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Wynn CS, Catallozzi M, Kolff CA, Holleran S, Meyer D, Ramakrishnan R, Stockwell MS. Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial. JMIR Mhealth Uhealth 2021; 9:e26356. [PMID: 34958306 PMCID: PMC8749571 DOI: 10.2196/26356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/09/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273
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Affiliation(s)
- Chelsea S Wynn
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Marina Catallozzi
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States
| | - Chelsea A Kolff
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Stephen Holleran
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Dodi Meyer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States
| | - Rajasekhar Ramakrishnan
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States.,Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States
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Stephens AB, Wynn CS, Hofstetter AM, Kolff C, Pena O, Kahn E, Dasgupta B, Natarajan K, Vawdrey DK, Lane MM, Robbins-Milne L, Ramakrishnan R, Holleran S, Stockwell MS. Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions. Appl Clin Inform 2021; 12:1101-1109. [PMID: 34911126 DOI: 10.1055/s-0041-1739516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Immunization reminders in electronic health records (EHR) provide clinical decision support (CDS) that can reduce missed immunization opportunities. Little is known about using CDS rules from a regional immunization information system (IIS) to power local EHR immunization reminders. OBJECTIVE This study aimed to assess the impact of EHR reminders using regional IIS CDS-provided rules on receipt of immunizations in a low-income, urban population for both routine immunizations and those recommended for patients with chronic medical conditions (CMCs). METHODS We built an EHR-based immunization reminder using the open-source resource used by the New York City IIS in which we overlaid logic regarding immunizations needed for CMCs. Using a randomized cluster-cross-over pragmatic clinical trial in four academic-affiliated clinics, we compared captured immunization opportunities during patient visits when the reminder was "on" versus "off" for the primary immunization series, school-age boosters, and adolescents. We also assessed coverage of CMC-specific immunizations. Up-to-date immunization was measured by end of quarter. Rates were compared using chi square tests. RESULTS Overall, 15,343 unique patients were seen for 26,647 visits. The alert significantly impacted captured opportunities to complete the primary series in both well-child and acute care visits (57.6% on vs. 54.3% off, p = 0.001, and 15.3% on vs. 10.1% off, p = 0.02, respectively), among most age groups, and several immunization types. Captured opportunities for CMC-specific immunizations remained low regardless of alert status. The alert did not have an effect on up-to-date immunization overall (89.1 vs. 88.3%). CONCLUSION CDS in this population improved captured immunization opportunities. Baseline high rates may have blunted an up-to-date population effect. Converting Centers for Disease Control and Prevention (CDC) rules to generate sufficiently sensitive and specific alerts for CMC-specific immunizations proved challenging, and the alert did not have an impact on CMC-specific immunizations, potentially highlighting need for more work in this area.
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Affiliation(s)
- Ashley B Stephens
- Department of Pediatrics and NewYork-Presbyterian Hospital, Columbia University Irving Medical Center New York, New York, United States
| | - Chelsea S Wynn
- Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
| | - Annika M Hofstetter
- Department of Pediatrics, University of Washington, Seattle, Washington, United States.,Seattle Children's Research Institute, University of Washington, Seattle, Washington, United States
| | - Chelsea Kolff
- Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
| | - Oscar Pena
- NewYork-Presbyterian Hospital New York, New York, United States
| | - Eric Kahn
- NewYork-Presbyterian Hospital New York, New York, United States
| | - Balendu Dasgupta
- Department of Biomedical Informatics, Columbia University Irving Medical Center New York, New York, United States
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center New York, New York, United States
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University Irving Medical Center New York, New York, United States.,Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania, United States
| | - Mariellen M Lane
- Department of Pediatrics and NewYork-Presbyterian Hospital, Columbia University Irving Medical Center New York, New York, United States
| | - Laura Robbins-Milne
- Department of Pediatrics and NewYork-Presbyterian Hospital, Columbia University Irving Medical Center New York, New York, United States
| | - Rajasekhar Ramakrishnan
- Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
| | - Stephen Holleran
- Department of Pediatrics, Columbia University Irving Medical Center New York, New York, United States
| | - Melissa S Stockwell
- Departments of Pediatrics and Population and Family Health, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital New York, New York, United States
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Reyes-Soffer G, Sztalryd C, Horenstein RB, Holleran S, Matveyenko A, Thomas T, Nandakumar R, Ngai C, Karmally W, Ginsberg HN, Ramakrishnan R, Pollin TI. Effects of APOC3 Heterozygous Deficiency on Plasma Lipid and Lipoprotein Metabolism. Arterioscler Thromb Vasc Biol 2019; 39:63-72. [PMID: 30580564 DOI: 10.1161/atvbaha.118.311476] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective- Apo (apolipoprotein) CIII inhibits lipoprotein lipase (LpL)-mediated lipolysis of VLDL (very-low-density lipoprotein) triglyceride (TG) and decreases hepatic uptake of VLDL remnants. The discovery that 5% of Lancaster Old Order Amish are heterozygous for the APOC3 R19X null mutation provided the opportunity to determine the effects of a naturally occurring reduction in apo CIII levels on the metabolism of atherogenic containing lipoproteins. Approach and Results- We conducted stable isotope studies of VLDL-TG and apoB100 in 5 individuals heterozygous for the null mutation APOC3 R19X (CT) and their unaffected (CC) siblings. Fractional clearance rates and production rates of VLDL-TG and apoB100 in VLDL, IDL (intermediate-density lipoprotein), LDL, apo CIII, and apo CII were determined. Affected (CT) individuals had 49% reduction in plasma apo CIII levels compared with CCs ( P<0.01) and reduced plasma levels of TG (35%, P<0.02), VLDL-TG (45%, P<0.02), and VLDL-apoB100 (36%, P<0.05). These changes were because of higher fractional clearance rates of VLDL-TG and VLDL-apoB100 with no differences in production rates. CTs had higher rates of the conversion of VLDL remnants to LDL compared with CCs. In contrast, rates of direct removal of VLDL remnants did not differ between the groups. As a result, the flux of apoB100 from VLDL to LDL was not reduced, and the plasma levels of LDL-cholesterol and LDL-apoB100 were not lower in the CT group. Apo CIII production rate was lower in CTs compared with CCs, whereas apo CII production rate was not different between the 2 groups. The fractional clearance rates of both apo CIII and apo CII were higher in CTs than CCs. Conclusions- These studies demonstrate that 50% reductions in plasma apo CIII, in otherwise healthy subjects, results in a significantly higher rate of conversion of VLDL to LDL, with little effect on direct hepatic uptake of VLDL. When put in the context of studies demonstrating significant protection from cardiovascular events in individuals with loss of function variants in the APOC3 gene, our results provide strong evidence that therapies which increase the efficiency of conversion of VLDL to LDL, thereby reducing remnant concentrations, should reduce the risk of cardiovascular disease.
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Affiliation(s)
- Gissette Reyes-Soffer
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Carol Sztalryd
- Maryland School of Medicine, University of Maryland, Baltimore (C.S., R.B.H., T.I.P.)
- Baltimore VA Medical Center, VA Research Service, Geriatric Research, Education and Clinical Center and VA Maryland Health Care System (C.S., T.I.P.)
| | - Richard B Horenstein
- Maryland School of Medicine, University of Maryland, Baltimore (C.S., R.B.H., T.I.P.)
| | - Stephen Holleran
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Anastasiya Matveyenko
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Tiffany Thomas
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Renu Nandakumar
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Colleen Ngai
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Wahida Karmally
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Henry N Ginsberg
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Toni I Pollin
- Maryland School of Medicine, University of Maryland, Baltimore (C.S., R.B.H., T.I.P.)
- Baltimore VA Medical Center, VA Research Service, Geriatric Research, Education and Clinical Center and VA Maryland Health Care System (C.S., T.I.P.)
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Nandakumar R, Matveyenko A, Thomas T, Pavlyha M, Ngai C, Holleran S, Ramakrishnan R, Ginsberg HN, Karmally W, Marcovina SM, Reyes-Soffer G. Effects of mipomersen, an apolipoprotein B100 antisense, on lipoprotein (a) metabolism in healthy subjects. J Lipid Res 2018; 59:2397-2402. [PMID: 30293969 DOI: 10.1194/jlr.p082834] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/25/2018] [Indexed: 01/17/2023] Open
Abstract
Elevated lipoprotein (a) [Lp(a)] levels increase the risk for CVD. Novel treatments that decrease LDL cholesterol (LDL-C) have also shown promise for reducing Lp(a) levels. Mipomersen, an antisense oligonucleotide that inhibits apoB synthesis, is approved for the treatment of homozygous familial hypercholesterolemia. It decreases plasma levels of LDL-C by 25% to 39% and lowers levels of Lp(a) by 21% to 39%. We examined the mechanisms for Lp(a) lowering during mipomersen treatment. We enrolled 14 healthy volunteers who received weekly placebo injections for 3 weeks followed by weekly injections of mipomersen for 7 weeks. Stable isotope kinetic studies were performed using deuterated leucine at the end of the placebo and mipomersen treatment periods. The fractional catabolic rate (FCR) of Lp(a) was determined from the enrichment of a leucine-containing peptide specific to apo(a) by LC/MS. The production rate (PR) of Lp(a) was calculated from the product of Lp(a) FCR and Lp(a) concentration (converted to pool size). In a diverse population, mipomersen reduced plasma Lp(a) levels by 21%. In the overall study group, mipomersen treatment resulted in a 27% increase in the FCR of Lp(a) with no significant change in PR. However, there was heterogeneity in the response to mipomersen therapy, and changes in both FCRs and PRs affected the degree of change in Lp(a) concentrations. Mipomersen treatment decreases Lp(a) plasma levels mainly by increasing the FCR of Lp(a), although changes in Lp(a) PR were significant predictors of reductions in Lp(a) levels in some subjects.
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Affiliation(s)
- Renu Nandakumar
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Tiffany Thomas
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Marianna Pavlyha
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Colleen Ngai
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Stephen Holleran
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Henry N Ginsberg
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Wahida Karmally
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Santica M Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
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Thomas T, Zhou H, Karmally W, Ramakrishnan R, Holleran S, Liu Y, Jumes P, Wagner JA, Hubbard B, Previs SF, Roddy T, Johnson-Levonas AO, Gutstein DE, Marcovina SM, Rader DJ, Ginsberg HN, Millar JS, Reyes-Soffer G. CETP (Cholesteryl Ester Transfer Protein) Inhibition With Anacetrapib Decreases Production of Lipoprotein(a) in Mildly Hypercholesterolemic Subjects. Arterioscler Thromb Vasc Biol 2017; 37:1770-1775. [PMID: 28729361 PMCID: PMC5567403 DOI: 10.1161/atvbaha.117.309549] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 04/18/2017] [Accepted: 07/04/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Lp(a) [lipoprotein (a)] is composed of apoB (apolipoprotein B) and apo(a) [apolipoprotein (a)] and is an independent risk factor for cardiovascular disease and aortic stenosis. In clinical trials, anacetrapib, a CETP (cholesteryl ester transfer protein) inhibitor, causes significant reductions in plasma Lp(a) levels. We conducted an exploratory study to examine the mechanism for Lp(a) lowering by anacetrapib. APPROACH AND RESULTS We enrolled 39 participants in a fixed-sequence, double-blind study of the effects of anacetrapib on the metabolism of apoB and high-density lipoproteins. Twenty-nine patients were randomized to atorvastatin 20 mg/d, plus placebo for 4 weeks, and then atorvastatin plus anacetrapib (100 mg/d) for 8 weeks. The other 10 subjects were randomized to double placebo for 4 weeks followed by placebo plus anacetrapib for 8 weeks. We examined the mechanisms of Lp(a) lowering in a subset of 12 subjects having both Lp(a) levels >20 nmol/L and more than a 15% reduction in Lp(a) by the end of anacetrapib treatment. We performed stable isotope kinetic studies using 2H3-leucine at the end of each treatment to measure apo(a) fractional catabolic rate and production rate. Median baseline Lp(a) levels were 21.5 nmol/L (interquartile range, 9.9-108.1 nmol/L) in the complete cohort (39 subjects) and 52.9 nmol/L (interquartile range, 38.4-121.3 nmol/L) in the subset selected for kinetic studies. Anacetrapib treatment lowered Lp(a) by 34.1% (P≤0.001) and 39.6% in the complete and subset cohort, respectively. The decreases in Lp(a) levels were because of a 41% reduction in the apo(a) production rate, with no effects on apo(a) fractional catabolic rate. CONCLUSIONS Anacetrapib reduces Lp(a) levels by decreasing its production. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00990808.
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Affiliation(s)
- Tiffany Thomas
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Haihong Zhou
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Wahida Karmally
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Stephen Holleran
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Yang Liu
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Patricia Jumes
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - John A Wagner
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Brian Hubbard
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Stephen F Previs
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Thomas Roddy
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Amy O Johnson-Levonas
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - David E Gutstein
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Santica M Marcovina
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Daniel J Rader
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Henry N Ginsberg
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - John S Millar
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Gissette Reyes-Soffer
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.).
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Khavandi M, Holleran S, Ramakrishnan S, Lovato A, Ginsberg H. Lipidomic and Proteomic Predictors of Drastic Reductions of HDL in the ACCORD Lipid Trial. J Clin Lipidol 2017. [DOI: 10.1016/j.jacl.2017.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Millar JS, Lassman ME, Thomas T, Ramakrishnan R, Jumes P, Dunbar RL, deGoma EM, Baer AL, Karmally W, Donovan DS, Rafeek H, Wagner JA, Holleran S, Obunike J, Liu Y, Aoujil S, Standiford T, Gutstein DE, Ginsberg HN, Rader DJ, Reyes-Soffer G. Effects of CETP inhibition with anacetrapib on metabolism of VLDL-TG and plasma apolipoproteins C-II, C-III, and E. J Lipid Res 2017; 58:1214-1220. [PMID: 28314859 PMCID: PMC5454510 DOI: 10.1194/jlr.m074880] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/16/2017] [Indexed: 01/30/2023] Open
Abstract
Cholesteryl ester transfer protein (CETP) mediates the transfer of HDL cholesteryl esters for triglyceride (TG) in VLDL/LDL. CETP inhibition, with anacetrapib, increases HDL-cholesterol, reduces LDL-cholesterol, and lowers TG levels. This study describes the mechanisms responsible for TG lowering by examining the kinetics of VLDL-TG, apoC-II, apoC-III, and apoE. Mildly hypercholesterolemic subjects were randomized to either placebo (N = 10) or atorvastatin 20 mg/qd (N = 29) for 4 weeks (period 1) followed by 8 weeks of anacetrapib, 100 mg/qd (period 2). Following each period, subjects underwent stable isotope metabolic studies to determine the fractional catabolic rates (FCRs) and production rates (PRs) of VLDL-TG and plasma apoC-II, apoC-III, and apoE. Anacetrapib reduced the VLDL-TG pool on a statin background due to an increased VLDL-TG FCR (29%; P = 0.002). Despite an increased VLDL-TG FCR following anacetrapib monotherapy (41%; P = 0.11), the VLDL-TG pool was unchanged due to an increase in the VLDL-TG PR (39%; P = 0.014). apoC-II, apoC-III, and apoE pool sizes increased following anacetrapib; however, the mechanisms responsible for these changes differed by treatment group. Anacetrapib increased the VLDL-TG FCR by enhancing the lipolytic potential of VLDL, which lowered the VLDL-TG pool on atorvastatin background. There was no change in the VLDL-TG pool in subjects treated with anacetrapib monotherapy due to an accompanying increase in the VLDL-TG PR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Joseph Obunike
- New York City College of Technology, CUNY, Brooklyn, NY 11201
| | - Yang Liu
- Merck & Co., Inc., Kenilworth, NJ 07033
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8
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Reyes-Soffer G, Pavlyha M, Ngai C, Thomas T, Holleran S, Ramakrishnan R, Karmally W, Nandakumar R, Fontanez N, Obunike J, Marcovina SM, Lichtenstein AH, Matthan NR, Matta J, Maroccia M, Becue F, Poitiers F, Swanson B, Cowan L, Sasiela WJ, Surks HK, Ginsberg HN. Effects of PCSK9 Inhibition With Alirocumab on Lipoprotein Metabolism in Healthy Humans. Circulation 2016; 135:352-362. [PMID: 27986651 PMCID: PMC5262523 DOI: 10.1161/circulationaha.116.025253] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/07/2016] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Alirocumab, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), lowers plasma low-density lipoprotein (LDL) cholesterol and apolipoprotein B100 (apoB). Although studies in mice and cells have identified increased hepatic LDL receptors as the basis for LDL lowering by PCSK9 inhibitors, there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism. In particular, it is not known whether inhibition of PCSK9 has any effects on very low-density lipoprotein or intermediate-density lipoprotein (IDL) metabolism. Inhibition of PCSK9 also results in reductions of plasma lipoprotein (a) levels. The regulation of plasma Lp(a) levels, including the role of LDL receptors in the clearance of Lp(a), is poorly defined, and no mechanistic studies of the Lp(a) lowering by alirocumab in humans have been published to date. Methods: Eighteen (10 F, 8 mol/L) participants completed a placebo-controlled, 2-period study. They received 2 doses of placebo, 2 weeks apart, followed by 5 doses of 150 mg of alirocumab, 2 weeks apart. At the end of each period, fractional clearance rates (FCRs) and production rates (PRs) of apoB and apo(a) were determined. In 10 participants, postprandial triglycerides and apoB48 levels were measured. Results: Alirocumab reduced ultracentrifugally isolated LDL-C by 55.1%, LDL-apoB by 56.3%, and plasma Lp(a) by 18.7%. The fall in LDL-apoB was caused by an 80.4% increase in LDL-apoB FCR and a 23.9% reduction in LDL-apoB PR. The latter was due to a 46.1% increase in IDL-apoB FCR coupled with a 27.2% decrease in conversion of IDL to LDL. The FCR of apo(a) tended to increase (24.6%) without any change in apo(a) PR. Alirocumab had no effects on FCRs or PRs of very low-density lipoproteins-apoB and very low-density lipoproteins triglycerides or on postprandial plasma triglycerides or apoB48 concentrations. Conclusions: Alirocumab decreased LDL-C and LDL-apoB by increasing IDL- and LDL-apoB FCRs and decreasing LDL-apoB PR. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition. The increase in apo(a) FCR during alirocumab treatment suggests that increased LDL receptors may also play a role in the reduction of plasma Lp(a). Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01959971.
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Affiliation(s)
- Gissette Reyes-Soffer
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.).
| | - Marianna Pavlyha
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Colleen Ngai
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Tiffany Thomas
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Stephen Holleran
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Rajasekhar Ramakrishnan
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Wahida Karmally
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Renu Nandakumar
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Nelson Fontanez
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Joseph Obunike
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Santica M Marcovina
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Alice H Lichtenstein
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Nirupa R Matthan
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - James Matta
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Magali Maroccia
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Frederic Becue
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Franck Poitiers
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Brian Swanson
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Lisa Cowan
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - William J Sasiela
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Howard K Surks
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Henry N Ginsberg
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.).
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Reyes-Soffer G, Moon B, Hernandez-Ono A, Dionizovik-Dimanovski M, Dionizovick-Dimanovski M, Jimenez J, Obunike J, Thomas T, Ngai C, Fontanez N, Donovan DS, Karmally W, Holleran S, Ramakrishnan R, Mittleman RS, Ginsberg HN. Complex effects of inhibiting hepatic apolipoprotein B100 synthesis in humans. Sci Transl Med 2016; 8:323ra12. [PMID: 26819195 DOI: 10.1126/scitranslmed.aad2195] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mipomersen is a 20mer antisense oligonucleotide (ASO) that inhibits apolipoprotein B (apoB) synthesis; its low-density lipoprotein (LDL)-lowering effects should therefore result from reduced secretion of very-low-density lipoprotein (VLDL). We enrolled 17 healthy volunteers who received placebo injections weekly for 3 weeks followed by mipomersen weekly for 7 to 9 weeks. Stable isotopes were used after each treatment to determine fractional catabolic rates and production rates of apoB in VLDL, IDL (intermediate-density lipoprotein), and LDL, and of triglycerides in VLDL. Mipomersen significantly reduced apoB in VLDL, IDL, and LDL, which was associated with increases in fractional catabolic rates of VLDL and LDL apoB and reductions in production rates of IDL and LDL apoB. Unexpectedly, the production rates of VLDL apoB and VLDL triglycerides were unaffected. Small interfering RNA-mediated knockdown of apoB expression in human liver cells demonstrated preservation of apoB secretion across a range of apoB synthesis. Titrated ASO knockdown of apoB mRNA in chow-fed mice preserved both apoB and triglyceride secretion. In contrast, titrated ASO knockdown of apoB mRNA in high-fat-fed mice resulted in stepwise reductions in both apoB and triglyceride secretion. Mipomersen lowered all apoB lipoproteins without reducing the production rate of either VLDL apoB or triglyceride. Our human data are consistent with long-standing models of posttranscriptional and posttranslational regulation of apoB secretion and are supported by in vitro and in vivo experiments. Targeting apoB synthesis may lower levels of apoB lipoproteins without necessarily reducing VLDL secretion, thereby lowering the risk of steatosis associated with this therapeutic strategy.
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Affiliation(s)
- Gissette Reyes-Soffer
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
| | - Byoung Moon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Antonio Hernandez-Ono
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | | | | | - Jhonsua Jimenez
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Joseph Obunike
- Biological Sciences Department, New York City College of Technology, 300 Jay Street, Brooklyn, NY 11201, USA
| | - Tiffany Thomas
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Colleen Ngai
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Nelson Fontanez
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Daniel S Donovan
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Wahida Karmally
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Stephen Holleran
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Rajasekhar Ramakrishnan
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | | | - Henry N Ginsberg
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
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Teplow-Phipps RL, Papadouka V, Benkel DH, Holleran S, Ramakrishnan R, Rosenthal SL, Soren K, Stockwell MS. Influence of Gender and Gender-Specific Recommendations on Adolescent Human Papillomavirus Vaccination. Am J Prev Med 2016; 51:161-169. [PMID: 27032464 DOI: 10.1016/j.amepre.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The human papillomavirus (HPV) vaccine was introduced for female adolescents prior to male adolescents. Understanding coverage patterns related to gender-specific recommendations and factors associated with early adoption and timely completion may be important for future vaccines. METHODS Retrospective analysis of HPV vaccine initiation (one or more dose) and completion (three or more doses) patterns in adolescents aged 11-18 years using 2009-2013 New York Citywide Immunization Registry data. Log binomial models assessed patient-specific (age, insurance) and practice-specific (facility type, number of adolescents, poverty level) variables on early adoption (within 1 year of recommendation) and timely completion (within 12 months) by gender. RESULTS Of 1,494,767 adolescents, 50.2% were male, 57.5% were vaccinated in private practices, 58.7% in practices with more adolescents, and 48.8% in highest poverty locations. More female (54.0%) than male (33.5%) adolescents initiated vaccination (p<0.001). Of those, 56.1% received three or more doses, 34.1% within 12 months (30.0% male, 36.8% female, p<0.001). In 2009-2012, the proportion of still-eligible male adolescents who newly initiated increased from 0.1% to 17.0%; rates for female adolescents increased from 15.4% to 17.3%. Vaccination initiation within 1 year of gender-specific recommendations was similar (27.4% female, 27.3% male). For both genders, the uninsured were less likely to have early adoption and timely completion. Being publicly insured was associated with early adoption in both genders, but with timely completion in male adolescents only. Being seen in a public facility and in a practice with more adolescents was also associated with early adoption. CONCLUSIONS Changing HPV vaccine recommendations had minimal cross-gender impact. Early adoption and timely completion patterns were mostly similar across genders.
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Affiliation(s)
- Randi L Teplow-Phipps
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Vikki Papadouka
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Denise H Benkel
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York, New York
| | - Stephen Holleran
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Rajasekhar Ramakrishnan
- Division of Biomathematics, Department of Pediatrics, Columbia University, New York, New York
| | - Susan L Rosenthal
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Karen Soren
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
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Stockwell MS, Natarajan K, Ramakrishnan R, Holleran S, Forney K, Aponte A, Vawdrey DK. Immunization Data Exchange With Electronic Health Records. Pediatrics 2016; 137:peds.2015-4335. [PMID: 27244856 DOI: 10.1542/peds.2015-4335] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the impact of exchange of immunization information between an immunization information system (IIS) and an electronic health record on up-to-date rates, overimmunization, and immunization record completeness for low-income, urban children and adolescents. METHODS The New York City Department of Health maintains a population-based IIS, the Citywide Immunization Registry (CIR). Five community clinics in New York City implemented direct linkage of immunization data from the CIR to their local electronic health record. We compared immunization status and overimmunization in children and adolescents 19 to 35 month, 7 to 10 year, and 13 to 17 year-olds with provider visits in the 6-month period before data exchange implementation (2009; n = 6452) versus 6-months post-implementation (2010; n = 6124). We also assessed immunization record completeness with and without addition of CIR data for 8548 children and adolescents with visits in 2012-2013. RESULTS Up-to-date status increased from before to after implementation from 75.0% to 81.6% (absolute difference, 6.6%; 95% confidence interval [CI], 5.2% to 8.1%) and was significant for all age groups. The percentage overimmunized decreased from 8.8% to 4.7% (absolute difference, -4.1%; 95% CI, -7.8% to -0.3%) and was significant for adolescents (16.4% vs 1.2%; absolute difference, -15.2%; 95% CI, -26.7 to -3.6). Up-to-date status for those seen in 2012 to 2013 was higher when IIS data were added (74.6% vs 59.5%). CONCLUSIONS This study demonstrates that data exchange can improve child and adolescent immunization status. Development of the technology to support such exchange and continued focus on local, state, and federal policies to support such exchanges are needed.
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Affiliation(s)
- Melissa S Stockwell
- Department of Pediatrics, Department of Population and Family Health, and New York-Presbyterian Hospital, New York, New York; and
| | - Karthik Natarajan
- New York-Presbyterian Hospital, New York, New York; and Department of Biomedical Informatics, Columbia University Medical Center, New York, New York
| | | | | | - Kristen Forney
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Angel Aponte
- New York City Department of Health and Mental Hygiene, New York, New York
| | - David K Vawdrey
- New York-Presbyterian Hospital, New York, New York; and Department of Biomedical Informatics, Columbia University Medical Center, New York, New York
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12
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Millar JS, Reyes-Soffer G, Jumes P, Dunbar RL, deGoma EM, Baer AL, Karmally W, Donovan DS, Rafeek H, Pollan L, Tohyama J, Johnson-Levonas AO, Wagner JA, Holleran S, Obunike J, Liu Y, Ramakrishnan R, Lassman ME, Gutstein DE, Ginsberg HN, Rader DJ. Anacetrapib lowers LDL by increasing ApoB clearance in mildly hypercholesterolemic subjects. J Clin Invest 2016; 126:1603-4. [PMID: 27035815 DOI: 10.1172/jci87364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Reyes-Soffer G, Millar JS, Ngai C, Jumes P, Coromilas E, Asztalos B, Johnson-Levonas AO, Wagner JA, Donovan DS, Karmally W, Ramakrishnan R, Holleran S, Thomas T, Dunbar RL, deGoma EM, Rafeek H, Baer AL, Liu Y, Lassman ME, Gutstein DE, Rader DJ, Ginsberg HN. Cholesteryl Ester Transfer Protein Inhibition With Anacetrapib Decreases Fractional Clearance Rates of High-Density Lipoprotein Apolipoprotein A-I and Plasma Cholesteryl Ester Transfer Protein. Arterioscler Thromb Vasc Biol 2016; 36:994-1002. [PMID: 26966279 DOI: 10.1161/atvbaha.115.306680] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/22/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Anacetrapib (ANA), an inhibitor of cholesteryl ester transfer protein (CETP) activity, increases plasma concentrations of high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (apoA)-I, apoA-II, and CETP. The mechanisms responsible for these treatment-related increases in apolipoproteins and plasma CETP are unknown. We performed a randomized, placebo (PBO)-controlled, double-blind, fixed-sequence study to examine the effects of ANA on the metabolism of HDL apoA-I and apoA-II and plasma CETP. APPROACH AND RESULTS Twenty-nine participants received atorvastatin (ATV) 20 mg/d plus PBO for 4 weeks, followed by ATV plus ANA 100 mg/d for 8 weeks (ATV-ANA). Ten participants received double PBO for 4 weeks followed by PBO plus ANA for 8 weeks (PBO-ANA). At the end of each treatment, we examined the kinetics of HDL apoA-I, HDL apoA-II, and plasma CETP after D3-leucine administration as well as 2D gel analysis of HDL subspecies. In the combined ATV-ANA and PBO-ANA groups, ANA treatment increased plasma HDL-C (63.0%; P<0.001) and apoA-I levels (29.5%; P<0.001). These increases were associated with reductions in HDL apoA-I fractional clearance rate (18.2%; P=0.002) without changes in production rate. Although the apoA-II levels increased by 12.6% (P<0.001), we could not discern significant changes in either apoA-II fractional clearance rate or production rate. CETP levels increased 102% (P<0.001) on ANA because of a significant reduction in the fractional clearance rate of CETP (57.6%, P<0.001) with no change in CETP production rate. CONCLUSIONS ANA treatment increases HDL apoA-I and CETP levels by decreasing the fractional clearance rate of each protein.
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Affiliation(s)
- Gissette Reyes-Soffer
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - John S Millar
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Colleen Ngai
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Patricia Jumes
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Ellie Coromilas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Bela Asztalos
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Amy O Johnson-Levonas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - John A Wagner
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Daniel S Donovan
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Wahida Karmally
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Stephen Holleran
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Tiffany Thomas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Richard L Dunbar
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Emil M deGoma
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Hashmi Rafeek
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Amanda L Baer
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Yang Liu
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Michael E Lassman
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - David E Gutstein
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Daniel J Rader
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Henry N Ginsberg
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
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14
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Millar JS, Reyes-Soffer G, Jumes P, Dunbar RL, deGoma EM, Baer AL, Karmally W, Donovan DS, Rafeek H, Pollan L, Tohyama J, Johnson-Levonas AO, Wagner JA, Holleran S, Obunike J, Liu Y, Ramakrishnan R, Lassman ME, Gutstein DE, Ginsberg HN, Rader DJ. Anacetrapib lowers LDL by increasing ApoB clearance in mildly hypercholesterolemic subjects. J Clin Invest 2015; 125:2510-22. [PMID: 25961461 DOI: 10.1172/jci80025] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/13/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals treated with the cholesteryl ester transfer protein (CETP) inhibitor anacetrapib exhibit a reduction in both LDL cholesterol and apolipoprotein B (ApoB) in response to monotherapy or combination therapy with a statin. It is not clear how anacetrapib exerts these effects; therefore, the goal of this study was to determine the kinetic mechanism responsible for the reduction in LDL and ApoB in response to anacetrapib. METHODS We performed a trial of the effects of anacetrapib on ApoB kinetics. Mildly hypercholesterolemic subjects were randomized to background treatment of either placebo (n = 10) or 20 mg atorvastatin (ATV) (n = 29) for 4 weeks. All subjects then added 100 mg anacetrapib to background treatment for 8 weeks. Following each study period, subjects underwent a metabolic study to determine the LDL-ApoB-100 and proprotein convertase subtilisin/kexin type 9 (PCSK9) production rate (PR) and fractional catabolic rate (FCR). RESULTS Anacetrapib markedly reduced the LDL-ApoB-100 pool size (PS) in both the placebo and ATV groups. These changes in PS resulted from substantial increases in LDL-ApoB-100 FCRs in both groups. Anacetrapib had no effect on LDL-ApoB-100 PRs in either treatment group. Moreover, there were no changes in the PCSK9 PS, FCR, or PR in either group. Anacetrapib treatment was associated with considerable increases in the LDL triglyceride/cholesterol ratio and LDL size by NMR. CONCLUSION These data indicate that anacetrapib, given alone or in combination with a statin, reduces LDL-ApoB-100 levels by increasing the rate of ApoB-100 fractional clearance. TRIAL REGISTRATION ClinicalTrials.gov NCT00990808. FUNDING Merck & Co. Inc., Kenilworth, New Jersey, USA. Additional support for instrumentation was obtained from the National Center for Advancing Translational Sciences (UL1TR000003 and UL1TR000040).
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15
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Hofstetter AM, Vargas CY, Camargo S, Holleran S, Vawdrey DK, Kharbanda EO, Stockwell MS. Impacting delayed pediatric influenza vaccination: a randomized controlled trial of text message reminders. Am J Prev Med 2015; 48:392-401. [PMID: 25812465 DOI: 10.1016/j.amepre.2014.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/21/2014] [Accepted: 10/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Influenza vaccination coverage is low, especially among low-income populations. Most doses are generally administered early in the influenza season, yet sustained vaccination efforts are crucial for achieving optimal coverage. The impact of text message influenza vaccination reminders was recently demonstrated in a low-income population. Little is known about their effect on children with delayed influenza vaccination or the most effective message type. PURPOSE To determine the impact of educational plus interactive text message reminders on influenza vaccination of urban low-income children unvaccinated by late fall. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Parents of 5,462 children aged 6 months-17 years from four academically affiliated pediatric clinics who were unvaccinated by mid-November 2011. INTERVENTION Eligible parents were stratified by their child's age and pediatric clinic site and randomized using a 1:1:1 allocation to educational plus interactive text message reminders, educational-only text message reminders, or usual care. Using an immunization registry-linked text messaging system, parents of intervention children received up to seven weekly text message reminders. One of the messages sent to parents in the educational plus interactive text message arm allowed selection of more information about influenza and influenza vaccination. MAIN OUTCOME MEASURES Influenza vaccination by March 31, 2012. Data were collected and analyzed between 2012 and 2014. RESULTS Most children were publicly insured and Spanish speaking. Baseline demographics were similar between groups. More children of parents in the educational plus interactive text message arm were vaccinated (38.5%) versus those in the educational-only text message (35.3%; difference=3.3%, 95% CI=0.02%, 6.5%; relative risk ratio (RRR)=1.09, 95% CI=1.002, 1.19) and usual care (34.8%; difference=3.8%, 95% CI=0.6%, 7.0%; RRR=1.11, 95% CI=1.02-1.21) arms. CONCLUSIONS Text message reminders with embedded educational information and options for interactivity have a small positive effect on influenza vaccination of urban, low-income, minority children who remain unvaccinated by late fall.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics, Columbia University; NewYork-Presbyterian Hospital, New York, New York
| | | | | | | | - David K Vawdrey
- Department of Biomedical Informatics, Mailman School of Public Health, Columbia University
| | | | - Melissa S Stockwell
- Department of Pediatrics, Columbia University; Department of Population and Family Health, Mailman School of Public Health, Columbia University; NewYork-Presbyterian Hospital, New York, New York.
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Stockwell MS, Catallozzi M, Camargo S, Ramakrishnan R, Holleran S, Findley SE, Kukafka R, Hofstetter AM, Fernandez N, Vawdrey DK. Registry-linked electronic influenza vaccine provider reminders: a cluster-crossover trial. Pediatrics 2015; 135:e75-82. [PMID: 25548331 DOI: 10.1542/peds.2014-2616] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the impact of a vaccination reminder in an electronic health record supplemented with data from an immunization information system (IIS). METHODS A noninterruptive influenza vaccination reminder, based on a real-time query of hospital and city IIS, was used at 4 urban, academically affiliated clinics serving a low-income population. Using a randomized cluster-crossover design, each study site had "on" and "off" period during the fall and winter of 2011-2012. Influenza vaccination during a clinic visit was assessed for 6-month to 17-year-old patients. To assess sustainability, the reminder was active at all sites during the 2012-2013 season. RESULTS In the 2011-2012 season, 8481 unique non-up-to-date children had visits. Slightly more non-up-to-date children seen when the reminder was 'on' were vaccinated than when 'off' (76.2% vs 73.8%; P = .027). Effects were seen in the winter (67.9% vs 62.2%; P = .005), not fall (76.8% vs 76.5%). The reminder also increased documentation of the reason for vaccine non-administration (68.1% vs 41.5%; P < .0001). During the 2011-2012 season, the reminder displayed for 8630 unique visits, and clinicians interacted with it in 83.1% of cases where patients required vaccination. During the 2012-2013 season, it displayed for 22 248 unique visits; clinicians interacted with it in 84.8% of cases. CONCLUSIONS An IIS-linked influenza vaccination reminder increased vaccination later in the winter when fewer vaccine doses are usually given. Although the reminder did not require clinicians to interact with it, they frequently did; utilization did not wane over time.
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Affiliation(s)
- Melissa S Stockwell
- Departments of Pediatrics, Population and Family Health, NewYork-Presbyterian Hospital, New York, New York
| | - Marina Catallozzi
- Departments of Pediatrics, Population and Family Health, NewYork-Presbyterian Hospital, New York, New York
| | | | | | | | | | - Rita Kukafka
- Biomedical Informatics, and Sociomedical Sciences, Columbia University, New York, New York; and
| | - Annika M Hofstetter
- Departments of Pediatrics, NewYork-Presbyterian Hospital, New York, New York
| | | | - David K Vawdrey
- NewYork-Presbyterian Hospital, New York, New York Biomedical Informatics, and
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Reyes-Soffer G, Dionizovik M, Jimenez J, Obunike J, Holleran S, Ramakrishnan R, Karmally W, Fontanez N, Thomas T, Donovan D, Morey R, Mittleman R, Chin W, Baker B, Ginsberg HN. Abstract 634: Treatment with Mipomersen Reduces Levels of ApoB-Containing Lipoproteins by Increasing Fractional Removal of VLDL and LDL-apoB Without Reducing VLDL-apob Secretion. Arterioscler Thromb Vasc Biol 2014. [DOI: 10.1161/atvb.34.suppl_1.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Mipomersen (MIPO), a second generation antisense oligonucleotide, targets apoB mRNA, thereby inhibiting apolipoprotein B (apoB) synthesis. In humans, MIPO reduces plasma levels of low density lipoprotein-cholesterol (LDL-C), and plasma triglycerides (TG). We hypothesized that these changes are due to reduced assembly and secretion of very low density lipoproteins (VLDL) and lower production of LDL.
Methods:
Healthy volunteers (HVs) (9M, 8F), mean age 43.5 ± 14.2 yr, completed a single-blind, fixed-sequence, phase I study. They received sc-placebo injections once weekly for 3-wks followed by 200mg sc-MIPO injections once weekly for 7-9 wks. Stable isotope turnover studies were performed after each treatment. Blood samples were collected over 48-hrs to determine fractional catabolic rates (FCRs) and production rates (PRs) of apoB in VLDL, IDL, and LDL, and of TG in VLDL. Rates of de novo lipogenesis (DNL) were also measured.
Results:
MIPO treatment resulted in significant reductions in plasma LDL-C (45%), TG (29%), and apoB (40%). VLDL, IDL, and LDL apoB levels fell by 29%, 25%, and 42%, respectively. These changes were associated with increases in FCRs of VLDL apoB (42%) and LDL apoB (30%), and by reductions in PRs of IDL apoB (15%) and LDL apoB (27%). The PR of VLDL apoB was unaffected. The FCR of VLDL-TG increased 46% without change in PR. DNL did not change.
Conclusion:
In summary, 7 wks of MIPO significantly reduced levels of all apoB-lipoproteins in HVs by increasing the FCRs of VLDL and LDL apoB. The absence of a reduction in VLDL apoB secretion is consistent with many studies in isolated hepatocytes demonstrating both intracellular degradation and secretion of newly synthesized apoB. Thus, if MIPO submaximally inhibited apoB synthesis in this study, the liver could have compensated by increasing the efficiency of VLDL assembly and secretion. The basis of increases in VLDL and LDL FCRs requires further investigation.
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Affiliation(s)
| | | | | | - Joseph Obunike
- Biology/Physiology, New York City College of Technology, New York, NY
| | | | | | - Wahida Karmally
- Irving Institute for Clinical and Translational Rsch, Columbia Univ Med Cntr, New York, NY
| | - Nelson Fontanez
- Preventive Medicine and Nutrition, Columbia Univ Med Cntr, New York, NY
| | | | | | | | | | - Wai Chin
- Biostatistics, Genzyme Corp, Cambridge, MA
| | - Brenda Baker
- Clinical Development, ISIS Pharmaceuticals, Carlsbad, CA
| | - Henry N Ginsberg
- Preventive Medicine and Nutrition, Columbia Univ Med Cntr, New York, NY
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Hill AM, Stewart PW, Fung MK, Kris-Etherton PM, Ginsberg HN, Tracy RP, Pearson TA, Lefevre M, Reed RG, Elmer PJ, Holleran S, Ershow AG. Monthly haemostatic factor variability in women and men. Eur J Clin Invest 2014; 44:309-18. [PMID: 24382103 PMCID: PMC4153833 DOI: 10.1111/eci.12235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 12/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hormonal status influences haemostatic factors including fibrinogen, factor VII and plasminogen activator inhibitor (PAI-1), and concentrations differ among men, premenopausal and postmenopausal women. This study examines how phases of the menstrual cycle influence variability of fibrinogen, factor VII and PAI-1. DESIGN We studied 103 subjects (39 premenopausal women, 18 postmenopausal women and 46 men) during three, randomized, 8-week energy- and nutrient-controlled experimental diets in the Dietary Effects on Lipids and Thrombogenic Activity (DELTA) Study. Fasting blood samples were collected weekly during the last 4 weeks of each diet period, and haemostatic factors were quantified. Two linear mixed-effects models were used for fibrinogen, factor VII and PAI-1: one to estimate and compare group-specific components of variance, and the other to estimate additional fixed effects representing cyclical functions of day of menstrual cycle in premenopausal women. RESULTS Systematic cyclical variation with day of menstrual cycle was observed for fibrinogen (P < 0.0001), factor VII (P = 0.0012) and PAI-1 (P = 0.0024) in premenopausal women. However, the amplitude of cycling was small relative to the total magnitude of intra-individual variability. In addition, the intra-individual variance and corresponding coefficient of variation observed in premenopausal women did not differ from postmenopausal women and men. CONCLUSIONS The variability in haemostatic factors in premenopausal women is no greater than for postmenopausal women or men. Consequently, premenopausal women can be included in studies investigating haemostatic factor responses without controlling for stage of menstrual cycle.
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Affiliation(s)
- Alison M Hill
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA; Nutritional Physiology Research Centre, The University of South Australia, Adelaide, Australia
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Reyes-Soffer G, Millar JS, Lassman ME, Jumes P, Wagner JA, Gutstein DE, Ramakrishnan R, Holleran S, Rader DJ. Abstract 120: Effects of Anacetrapib Treatment on CETP Metabolism. Arterioscler Thromb Vasc Biol 2013. [DOI: 10.1161/atvb.33.suppl_1.a120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Cholesteryl ester transfer protein (CETP) is required for the exchange of core lipids, cholesteryl esters and triglycerides (TG), between lipoproteins. This results in net exchanges of TG in very-low-density (VLDL) or low-density lipoproteins (LDL) for cholesteryl esters in high-density lipoproteins (HDL). Treatment with anacetrapib, a CETP inhibitor in phase 3 development, is associated with an increased HDL-C and apo AI, and reduced both LDL-C and triglycerides. There are no published data on the regulation of CETP levels in humans. CETP mass has been reported to increase following CETP inhibition which prompted us to examine CETP kinetics. We developed a novel method using stable isotopes and LC-MS analysis to study the effects of anacetrapib on CETP turnover.
Methods
Thirty-nine moderately hyperlipidemic participants were enrolled in a fixed-sequence study: 75% (N=29) were on atorvastatin (20mg/day) plus placebo for four weeks followed by atorvastatin plus anacetrapib (100 mg/day) for 8 weeks (S-ANA). Twenty-Five percent (N=10) of participants received double placebo for four weeks followed by placebo plus anacetrapib for 8 weeks (P-ANA). At the end of each period, we measured CETP mass, and kinetic studies were performed using D3 leucine to determine the fractional clearance and production rates of CETP.
Results
Eight weeks of anacetrapib treatment was associated with 129% increase in CETP plasma levels and an 18% decrease in CETP activity (RFU/sec) in both groups. The increase in CETP mass was associated with a significant reduction in the fractional clearance of CETP from plasma (0.48 vs. 0.23 pools/day) p <.001. The decrease in fractional clearance of CETP was similar in Panel A and Panel B (Panel A 57%, Panel B 55%). There were no significant changes in the production rate of CETP.
Conclusions
Using a novel method, we demonstrated significant effects of CETP inhibition with anacetrapib on the metabolism of CETP in plasma.
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Affiliation(s)
| | - John S Millar
- Div of Translational Medicine and Human Genetics, Univ of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Stephen Holleran
- Biomathematics Div, Pediatrics, Columbia Univ Med Cntr, New York, NY
| | - Daniel J Rader
- The Div of Translational Medicine and Human Genetics, Univ of Pennsylvania, Philadelphia, PA
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Reyes-Soffer G, Ngai CI, Lovato L, Karmally W, Ramakrishnan R, Holleran S, Ginsberg HN. Effect of combination therapy with fenofibrate and simvastatin on postprandial lipemia in the ACCORD lipid trial. Diabetes Care 2013; 36:422-8. [PMID: 23033246 PMCID: PMC3554305 DOI: 10.2337/dc11-2556] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Action to Control Cardiovascular Risk in Diabetes lipid study (ACCORD Lipid), which compared the effects of simvastatin plus fenofibrate (FENO-S) versus simvastatin plus placebo (PL-S) on cardiovascular disease outcomes, measured only fasting triglyceride (TG) levels. We examined the effects of FENO-S on postprandial (PP) lipid and lipoprotein levels in a subgroup of ACCORD Lipid subjects. RESEARCH DESIGN AND METHODS We studied 139 subjects (mean age of 61 years, 40% female, and 76% Hispanic or black) in ACCORD Lipid, from a total 529 ACCORD Lipid subjects in the Northeast Clinical Network. PP plasma TG, apolipoprotein (apo)B48, and apoCIII were measured over 10 h after an oral fat load. RESULTS The PP TG incremental area under the curve (IAUC) above fasting (median and interquartile range [mg/dL/h]) was 572 (352-907) in the FENO-S group versus 770 (429-1,420) in the PL-S group (P = 0.008). The PP apoB48 IAUC (mean ± SD [μg/mL/h]) was also reduced in the FENO-S versus the PL-S group (23.2 ± 16.3 vs. 35.2 ± 28.6; P = 0.008). Fasting TG levels on the day of study were correlated with PP TG IAUC (r = 0.73 for FENO-S and r = 0.62 for PL-S; each P < 0.001). However, the fibrate effect on PP TG IAUC was a constant percentage across the entire range of fasting TG levels, whereas PP apoB48 IAUC was only reduced when fasting TG levels were increased. CONCLUSIONS FENO-S lowered PP TG similarly in all participants compared with PL-S. However, levels of atherogenic apoB48 particles were reduced only in individuals with increased fasting levels of TG. These results may have implications for interpretation of the overall ACCORD Lipid trial, which suggested benefit from FENO-S only in dyslipidemic individuals.
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21
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Reyes G, Yasunaga K, Rothenstein E, Karmally W, Ramakrishnan R, Holleran S, Ginsberg HN. Effects of a 1,3-diacylglycerol oil-enriched diet on postprandial lipemia in people with insulin resistance. J Lipid Res 2007; 49:670-8. [PMID: 18089891 DOI: 10.1194/jlr.p700019-jlr200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postprandial hypertriglyceridemia is common in individuals with insulin resistance, and diets enriched in 1,3-diacylglycerol (DAG) may reduce postprandial plasma triglycerides (PPTGs). We enrolled 25 insulin-resistant, nondiabetic individuals in a double-blind, randomized crossover trial to test the acute and chronic effects of a DAG-enriched diet on PPTG. Participants received either DAG or triacylglycerol (TAG) oil, in food products, for 5 weeks. Fasting lipids, and two separate postprandial tests, one with DAG oil and one with TAG oil, were performed at the end of each 5 week diet period. We found no acute or chronic effects of DAG oil on PPTG. Thus, neither the DAG oil PPTG (h/mg/dl) on a chronic TAG diet [area under the curve (AUC) = 503 +/- 439] nor the TAG oil PPTG on a chronic DAG diet (AUC = 517 +/- 638) was different from the TAG oil PPTG on a chronic TAG diet (AUC = 565 +/- 362). Five weeks of a DAG-enriched diet had no acute or chronic effects on PPTG in insulin-resistant individuals. We suggest further studies to evaluate the effects of DAG on individuals with low and high TG levels.
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Affiliation(s)
- Gissette Reyes
- Departments of Medicine and Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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22
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Brar P, Kwon GY, Egbuna II, Holleran S, Ramakrishnan R, Bhagat G, Green PHR. Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease. Dig Liver Dis 2007; 39:26-9; discussion 30-2. [PMID: 16982222 DOI: 10.1016/j.dld.2006.07.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 07/10/2006] [Accepted: 07/26/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.
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Affiliation(s)
- P Brar
- Department of Medicine, Pediatrics and Pathology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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23
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Goldberg IJ, Vanni-Reyes T, Ramakrishnan S, Holleran S, Ginsberg HN. Circulating lipoprotein profiles are modulated differently by lipoprotein lipase in obese humans. J Cardiovasc Risk 2000; 7:41-7. [PMID: 10785873 DOI: 10.1177/204748730000700108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several genetic analyses have suggested that lipoprotein lipase (LpL) genotypes causing decreased LpL activity correlate with increased triglyceride concentrations and risk for coronary artery disease. In contrast, in some other studies LpL activity was positively correlated with plasma low-density lipoprotein (LDL) cholesterol concentrations. OBJECTIVE To assess whether these different associations represent physiologic differences in lipoprotein metabolism. METHODS We correlated postheparin lipase activities, postprandial lipemia, and fasting lipoprotein concentrations in obese (BMI > or = 30 kg/m2, n = 26) and non-obese (BMI < or = 30 kg/m2, n = 57) individuals. LpL was measured using specific inhibitory antibodies. RESULTS Surprisingly, LpL activity was significantly correlated with triglyceride area under the curve after a fat load in the non-obese, but not the entire group. Moreover, in non-obese individuals, LpL activity correlated directly (r = 0.40) and hepatic lipase activity correlated inversely (r = -0.32) with high-density lipoprotein (HDL) cholesterol concentrations. These relationships were not found in the obese group, in whom LpL correlated with LDL cholesterol concentrations (r = 0.54). CONCLUSIONS We conclude that postheparin LpL activity relates to different lipoproteins in obese and non-obese individuals. In obesity, greater LpL activity may enhance conversion of very-low-density lipoprotein cholesterol to LDL cholesterol, whereas in non-obese individuals the correlation is with HDL cholesterol. Whether this is due to differences in the source of LpL (muscle or fat), or to other associated alterations in lipoprotein metabolism is unknown. These results may explain the non-uniformity of correlations between LpL and atherogenic lipoproteins in different populations.
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Affiliation(s)
- I J Goldberg
- Department of Medicine, Columbia University, New York, NY 10032, USA.
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24
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Berglund L, Oliver EH, Fontanez N, Holleran S, Matthews K, Roheim PS, Ginsberg HN, Ramakrishnan R, Lefevre M. HDL-subpopulation patterns in response to reductions in dietary total and saturated fat intakes in healthy subjects. Am J Clin Nutr 1999; 70:992-1000. [PMID: 10584043 DOI: 10.1093/ajcn/70.6.992] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little information is available about HDL subpopulations during dietary changes. OBJECTIVE The objective was to investigate the effect of reductions in total and saturated fat intakes on HDL subpopulations. DESIGN Multiracial, young and elderly men and women (n = 103) participating in the double-blind, randomized DELTA (Dietary Effects on Lipoproteins and Thrombogenic Activities) Study consumed 3 different diets, each for 8 wk: an average American diet (AAD: 34.3% total fat,15.0% saturated fat), the American Heart Association Step I diet (28.6% total fat, 9.0% saturated fat), and a diet low in saturated fat (25.3% total fat, 6.1% saturated fat). RESULTS HDL(2)-cholesterol concentrations, by differential precipitation, decreased (P < 0.001) in a stepwise fashion after the reduction of total and saturated fat: 0.58 +/- 0.21, 0.53 +/- 0.19, and 0.48 +/- 0.18 mmol/L with the AAD, Step I, and low-fat diets, respectively. HDL(3) cholesterol decreased (P < 0.01) less: 0.76 +/- 0.13, 0.73 +/- 0.12, and 0.72 +/- 0.11 mmol/L with the AAD, Step I, and low-fat diets, respectively. As measured by nondenaturing gradient gel electrophoresis, the larger-size HDL(2b) subpopulation decreased with the reduction in dietary fat, and a corresponding relative increase was seen for the smaller-sized HDL(3a, 3b), and (3c) subpopulations (P < 0.01). HDL(2)-cholesterol concentrations correlated negatively with serum triacylglycerol concentrations on all 3 diets: r = -0.46, -0.37, and -0.45 with the AAD, Step I, and low-fat diets, respectively (P < 0.0001). A similar negative correlation was seen for HDL(2b), whereas HDL(3a, 3b), and (3c) correlated positively with triacylglycerol concentrations. Diet-induced changes in serum triacylglycerol were negatively correlated with changes in HDL(2) and HDL(2b) cholesterol. CONCLUSIONS A reduction in dietary total and saturated fat decreased both large (HDL(2) and HDL(2b)) and small, dense HDL subpopulations, although decreases in HDL(2) and HDL(2b) were most pronounced.
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Affiliation(s)
- L Berglund
- Department of Medicine and Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Xu Y, Berglund L, Ramakrishnan R, Mayeux R, Ngai C, Holleran S, Tycko B, Leff T, Shachter NS. A common Hpa I RFLP of apolipoprotein C-I increases gene transcription and exhibits an ethnically distinct pattern of linkage disequilibrium with the alleles of apolipoprotein E. J Lipid Res 1999; 40:50-8. [PMID: 9869649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Apolipoprotein (apo) C-I is a constituent of triglyceride-rich lipoproteins (TGRL) that interferes with their hepatic clearance. Functional polymorphism in the apoC-I gene has not been established. We determined that an Hpa I site variably present at -317 relative to the apoC-I gene is produced by a 4-bp CGTT insertion. The apoC-I Hpa I alleles showed an ethnically distinct pattern of linkage disequilibrium with the alleles of the adjacent apoE gene. The frequency of apoC-I Hpa I-positive (H2) with apoE varepsilon2 was 0. 98, without significant ethnic difference. In contrast, the frequency of H2 with apoE epsilon4 was 0.85 in European-Americans but only 0.55 in African-Americans (P < 0.001). The frequency of H2 with apoE epsilon3 was 0.02 in European-Americans and 0.08 in African-Americans (P < 0.001). African-American apoE epsilon3/epsilon3 carriers of apoC-I H2 had 19% lower fasting triglyceride levels than H1 homozygotes (P = 0.03) along with 18% higher HDL-cholesterol levels (P = 0.02). ApoB levels were 21% lower (P = 0.002). H2-allelic reporter-gene constructions showed 50% higher expression in transient transfection studies. We localized the source of this difference in expression to the CGTT insertion itself. Deletion studies of the H1 allele showed a negative transcriptional effect of the polymorphic region. An H1 oligodeoxynucleotide showed specific binding of a hepatoma-cell nuclear protein not evident with an H2 oligodeoxynucleotide. The H2 sequence may decrease the binding of a negatively acting transcription factor, leading to overexpression of apoC-I. This may produce a functional effect on lipoprotein levels but confirmation is needed in other populations.
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Affiliation(s)
- Y Xu
- Division of Preventive Medicine and Nutrition, Department of Medicine, College of Physicians and Surgeons of Columbia University, 630 W. 168th Street, New York, NY 10032, USA
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Talmud PJ, Hall S, Holleran S, Ramakrishnan R, Ginsberg HN, Humphries SE. LPL promoter -93T/G transition influences fasting and postprandial plasma triglycerides response in African-Americans and Hispanics. J Lipid Res 1998; 39:1189-96. [PMID: 9643350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The lipoprotein lipase (LPL) promoter -93T/G transition has previously been reported as having a triglyceride (Tg)-lowering effect, whereas the D9N variant has been shown to have a Tg-raising effect. These two variants were studied in 66 healthy subjects of Hispanic and 42 subjects of African-American origin, who had participated in a study of postprandial lipemia. While the allele frequency of the -93G was significantly different in the Hispanics and African Americans (0.09: 95% CI 0.04-0.13 and 0.28: 95% CI 0.19-0.38; P=0.0001, respectively), the N9 allele frequency was not different (0.06: 95% CI 0.02-0.1 and 0.05: 95% CI 0.002-0.093, respectively). Linkage disequilibrium between the -93T/G and D9N was highly significant in Hispanics (delta=0.67. P=0.0001), compared to delta=0.09 (NS) in African-Americans. In the combined group, compared to individuals with the common genotype (TT/DD; n=71) with fasting plasma Tg of 1.34 (+/-4.5% SEM) mmol/l, carriers of the G/D haplotype (TG/DD + GG/DD; n=25) had significantly lower plasma Tg levels of 1.08 (+/-10% SEM) mmol/l (P < 0.02). After the fat meal, compared to individuals with neither mutation, TT/DD, the effect of the G/D haplotype was to reduce significantly postprandial Tg (P < 0.036). Retinyl palmitate concentration at 5 hrs was significantly lower in G/D carriers than TT/DD individuals (P < 0.05). The lipid-raising effect of the N9 allele in carriers of the -93G (TG/DN + GG/DN) and effect on postprandial Tg clearance was not significant in this group. Thus carriers of the G/D haplotype have lower fasting plasma Tg and reduced alimentary lipemia. This allele may be associated with reduced risk of coronary artery disease.
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Affiliation(s)
- P J Talmud
- Centre for Genetics of Cardiovascular Disorders, University College London Medical School, UK
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Tuck CH, Holleran S, Berglund L. Hormonal regulation of lipoprotein(a) levels: effects of estrogen replacement therapy on lipoprotein(a) and acute phase reactants in postmenopausal women. Arterioscler Thromb Vasc Biol 1997; 17:1822-9. [PMID: 9327783 DOI: 10.1161/01.atv.17.9.1822] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Estrogen lowers lipoprotein(a) [Lp(a)] levels, but the mechanisms involved have not been clarified. To address the relationship between estrogenic effects on Lp(a) and serum lipids, and on other plasma proteins of hepatic origin, 15 healthy postmenopausal women participated in a randomized, double-blinded, placebo-controlled, crossover study with 4 weeks of oral conjugated estrogens (0.625 mg/d) and placebo, separated by a 6-week period. Lp(a) levels decreased during estrogen treatment in 14 of the 15 subjects (mean decrease, 23%; P < .001). In response to estrogen, apolipoprotein A-I (apoA-I), HDL cholesterol, and triglyceride levels increased by 12% (P = .001), 11% (P < .001), and 10% (P = .02), respectively. Apolipoprotein B (apoB) and LDL cholesterol levels decreased by 7% (P = .01) and 12% (P = .03), respectively, ApoB, LDL cholesterol, and Lp(a) levels fell within 1 week of treatment, whereas apoA-I and HDL cholesterol levels rose more slowly. Levels of acid alpha 1-glycoprotein (AAG) and haptoglobin (HPT), two hepatically derived acute phase proteins, also decreased during estrogen treatment by 18% (P < .001) and 25% (P = .002), respectively. Although the changes in AAG and HPT in response to estrogen were highly correlated (r = .67, P = .009), we were unable to detect a correlation between change in either acute phase protein and change in Lp(a) (r = -.14 and -.24, P = .64 and .41). The lack of correlation between the changes in two acute phase reactants and Lp(a) suggests different underlying mechanisms for the effects of estrogen on these liver-derived proteins.
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Affiliation(s)
- C H Tuck
- Department of Medicine, Columbia University, New York, NY 10032, USA
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Abstract
Two experiments investigated the influence of melodic and harmonic context on the obviousness of pitch changes in 3 Western tonal melodies. In Experiment 1, listeners with different levels of musical skill heard standard melodies followed by comparison melodies in which single pitch changes could occur. In-key pitch changes that were not implied by the local harmony were judged more obvious than in-key pitch changes that were so implied. This effect was influenced by the surrounding context of melodic line and chords and was absent when the context contained chords that were not consistent with the harmony implied by the melodic line. In Experiment 2, with similar listeners, implied harmony effects were eliminated by removing parts of the melodic line, indicating the relative importance of melodic context as a determinant of implied harmony. Questionnaire data suggested that knowledge of tonal relationships was tacit, even in many trained listeners.
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Affiliation(s)
- S Holleran
- Department of Psychology, Ohio State University, Columbus 43210, USA
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29
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Abstract
Two experiments investigated the influence of melodic and harmonic context on the obviousness of pitch changes in 3 Western tonal melodies. In Experiment 1, listeners with different levels of musical skill heard standard melodies followed by comparison melodies in which single pitch changes could occur. In-key pitch changes that were not implied by the local harmony were judged more obvious than in-key pitch changes that were so implied. This effect was influenced by the surrounding context of melodic line and chords and was absent when the context contained chords that were not consistent with the harmony implied by the melodic line. In Experiment 2, with similar listeners, implied harmony effects were eliminated by removing parts of the melodic line, indicating the relative importance of melodic context as a determinant of implied harmony. Questionnaire data suggested that knowledge of tonal relationships was tacit, even in many trained listeners.
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Affiliation(s)
- S Holleran
- Department of Psychology, Ohio State University, Columbus 43210, USA
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Ginsberg HN, Karmally W, Siddiqui M, Holleran S, Tall AR, Blaner WS, Ramakrishnan R. Increases in dietary cholesterol are associated with modest increases in both LDL and HDL cholesterol in healthy young women. Arterioscler Thromb Vasc Biol 1995; 15:169-78. [PMID: 7749822 PMCID: PMC3287065 DOI: 10.1161/01.atv.15.2.169] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We studied the effects of dietary cholesterol intake on lipid and lipoprotein levels in healthy young women (n = 13) who were otherwise eating an American Heart Association (AHA) diet. The study used a randomized, three-way crossover design to determine the effects of 0, 1, or 3 eggs added per day (dietary cholesterol range, 108 to 667 mg/d). Each of the three diets was eaten for 8 weeks, with a washout period between diets. Three fasting blood samples were obtained during the last 3 weeks of each diet period to observe changes in fasting plasma lipid levels associated with the menstrual cycle. We also obtained blood just before and 4 and 8 hours after the subjects ingested a standard high-fat formula. During the menstrual cycle, total cholesterol and LDL cholesterol levels fell by 0.051 mmol/L (1.99 mg/dL) and 0.064 mmol/L (2.48 mg/dL) per week, respectively. HDL cholesterol concentrations increased by 0.060 mmol/L (2.3 mg/dL) per week during the first half of the cycle and then fell by 0.050 mmol/L (1.94 mg/dL) per week during the second half. Therefore, all statistical analyses were performed on values adjusted to midcycle. Total fasting cholesterol concentrations increased by 0.073 mmol/L (2.81 mg/dL) per 100 mg dietary cholesterol added to the diet per day (P = .001). LDL cholesterol increased by 0.054 mmol/L (2.08 mg/dL) per 100 mg/d dietary cholesterol (P = .003); this accounted for about 75% of the rise in total cholesterol. HDL cholesterol concentrations increased by 0.015 mmol/L (0.57 mg/dL) per 100 mg/d dietary cholesterol (P < .04). There was a wide range of responses among the women. Plasma apoB levels increased significantly, 0.93 mg/dL per 100 mg/d dietary cholesterol (P = .025), whereas apoA-I levels tended to rise (1.35 mg/dL per 100 mg/d, P = .056). Increases in dietary cholesterol did not produce any observable effects on fasting plasma cholesteryl ester transfer protein levels and had no effect on the response to a standard high-fat formula. Although menstrual-cycle changes in plasma total, LDL, and HDL cholesterol levels were observed, the effects of the diets were similar in the follicular and luteal phases of the menstrual cycle. Additionally, despite changes associated with the menstrual cycle, within-subject variation in plasma total cholesterol was actually smaller in this study than in our study of young men.
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Affiliation(s)
- H N Ginsberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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31
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Yee W, Holleran S, Jones MR. Sensitivity to event timing in regular and irregular sequences: influences of musical skill. Percept Psychophys 1994; 56:461-71. [PMID: 7984401 DOI: 10.3758/bf03206737] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In two experiments, the performance of listeners with different amounts of musical training (high skill, low skill) was examined in a two-alternative forced choice time-detection task involving simple five-cycle acoustic sequences. In each of a series of trials, all listeners determined which of two pattern cycles contained a small time change. Sequence context was also varied (regular vs. irregular timing). In Experiment 1, in which context was manipulated as a between-subjects variable, high-skill listeners performed significantly better than low-skill listeners only with regular patterns. In Experiment 2, in which context was manipulated as a within-subjects variable, the only significant source of variance was pattern context: All listeners were better at detecting time changes in regular than in irregular patterns. The results are considered in light of several hypotheses, including the expectancy/contrast model (Jones & Boltz, 1989).
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Affiliation(s)
- W Yee
- Department of Psychology, Ohio State University, Columbus 43210
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32
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Abstract
Two experiments addressed the influences of harmonic relations, melody location, and relative frequency height on the perceptual organization of multivoiced music. In Experiment 1, listeners detected pitch changes in multivoiced piano music. Harmonically related pitch changes and those in the middle-frequency range were least noticeable. All pitch changes were noticeable in the high-frequency voice containing the melody (the most important voice), suggesting that melody can dominate harmonic relations. However, the presence of upper partials in the piano timbre used may have accounted for the harmonic effects. Experiment 2 employed pure sine tones, and replicated the effects of Experiment 1. In addition, the influence of the high-frequency melody on the noticeability of harmonically related pitches was lessened by the presence of a second melody. These findings suggest that harmonic, melodic, and relative frequency height relationships among voices interact in the perceptual organization of multivoiced music.
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Affiliation(s)
- C Palmer
- Psychology Department, Ohio State University, Columbus 43210
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Ginsberg HN, Karmally W, Barr SL, Johnson C, Holleran S, Ramakrishnan R. Effects of increasing dietary polyunsaturated fatty acids within the guidelines of the AHA step 1 diet on plasma lipid and lipoprotein levels in normal males. Arterioscler Thromb 1994; 14:892-901. [PMID: 8199179 PMCID: PMC3275914 DOI: 10.1161/01.atv.14.6.892] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We attempted to ascertain the effects of polyunsaturated fatty acids by conducting two studies in normal young men, in which monounsaturated fats were replaced by polyunsaturated fats within the guidelines of the American Heart Association step 1 diet. Study A employed a randomized parallel design in which subjects first consumed an average American diet (AAD) containing 37% of calories as fat (saturated fat, 16% calories; monounsaturated fat, 14% calories; and polyunsaturated fat, 7% calories). After 3 weeks, one third of the subjects continued with the AAD, one third switched to a step 1 diet in which total fat calories were reduced to 30% by replacing saturated fat with carbohydrate, and one third switched to a polyunsaturated fat-enriched (Poly) diet with the same 30% fat calories and a reduction of monounsaturated fat from 14% to 8% and an increase of polyunsaturated fat from 7% to 13% of calories. The randomized period lasted 6 weeks. Total and low-density lipoprotein (LDL) cholesterol levels on the step 1 and Poly diets were reduced compared with levels on the AAD (P < .001). Total and LDL cholesterol did not differ between the step 1 and Poly diets, although comparison between the two diets is limited by the small study groups. Serum apolipoprotein (apo) B levels fell on the Poly diet compared with the AAD. Total high-density lipoprotein (HDL), HDL2, and HDL3 cholesterol levels were not significantly affected by the diets. Postprandial lipid and lipoprotein concentrations did not significantly differ either. In study B, a randomized crossover design was used in which all subjects ate the step 1 and Poly diets for 5 weeks each with a 4-day break between diets. In the eight subjects studied, the values for fasting plasma total, LDL, and HDL cholesterol; triglycerides; apoB; and apoA-I were essentially identical at the end of each diet period. Postprandial triglyceride areas obtained after ingestion of a large, standard fat load were also the same. Finally, LDL apoB and HDL apoA-I turnovers were unaffected by replacement of monounsaturates with polyunsaturates. In summary our results indicate that modest exchanges of monounsaturated for polyunsaturated fats do not significantly affect LDL or HDL levels or metabolism, which supports the view that reducing saturated fats is the key to lowering total and LDL cholesterol.
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Affiliation(s)
- H N Ginsberg
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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Ginsberg HN, Karmally W, Siddiqui M, Holleran S, Tall AR, Rumsey SC, Deckelbaum RJ, Blaner WS, Ramakrishnan R. A dose-response study of the effects of dietary cholesterol on fasting and postprandial lipid and lipoprotein metabolism in healthy young men. Arterioscler Thromb 1994; 14:576-86. [PMID: 8148356 PMCID: PMC3292202 DOI: 10.1161/01.atv.14.4.576] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Despite many previous studies, controversy remains concerning the effects of dietary cholesterol on plasma cholesterol concentrations. In addition, the focus of previous studies has been fasting lipid and lipoprotein concentrations; there are no published studies with postprandial measurements. We studied the effects of four levels of dietary cholesterol intake on fasting lipid, lipoprotein, and apoprotein levels, as well as postprandial lipid levels, in a group of young, healthy men who were otherwise eating a low-fat, American Heart Association step 1 diet. Twenty young, healthy men completed a randomized, four-way crossover design study to test the effects of an American Heart Association step 1 diet containing 0, 1, 2, or 4 eggs per day. Dietary cholesterol ranged from 128 to 858 mg cholesterol per day. Each diet was eaten for 8 weeks, with a break between diets. Three fasting blood samples were obtained at the end of each diet period. In addition, blood samples were obtained just before and 2, 4, and 6 hours after ingestion of a standard lunch containing the various amounts of egg cholesterol. We also obtained blood 4 and 8 hours after the subjects ingested a standard, high-fat formula. Fasting plasma total cholesterol concentrations increased by 1.47 mg/dL (0.038 mmol/L) for every 100 mg dietary cholesterol added to the diet (P < .001). Low-density lipoprotein (LDL) cholesterol increased in parallel. Responsiveness varied but appeared to be normally distributed. Fasting plasma apoprotein B concentrations increased approximately 10% between the 0- and 4-egg diets and were correlated with changes in total and LDL cholesterol concentrations. Although there was a trend toward a greater response in men with an apoprotein E4 allele, this was not statistically significant. Fasting plasma cholesteryl ester transfer protein levels were higher only on the 4-egg diet, and changes in cholesteryl ester transfer protein levels between the 0- and 4-egg diets correlated with changes in total and LDL cholesterol. There were no differences in the postlunch or post-fat-formula responses of plasma lipids across the diets. Incubation of the 4-hour postlunch serum with J774 macrophages did not affect cell cholesteryl ester content at any level of dietary cholesterol. Cellular free cholesterol levels were slightly higher on each of the egg-containing diets versus the 0-egg diet. In summary, increases in dietary cholesterol resulted in linear increases in fasting total and LDL cholesterol in young, healthy men.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- H N Ginsberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032
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35
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Barr SL, Ramakrishnan R, Johnson C, Holleran S, Dell RB, Ginsberg HN. Reducing total dietary fat without reducing saturated fatty acids does not significantly lower total plasma cholesterol concentrations in normal males. Am J Clin Nutr 1992; 55:675-81. [PMID: 1550043 DOI: 10.1093/ajcn/55.3.675] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Forty-eight healthy male students ate an average American diet (AAD) with 37% of calories from fat and 16% from saturated fatty acids for 3 wk. During the next 7 wk, one-third of the students continued to eat the AAD, one-third switched to a 30%-fat diet with 9% saturated fatty acids (Step 1 diet), and one-third switched to a 30%-fat diet with 14% saturated fatty acids (Sat diet). The Step 1 group had a significant reduction in plasma total cholesterol (TC) (0.36 +/- 0.37 mmol/L) compared with the AAD group (0.07 +/- 0.39 mmol/L) and the Sat group (0.08 +/- 0.25 mmol/L). The Sat group did not differ from the AAD group. Changes in low-density-lipoprotein (LDL) cholesterol paralleled changes in total cholesterol. High-density-lipoprotein cholesterol fell significantly in the Step 1 group (0.11 +/- 0.08 mmol/L) compared with the AAD group. Plasma triglycerides did not differ between groups at the end of the randomized periods. In summary, reduction of dietary fat intake from 37% to 30% of calories did not lower plasma total and LDL cholesterol concentrations unless the reduction in total fat was achieved by decreasing saturated fatty acids.
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Affiliation(s)
- S L Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032
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Goldberg IJ, Holleran S, Ramakrishnan R, Adams M, Palmer RH, Dell RB, Goodman DS. Lack of effect of lovastatin therapy on the parameters of whole-body cholesterol metabolism. J Clin Invest 1990; 86:801-8. [PMID: 2394831 PMCID: PMC296795 DOI: 10.1172/jci114777] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED The effects of lovastatin therapy on the parameters of body cholesterol metabolism were explored in nine hypercholesterolemic patients. Long-term cholesterol turnover studies were performed before therapy, and were repeated after 15 mo of lovastatin therapy (40 mg/d) while continuing on therapy. The major question addressed was whether a reduction in plasma cholesterol level with lovastatin would be associated with a reduction in the whole-body production rate of cholesterol or with the sizes of exchangeable body cholesterol pools as determined by the three-pool model of cholesterol turnover. The mean plasma cholesterol level decreased 19.4% (from 294 to 237 mg/dl), and low-density lipoprotein cholesterol decreased 23.8% (from 210 to 159 mg/dl) with lovastatin therapy. Changes in high-density lipoprotein cholesterol level were not significant. The cholesterol production rate did not change significantly with therapy (1.09 +/- 0.10 [mean +/- S.D.] vs. 1.17 +/- 0.09 g/d). By comparison, colestipol and niacin treatment in three other subjects more than doubled the cholesterol production rate (1.14 +/- 0.28 vs. 2.42 +/- 0.34 g/d). Thus, hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibition by lovastatin at the therapeutic dose used here did not change the steady-state rate of whole-body cholesterol synthesis. Despite the changes in plasma cholesterol levels, no significant changes were seen in the values of M1, of M3 or of Mtot, the sizes of the pools of rapidly, of slowly, and of total body exchangeable cholesterol. CONCLUSION lovastatin therapy to lower plasma cholesterol does not lead to corresponding reductions in body cholesterol pools or to a reduction in the rate of whole-body cholesterol synthesis. In the new steady state that exists during long-term lovastatin therapy, along with increased expression of the genes for HMG-CoA reductase and the LDL receptor, the body compensates for the effects of the drug so that cholesterol production rate and tissue pool sizes are not changed from pretreatment values.
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Affiliation(s)
- I J Goldberg
- Department of Medicine, Columbia University, New York 10032
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37
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Ginsberg HN, Barr SL, Gilbert A, Karmally W, Deckelbaum R, Kaplan K, Ramakrishnan R, Holleran S, Dell RB. Reduction of plasma cholesterol levels in normal men on an American Heart Association Step 1 diet or a Step 1 diet with added monounsaturated fat. N Engl J Med 1990; 322:574-9. [PMID: 2304504 DOI: 10.1056/nejm199003013220902] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The design of diets to achieve optimal changes in plasma lipid levels is controversial. In a randomized, double-blind trial involving 36 healthy young men, we evaluated the effects on plasma lipid levels of both an American Heart Association Step 1 diet (in which 30 percent of the total calories were consumed as fat: 10 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day) and a monounsaturated fat-enriched Step 1 diet (with 38 percent of the calories consumed as fat: 10 percent saturated, 18 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day). The effects of these diets were then compared with those of an average American diet, in which 38 percent of the total calories were consumed as fat: 18 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 500 mg of cholesterol per day. The men consumed the average American diet for 10 weeks before random assignment to one of the two Step 1 diets or to continuation of the average diet for an additional 10 weeks. Caloric intake was adjusted to maintain a constant body weight. As compared with the mean (+/- SD) change in the plasma total cholesterol level in the group that followed the average American diet throughout the study (-0.05 +/- 0.36 mmol per liter), there were statistically significant reductions (P less than 0.025) in the plasma total cholesterol level in the group on the Step 1 diet (-0.37 +/- 0.27 mmol per liter) and in the group on the monounsaturated fat-enriched Step 1 diet (-0.46 +/- 0.36 mmol per liter). There were parallel reductions in the plasma low-density lipoprotein cholesterol levels in these two groups. Neither the plasma triglyceride levels nor the high-density lipoprotein cholesterol concentrations changed significantly with any diet. We conclude that enrichment of the Step 1 diet with monounsaturated fat does not alter the beneficial effects of the Step 1 diet on plasma lipid concentrations.
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Affiliation(s)
- H N Ginsberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032
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