Fractional Catabolic Rate Of Low-density Lipoprotein Research Articles

Lack of association between plasma PCSK9 and LDL-apoB100 catabolism in patients with uncontrolled type 2 diabetes

ObjectivePro-protein convertase subtilisin/kexin type 9 (PCSK9) is a post-transcriptional inhibitor of LDL-receptor. In non-diabetic men, plasma PCSK9 levels were found to be inversely correlated with low-density lipoprotein (LDL) apolipoprotein B100 (apoB) fractional catabolic rate (FCR). Here, we aimed to determine the effect of type 2 diabetes on the association between plasma PCSK9 and FCR of LDL. MethodsA kinetic study of LDL-apoB100, using stable isotopes, was performed in 38 individuals (20 men, 18 women) including 23 non-diabetic normolipidemic subjects and 15 patients with type 2 diabetes. ResultsIn the non-diabetic group, plasma PCSK9 was positively correlated with LDL-C (r=0.64, p=0.001), apoB (r=0.67, p<0.001), and inversely correlated with LDL-apoB FCR (r=−0.61, p=0.002). In contrast, in type 2 diabetic patients, plasma PCSK9 was not associated with LDL-C, apoB and LDL-apoB FCR. However, the lack of association between PCSK9 and LDL-apoB FCR seemed to be limited to the patients with “uncontrolled” diabetes (HbA1c>7%) since a borderline significant negative correlation between PCSK9 and LDL FCR (r=−0.70, p=0.08) was retrieved in patients with HbA1c≤7%. In multivariate analysis, LDL-apoB FCR was independently associated with PCSK9 (p=0.001) and fasting glycaemia (log) (p=0.030) in the non-diabetic population and with PCSK9 (p=0.040) and HbA1c (p=0.029) in diabetic patients. ConclusionOur data indicate that both PCSK9 and glycaemia are independent factors influencing LDL catabolism. Plasma PCSK9 influences significantly the catabolism of LDL-apoB100 in individuals without diabetes, but not in patients with uncontrolled type 2 diabetes. Thus, the influence of diabetes on LDL-apoB FCR catabolism may overwhelm the influence of PCSK9.

The hyperenergetic-fed obese dog, a model of disturbance of apolipoprotein B-100 metabolism associated with insulin resistance: kinetic study using stable isotopes

The hyperenergetic-fed beagle dog model of obesity-associated insulin resistance has previously demonstrated lipoprotein abnormalities similar to those of obese insulin-resistant humans. The aim of this study was to check, in the insulin-resistant dog, the mechanism leading to abnormalities in the mass of apolipoprotein B-100 (apo B-100) containing lipoproteins. Six healthy male beagle dogs were overfed with a high-fat diet for 28 ± 2.5 weeks. Obesity was associated with insulin resistance as assessed by the euglycemic hyperinsulinemic clamp technique. The kinetics of very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) apo B-100 were recorded in dogs, at healthy and insulin-resistant states, using a primed constant infusion of [5,5,5-D 3]leucine. Isotopic enrichment was measured by gas chromatography–mass spectrometry (GC-MS). A multicompartmental model was used for the analysis of tracer kinetics data. Apolipoprotein B-100 concentration was higher in VLDL (2.8-fold, P < .05) but lower in LDL (2-fold, P < .05) in the insulin-resistant compared to the healthy state. Kinetic analysis showed a higher VLDL apo B-100 production (1.7-fold, P < .05). The fractional catabolic rate of VLDL did not change significantly, but the lipolysis was decreased significantly (3-fold, P < .05). The lower LDL apo B-100 level in insulin-resistant dogs was explained by a higher LDL fractional catabolic rate (2.5-fold, P < .05). The mechanisms leading to hypertriglyceridemia (higher production rate and lower lipolysis of VLDL) in insulin-resistant dogs were similar to those described in the insulin-resistant humans.

Polymorphisms in Apolipoprotein B and Risk of Ischemic Stroke

Apolipoprotein B levels associate with risk of ischemic stroke. APOB polymorphisms may influence levels of apolipoprotein B and low-density lipoprotein (LDL), but whether they associate with risk of ischemic stroke is unknown. We tested the hypothesis that the APOB T71I, A591V, P2712L, R3611Q, E4154K, and N4311S polymorphisms associate with risk of ischemic stroke in the general population and performed in vivo human LDL turnover studies of E4154K heterozygotes vs. K4154K homozygotes. This was a prospective study (the Copenhagen City Heart Study) with 23-yr, 100% complete follow-up. The study was conducted with a Danish general population. A total of 9157 women and men aged 20-80+ yr participated in the study. Risk of ischemic cerebrovascular disease and ischemic stroke, apolipoprotein B and LDL levels, and LDL fractional catabolic rate were measured. The hypothesis was formulated before genotyping. APOB K4154K homozygotes had an age-adjusted hazard ratio of 0.4 (95% confidence interval 0.2-0.9) for ischemic cerebrovascular disease and 0.2 (0.1-0.7) for ischemic stroke relative to E4154E homozygotes. Corresponding multifactorially adjusted hazard ratios were 0.5 (0.2-1.0) and 0.2 (0.1-0.8). Furthermore, E4154K heterozygotes and K4154K homozygotes had lower levels of apolipoprotein B and LDL cholesterol, compared with E4154E homozygotes. Finally, E4154K heterozygotes had an increased fractional catabolic rate of LDL relative to E4154E homozygotes. None of the other polymorphisms studied influenced risk of ischemic stroke. APOB K4154K homozygosity predicts a 3- to 5-fold reduction in risk of ischemic cerebrovascular disease and ischemic stroke. This may be explained by lower plasma levels of apolipoprotein B and LDL cholesterol caused by an increased catabolism of LDL particles, although another yet-unknown mechanism is also possible.

Low Density Lipoprotein Apolipoprotein B Metabolism in Treatment-Naive HIV Patients and Patients on Antiretroviral Therapy

Dyslipidaemia and lipodystrophy have been described in treated HIV patients and in a small percentage of untreated HIV patients. Lipodystrophy in these patients has been shown to be associated with a lower expression of low density lipoprotein (LDL) receptors. We have investigated the effect of antiretroviral treatment with either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) on body fat distribution and LDL apolipoprotein B (apoB) kinetics in 12 HIV-negative controls and 52 HIV-infected patients, including antiretroviral treatment-naive (TN) patients (n=13) and patients taking two nucleoside analogues plus either a PI (n=15) or an NNRTI (n=24). LDL cholesterol was not different between groups. Compared with the controls, LDL apoB absolute synthetic rate (ASR) and fractional catabolic rate (FCR) were lower and residence time (RT) was higher in the PI and NNRTI groups (P<0.05). In the TN patients, LDL ASR was lower (P<0.05) and there was a trend for a lower FCR and higher RT compared with the controls (P=0.07). LDL apoB pool size was greater in the PI group compared with the controls (P<0.05). In the PI group, patients on ritonavir (RTV)-containing regimens had a lower LDL apoB ASR (P=0.009) and a trend to a lower LDL apoB FCR and increased RT compared with non-RTV-containing PI regimens (P=0.05). There was a positive correlation between LDL apoB FCR and limb fat/lean body mass (P=0.004) in all subjects. Decreased LDL FCR, despite unchanged LDL cholesterol, was demonstrated in both treated and untreated HIV patients. It was more marked with RTV-containing regimens and was associated with reduced limb fat. The increased LDL RT may lead to an increased risk of atherogenesis thus contributing to the risk for cardiovascular disease in these patients.

Apolipoprotein B100 metabolism in autosomal-dominant hypercholesterolemia related to mutations in PCSK9.

We have reported further heterogeneity in familial autosomal-dominant hypercholesterolemia (FH) related to mutation in proprotein convertase subtilisin/kexin type 9 (PCSK9) gene previously named neural apoptosis regulated convertase 1 (Narc-1). Our aim was to define the metabolic bases of this new form of hypercholesterolemia. In vivo kinetics of apolipoprotein B100-containing lipoproteins using a 14-hour primed constant infusion of [2H3] leucine was conducted in 2 subjects carrying the mutation S127R in PCSK9, controls subjects, and FH subjects with known mutations on the low-density lipoprotein (LDL) receptor gene (LDL-R). Apo B100 production, catabolism, and transfer rates were estimated from very LDL (VLDL), intermediate-density lipoprotein (IDL), and LDL tracer enrichments by compartmental analysis. PCSK9 mutation dramatically increased the production rate of apolipoprotein B100 (3-fold) compared with controls or LDL-R mutated subjects, related to direct overproduction of VLDL (3-fold), IDL (3-fold), and LDL (5-fold). The 2 subjects also showed a decrease in VLDL and IDL conversion (10% to 30% of the controls). LDL fractional catabolic rate was slightly decreased (by 30%) compared with controls but still higher than LDL-R-mutated subjects. These results showed that the effect of the S127R mutation of PCSK9 on plasma cholesterol homeostasis is mainly related to an overproduction of apolipoprotein B100.

Lipoprotein metabolism in subjects with hepatic lipase deficiency

A heritable deficiency of hepatic lipase (HL) provides insights into the physiologic function of HL in vivo. The metabolism of apolipoprotein B (apoB)-100 in very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and low-density lipoprotein (LDL) and of apoA-I and apoA-II in high-density lipoprotein (HDL) particles lipoprotein (Lp)(AI) and Lp(AI:AII) was assessed in 2 heterozygous males for compound mutations L334F/T383M or L334F/R186H, with 18% and 22% of HL activity, respectively, compared with 6 control males. Subjects were provided with a standard Western diet for a minimum of 3 weeks. At the end of the diet period, apo kinetics was assessed using a primed-constant infusion of [5,5,5- 2H 3] leucine. Mean plasma triglyceride (TG) and HDL cholesterol levels were 55% and 12% higher and LDL cholesterol levels 19% lower in the HL patients than control subjects. A higher proportion of apoB-100 was in the VLDL than IDL and LDL fractions of HL patients than control subjects due to a lower VLDL apoB-100 fractional catabolic rate (FCR) (4.63 v 9.38 pools/d, respectively) and higher hepatic production rate (PR) (33.24 v 10.87 mg/kg/d). Delayed FCR of IDL (2.78 and 6.31 pools/d) and LDL (0.128 and 0.205 pools/d) and lower PR of IDL (3.67 and 6.68 mg/kd/d) and LDL 4.57 and 13.07 mg/kg/d) was observed in HL patients relative to control subjects, respectively. ApoA-I FCR (0.09 and 0.13 pools/d) and PR (4.01 and 6.50 mg/kg/d) were slower in Lp(AI:AII) particles of HL patients relative to control subjects, respectively, accounting for the somewhat higher HDL cholesterol levels. HL deficiency may result in a lipoprotein pattern associated with low heart disease risk.

Growth hormone induces low-density lipoprotein clearance but not bile acid synthesis in humans.

Growth hormone (GH) induces hepatic low-density lipoprotein (LDL) receptors and lowers plasma cholesterol. We characterized the influence of GH treatment on plasma LDL clearance in normal humans and investigated the relative role of LDL receptor (LDLR) activity and stimulation of bile acid synthesis in subjects with different LDLR expression. Plasma clearance of autologous 125I-LDL was measured before and during 3 weeks of treatment with GH (0.1 IU/kg per day) in 9 healthy young males. Plasma LDL cholesterol was reduced by 13% and the fractional catabolic rate of LDL increased by 27%. More marked changes were seen in a patient with hypopituitarism substituted with GH (0.07 IU/kg per day) for 3 months. In a second study, GH dose-dependently reduced LDL cholesterol and increased Lp(a) levels in 3 groups of males: younger and elderly healthy subjects and heterozygous familial hypercholesterolemia (FH). No effect on bile acid synthesis measured by the plasma marker 7alpha-hydroxy-4-cholesten-3-one was observed. In an LDLR-deficient FH homozygote, LDL cholesterol was not affected by GH. GH treatment reduces plasma LDL cholesterol by inducing LDL clearance. In humans, LDLR expression is a prerequisite for this effect, whereas it is not related to stimulation of bile acid synthesis.

Effect of taurine on cholesterol metabolism in hamsters: Up-regulation of low density lipoprotein (LDL) receptor by taurine

The effects of taurine on hepatic cholesterol metabolism were investigated in hamsters fed a high-fat diet or normal chow. Two weeks-treatment of taurine at 1% in drinking water prevented high-fat diet-induced increase in cholesterol levels of serum and liver. The decrease in serum cholesterol by taurine was due to decrease in non-HDL cholesterols. A similar tendency was noted in serum and liver cholesterol levels of hamsters fed a normal diet. In hamsters fed a high-fat diet, taurine prevented elevation in hepatic activity of acyl-CoA:cholesterol acyltransferase (ACAT) and increased the activity of cholesterol 7α–hydroxylase. Taurine also increased cholesterol 7α–hydroxylase activity in hamsters fed normal chow. Studies on liver membranes revealed that taurine increased 125I–labeled LDL binding by 52% and 58% in hamsters fed either a normal chow or high-fat diet, respectively. Furthermore, LDL kinetic analysis showed that taurine intake resulted in significant faster plasma LDL fractional catabolic rates (FCR). These results suggest that taurine elevates hepatic LDL receptor and thereby decreases serum cholesterol levels, an event which may be the result of hepatic cholesterol depletion as a consequence of increased bile acid synthesis via enhancement of cholesterol 7α–hydroxylase activity. Thus, up-regulation of the LDL receptor and subsequent increase in receptor-mediated LDL turnover may be a key event in the cholesterol-lowering effects of taurine in hamsters.

Effect of low-density lipoprotein apheresis on kinetics of apolipoprotein B in heterozygous familial hypercholesterolemia.

The acute reduction of low-density lipoprotein (LDL) cholesterol obtained by LDL-apheresis allows the role of the high level of circulating LDL on lipoprotein metabolism in heterozygous familial hypercholesterolemia (heterozygous FH) to be addressed. We studied apolipoprotein B (apoB) kinetics in five heterozygous FH patients before and the day after an apheresis treatment using endogenous labeling with [(2)H(3)]leucine. Compared with younger control subjects, heterozygous FH patients before apheresis showed a significant decrease in the fractional catabolic rate of LDL (0.24 +/- 0.08 vs. 0.65 +/- 0.22 day(-1); P < 0.01), and LDL production was increased in heterozygous FH patients (18.9 +/- 7.0 vs. 9.9 +/- 4.2 mg/kg.day; P < 0.05). The modeling of postapheresis apoB kinetics was performed using a nonsteady state condition, taking into account the changing pool size of very low density lipoprotein (VLDL), intermediate density lipoprotein, and LDL apoB. The postapheresis kinetic parameters did not show statistical differences compared with preapheresis parameters in heterozygous FH patients; however, a trend for increases in fractional catabolic rate of LDL (0.24 +/- 0.08 vs. 0.35 +/- 0.09 day(-1); P = 0.067) and the production of VLDL (13.7 +/- 8.3 vs. 21.9 +/- 1.6 mg/kg.day; P = 0.076) was observed. These results suggested that the marked decrease in plasma LDL obtained a short time after LDL-apheresis is able to stimulate LDL receptor activity and VLDL production in heterozygous FH.

Soy protein reduces the arterial low-density lipoprotein (LDL) concentration and delivery of LDL cholesterol to the arteries of diabetic and nondiabetic male cynomolgus monkeys

We have previously shown that soy protein consumption improves lipoprotein concentrations and reduces the progression of atherosclerosis in cynomolgus monkeys. The mechanism for these beneficial effects is unclear. The purpose of this study was to determine potential mechanisms for the atheroprotective effects of soy and to determine if these effects extend to diabetic monkeys. We designed an experiment with a 2 × 2 factorial design in which adult male monkeys (N = 23) were fed an atherogenic diet with a protein source of either soy isolate or casein and lactalbumin, and the monkeys were either control or streptozotocin-induced diabetic. Diabetics had significantly increased fasting glucose and glycated hemoglobin (GHb) levels; this relationship was not affected by the type of dietary protein. Diabetics also had increased total (TC) and low-density lipoprotein cholesterol (LDLC) concentrations. However, soy consumption significantly reduced TC and LDLC concentrations in both control and diabetic monkeys. Plasma and arterial LDL metabolism was determined by injecting 125I-LDL at 48 hours and 131I-tyramine cellobiose LDL at 1 hour prior to necropsy. This allowed a determination of the arterial LDL concentration, permeability, and arterial LDL delivery. An increase in the whole-body plasma LDL fractional catabolic rate (FCR) was found with soy. Soy significantly reduced the arterial LDL concentration across all arterial sites by an average of 50%. Soy also significantly reduced the delivery of LDLC to all arterial sites by an average of 40%. While this was primarily due to the lower plasma LDLC concentration, LDL permeability in the carotid bifurcation and internal carotid arteries was also reduced. There was no additional effect of diabetes. These beneficial effects on plasma and arterial LDL metabolism would be expected to reduce atherosclerosis and were found in both control and diabetic monkeys.

Hypocholesterolemic effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in the guinea pig: Atorvastatin versus simvastatin

Male Hartley guinea pigs were fed a hypercholesterolemic diet rich in lauric and myristic acids with 0, 10, or 20 mg/kg of simvastatin or atorvastatin for 21 days. Atorvastatin and simvastatin resulted in a lowering of plasma low-density lipoprotein (LDL) cholesterol in a dose-dependent manner by an average of 48 and 61% with 10 and 20 mg/kg, respectively. Both statins were equally effective in lowering plasma LDL cholesterol and apolipoprotein B (apo-B) levels. Atorvastatin and simvastatin treatments yielded LDL particles that differed in composition from the control. Due to the relevance of LDL oxidation and cholesteryl ester transfer in plasma to the progression of atherosclerosis, these parameters were analyzed after statin treatment. Atorvastatin and simvastatin treatment decreased the susceptibility of LDL particles to oxidation by 95% as determined by the formation of thiobarbituric acid reactive substances. An 80% decrease in the transfer of cholesteryl ester between high-density lipoprotein (HDL) and the apo-B-containing lipoproteins was observed after simvastatin and atorvastatin treatment. In addition, statin effects on plasma LDL transport were studied. Simvastatin- and atorvastatin-treated guinea pigs exhibited 125 and 175% faster LDL fractional catabolic rates, respectively, compared with control animals. No change in LDL apo-B flux was induced by either treatment; however, LDL apo-B pool size was reduced after statin treatment. Hepatic microsomal free cholesterol was lower in the atorvastatin and simvastatin groups. However, only atorvastatin treatment resulted in an 80% decrease of acyl-CoA:cholesterol acyltransferase activity ( P < 0.001). In summary, atorvastatin and simvastatin had similar LDL cholesterol lowering properties, but these drugs modified LDL transport and hepatic cholesterol metabolism differently.

Variation of apolipoprotein B as a possible cause of decreased low density lipoprotein clearance and hypercholesterolemia

The fractional catabolic rate (FCR) for low density lipoprotein (LDL) apolipoprotein B (apo B) was studied to explore the variations in apo B as a possible cause of hypercholesterolemia. The FCR of radioiodine labelled autologous LDL and homologous LDL isolated from a normocholesterolemic subject were compared in forty-nine type II hypercholesterolemic males and females with the mean plasma concentration of total cholesterol of 7.78 mmol/l, LDL-cholesterol 5.41 mmol/l and triglycerides 2.09 mmol/l. In most patients the autologous LDL was catabolized at an equal rate and sometimes even faster than the homologous LDL. However, twelve out of forty-nine patients catabolized homologous LDL 0.8–19.3% faster than autologous LDL and several apo B polymorphisms were determined. No apo B-3500 or apo B-3531 mutations were detected. Patients with XbaI −/− (absence of cutting site) had lower total, IDL and LDL cholesterol and LDL apoB than the other genotypes. Patients with EcoRI +/+(presence of cutting site) had higher total, VLDL and LDL cholesterol and slower FCR for autologous LDL, and their VLDL was richer in cholesterol than that of patients with the EcoRI +/−. The MspI and ins/del polymorphisms were not associated with variations in the measured parameters. The apo E 4 was associated with higher VLDL and IDL cholesterol, higher triglycerides and LDL apo B than E 3/3. Overall, the determined apo B polymorphisms were not related to the slow clearance of autologous LDL among the 12 patients, in whom autologous LDL was cleared at a slower rate than homologous LDL. In conclusion, hypercholesterolemia can be due to particle-related slow clearance of LDL in some patients. However, this is not a common cause of hypercholesterolemia.

Three-fold effect of lovastatin treatment on low density lipoprotein metabolism in subjects with hyperlipidemia: increase in receptor activity, decrease in apoB production, and decrease in particle affinity for the receptor. Results from a novel triple-tracer approach

To differentiate effects of lovastatin on low density lipoprotein (LDL) receptor activity from effects on LDL metabolic properties, LDL apolipoprotein B (apoB) turnover was studied in eight hyperlipidemic subjects during baseline and lovastatin treatment, in the latter case with LDL tracers isolated during both baseline (C-LDL) and drug treatment (Rx-LDL) conditions. Lovastatin (40 mg/day) significantly lowered total plasma and LDL cholesterol levels (27% and 25%, respectively) as well as plasma triglyceride levels (30%). Using contemporaneous tracers (C-LDL before and Rx-LDL during treatment), lovastatin caused a modest increase in LDL fractional catabolic rate (FCR) (0.410 ± 0.113 vs. 0.339 ± 0.108 pools/day, P < 0.04 by paired t). The increase in LDL tracer FCR was higher when C-LDL tracer isolated during the untreated period was injected during lovastatin treatment (0.496 ± 0.177 vs. 0.339 ± 0.108 pools/day, P < 0.02). These in vivo studies in humans were confirmed by injecting LDL tracers from two patients into five guinea pigs. The C-LDL tracer was cleared consistently faster than the Rx-LDL tracer (0.082 ± 0.018 vs. 0.057 ± 0.015 pools/h, P < 0.001). The results demonstrate three important outcomes of lovastatin treatment in these subjects: LDL receptor activity increased by 49% (P < 0.02); LDL apoB production rate decreased by 17% (P < 0.03), and LDL particle in vivo affinity for the LDL receptor decreased by 15% (P < 0.01). The decrease in LDL particle affinity partially negated the expected effect of increased LDL receptors on LDL clearance. The present study provides an explanation for earlier observations by several investigators using contemporaneous tracers that treatment with HMG-CoA reductase inhibitors resulted in only modest increases in low density lipoprotein functional catabolic rate.—Berglund, L., J. L. Witztum, N. F. Galeano, A. S. Khouw, H. N. Ginsberg, and R. Ramakrishnan. Three-fold effect of lovastatin treatment on low density lipoprotein metabolism in subjects with hyperlipidemia: increase in receptor activity, decrease in apoB production, and decrease in particle affinity for the receptor. Results from a novel triple-tracer approach. J. Lipid Res. 1998. 39: 913–924.

Low-density lipoprotein-apolipoprotein B metabolism following apheresis: simulation studies of mass changes and tracer kinetics.

Low-density lipoprotein (LDL) apheresis is an effective method to treat severe hyperlipoproteinemia such as heterozygous familial hypercholesterolemia (FH). It is unknown whether apheresis induces changes in metabolic parameters of LDL-apolipoprotein B (apoB) such as the fractional catabolic rate (FCR) or production rate. We performed simulation studies to determine the effect of potential changes in the LDL FCR on LDL-apoB mass and on exogenous and endogenous tracer studies. For these studies, we assumed a two-compartment LDL model and the following metabolic parameters: plasma LDL-apoB, 180 mg.dL(-1); LDL-apoB production rate, 36 mg.dL(-1).d(-1) (approximately 14.4 mg.kg(-1).d(-1)); and LDL-apo FCR, 0.2 d(-1). It was also assumed that apheresis instantaneously decreased the LDL-apoB concentration to 60 mg.dL(-1) and that LDL-apoB production was not perturbed. The simulations examined three possible outcomes: (1) no change in FCR, (2) a temporary doubling in FCR, and (3) a temporary tripling in FCR. Monoexponential models were fit to the rebound of LDL-apoB mass data generated using the different FCRs. In no instance did the FCR determined from the fit match the FCR used to generate the data; FCRs were either higher or lower than the original FCR used to generate the data. Simulations of the kinetics of exogenously labeled LDL showed that if apheresis was performed on day 7 of a turnover study, it would be possible to detect large changes in LDL-apoB FCR. In contrast, during an endogenous labeling study, potential increases in FCR induced by apheresis may not be detected. However, our simulations do show that endogenous labeling studies performed before and after apheresis should yield data that will permit detection of changes in the FCR. Thus, these studies indicate that large differences in the LDL-apoB FCR induced by apheresis can be detected by either an exogenous tracer experiment perturbed by apheresis or by endogenous labeling experiments performed before and after apheresis. Small changes in the FCR that may be induced by apheresis will probably be indistinguishable from experimental noise.

Increased VLDL in nephrotic patients results from a decreased catabolism while increased LDL results from increased synthesis

Increased VLDL in nephrotic patients results from a decreased catabolism while increased LDL results from increased synthesis

Review of human studies evaluating individual dietary responsiveness in patients with hypercholesterolemia

Individual variation in the low-density-lipoprotein (LDL)-cholesterol response to a cholesterol-lowering diet has been well documented in inpatient and outpatient diet studies. This variation could be due to both clinical and biological factors. Clinical factors include adherence to dietary changes and changes in body weight. Biological factors include specific changes in dietary composition, initial serum cholesterol concentrations, presence of excess body weight, the fractional catabolic rate of LDL with a diet high in saturated fatty acid, the presence of specific isoforms of apoprotein E and apoprotein A-IV, changes in the gene encoding apoprotein B or the apoprotein A-I promoter region, and the ultracentrifugation pattern of LDL lipoproteins. Work exploring the metabolic basis for individual variation in responsiveness to a cholesterol-lowering diet is in its infancy. Careful studies controlling for the clinical influences of responsiveness are needed so that true biological determinants of response can be uncovered.

Comparative effects of HMG-CoA reductase inhibitors on apo B production in the casein-fed rabbit: Atorvastatin versus lovastatin

Rabbits fed a diet enriched in casein develop an endogenous hypercholesterolemia (EH) due both to an increased low density lipoprotein (LDL) synthetic rate and decreased LDL receptor activity. Pre-established EH in this model was used to assess the ability and mechanism by which atorvastatin lowers total plasma cholesterol (TPC) compared to the reference agent lovastatin. Rabbits were fed a casein diet for 6 weeks, obtaining average TPC levels above 200 mg/dl. To ensure equivalent mean cholesterol concentrations, animals were randomized into treatment groups based on the 6-week TPC levels, and fed the casein diet alone or in combination with either atorvastatin or lovastatin for an additional 6 weeks. Under these conditions, new steady-state cholesterol values were established. Lipoprotein concentrations and distributions were determined at this point. Compared to pretreatment values, TPC were similar in untreated animals. Atorvastatin, however, significantly reduced TPC by 38%, 45%, and 54% at the 1, 3, and 10 mg/kg doses, respectively. Statistically significant lowering of TPC (35%) by lovastatin was only achieved at the 10 mg/kg dose. To determine the mechanism by which atorvastatin lowered TPC in the EH rabbits, kinetic studies using human [ 125I]-LDL were performed in a subset of animals maintained on the casein diet alone ( n = 5), or those treated with 3 mg/kg of atorvastatin ( n = 5) or lovastatin ( n = 7). In this set of studies, atorvastatin significantly lowered TPC compared to control and lovastatin-treated rabbits by 57% and 46%, respectively. Lovastatin treatment resulted in a 20% decrease in TPC as compared to untreated controls. The LDL fractional catabolic rates (FCR) were similar for all groups (0.06–0.07 pools/hour). LDL production rates (PR), however, were significantly less in the atorvastatintreated rabbits than either the control or lovastatin groups (1.0 ± 0.1 vs. 2.2 ± 0.3 and 1.8 ± 0.3 mg/kg/hour, respectively). The atorvastatin-induced decrease in LDL PR resulted in a diminished apolipoprotein (apo) B pool size (16.8 ± 2.0 mg/kg) as compared to either control (40.4 ± 3.7 mg/kg) or lovastatin-treated (28.4 ± 3.4 mg/kg) groups. The LDL PR with lovastatin treatment was 20% lower than that of the control group, though this value did not reach statistical significance, whereas the apo B mass was significantly reduced by 30%. These studies demonstrate that 3-hydroxy-3-methylglutaryl-co-enzyme A (HMG-CoA) reductase inhibitors can reverse the diet-induced hypercholesterolemia in the EH rabbit model. The underlying mechanism of this reversal is a decrease in the apparent LDL production rate. At equivalent doses, atorvastatin is more efficacious in this model than lovastatin.

Decreased clearance of low-density lipoprotein in patients with chronic renal failure

The clearance of low-density lipoprotein (LDL) isolated from uremic patients (autologous-LDL) and from a control subject (control-LDL) was studied in 12 uremic patients on conservative management and compared to the LDL clearance in control subjects. The clearances of autologous-LDL and control-LDL were almost the same in the patients. However, the fractional catabolic rate (FCR) of the autologous-LDL (0.307 +/- 0.094 pools/day, mean +/- SD) and the control-LDL (0.289 +/- 0.081 pools/day) were significantly lower (P < 0.05 and P < 0.01, respectively) than the FCR for LDL in the control subjects (0.376 +/- 0.045 pools/day). Moreover, one-half of the patients had an abnormally low LDL clearance rate ranging from 0.146 to 0.282 pools/day. The FCR for the autologous-LDL varied from 0.146 to 0.416 pools/day between the patients and was negatively related (r = -0.68, P = 0.02) to the serum urea concentration (from 11.8 to 39.2 mmol/liter) and tended to correlate positively with the glomerular filtration values (from 9.2 to 48.3 ml/min/1.73 m2; r = 0.57, P = 0.096, non-linear relationship). In conclusion, the clearance of LDL in patients with advanced uremia on conservative management is frequently decreased. This alteration in the metabolism of the most atherogenic particle in plasma may contribute to the accelerated atherosclerosis in uremic patients.

Lovastatin enhances hepatic uptake of low density lipoprotein in humans.

A noninvasive method for visualizing the uptake of low density lipoprotein (LDL) was used to investigate the effect of hypolipidemic drugs on LDL uptake by the human liver in vivo. Fourteen hypercholesterolemic patients (six with familial hypercholesterolemia and eight with common hypercholesterolemia) were studied. Autologous LDL particles were isolated and divided into two aliquots; one was labeled with 99mTC and the other with 131I, and both preparations were reinjected simultaneously. The labeled LDL was visualized 24 h later by scanning the thorax and abdomen with a gamma camera, and the liver/heart ratio was calculated as an estimate of the hepatic uptake of LDL. The results of 99mTC-labeled LDL scintigraphy were compared with conventional determinations of the fractional catabolic rate (FCR) for 131I-labeled LDL. The latter correlated best with the liver/heart ratio (r = 0.80, P < 0.001). Lovastatin treatment increased the liver/heart ratio (15%, P < 0.01) in the patients with polygenic hypercholesterolemia and the FCR for LDL in both groups (22%, P < 0.05, for those with familial hypercholesterolemia and 37%, P < 0.01 for those with polygenic hypercholesterolemia). Scanning of the liver using the 99mTC-labeled LDL method provides a noninvasive method for visualizing the hepatic uptake of LDL in vivo in humans. This study also provides direct proof that lovastatin, a drug that enhances LDL receptor activity in the liver, also increases the hepatic uptake of LDL in humans.

Dietary fat saturation modifies the metabolism of LDL subfractions in guinea pigs.

The effects of dietary fat saturation on the metabolism of low-density lipoprotein (LDL) subfractions were measured in adult male guinea pigs fed semipurified diets containing 15% (wt/wt) corn oil (CO; 58% linoleic acid), lard (24% palmitic/14% stearic acid), or palm kernel oil (PK; 52% lauric/18% myristic acid). Animals fed the CO diet had lower plasma total cholesterol levels than guinea pigs fed the PK or lard diets (P < .01). Plasma LDL-1 (d = 1.019 to 1.05 g/mL) concentrations were 3.5- and 2.4-fold higher in animals fed the PK diet compared with the CO and lard groups, respectively, while LDL-2 (d = 1.05 to 1.09 g/mL) concentrations were not different among groups. For all dietary fat groups LDL-1 had a higher molecular weight and a larger diameter than LDL-2. LDL fractional catabolic rates (FCRs) varied, depending on both the diet and the LDL subfraction. Animals fed the polyunsaturated CO diet had a more rapid LDL FCR than animals from the other two groups (P < .01). Within the same diet group, LDL-2 exhibited a slower turnover rate than LDL-1 in animals fed the PK diet, while no differences in LDL subfraction FCR were found in the CO and lard groups. Animals fed the PK and lard diets did not exhibit significant modifications in the density distribution of LDL subfractions over a period of 33 hours. In contrast, animals fed the CO diet exhibited a shift of more buoyant to denser LDL particles, suggesting that differences in LDL intravascular processing are mediated by dietary fat saturation. In vitro LDL binding to hepatic membranes confirmed the in vivo data with an increased expression of apolipoprotein B/E receptors (Bmax) in animals fed the CO diet (P < .01). Hepatic apolipoprotein B/E receptors exhibited less affinity for LDL-2 in the PK group, a result consistent with the less rapid turnover of LDL-2 in PK-fed animals. The results suggest that dietary fatty acids varying in saturation and composition have distinctive atherogenic potentials. The lowest plasma LDL cholesterol concentrations mediated by CO intake could in part be explained by induced changes in the composition and processing of LDL subfractions, resulting in faster LDL turnover rates in addition to increased expression of hepatic apolipoprotein B/E receptors.(ABSTRACT TRUNCATED AT 400 WORDS)