Type IIb Hyperlipoproteinemia Research Articles

Akutni rekurentni pankreatitis izazvan hiperlipidemijom tip IIb

Hypertriglyceridemia is a known but underestimated cause of acute pancreatitis. Although the connection between acute pancreatitis and type I, IV, and V hyperlipoproteinemia has been described, using Fredrickson’s classification, the connection between type IIb hyperlipoproteinemia and associated pancreatitis has only been reported in a few more rare cases. That is why we present a female patient with recurrent hyperlipidaemic pancreatitis with type IIb hyperlipidaemia.

Monitoring of pregnancies with successful deliveries in a Niemann-Pick disease type B patient - case report and literature review

Introduction. Niemann?Pick disease type B is an autosomal recessive disease caused by sphingomyelinase deficiency resulting in sphingomyelin accumulation in macrophages of various organs. Visceral involvement includes spleen enlargement, thrombocytopenia, dyslipidemia, sphingomyelin deposition in lung and liver, and bleeding risk. This is a rare disease and literature data about pregnancy in this setting are scarce. We present two favorable pregnancy outcomes in a patient with Niemann?Pick disease type B along with the review of the literature. Case outline. At the time of the first intended pregnancy, the patient was 34 years old. She had an extremely enlarged spleen, mild restrictive pulmonary disorder, hyperlipoproteinemia type IIb, thrombocytopenia with impaired aggregation tests. Cesarean section was indicated. She was prepared for delivery with platelet concentrates and prophylactic use of antibiotics. In the 36th week of gestation, a Cesarean section without complications was performed. The newborn?s anthropometric parameters were BW 2490, BL 47 cm, HC 32 cm, and Apgar score was 7/8. The infant?s development was normal. Three years later, in the second wanted pregnancy, the same examinations were done. The planned Cesarean section was done without complication after the same procedures, including prophylactic use of antibiotics and platelet concentrates, and a healthy female child was born. Conclusion. A multidisciplinary approach in female patients who suffer from lysosomal storage disease such as Niemann?Pick disease type B is essential and a favorable course is possible despite all risks.

Три варианта переноса жирных кислот в форме триглицеридов у плотоядных, травоядных до синтеза инсулина и при действии гормона инсулина

Является ли человек всеядным? Биологически это невозможно; Homo sapiens - травояден. В филогенезе же предки человека при жизни в океане, были плотоядными, рыбоядными. Предполагается, что в филогенезе последовательно с интервалами в миллионы лет сформировались 3 системы переноса к клеткам жирных кислот в форме неполярных триглицеридов в составе апоВ липопротеинов. 1. У плотоядных (Carnivore) в океане и на суше: энтероциты, апоЕ/В-48 хиломикроны → гепатоциты→ апоВ-100 ЛПОНП→ ЛПНП→ апоВ-100 эндоцитоз. 2. У травоядных (Herbivore), до синтеза инсулина перенос химически инертной пальмитиновой насыщенных жирных кислот осуществлялся по пути: гепатоциты→ пальмитиновые ЛПОНП→ ЛПНП→ апоВ-100 поглощение клетками. 3. У травоядных (Herbivore) при действии инсулина перенос химически активной олеиновой мононенасыщенной жирной кислоты представлял наиболее короткий путь: гепатоциты→ олеиновые ЛПОНП→ апоЕ/В-100 эндоцитоз инсулинзависимыми клетками. На ступенях филогенеза; 1. у плотоядных, 2. у травоядных до синтеза инсулина и 3. у травоядных при действии инсулина: 1. хиломикроны → пальмитиновые ЛПОНП→ ЛПНП→ апоВ-100 эндоцитоз; 2. пальмитиновые ЛПОНП→ ЛПНП→апоВ-100 эндоцитоз и 3. олеиновые ЛПОНП→ апоЕ/В-100 эндоцитоз, видно, почему олеиновые ЛПОНП не могут переносить пальмитиновые ЛПОНП с иными физико-химическими свойствами. В инсулинзависимой системе переноса олеиновой мононенасыщенной жирной кислоты, триглицериды задействованы только ЛПОНП и нет ЛПНП. При избытке плотоядной (мясной) пищи и пальмитиновой насыщенной жирной кислоты НЖК клетки не поглощают безлигандные пальмитиновые ЛПОНП→ЛПНП путем апоЕ/В-100 эндоцитоза. Формирование у пациента переноса насыщенных жирных кислот до действия инсулина объективизируется по уровню гиперлипопротеинемии (ГЛП) типа IIб. При избыточном потреблении мясной пищи и формировании переноса насыщенных жирных кислот, что характерно для плотоядных, у пациентов методом электрофореза выявляется гиперлипопротеинемия типа V. Атеросклероз и атероматоз, хотя и имеют общие звенья патогенеза, являются биологически разными, последовательными процессами, отражающими нарушение биологической функции трофологии и функции эндоэкологии. Is the human being an omnivore? Biologically, this is impossible. Homo sapiens is the herbivore. However phylogenetically, ocean-living ancestors of people were fish-eating carnivores. We suggest that three systems of fatty acid (FA) transport to cells have formed successively, at several million-year intervals, in the form of nonpolar triglycerides (TG) as constituents of apoB lipoproteins (LP): i) in the carnivores, both in the ocean and on land: enterocytes → apoВ-100 VLDL → LDL → apoВ-100 endocytosis; ii) in herbivores prior to insulin production: transport of chemically inert palmitic FA along the hepatocytes → palmitic VLDL→ LDL→ apoВ-100 cellular uptake pathway; iii) in herbivores under the action of insulin, the transport pathway for chemically active oleic FA is the shortest: hepatocytes→ oleic VLDL→ apoЕ/В-100 endocytosis by insulin-dependent cells. Thus, oleic VLDL cannot transport palmitic TG that have different physico-chemical parameters. In the insulin-dependent transport of oleic FA, TG are associated only with VLDL but not with LDL. When the diet is rich in meat and palmitic saturated FA cells do not internalize nonligand palmitic VLDL→LDL via apoЕ/В-100 endocytosis; physiologically, this endocytosis does not exist. In type IIb hyperlipoproteinemia, saturated FA are transported before the effect of insulin. If a patient eats excessive meat, transport of saturated FA follows the pathway typical of carnivore animals, which results in type V hyperproteinemia as detected by LP electrophoresis. Although atherosclerosis and atheromatosis share some pathogenetic features they are biologically different processes associated with impaired biological functions of trophology and endoecology.

Clinical biochemistry methods in objectiva evalution of overeating foood of carnivores (meat)by a phylogenetically herbivorous homo sapiens (a patient).

The abuse of food of carnivores (meat) by phylogeneticallyI herbivorous Homo sapiens (a patient) initiates atherosclerosis. Addressing biogenetic law of E. Haeckel that ontogeny recapitulates phylogeny (a universal anamnesis), we suggest a diagnostic technique that allows evaluation of the meat diet abuse by a herbivorous Homo sapiens. This technique is based on application of phylogenetic theory of general pathology to clinical practice. The degrees of objective evaluation of nonphysiological overeating of meat are: the first, an increase in the fast plasma content of oleic triglycerides palmitoyl-oleyl-palmitate (POP). The second, hyperglyceridemia + an increase in low density lipoprotein cholesterol (LDL-CL) content. The third, increased plasma content of apoС-III. The fourth, an increase in the concentration of apoВ-48. If electrophoregrams are analyzed and hyperlipoproteinemia (HLP) type is determined according to WHO classification, the first degree of meat overeating is not informative, the second, corresponds to type IV HLP; the third, to type IIb HLP, and the forth, to type V HLP, i.e, the patient diet consists practically of the food of carnivores. Hyperlipoproteinemia coincides with insulin resistance syndrome, hyperglycemia and hyperinsulinemia, which is based on blood increase of fatty acids in the form of polar unesterified fatty acids (UFA). According to phylogenetic theory of general pathology, in vivo cells do not internalize glucose if there is a possibility to internalize UFA. Preventive examination allows evaluation of disorders in the biological function of trophology (food consumption). Thus, the use of different methods in the analysis of this function offers evaluation of the effectiveness of diet therapy from the level of disorders when treatment was started.

Clinical biochemistry methods in objectiva evalution of overeating foood of carnivores (meat) by a phylogenetically herbivorous homo sapiens (a patient).

The abuse of food of carnivores (meat) by phylogeneticallyI herbivorous Homo sapiens (a patient) initiates atherosclerosis. Addressing biogenetic law of E. Haeckel that ontogeny recapitulates phylogeny (a universal anamnesis), we suggest a diagnostic technique that allows evaluation of the meat diet abuse by a herbivorous Homo sapiens. This technique is based on application of phylogenetic theory of general pathology to clinical practice. The degrees of objective evaluation of nonphysiological overeating of meat are: the first, an increase in the fast plasma content of oleic triglycerides palmitoyl-oleyl-palmitate (POP). The second, hyperglyceridemia + an increase in low density lipoprotein cholesterol (LDL-CL) content. The third, increased plasma content of apoС-III. The fourth, an increase in the concentration of apoВ-48. If electrophoregrams are analyzed and hyperlipoproteinemia (HLP) type is determined according to WHO classification, the first degree of meat overeating is not informative, the second, corresponds to type IV HLP; the third, to type IIb HLP, and the forth, to type V HLP, i.e, the patient diet consists practically of the food of carnivores. Hyperlipoproteinemia coincides with insulin resistance yndrome, hyperglycemia and hyperinsulinemia, which is based on blood increase of fatty acids in the form of polar unesterified fatty acids (UFA). According to phylogenetic theory of general pathology, in vivo cells do not internalize glucose if there is a possibility to internalize UFA. Preventive examination allows evaluation of disorders in the biological function of trophology (food consumption). Thus, the use of different methods in the analysis of this function offers evaluation of the effectiveness of diet therapy from the level of disorders when treatment was started.

The becoming of reactions of lipolysis in phylogenesis. The palmitic and oleic triglycerides as substrates. Insulin, condition of normolipemia and formation of hyper lipoproteinemia type IIb, IV and V

According to phylogenetic theory of general pathology, when living in ocean all were carnivorous (piscivorous) fatty acids transferring to cells in form of non-polar triglycerides nitially began apoB-48 chylomicrons, continued lipoproteins of very low and low density and fnalized its apoB-100 endocytosis. The fatty acids are transferred by chylomicrons + lipoproteins of very low density + lipoproteins of low density and non-polar triglycerides are hydrolyzed by hepatic glycerolhydrogenase and co-enzyme apoC-III; according WHO classifcation, hyperlipoproteinemia corresponds to type V. On land, in herbivorous who are not yet synthesized insulin, apoB-48 and chylomicrons left process of non-polar triglycerides transferring. In lipoproteins of very low density and lipoproteins of low density, the carnivorous transfer exogenous palmitic non-polar triglycerides. The herbivorous also transfer palmitic non-polar triglycerides though synthesized by hepatocytes from glucose endogenically. In herbivorous, transferring of palmitic non-polar triglycerides prior to synthesis of insulin is forming apoB-100 in composition of lipoproteins of very low density and lipoproteins of low density. The hydrolysis of palmitic non-polar triglycerides in lipoproteins of very low density is activated by hepatic glycerol hydrogenase and apoC-III; cells absorb lipoproteins of low density by means of apoB-100 endocytosis. The content on lipoproteins in blood plasma under electrophoresis of lipoproteins corresponds to hepatic glycerol hydrogenase type IIb. In frst and second types of fatty acids transferring in form of triglycerides to lipoproteins of very low density + lipoproteins of low density predominate palmitic fatty acid, triglycerides of the same name and palmitic metabolism of fatty acids in vivo. The insulin initiated the third type of transferring of oleic fatty acid by now to insulin-depended cells only in oleic lipoproteins of very low density; hydrolysis of oleic triglycerides is activated by late in phylogenesis post-heparin hepatic glycerol hydrogenase and apoC-II cofactor. The dynamic apoE is actively bound by apoB-100 forming apoE/B-100 ligand. At later stages of phylogenesis insulin formed fatty acids transferring in form of oleic triglycerides in lipoproteins of very low density of the same name without forming of oleic lipoproteins of low density; the electrophoregram of lipoproteins reflects absence of hepatic glycerol hydrogenase. In phylogenesis three types of fatty acids transferring to triglycerides in composition of lipoproteins formed sequentially: 1) chylomicrons + lipoproteins of very low and density + lipoproteins of low density; 2) lipoproteins of very low density + lipoproteins of low density; 3) only in lipoproteins of very low density. The frst one is specifc to piscivorous (carnivorous) while living in ocean. The second one is implemented by herbivorous while they didn't begin to synthesize insulin and hepatocytes not yet transform all endogenous palmitic fatty acid into oleic fatty acid. Insulin initiated: a) transferring of oleic fatty acids to lipoproteins of very low density without forming oleic lipoproteins of low density; b) highly effective oleic metabolism of fatty acids in vivo: c) becoming of biological function of locomotion. The aphysiological induction by substrate, surplus of palmitic fatty acids in food initiate negative alterations in composition of lipoproteins in opposite direction than in case of phylogenesis. When homo sapiens, herbivorous in phylogenesis, begins to misuse carnivorous (meat) food then instead of normolipoproteinemia in blood plasma under electrophoresis of lipoproteins one can initially detect transitory hyperlipoproteinemia type IV and then prolonged hyperlipoproteinemia type IIb. If patient factually passes on to carnivorous diet then hyperlipoproteinemia type V is developing. If content of exogenous palmitic fatty acid in food surpasses physiological capacities of its transferring in oleic triglycerides as palmitoyl-oleyl-palmitate glycerol, palmitic triglycerides as oleyl-palmitoyl-palmitate glycerol begin to form and epigenetically aphysiological non-ligand palmitic lipoproteins of very low density → lipoproteins of low density are formed. Their circulation in blood is a cause of hypertriglyceridemia, higher level of cholesterol-lipoproteins of low density, compensatory increasing of apoC-III. Then occurs induced by substrate formation of hyperlipoproteinemia initially of type IV, then of type IIb and fnally of type V. The pathogenesis of atherosclerosis and atheromotosis is activated when homo sapiens, herbivorous in phylogenesis, begin to misuse carnivorous food affecting biological functions of trophology, reaction of exotrophy (external nutrition), function of homeostasis, endoecology and function of adaptation. The formation of palmitic metabolism if fatty acids instead of oleic one is a cause of chronic defciency of energy and ATP synthesis in vivo. Insulin activates absorption of glucose by cells with purpose to use it for synthesis of oleic fatty acids. In the frst place, insulin regulates in vivo metabolism of fatty acids and only in second place metabolism of glucose.

Efficacy of rosuvastatin for the treatment of non‐alcoholic steatohepatitis with dyslipidemia: An open‐label, pilot study

Statins, an inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, are reported to be useful for the treatment of non-alcoholic steatohepatitis (NASH). Currently, there is no proven therapy for NASH. In this study, we assessed the efficacy of rosuvastatin in NASH patients with dyslipidemia. Nineteen patients with biopsy-proven NASH with dyslipidemia who agreed to participate in this prospective study were enrolled. The patients were treated for 24 months with 2.5 mg/day rosuvastatin. Clinical and histological alterations were comparatively evaluated before and after treatment. Standard weight-loss counseling was continued during the treatment period. Follow-up liver biopsy was performed in nine patients. Twenty-six percent of patients had hyperlipoproteinemia type IIa and 74% had hyperlipoproteinemia type IIb at baseline. Body mass indices were not significantly changed during the treatment. The levels of transaminases were relatively low at the beginning, and were not significantly changed during the treatment. Lipid profiles were significantly improved by the treatment with rosuvastatin for 24 months. While non-alcoholic fatty liver disease activity score and fibrotic stage did not change significantly in all patients, they were improved in 33.3% and 33.3% individual patients, and stayed stable in 33.3% and 55.6%, respectively. NASH-related metabolic parameters improved with therapy including histology in some patients. However, one of nine patients had progression of fibrosis during the treatment. Our pilot study demonstrated the efficacy of rosuvastatin for the treatment of NASH with dyslipidemia, even if transaminases are not so elevated and controlled trials are needed in the future.

Clinical Study on the Effect of Simvastatin on Butyrylcholinesterase Activity

Although the physiological function of serum butyrylcholinesterase (BuChE) has not yet been clarified, there is evidence that this enzyme is involved in serum lipoprotein metabolism. It has been suggested that serum BuChE is positively correlated with LDL (low-density lipoprotein) and negatively with HDL (high-density lipoprotein) levels. The objective of this study was to determine whether the activity of BuChE changes during treatment with simvastatin (CAS 79902-63-9). The effects of simvastatin therapy on serum lipoproteins and plasma BuChE activity were studied in 15 patients with type IIa and 17 patients with type IIb hyperlipoproteinemia. Beside the expected influence on serum lipid concentration, a statistically significant decrease in BuChE activity in patients with hyperlipoproteinemia type IIa and IIb during treatment with simvastatin was not observed.

Clinical Study on the Effect of Simvastatin on Paraoxonase Activity

Human paraoxonase (PON1) is a serum high-density lipoprotein-associated phosphotriesterase. High-density lipoprotein (HDL) plays the role of a carrier and the site of action of this enzyme. According to a majority of authors, PON1 acts as an antioxidant, preventing low-density lipoprotein (LDL) peroxidation. However, due to the fact that in vivo serum PON1 is predominantly associated with HDL, its major physiological role might be to protect HDL, rather than LDL, from oxidation. Nevertheless, the physiological substrate of PON1 still remains to be discovered. The objective of this study was to determine changes in PON1 activity during treatment with simvastatin (CAS 79902-63-9, Lipex) in patients with type IIa and/or IIb hyperlipoproteinemia. PON1 activity was assessed in 32 patients with hyperlipoproteinemia type IIa or IIb with an LDL cholesterol concentration higher than 4.2 mmol/l. Patients received simvastatin in a daily dose of 20 mg. The lipid status and PON1 activity were assessed at baseline, as well as 3 and 6 months after the beginning of treatment. The study demonstrated a statistically significant lipid lowering effect of simvastatin on total and LDL cholesterol, and an increase in PON1 activity in patients with both types of hyperlipoproteinemia. No statistically significant correlation was observed either between changes in PON1 activity and HDL, HDL2, HDL3 and LDL cholesterol and triglyceride levels, or between their first differences in patients with both type IIa and IIb hyperlipoproteinemia. The obtained results suggest that the antioxidant properties of simvastatin might be caused by a mechanism independent of apoAI-containing lipoprotein concentration. The antioxidant properties of simvastatin, which play an important role in HDL protection from oxidation, could be the mechanism inducing the increase in PON1 activity.

Efficacy of pitavastatin for the treatment of non‐alcoholic steatohepatitis with dyslipidemia: An open‐label, pilot study

Non-alcoholic fatty liver disease (NAFLD) that encompasses a spectrum of liver disorders characterized by simple steatosis, non-alcoholic steatohepatitis (NASH) through cirrhosis, is becoming an important chronic liver disease in Japan. Currently, there is no proven therapy for NASH. In this study, we assessed the efficacy of statin therapy in NASH patients with dyslipidemia. Twenty patients with biopsy-proven NASH with dyslipidemia who agreed to participate in this multicentric prospective study were enrolled. The patients were treated for 12 months with pitavastatin 2 mg/day. Clinical and histological alterations were comparatively evaluated before and after treatment. Standard weight loss counseling was continued during the treatment period. Follow-up liver biopsy was performed in 13 patients. Twenty-five percent of patients had hyperlipoproteinemia type IIa and 75% had hyperlipoproteinemia type IIb at baseline. The levels of alanine aminotransferase, γ-glutamyl transpeptidase and lipid profiles were significantly improved by the treatment with pitavastatin for 12 months. Especially, these improvements were prominent in NASH patients with hyperlipoproteinemia type IIb. While non-alcoholic fatty liver disease activity score and fibrosis stage did not change significantly in all patients, they did improve in 54% and 42% in individual patients, respectively. NASH-related metabolic parameters improved with therapy including histology in some patients. However, three of 13 patients had progression of fibrosis during the treatment. Our pilot study demonstrated the efficacy of pitavastatin for the treatment of NASH with dyslipidemia, especially with hyperlipoproteinemia type IIb and controlled trials are needed in the future.

Impact of Mild hypertriglyceridemia on fibrinolysis, Lp(a), and platelet activation indexes in mildly hypercholesterolemic patients

The relationship between high triglyceride values and alterations of the fibrinolytic system in cardiovascular heart disease (CHD) patients is well known. The aim of the study was to evaluate the effect of moderate hypertriglyceridemia on fibrinolysis, lipoprotein(a) [(Lp(a)], and platelet activation indexes in asymptomatic patients. To this end, 46 nondiabetic, dyslipidemic patients (age 51±8 years), with no associated pathologies and 23 normolipidemic, homogeneus patients (in terms of age, sex, and smoke habits) were studied. The dyslipidemic patients were split up into two groups: 23 type IIb hyperlipoproteinemia patients (Group I), and 23 type IIa hyperlipoproteinemia patients (Group 2). The control group had total cholesterol values of <5.18 mmol/L and triglyceride concentrations of <2.25 mmol/L. The result showed a significant difference (p<0.05) in the baseline plasminogen tissue activator inhibitor (PAI-1 b) values for the Group 1 patients as compared with the Group 2 and the controls, in the baseline tissue plasminogen activator (t-PA b) values for the Group 1 patients as compared with the Group 2 patients and in the lipoprotein (a) (Lp(a)) (p<0.01) values for the Group 2 as compared with the controls. On the other hand, no statistically significant difference was observed in β-thromboglobulin (β-TG), platelet factor 4 (PF4). This study shows that mild hypertriglyceridemia in asymptomatic hypercholesterolemic patients is associated with a different regulation of the fibrinolytic mechanism. In patients with moderate hypercholesterolemia, higher blood concentrations of Lp(a) were found than in the controls.

Bevacizumab-associated hyperlipoproteinemia type IIb in a patient with advanced invasive-ductal breast cancer

We report a case of bevacizumab-associated hyperlipoproteinemia in a patient with advanced breast cancer. A 57-year-old woman with advanced invasive-ductal breast cancer was administered bevacizumab from March 2008 to February 2009. Pretreatment laboratory showed borderline hypercholesterolemia (5.1 mmol/L, 197 mg/dL) and normal triglycerides (1.3 mmol/L, 115 mg/dL). Three months on treatment with bevacizumab, both serum cholesterol (11.9 mmol/L, 460 mg/dL) and triglycerides (7.4 mmol/L, 655 mg/dL) increased substantially, and remained well above the normal range for a period of bevacizumab treatment. From March 2008 to August 2008, the patient also received anticancer treatment with liposomal doxorubicin that was stopped early due to hand-foot syndrome. No concurrent hyperlipidemic drugs have been taken by the patient at the time of bevacizumab treatment. In February 2009, bevacizumab was stopped and the patient went on to receive paclitaxel for hepatic tumor progression. By December 2009, both serum triglycerides (1.3 mmol/L, 115 mg/dL) and cholesterol (3.2 mmol/L, 123 mg/dL) had normalized. This is the first published case of bevacizumab-associated hyperlipoproteinemia. By applying the Naranjo ADR probability scales, at least a possible relationship between hyperlipoproteinemia type IIb and bevacizumab in this patient is supported by the data (Naranjo score 4). No hyperlipidemic drugs were given concurrently with bevacizumab, and the serum cholesterol and triglycerides decreased quickly after bevacizumab was discontinued. This study describes a case of bevacizumab-associated hyperlipidemia. Patients receiving bevacizumab should have their cholesterol and triglycerides checked for potential worsening.

Hyperlipoproteinaemia during additional methenolone administration in the treatment of metastasizing carcinoma of the breast

The effect of additive administration of methenolone oenanthate (Primobolan) on lipid metabolism was studied in 28 menopausal women with metastasizing carcinoma of the breast. In ten women hyperlipoproteinaemia type IIa was demonstrated in the course of treatment, while in two there was hyperlipoproteinaemia type IIb. One of the latter patients had a myocardial infarction in the course of treatment. There was no relationship between the level of hypercholesterolaemia and the methenolone dosage. Nor was it possible to classify the type of cholesterolaemia as a bile stasis syndrome. The hyperlipoproteinaemia regressed in every case once methenolone treatment was discontinued.

Non-HDL cholesterol and apoB in dyslipidaemia

On the basis of a high correlation, non-HDL-C (non-high-density lipoprotein cholesterol) and apoB (apolipoprotein B) have been suggested to be of equivalent value for clinical practice; however, the strength of this relationship has not been examined in detail in patients with dyslipidaemia. The present study examines the variance of non-HDL-C compared with apoB in 1771 consecutive patients evaluated in a lipid clinic. These patients were divided into normolipidaemic subjects (n=407), type I hyperlipoproteinaemia (n=16), type IIa (n=736) and IIb (n=231) hyperlipoproteinaemia, type III hyperlipoproteinaemia (n=38), type IV hyperlipoproteinaemia (n=509) and type V hyperlipoproteinaemia (n=101). The relationship between non-HDL-C and apoB was examined both in terms of correlation and concordance. Correlation was high, but concordance was only moderate in the normolipidaemic subjects and in those with type IIa and type IIb hyperlipoproteinaemia. Correlation and concordance were both low in the subgroups with type III and type V hyperlipoproteinaemia. In those with type IV hyperlipoproteinaemia, correlation was moderately high (r=0.74), but concordance was only fair. In conclusion, our results indicate that there is substantial variance of apoB for given values of non-HDL-C in many dyslipidaemic subjects. It follows that correlation is not adequate as a sole judge of equivalence of laboratory parameters.

Diagnosis of type III hyperlipoproteinemia from plasma total cholesterol, triglyceride, and apolipoprotein B

Our objective was to develop a simple algorithm that could be applied in routine clinical practice to diagnose type III hyperlipoproteinemia based on plasma total cholesterol, triglyceride and apolipoprotein (Apo) B. Analysis of plasma lipid, lipoprotein lipid, and apolipoprotein data from 1771 patients in a tertiary care lipid clinic, from whom all data had been collected prospectively by standardized methods. Of the 1771, based on the Fredrickson classification, 16 had type I hyperlipoproteinemia, 736 type IIa hyperlipoproteinemia, 371 type IIb hyperlipoproteinemia, 38 type III hyperlipoproteinemia, 509 type IV hyperlipoproteinemia, and 101 type V hyperlipoproteinemia. Mean plasma ApoB was highest in type IIb (1.53 ± 0.36 g/L), borderline high (1.1 ± 0.23 g/L) in type IV, normal in type III and type V (1.04 ± 0.21 g/L and 0.96 ± 0.40 g/L, respectively) and low in type I (0.48 ± 0.16 g/L). In type III hyperlipoproteinemia, very low-density lipoprotein ApoB (ie, d<1.006 g/mL) accounted for 42.3% of total ApoB, a value that was substantially higher than in any of the other dyslipoproteinemias. The total cholesterol (TC)/ApoB ratio was similar in the uncommon dyslipoproteinemias-type I, III, and V hyperlipoproteinemia (10.5 ± 4.8, 8.7 ± 1.8, 10.3 ± 7.7, respectively)-and much higher than in the common dyslipoproteinemias-type IIa, IIb, and type IV hyperlipoproteinemia (5.0 ± 0.4, 4.6 ± 0.4, 4.9 ± 1.1, respectively). Notwithstanding that the TC/ApoB area under the curve-receiver operating characteristic (AUC-ROC) was very high (0.93), it did not discriminate among the uncommon dyslipoproteinemias. However, the triglyceride (TG)/ApoB ratio was much higher in type I (42.4 ± 28.8) and type V (25.6 ± 30.2) than in type III (5.8 ± 3.2). All cases of type III had a TC/ApoB ratio >6.2 and a TG/ApoB ratio of <10.0. Using these cutpoints, there were also no false positives. Based on the TC/ApoB ratio and the TG/ApoB ratio, the AUC-ROC was 0.99. These data indicate that type III hyperlipoproteinemia can be reliably diagnosed based on plasma cholesterol, TG, and ApoB.

Apolipoproteins AI and B as therapeutic targets

Currently the apolipoprotein B:AI ratio integrates information about the potential for cardiovascular disease (CVD) risk reduction better than any other lipid or lipoprotein index. Certainly it could, with benefit, replace serum cholesterol and HDL cholesterol in the estimation of CVD risk. Defining the therapeutic target of statin therapy in terms of serum apolipoprotein B (apo B) rather than LDL cholesterol could also help to optimize statin treatment. Deciding whether a therapeutic response is adequate also requires knowledge of whether there is persisting hypertriglyceridaemia, because this gives an indication of whether small dense LDL is likely to have been satisfactorily reduced. Raising low levels of HDL, probably best measured as apo AI, may also prove to be an important aim of treatment. This is, however, a more complex issue and also depends on the mechanism by which a particular therapy alters HDL levels and on whether the capacity of HDL to perform its anti-inflammatory and antioxidative functions is restored. A meta-analysis of randomized clinical trials of statins in which apo B and apo AI have been reported could provide valuable information.

Recurrent Acute Pancreatitis in a Patient with Type IIb hyperlipoproteinemia: A Case Report and Review of the Literature in Korea

Hyperlipidemia is a rare cause of pancreatitis. It has been believed that free fatty acids released from hydrolyzed serum chylomicrons or triglycerides and chylomicrons induce hyperlipidemic pancreatitis by damaging acinar cells and capillaries. Type I, IV or V hyperlipidemic (Fredrickson's classification) pancreatitides have distinctive features of increased and heightened serum chylomicron and triglyceride levels. In contrast, type IIb hyperlipidemia usually doesn't have increased chylomicrons. It is a dominant inherited genetic disorder and doesn't manifest the subjective symptom before combining vascular complications such as coronary artery disease. Only a few cases of type IIb hyperlipidemic pancreatitis have been reported. We experienced a male patient with recurrent hyperlipidemic pancreatitis combined with type IIb hyperlipidemia. We present the case report and a review of the literature of hyperlipidemic pancreatitis, especially cases in Korea.

Increased apoC-III production is a characteristic feature of patients with hypertriglyceridemia

Apolipoprotein (apo) C-III plays an important role in regulating plasma triglyceride (TG) metabolism. In order to further investigate the plasma metabolism of apoC-III in hypertriglyceridemic subjects, we have studied the plasma kinetics of VLDL apoC-III, HDL apoC-III and total plasma apoC-III with a primed constant intravenous infusion of deuterated leucine in a group of male patients with mixed hyperlipidemia (type IIb hyperlipoproteinemia, HLP, n = 6) and in a group with type III HLP ( n = 6). Compared to normolipidemic control subjects ( n = 5), patients with type IIb and type III HLP had significantly higher levels of plasma TG (0.89 ± 0.15 mmol/l vs 2.56 ± 0.40 mmol/l vs 8.76 ± 1.39 mmol/l, respectively, P < 0.01), plasma apoC-III (9.5 ± 0.8 mg/dl vs 20.8 ± 2.5 mg/dl vs 41.7 ± 5.6 mg/dl, P < 0.01) and VLDL apoC-III (3.6 ± 0.8 mg/dl vs 14.6 ± 2.2 mg/dl vs 35.4 ± 5.1 mg/dl, P < 0.01). VLDL apoC-III production rates were significantly elevated in type IIb and type III patients (1.35 ± 0.23 mg kg −1 day −1 vs 3.53 ± 0.43 mg kg −1 day −1 vs 5.60 ± 0.78 mg kg −1 day −1, P < 0.01), as were total plasma apoC-III production rates (1.80 ± 0.22 mg kg −1 day −1 vs 4.16 ± 0.44 mg kg −1 day −1 vs 7.26 ± 0.74 mg kg −1 day −1, P < 0.01). VLDL apoC-III but not total plasma apoC-III fractional catabolic rates were reduced in type IIb and type III patients. Together with our previous results showing an increase of apoC-III production in patients with type IV HLP, and in overweight subjects with reduced insulin sensitivity, our data suggest that increased apoC-III production is a characteristic feature of patients with hypertriglyceridemia.

Soluble epoxide hydrolase variant (Glu287Arg) modifies plasma total cholesterol and triglyceride phenotype in familial hypercholesterolemia: intrafamilial association study in an eight-generation hyperlipidemic kindred.

Plasma lipid and lipoprotein in general reflect the complex influences of multiple genetic loci, for instance, even familial hypercholesterolemia (FH), a representative example of monogenic hyperlipidemia, often presents with phenotypic heterogeneity. In the course of investigating familial coronary artery disease in Utah, we studied 160 members of an eight-generation extended family of FH in which 69 members were affected with type IIa hyperlipoproteinemia (HLPIIa; high plasma cholesterol) and ten with type IIb hyperlipoproteinemia (HLPIIb; high plasma cholesterol as well as plasma triglyceride). Soluble epoxide hydrolase ( EPHX2, sEH) plays a role in disposition of epoxides in plasma lipoprotein particles. Intrafamilial correlation analysis of the modifier effect of Glu287Arg substitution in the EPHX2 gene was carried out among 79 LDLR mutation carriers and 81 noncarriers. In the carriers, plasma cholesterol levels were elevated among carriers of the 287Arg allele (mean +/- SD=358 +/- 72 mg/dl) in comparison with 287Glu homozygotes (mean +/- SD=302 +/- 72 mg/dl) (p=0.0087). Similarly, in the LDLR mutation carriers, the plasma triglyceride levels were elevated among carriers of the 287Arg allele (mean +/- SD=260 +/- 100 mg/dl) in comparison with 287Glu homozygotes (mean +/- SD=169 +/- 83 mg/dl) (p=0.020). No such gene-interactive effect was observed among noncarriers of the LDLR mutation. Half of the patients who presented with HLPIIb had inherited a defective LDLR allele as well as an EPHX2-287Arg allele, whereas the majority who presented with HLPIIa had a defective LDLR allele but not an EPHX2-287Arg allele. These results indicate a significant modification of the phenotype of FH with defective LDLR allele by EPHX2-287Arg variation in our studied kindred.

The effect of micronised fenofibrate on paraoxonase activity in patients with coronary heart disease

To evaluate the effect of micronised fenofibrate on serum paraoxonase (PON) and lipoprotein levels in coronary heart disease patients with type IIb hyperlipidemia. Fifty-two patients were investigated for the three-month effect of 200 mg per day micronised fenofibrate on the serum enzyme activity and concentration of PON and their relationship with serum lipids, high-density lipoprotein (HDL-C) parameters. Serum paraoxonase activity was lower in CHD patients with type IIb hyperlipoproteinemia. During the three-month study it was observed that following treatment with micronised fenofibrate, serum triglyceride and cholesterol levels decreased, while HDL-C increased significantly (p<0.001). Low-density lipoprotein (p<0.05) and apolipoprotein B-100 (p<0.01) decreased, while HDL constituent apolipoprotein A-I (p<0.05) increased after micronised fenofibrate treatment. The HDL-associated paraoxonase specific activity increased significantly (p<0.05). To assess whether the increased PON activity was due to elevated HDL and apoA-I level, we standardized PON activity for HDL and apoA-I concentrations. The standardized values for HDL (PON/HDL) increased (p<0.05) while the PON/apoA-I ratio did not change significantly. Three months of treatment with micronised fenofibrate is thought to normalize lipid profile and improve antioxidant status by increasing serum paraoxonase activity in these patients.