to processes which give rise to an anti-atherogenic lipid profile. After completion of the present studies, an N-terminal sequence identical to that of K-45 was reported in recently isolated cDNA clones. These clones encode paraoxonase.

Distribution of apolipoprotein E between free and A-II complexed forms in very-low- and high-density lipoproteins: functional implications

The stability of apolipoprotein E/lipoprotein associations has been examined as a function of apolipoprotein E phenotype. Visualisation by immunoblotting showed plasma apolipoprotein E to be present in two forms; the free form and, as previously described, an E-A-II complex. In very low density lipoproteins isolated by gel filtration from subjects with E3/3 and E4/3 phenotypes, apolipoprotein E was present essentially in the free form (ratio free: complex of 12.2 and 37.5, respectively). Exploiting ultracentrifugation as the disruptive agent, very-low-density lipoproteins thus isolated were shown to have substantially lower ratios (5.6 and 5.4, respectively) reflecting preferential loss of free apolipoprotein E. In high-density lipoproteins isolated by gel filtration from E3/3 phenotypes, apolipoprotein E was largely present as an E-A-II complex (80.3%). In contrast, the majority of apolipoprotein E in high-density lipoproteins from E4/3 phenotypes was present in the free form (58.7%). In both phenotypes, the content of free apolipoprotein E was markedly reduced by ultracentrifugation. The results confirm the notion that the formation of the E-A-II complex is a major determinant of the stability of apolipoprotein E-high-density lipoprotein associations. Moreover, that the predominant, ancestral isoform, apolipoprotein E3, exists largely as an E-A-II complex in higher density lipoproteins has important functional implications for this plasma source of apolipoprotein E.

Characterization of a human high density lipoprotein-associated protein, NA1/NA2. Identity with SP-40,40, an inhibitor of complement-mediated cytolysis

Two peptides, NA1 and NA2, which we previously suggested to be associated with high density lipoproteins (HDLs), have been purified. Polyclonal antibodies against each peptide and a monoclonal antibody against NA2 have been used to further characterize them and their association with HDL. Immunoblotting studies revealed that the peptides form a complex of molecular mass of approximately 80 kd. Agarose gel filtration showed coelution of NA1/NA2 and apolipoprotein (apo) A-I, the structural protein of HDL. This was confirmed by fast protein liquid chromatography, which further indicated that up to 60% of NA1/NA2 was located within the lower density range of the HDL spectrum. Complementary studies with anti-apo A-I immunoaffinity columns provided evidence that at least 40% of NA1/NA2 was associated with HDL, an association easily disrupted by ultracentrifugal manipulation. Finally, partial amino acid sequences showed virtually complete homology with a recently identified protein, SP-40,40, or cytolysis inhibitor. The protein is suggested to have a powerful inhibitory effect on complement-mediated cell lysis. Our results could thus furnish an explanation for the previously observed modulating influence of HDL on complement activity.

The distribution profiles of very low density and low density lipoproteins in poorly-controlled male, type 2 (non-insulin-dependent) diabetic patients

The distribution and composition of lipoproteins spanning the very low density and low density lipoprotein spectra have been analysed in ten poorly-controlled, male, Type 2 (non-insulin-dependent), diabetic patients pre-disposed to mild, secondary hypertriglyceridaemia. As compared to age-matched control subjects, the diabetic patients displayed grossly modified, distinctly atherogenic lipoprotein profiles. Modifications were not limited to the very low density lipoprotein profile, as would be expected from the pre-treatment hypertriglyceridaemia. There was also an aberrant low density lipoprotein profile, which was not evident from plasma cholesterol measurements, especially as the diabetic patients at entry were well matched to control subjects with respect to plasma levels of this lipid. Compositional abnormalities were also observed in the poorly-controlled diabetic group, although these were less marked than the distributional changes. There were substantial improvements of the abnormalities detailed above, even over a short treatment period (two weeks), with therapy designed primarily to ameliorate metabolic control. The data suggest that, in the presence of poor metabolic control and hypertriglyceridaemia, occult, atherogenic modifications of low density lipoproteins can occur. The results argue in favour of strict control of triglyceride levels even in diabetic patients with apparently acceptable cholesterol levels.

[Dyslipidemia in diabetes mellitus: significance, diagnosis and treatment]

Dyslipidemias are frequent in diabetic subjects: they increase the risk for atherosclerosis, in addition to the risk of diabetes mellitus per se. The pathogenesis of dyslipidemias differs between type I and type II diabetes: untreated type I diabetic subjects demonstrate frequently increased triglyceride concentrations due to diminished removal of triglyceride-containing particles, as a result of diminished activity of lipoprotein lipase. In addition, more triglycerides are produced due to increased lipolysis and increased free fatty acid supply to the liver. Type II diabetic subjects demonstrate very low density lipoprotein (VLDL) over-production due to obesity, insulin resistance and caloric overconsumption. In addition, triglyceride removal may be diminished due to diminished lipoprotein lipase activity when diabetes mellitus is poorly controlled. In addition, high density lipoprotein (HDL) is frequently lowered. During decompensation low density lipoprotein (LDL) concentrations may also increase. LDL particle composition is frequently abnormal. A severe dyslipidemia in diabetes mellitus is frequently a combined effect of diabetes mellitus and a congenital lipoprotein abnormality. The evaluation and treatment of dyslipidemias in diabetic subjects should be performed similarly to non-diabetics according to the guidelines published recently by the Working Group 'Lipids' of the Swiss Foundation of Cardiology. Additional accents in diabetic subjects are necessary. It is recommended that serum cholesterol, triglycerides and HDL are determined in every patient when diabetes mellitus is diagnosed. If serum cholesterol is greater than 6.5 mmol/l and the cholesterol/HDL-ratio is greater 6.5, dietary treatment should be reinforced; if its effect is insufficient, drug therapy should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in lipoprotein subfraction composition and distribution between type I diabetic men and control subjects

Subfractions of very-low-density and low-density lipoproteins were examined in 10 male normolipidemic type I (insulin-dependent) diabetic patients before and after improvement of metabolic control and were compared with subfractions from male control subjects matched to the diabetic patients at entry for age, body mass index, plasma cholesterol, and plasma triglycerides. Two consistent differences in subfraction composition were noted between the diabetic patients at entry and the control subjects. First, subfractions from diabetic patients tended to be cholesterol-ester poor and triglyceride rich; this was particularly marked for the low-density lipoprotein subfractions. Second, the subfractions from pretreatment diabetic patients contained higher proportions of non-apolipoprotein B apolipoproteins. This compositional anomaly, but not the lipid modifications, responded to but was not completely normalized by improved glycemic control, which was also accompanied by reductions in the plasma concentrations of all subfractions. Treatment modified subfraction distribution so that the lipoprotein profile of posttreatment diabetic patients more closely resembled the profile observed in the control subjects. These changes were achieved without significant modification of daily insulin dose. In the context of blood lipid risk factors, the results argue for the need to maintain optimal insulinization even in apparently normolipidemic diabetic patients to avoid modifications of the lipoprotein pattern toward a potentially more atherogenic profile.

Immunofractionation of high density lipoprotein subclasses 2 and 3. Similarities and differences of fractions isolated from male and female populations

High density lipoprotein (HDL) subclasses 2 and 3 isolated from male and female populations were further subfractionated by immunoaffinity techniques. Each subclass gave rise to 2 fractions: one contained apolipoprotein (apo) A-I but no apo A-II (LpAI); the other contained apo A-I and apo A-II (LpAI,AII). The bulk fraction (HDL-3(LpAI,AII)) comprised over 70% of total HDL and was present in similar concentrations in both populations. There were, however, significant male-female differences in plasma levels of the minor HDL-3 fraction i.e. HDL-3(LpAI). Females had significantly higher plasma concentrations of both fractions within HDL-2. These fractions also exhibited strong, positive correlations with total HDL cholesterol concentrations, both in males as well as females. It suggests that metabolic activities giving rise to both HDL-2(LpAI) and HDL-2(LpAI,AII) determine plasma HDL cholesterol concentrations. Several similarities were noted between the male and female populations. Triglyceridaemia was negatively correlated with HDL-2 derived fractions and positively correlated with the bulk fraction HDL-3(LpAI,AII). Compositional data showed that the fraction (LpAI) had a lower esterified cholesterol to total cholesterol ratio than the fraction (LpAI,AII), the differences being more apparent at the HDL-3 level. Additionally, analysis of the surface components of HDL-3 fractions suggested that (LpAI,AII) had a greater potential than (LpAI) for absorbing lipoprotein surface material. Finally, the relative concentrations of the individual components of fractions within the same population and defined by the same apolipoprotein criterion showed highly significantly, positive correlations. Such correlations were not apparent for apolipoprotein dissimilar fractions. These observations could reflect a metabolic link between apolipoprotein similar fractions.

A novel high-density lipoprotein particle and associated protein in rat plasma

This report describes the characterization of a novel rat apolipoprotein, which, as partial sequencing suggests, does not correspond to any described protein. The protein (termed PX) has an estimated molecular mass of 19.5 kDa and pI in the range 5.5-5.8. Monoclonal antibodies were obtained against protein PX and results on distribution among rat lipoproteins show it to be associated mainly with high-density lipoproteins (HDL), but also with VLDL. Immunoaffinity chromatography of total HDL shows protein PX to be included in a distinct lipoprotein particle, particularly enriched in free cholesterol, with which only traces of other apolipoproteins are associated. Immunologically crossreacting entities are found in the plasma of several species, including man. Retention of the epitope carried by the protein PX would suggest that it is of particular structural or functional importance. It remains to be established whether its function is associated with lipid metabolism.

[Remnant disease associated with apoprotein E1; clinical importance of apoprotein E (apo E) phenotypes]

The diagnosis of type III hyperlipoproteinemia, or remnant disease, is greatly facilitated by the determination of the apoprotein E (apo E) phenotype. The disease is associated, in over 90% of the documented cases, with homozygosity for the E2 isoform of apo E. Phenotyping apo E directly from plasma offers certain advantages as compared to phenotyping from very low density lipoprotein samples. Elaboration of such a procedure in our laboratory allowed us to detect a rare isoform of apo E, apo E1, which was associated with remnant disease in 3 patients.

Immunoaffinity fractionation of high-density lipoprotein subclasses 2 and 3 using anti-apolipoprotein A-I and A-II immunosorbent gels

High-density lipoprotein (HDL) subclasses 2 and 3 prepared by density gradient ultracentrifugation have been further fractionated by immunoaffinity chromatography using antibody affinity gels targetting the major HDL apolipoproteins, A-I and A-II. Fractions containing A-I without A-II (AI w/o AII) and A-I with A-II (AI w AII) were isolated from both density ranges. Whereas there were similar concentrations of the major subfraction (HDL3(AI w AII] in both males and females, the remaining subfractions were present in higher concentrations in females as compared to males, in the order HDL3 (AI w/o AII) less than HDL2(AI w AII) less than HDL2(AI w/o AII). The difference was most marked for HDL2 (AI w/o AII), where plasma concentrations in females were almost 3-fold greater than in males. Compositional analyses indicated that the plasma concentrations of the fractions, rather than their compositions, were the major determinants of male-female differences in HDL levels. In contrast, fractions defined by similar apolipoprotein criteria and isolated from different density subclasses (i.e., HDL2(AI w/o AII) vs. HDL3(AI w/o AII) and HDL2(AI w AII) vs. HDL3(AI w AII] showed major compositional differences. This is suggestive of distinct lipoprotein particles.

Actin stress fiber content of regenerated endothelial cells correlates with intramural retention of intermediate plus low density lipoproteins in rat aorta after balloon injury

The rat aortic model of endothelial injury (balloon catheter induced) has been used to establish whether changes in protein intramural penetration in specific areas of the injured aorta were accompanied by phenotypic modifications of the regenerated endothelial cells covering these particular regions. Iodinated lipoproteins (IDL/LDL fraction) and albumin were used as tracers to localize protein permeability and retention in the aorta. Lipoproteins, but not albumin, were retained in the thickened areas covered with regenerated endothelium (i.e., 60 days after balloon induced injury). Neither lipoproteins nor albumin were retained in the other aortic areas studied, including the intimal thickening of de-endothelialized areas (15 days after injury). The relative volume of cytoplasmic stress fibers was significantly increased in regenerated endothelium covering thickened areas as compared with the other regions of the injured or normal aorta. The accumulation of lipids usually observed in atherosclerotic lesions, compatible with the trapping of lipoproteins by the matrix component of the intimal thickening, may be related to modulated features of endothelial cells regenerated over thickened areas of the aorta.

Apolipoprotein B metabolism in homozygous familial hypercholesterolemia

This report describes the metabolism of apolipoprotein B-containing lipoproteins in seven familial hypercholesterolemic (FH) homozygotes and compares the results to the values obtained from five healthy control subjects. The concentration, composition, and metabolism of large, triglyceride-rich very low density lipoproteins (VLDL1, Sf 60-400) were the same in the control and FH groups, indicating that this component of the VLDL delipidation cascade ws unaffected by the absence of receptors. In contrast, familial hypercholesterolemic small VLDL2 (Sf 20-60) was enriched with cholesterol and depleted in triglyceride. Moreover, its plasma concentration was elevated as a result of an increase in its synthesis and a defect in the removal of a remnant population within this density interval. The latter accounted for up to 50% of the total mass of the fraction. Onward transfer of apolipoprotein B (apoB) from small VLDL through intermediate density lipoprotein (IDL) to low density lipoprotein (LDL) was retarded, suggesting that receptors were involved in this supposedly lipase-mediated event. IDL and LDL concentrations increased up to fourfold above normal in the plasma of the FH patients due partly to the delay in maturation and partly to defective direct catabolism. We conclude that the LDL receptor plays multiple and important roles in the metabolism and transformation of apoB-containing particles in the Sf 0-400 flotation interval.

Protein heterogeneity of lipoprotein particles containing apolipoprotein A-I without apolipoprotein A-II and apolipoprotein A-I with apolipoprotein A-II isolated from human plasma

The protein heterogeneity of fractions isolated by immunoaffinity chromatography on anti-apolipoprotein A-I and anti-apolipoprotein A-II affinity columns was analyzed by high resolution two-dimensional gel electrophoresis. The two-dimensional gel electrophoresis profiles of the fractions were analyzed and automatically compared by the computer system MELANIE. Fractions containing apolipoproteins A-I + A-II and only A-I as the major protein components have been isolated from plasma and from high density lipoproteins prepared by ultracentrifugation. Similarities between the profiles of the fractions, as indicated by two-dimensional gel electrophoresis, suggested that those derived from plasma were equivalent to those from high density lipoproteins (HDL), which are particulate in nature. The established apolipoproteins (A-I, A-II, A-IV, C, D, and E) were visible and enriched in fractions from both plasma and HDL. However, plasma-derived fractions showed a much greater degree of protein heterogeneity due largely to enrichment in bands corresponding to six additional proteins. They were present in trace amounts in fractions isolated from HDL and certain of the proteins were visible in two-dimensional gel electrophoresis profiles of the plasma. These proteins are considered to be specifically associated with the immunoaffinity-isolated particles. They have been characterized in terms of Mr and pI. Computer-assisted measurements of protein spot-staining intensities suggest an asymmetric distribution of the proteins (as well as the established apolipoproteins), with four showing greater prominence in particles containing apolipoprotein A-I but no apolipoprotein A-II.

The influence of metabolic control on very low density lipoprotein composition in hypertriglyceridemic type II diabetics. A study using heparin-sepharose chromatography

The composition and heparin-binding capacity of very low density lipoproteins (VLDL) from type II diabetics prone to develop secondary hypertriglyceridemia have been examined. Twelve diabetic patients whose triglyceride levels normalized during short-term treatment for hyperglycemia were studied. Normalization of triglyceride values reduced plasma levels of VLDL without modifying its relative lipid composition. There was, however, an increase in its relative apoprotein (apo) content, to which apo B made a greater percentage contribution. The calculated average particle diameter of posttreatment VLDL was reduced. The fraction of VLDL binding to heparin increased after treatment. Binding was strongly correlated to the apo B content and, to a lesser extent, to the apo E content. The data suggest that treatment of hyperglycemia favorably modified VLDL such that they more closely resemble VLDL from normolipidemic subjects, with potentially beneficial physiological consequences.

Low density lipoprotein causes general cellular activation with increased phosphatidylinositol turnover and lipoprotein catabolism

Low density lipoprotein (LDL), at concentrations high enough for receptor binding but not high enough to saturate the receptor, induces activation of phosphatidylinositol (PtdIns) turnover in a variety of cell types with various biological functions. Using both biochemical and electron microscopic studies, we have shown that blood platelets take up and degrade LDL in a manner reminiscent of phagocytic cell types. The activation of both PtdIns turnover and LDL metabolism is inhibited by high density lipoprotein. Thus, LDL at hormonal concentrations causes general cellular activation. Since all cell types studied responded to LDL with increased PtdIns turnover and uptake of LDL cholesterol, the PtdIns cycle may also be involved in the cellular regulation of LDL cholesterol metabolism.

High density lipoprotein (HDL) subfractions in cardiovascular patients with low levels of HDL-cholesterol. Influence of hypertriglyceridaemia on subfraction concentration and composition

The major high density lipoprotein (HDL) subfractions were examined in angiographically defined cardiovascular patients with low HDL-cholesterol (HDL-C) levels. The aims were to study subfraction concentration and composition, and the extent to which hypertriglyceridaemia (HTG) modified these variables. Normotriglyceridaemic (NTG)-low HDL-C patients showed similar subfraction composition to age-matched healthy controls. However, these groups showed notable differences in subfraction composition compared to HTG-low HDL-C patients, particularly with regard to the HDL2 subfraction. HDL subfraction mass was significantly reduced in both cardiovascular groups; the HTG group showed a greater reduction in HDL2, whilst the NTG group showed a greater reduction in HDL3. The major HDL apoprotein (apo A-I) was lower in both subfractions of the cardiovascular patients. Apo A-II showed significant reductions only in the HTG patients.

[Apoprotein E (apo E) phenotype and serum lipids in diabetics]

Apo E isoforms have been determined among diabetics. The allele distribution epsilon 2, epsilon 3 and epsilon 4 does not differ from the control population. Diabetics with epsilon 2 allele have increased serum triglycerides compared to diabetics with epsilon 3 and epsilon 4 alleles. In diabetics with E2/2 phenotype both serum cholesterol and serum triglycerides are elevated. The phenotype of apoprotein E does influence serum lipids in diabetics.

Interference of dimethyl alpha-(dimethoxyphosphinyl) p-chlorobenzyl phosphate (SR-202) in thyroid hormone metabolism: evidence of inhibition of monodeiodination

SR-202 is a non-iodinated potential lipid-altering agent. When administered (100 mg) three times per day for 3 days to six euthyroid subjects it was associated with a 30 +/- 3% (mean +/- S.E.M.) fall in 3,3',5-triiodothyronine (T3) (P less than 0.001), a reciprocal 104 +/- 14% rise in 3,3',5'-tri-iodothyronine (reverse T3, rT3) (P less than 0.01), and a 37 +/- 7% rise in thyroxine (T4) (P less than 0.001). Basal and TRH-stimulated TSH did not change. These results suggested that SR-202 was acting as an inhibitor of the peripheral monodeiodination of T4 to T3. During a second study the same subjects received the same dose of SR-202 for a further 3 days following 15 days of progressive substitutive treatment with L-T4, which they continued to take at 200 micrograms/day until the end of the study. Despite higher levels of thyroid hormones in the substituted subjects, similar results were observed, serum T3 falling by 40 +/- 2% (P less than 0.001), serum rT3 and T4 rising by 168 +/- 24% (P less than 0.01) and 37 +/- 9% (P less than 0.01) respectively. These changes provide compelling evidence that SR-202 is an inhibitor of the peripheral conversion of T4 to T3 that acts on thyroid hormone metabolism without provoking a counter-regulatory pituitary response. It might prove to be a useful tool for the clinical investigation of thyroid function.

Apoprotein D in a healthy, male population and in male myocardial infarction patients and their male, first-degree relatives

This report examines the correlation of serum apoprotein D with other lipoprotein lipids and apoproteins in a healthy, male population and compares the levels of high density lipoprotein apoprotein D of this control population with 2 samples composed of male, acute myocardial infarction patients and their healthy, male, first-degree relatives. Highly significant correlations were observed with very low density lipoprotein lipids (negative), high density lipoprotein lipids (positive) and serum triglycerides (negative). Serum and low density lipoprotein apoprotein B was not correlated with serum apoprotein D, whereas apoprotein A-I from serum and high density lipoproteins was strongly correlated with apoprotein D. A significant reduction in high density lipoprotein apoprotein D was observed in male, myocardial infarction patients. Their male, first-degree relatives also had lower apoprotein D levels, but the difference was not significant.

HDL cholesterol levels in patients with myocardial infarction and their families

The present study using a quartile distribution of myocardial infarction patients demonstrated that the first-degree relatives of the myocardial infarction patients with the lowest HDL cholesterol have similarly the lowest HDL cholesterol. Low HDL cholesterol among these relatives was not secondary to increased VLDL triglycerides, as it persisted when subjects with hyper VLDL triglycerides were excluded. Familial low HDL cholesterol could not be attributed to known environmental factors as their levels did not differ significantly between the groups compaired. There was a significant correlation between HDL cholesterol levels of the parents and that of their younger offspring. The correlation was not significant with the offspring aged 20 and over. It appeared that there was a familial trend in low HDL cholesterol levels, more apparent among the young offspring than among the adult offspring, who may possibly not share any more the parental environment for factors liable to influence HDL cholesterol. This finding is compatible with a hereditary trait.

[Relation between HDL cholesterol and fasting glycemia in a normal population and a diabetic group]

An inverse relationship exists between the levels of HDL-cholesterol and fasting blood sugar in a control population (active men, n = 522) and a group of diabetics. The diabetics also have reduced apoprotein A-I levels (98.7 +/- 21.0 U/l) in comparison with normoglycemic controls (115.0 +/- 8.3 U/l). Given the role that the HDL fraction has been suggested to exercise in the development of atherosclerosis, the inverse relationship described above could be involved in determining the extent of cardiovascular disease in diabetics.