Familial Hypercholesterolemic Research Articles

Glycosphingolipids and plasma lipoproteins: a review.

Glycosphingolipids (GSL) are complex, sugar-containing lipids that are transported in plasma on lipoproteins, particularly low density (beta) lipoproteins (LDL). LDL are taken up and metabolized by cells through a LDL receptor-mediated pathway. Cells from receptor-negative familial hypercholesterolemic (FH) homozygotes lack a functional LDL receptor and the cellular uptake of LDL occurs through a LDL receptor-independent pathway. We have studied the relation between LDL and GSL metabolism using an in vitro model of cultured human fibroblasts and an in vivo model of renal tubular cells shed in the urine. Using biochemical, morphological, and immunocytological techniques, we have demonstrated that LDL taken up through the LDL receptor-independent pathway results in the accumulation of GSL in cells in vitro and in vivo. The storage of GSL is localized to intracytoplasmic vesicles and such storage can be modulated by changing the concentration of LDL in the culture medium or in plasma. The possible effect of LDL on certain steps in the intracellular metabolism of GSL in normal and receptor-negative-homozygous FH cells is reviewed.

Low density lipoprotein receptor mutations in South African homozygous familial hypercholesterolemic patients.

The binding and catabolism of low density lipoprotein (LDL) were studied in cultured skin fibroblasts and/or Epstein-Barr virus-transformed lymphoblastoid cells from 20 familial hypercholesterolemic (FH) homozygotes of 14 Afrikaner kindreds. Cells from available heterozygotes were also analyzed. Good resolution between the normal, heterozygote, and homozygote groups was obtained on the basis of these assays using either cell type. Results obtained with fibroblasts allowed the classification of 13 of these kindreds as being typically receptor-defective, and one kindred with two homozygotes as being receptor-negative. Fibroblasts from homozygotes of the receptor-defective class expressed LDL receptor activities which varied between 3% and 25% of normal. Where two homozygotes from the same family were available for assays (six families), both yielded similar activities. In contrast to fibroblasts, all the lymphoblastoid cells derived from FH homozygotes yielded LDL receptor activities equal to or less than 10% of normal; in a number of cases no significant 125I-LDL binding was detectable. The use of lymphoblastoid cells provides a convenient means for screening for FH at the cellular level. Our results indicate a predominance of a receptor-defective type of abnormality, which is consistent with a founder gene effect in the Afrikaner population.

The absolute rate of cholesterol biosynthesis in monocyte-macrophages from normal and familial hypercholesterolaemic subjects.

The true rate of cholesterogenesis in cultured monocyte-macrophages was determined from the incorporation of [2-14C]acetate into cholesterol, using the desmosterol (cholesta-5,24-dien-3 beta-ol) that accumulated in the presence of the drug triparanol to estimate the specific radioactivity of the newly formed sterols. It was shown that this procedure could be successfully adapted for use with cultured monocytes despite the accumulation of other unidentified biosynthetic intermediates. In cells maintained in 20% (v/v) whole serum approx. 25% of the sterol carbon was derived from exogenous acetate. Cholesterol synthesis was as high in normal cells as in cells from homozygous familial hypercholesterolaemic (FH) subjects and accounted for 50% of the increase in cellular cholesterol. The addition of extra low-density lipoprotein (LDL) reduced cholesterol synthesis, apparently through a decrease in the activity of 3-hydroxy-3-methylglutaryl-CoA reductase (HMG-CoA reductase). When incubated in lipoprotein-deficient serum some cells did not survive, but those that remained showed a normal increase in protein content; the amount of cellular protein and cholesterol in each well did not increase and cholesterol synthesis was reduced by over 80%. HMG-CoA reductase activity fell less dramatically and the proportion of sterol carbon derived from exogenous acetate increased, suggesting that the low rate of cholesterogenesis with lipoprotein-deficient serum was due to a shortage of substrate. The results indicate that under normal conditions monocyte-macrophages obtain cholesterol from endogenous synthesis rather than through receptor-mediated uptake of LDL, and that synthesis together with non-saturable uptake of LDL provides the majority of the cholesterol required to support growth.

The hypolipidemic effect of locust bean gum food products in familial hypercholesterolemic adults and children

Seventeen adults and 11 children, a group of 18 familial hypercholesterolemic (FHC) and 10 normal subjects, were fed products with and without locust bean gum (LBG) (8 to 30 g/day) to assess the hypolipidemic effect of LBG. Identical food products with and without LBG were consumed by two groups (A and B) of arbitrarily assigned patients using a cross-over design. Plasma cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, very low-density lipoprotein cholesterol and triglycerides were measured at 2-wk intervals and compared to control feeding periods. In group A, FHC C decreased 10% and LDL-C 11%, normal subjects decreased C 6% and LDL-C 10% (p < 0.001). In group B, FHC C decreased 17% and LDL-C 19%, normal subjects decreased cholesterol 11%, and LDL-C 6% (p < 0.001). Cholesterol and LDL-C were lowered in FHC children in both groups. High-density lipoprotein/LDL ratios increased in both groups. The use of food products with LBG in children and adults is a unique approach to treating FHC. LBG food acceptance was good, and there were no significant side effects. LBG in food products appears to be an effective, safe approach to controlling hyperlipidemia.

Localization of urinary lactosylceramide in cytoplasmic vesicles of renal tubular cells in homozygous familial hypercholesterolemia.

An average 15-fold increase in lactosylceramide (LacCer) in the sediment of receptor-negative, familial hypercholesterolemic (FH) homozygotes has been reported [Chatterjee, S., Sekerke, C.S. & Kwiterovich, P.O., Jr. (1982) J. Lipid Res. 23, 513-522]. We report here the abnormal urinary excretion of significant numbers of renal tubular cells in eight FH homozygotes. The mean activity of gamma-glutamyltransferase, a marker for renal tubular cells, was twice as high in urinary sediment of FH homozygotes as in normals. Membrane-enclosed cytoplasmic vesicles that stained strongly positive with a fluorescein-labeled antibody against LacCer were found in the renal tubular cells of all homozygotes except two who had undergone a portacaval shunt. These two had normal urinary levels of LacCer, and the cytoplasmic vesicles were vacuolated. In the other six, most of the fluorescent antibody label was intracellular and perinuclear. The cytoplasmic vesicles stained strongly with polychromatic Papanicolaou stain, periodic acid/Schiff reagent, and oil red O. Electron microscopy revealed perinuclear membrane-enclosed lipid and free lipid droplets. When two FH homozygotes, who excreted increased LacCer, underwent plasma exchange, the cytoplasmic vesicles became empty, and the urinary LacCer level decreased into the normal range. We conclude that the increased urinary excretion of LacCer in FH homozygotes occurs in renal tubular cells and that the intracellular locatin of LacCer is within cytoplasmic vesicles. The presence of LacCer within these vesicles can be modulated by treatment with plasma exchange.

Changes in the metabolism of modified and unmodified low-density lipoproteins during the maturation of cultured blood monocyte-macrophages from normal and homozygous familial hypercholesterolaemic subjects.

Blood monocyte-macrophages from homozygous familial hypercholesterolaemic (FH) patients showed the same pattern of morphological and biochemical changes during maturation in vitro as cells from normal subjects. The protein content of both types of cell increased eightfold during the first two weeks of culture while the ratio of free cholesterol to protein in the cells remained constant. The specific activities of lysosomal enzymes increased between days 2 and 5 and again between days 7 and 12. The specific activity of 5′-nucleotidase increased rapidly during the first two days and then fell. Degradation of low-density lipoprotein (LDL) by cells from FH patients was not saturable and, when expressed per mg cell protein, gradually declined as the cells matured. Normal cells maintained in medium containing whole serum degraded LDL by an additional, saturable process that was, at all times, decreased if the cells were preincubated in medium with a high concentration of LDL and increased after preincubation with lipoprotein-deficient serum. Saturable degradation of LDL, expressed per mg cell DNA, was highest between the fifth and twelfth days of culture, which was the period of greatest cell growth. The results suggest that normal cells incubated in 20% whole serum expressed LDL receptors to obtain the cholesterol required for their growth, but that the lack of these receptors in cells from FH patients did not prevent normal development. Saturable degradation of acetylated LDL, or LDL complexed with dextran sulphate, was the same in cells from FH patients as in cells from normal subjects. The degradation of each was lower than that of unmodified LDL for the first 5 days in culture, but rapidly increased between days 5 and 9. This increase corresponded with the development of the phagocytic properties of the cells, as indicated by the release of lysosomal enzymes during incubation with opsonized zymosan.

Degradation by cultured monocyte-derived macrophages from normal and familial hypercholesterolaemic subjects of modified and unmodified low-density lipoproteins.

Human blood monocyte-derived macrophages that had been cultured for 7 days in the presence of 20% whole human serum exhibited saturable degradation of low-density lipoprotein (LDL). This degradation could be abolished by pre-incubating the cells with a high concentration of LDL in the medium and increased by pre-incubating the cells in medium containing lipoprotein-deficient serum. Cells obtained from the blood of homozygous familial-hypercholesterolaemic (FH) patients only exhibited a low rate of non-saturable degradation of LDL, even when pre-incubated without lipoproteins. Thus the saturable degradation of LDL by normal cells was mediated by the LDL receptors that are defective in FH patients and little LDL was taken up and degraded through any of the other endocytotic processes present in macrophages. Degradation by normal cells pre-incubated with lipoprotein-deficient serum had a higher apparent affinity for LDL than that of cells maintained in whole serum, which suggests that incubation with lipoprotein-deficient serum may not only induce the formation of LDL receptors but may also have a direct effect on the receptors themselves. Monocyte-derived macrophages from normal and FH subjects showed similar saturable degradation of acetylated LDL and also of LDL complexed with dextran sulphate. Maximal degradation of each was in the same range as the degradation of unmodified LDL by normal cells, and was not increased if the cells were pre-incubated with lipoprotein-deficient serum.

1193 CHOLESTEROL EXCRETION STUDIES IN FAMILIAL HYPERCHOLESTEROLEMIC CHILDREN

Normal (N) and familial hypercholesterolemic (FHC) siblings' excretion of fecal neutral sterols (FNS) and fecal bile acids (FBA) were compared as a possible mechanism to explain the hypercholesterolemia of FHC. Fifteen children, 5 N and 10 FHC, age 7-16, were studied on two diets. Diet A contained 188 mg cholesterol per day and Diet B contained 30 mg cholesterol per day. Children were admitted for 14 days. Three pooled stool samples, three days each, were collected with two markers and analyzed for FNS and FBA by TLC and GLC techniques. In Diet A there was no difference in FBA or FNS between N and FHC siblings. In the low cholesterol diet (Diet B), there was a significant increase in FBA and FNS excretion in FHC, but not in normals. The feedback mechanism for cholesterol production was intact in FHC children. Decreased FBA or FNS excretion does not explain the hypercholesterolemia in FHC children.

Abnormal induction of 3-hydroxy-3-methylglutaryl coenzyme A reductase in leukocytes from subjects with heterozygous familial hypercholesterolemia.

Human leukocytes isolated from fresh defibinated blood were shown to utilize acetate and mevalonate for sterol synthesis. The capacity of the leukocytes to synthesize sterols is limited severely as compared to their ability to convert mevalonate into farnesyl pyrophosphate (which they hydrolyze rapidly to free farnesol) and into squalene. When leukocytes are incubated in a medium containing lipid-free serum, synthesis of sterols from acetate, but not from mevalonate, is much enhanced. It was shown that this increased synthesis resulted from increased levels of 3-hydroxy-3-methylglutaryl-CoA reductase activity in the cells. A comparison was made of the activation of sterol synthesis from acetate in leukocytes of normal individuals and of heterozygous familial hypercholesterolemics. The latter group responded to incubation in lipid-free sera with a significantly higher activation than the cells of normocholesterolemics. This activation was shown to be well correlated with a higher induction of 3-hydroxy-3-methylglutaryl-CoA reductase in the heterozygous cells than in the normals. The leukocytes of a heterozygous familial hypercholesterolemic individual were found to release, into a lipid-free incubation medium, more endogenously synthesized [3H]sterol (but not [3H]squalene) than the cells of a normal person. It is suggested that the genetic abnormality in heterozygous familial hypercholesterolemia could be accounted for by a mutation resulting in a weaker binding of a sterol repressor by heterozygous cells than by normal cells.