VLDL Research Articles

Association of serum lipidomic profiles with risk of intracranial aneurysm: A Mendelian randomization study.

A two-sample Mendelian randomization (MR) analysis was utilized to assess the causal relationship between lipidomic profiles and the risk of intracranial aneurysms (IAs). Genetic variants related to lipidomic profiles (227 components) and IA [IA, aneurysmal subarachnoid hemorrhage (aSAH) only, unruptured IA (uIA) only] were obtained from published genome-wide association studies (GWASs) or the IEU Open GWAS project and used as instrumental variables for MR analysis. The inverse-variance weighted method was used in the primary analyses to derive causality estimates and was expressed as odds ratio (OR) with 95% confidence interval (CI). Of these 227 lipidomic profiles, only genetically predicted high levels of cholesterol to total lipids ratio in very small very-low-density lipoproteins (VLDL) [OR = 0.629 (95% CI, 0.504-0.786)], cholesteryl esters to total lipids ratio in very small VLDL [OR = 0.637 (95% CI, 0.509-0.797)], ratio of docosahexaenoic acid to total fatty acids [OR = 0.691 (95% CI, 0.582-0.820)], and ratio of polyunsaturated fatty acids to monounsaturated fatty acids [OR = 0.630 (95% CI, 0.522-0.760)] reduced the risk of aSAH, whereas genetically predicted high ratio of monounsaturated fatty acids to total fatty acids [OR = 1.471 (95% CI, 1.215-1.781)] increased the risk of aSAH. Moreover, genetically predicted high levels of cholesterol to total lipids ratio in very small VLDL [OR = 0.657 (95% CI, 0.542-0.798)], cholesteryl esters to total lipids ratio in very small VLDL [OR = 0.663 (95% CI, 0.548-0.803)], free cholesterol to total lipids ratio in small VLDL [OR = 0.682 (95% CI, 0.560-0.832)], phospholipids to total lipids ratio in small VLDL [OR = 0.674 (95% CI, 0.548-0.830)], and ratio of polyunsaturated fatty acids to monounsaturated fatty acids [OR = 0.678 (95% CI, 0.569-0.808)] reduced the risk of IA. The results of multivariable MR demonstrated that these causal associations persisted after adjusting for systolic blood pressure and cigarettes smoked per day. The effect of serum lipids on IA and aSAH may be mainly caused by subclasses of lipids such as VLDL.

Metabolites and Lipoproteins May Predict the Severity of Early Acute Pancreatitis in a South African Cohort.

Background: Acute pancreatitis (AP) can be life-threatening with unpredictable severity. Despite advances in management, its pathogenesis remains unclear. This study investigated metabolites and lipoprotein profiles in AP patients of African descent to understand the underlying pathophysiological conditions so as to inform prognosis and management. Methods: Serum samples were collected from 9 healthy controls (HCs) and 30 AP patients (8 with mild AP, 14 with moderately severe AP, and 8 with severe AP) on days 1, 3, 5, and 7 post epigastric pain and subjected to nuclear magnetic resonance (NMR) spectroscopy. Wilcoxon and Kruskal-Wallis rank-sum tests compared numerical covariates. Lipoprotein characterization was performed using the Liposcale test, and Spearman's rank test assessed data correlations. The p-values < 0.05 indicated significance. Results: Thirty-eight metabolic signals and information on lipoprotein subclasses were identified from the NMR spectra. The severity of AP correlated with increased levels of 3-hydroxybutyrate and acetoacetate and decreased levels of ascorbate. Distinct metabolic phenotypes were identified and characterized by unique inflammatory and lipoprotein profiles. High-density lipoprotein cholesterol (HDL-C) decreased across all the metabolic phenotypes of AP when compared with the HC, while elevated immediate density lipoprotein cholesterol (IDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels were observed. Time-dependent changes in metabolites were indicative of responsiveness to therapy. Conclusions: Our findings indicate that dysregulated metabolites and lipoproteins can be used to differentiate AP disease state and severity. Furthermore, integrating clinical parameters with data on metabolic and lipoprotein perturbations can contribute to a better understanding of the complex pathophysiology of AP.

Heterogeneity of metabolic phenotypes in adolescent boys with obesity due to excess calories

The aim of the study was to determine the heterogeneity of metabolic parameters in teenage boys diagnosed with “obesity due to excess calories” using cluster analysis. Materials and methods. One hundred and twenty-three randomly selected patients aged 14 to 17 years diagnosed with “obesity due to excess calories” were examined. The statistical analysis included descriptive and analytical methods, in particular aimed to identify clusters of biochemical indicators, including serum fasting glucose level, insulin level, total cholesterol level, low density lipoproteins (LDLP), very low-density lipoproteins (VLDL), high density lipoproteins (HDLP) and triglycerides. Results. Two clusters of observations have been identified. The first cluster consisted of 72 patients (58.5%) having fasting glucose levels slightly below average, insulin levels above average, total cholesterol, triglycerides, LDLP and VLDL above average, and HDLP levels below average (“metabolically unhealthy” obesity). The second cluster included 51 teenagers (41.5%) who presented with opposite trends in metabolic characteristics (“metabolically healthy” obesity). The adolescents from the first cluster were slightly older, had higher body mass, body mass index (BMI) and z-BMI scores, and higher HOMA-IR scores. Arterial hypertension and non-alcoholic fatty liver disease were diagnosed statistically significantly more frequently in adolescents from this cluster. Conclusion. Teenage boys with obesity are a heterogeneous group in terms of the values of major metabolic indicators.

Lomitapide: navigating cardiovascular challenges with innovative therapies.

Dyslipidemia is the most significant risk factor for cardiovascular diseases (CVDs) Secondary dyslipidemia: its treatments and association with atherosclerosis. Glob Health Med, Efficacy and safety of saroglitazar for the management of dyslipidemia: A systematic review and meta-analysis of interventional studies. The current treatment strategies for managing dyslipidemia focus on reducing low-density lipoprotein cholesterol (LDL-C) to minimize the risks of atherosclerosis and myocardial infarction (MI). Homozygous Familial Hypercholesterolemia (HoFH) is an inherited autosomal dominant disease caused by a mutation in the LDL receptor (LDLr), which can lead to extremely high levels of LDL-C The Beneficial Effect of Lomitapide on the Cardiovascular System in LDLr(-/-) Mice with Obesity, The microsomal triglyceride transfer protein inhibitor lomitapide improves vascular function in mice with obesity. Although statin therapy has been the primary treatment for dyslipidemia, HoFH patients do not respond well to statins, requiring alternative therapies. Microsomal triglyceride transfer protein (MTP) inhibition has emerged as a potential therapeutic target for treating HoFH. MTP is primarily responsible for transferring triglyceride and other lipids into apolipoprotein B (ApoB) during the assembly of very low-density lipoprotein (VLDL) particles in the liver. Lomitapide, an inhibitor of MTP, has been approved for treatingof HoFH adults. Unlike statins, lomitapide does not act on the LDLr to reduce cholesterol. Instead, lomitapide lowers the levels of ApoB-containing proteins, primarily VLDL, eventually decreasing LDL-C levels. Studies have shown that lomitapide can reduce LDL-C levels by more than 50% in patients with HoFH who have failed to respond adequately to other treatments. Lowering LDL-C levels is important for preventing atherosclerosis, reducing cardiovascular risk, improving endothelial function, and promoting overall cardiovascular health, especially for patients with HoFH Efficacy and safety of a microsomal triglyceride transfer protein inhibitor in patients with homozygous familial hypercholesterolaemia: a single-arm, open-label, phase 3 study. This review paper focuses on research findings regarding the therapeutic benefits of lomitapide, highlighting its effectiveness in lowering cholesterol levels and reducing the risk of CVDs The microsomal triglyceride transfer protein inhibitor lomitapide improves vascular function in mice with obesity.

The Impact of Atorvastatin Treatment on the Distribution of Low-Density Lipoprotein Subfractions and the Level of Vitamin D in Patients After Acute Myocardial Infarction: Preliminary Findings

Clinical trial results indicate that statin therapy aimed at normalising the lipid profile can prevent and reduce the risk of cardiovascular events. Both LDL and HDL consist of several subfractions, with only the smallest and densest subfractions being the most atherogenic. We examine the effect of Atorvastatin treatment not only on basic lipid profile parameters but also atherogenic lipoprotein subfractions and 25(OH)D levels in patients after the first acute myocardial infarction. The study population had not previously received lipid-lowering medications. Serum 25(OH)D concentration was determined by direct competitive immunochemiluminescent assays. Lipoprotein subfractions, including VLDL, IDL-C, IDL-B, and IDL-A, as well as LDL1, LDL2 (large LDL), and LDL3-7 (sdLDL), were measured in serum (Lipoprint® system). Almost all patients had 25(OH)D deficiency. Atorvastatin primarily reduced strongly atherogenic sdLDL and decreased the less atherogenic large LDL subfractions. A statistically significant reduction in VLDL cholesterol and IDL fractions was also observed. Analysing LDL subfractions provides a more detailed insight into lipid metabolism and enables the identification of patients with a more atherogenic phenotype. LDL subfractions may thus become not only more accurate prognostic biomarkers but also targets for lipid-lowering therapy. Vitamin D deficiency is associated with atherogenic dyslipidaemia, particularly high levels of sdLDL.

FITM2 deficiency results in ER lipid accumulation, ER stress, and reduced apolipoprotein B lipidation and VLDL triglyceride secretion in vitro and in mouse liver

ObjectivesTriglycerides (TGs) associate with apolipoprotein B100 (apoB100) to form very low density lipoproteins (VLDLs) in the liver. The repertoire of factors that facilitate this association is incompletely understood. FITM2, an integral endoplasmic reticulum (ER) protein, was originally discovered as a factor participating in cytosolic lipid droplet (LD) biogenesis in tissues that do not form VLDL. We hypothesized that in the liver, in addition to promoting cytosolic LD formation, FITM2 would also transfer TG from its site of synthesis in the ER membrane to nascent VLDL particles within the ER lumen. MethodsExperiments were conducted using a rat hepatic cell line (McArdle-RH7777, or McA cells), an established model of mammalian lipoprotein metabolism, and mice. FITM2 expression was reduced using siRNA in cells and by liver specific cre-recombinase mediated deletion of the Fitm2 gene in mice. Effects of FITM2 deficiency on VLDL assembly and secretion in vitro and in vivo were measured by multiple methods, including density gradient ultracentrifugation, chromatography, mass spectrometry, stimulated Raman scattering (SRS) microscopy, sub-cellular fractionation, immunoprecipitation, immunofluorescence, and electron microscopy. Main findings1) FITM2-deficient hepatic cells in vitro and in vivo secrete TG-depleted VLDL particles, but the number of particles is unchanged compared to controls; 2) FITM2 deficiency in mice on a high fat diet (HFD) results in decreased plasma TG levels. The number of apoB100-containing lipoproteins remains similar, but shift from VLDL to low density lipoprotein (LDL) density; 3) Both in vitro and in vivo, when TG synthesis is stimulated and FITM2 is deficient, TG accumulates in the ER, and despite its availability this pool is unable to fully lipidate apoB100 particles; 4) FITM2 deficiency disrupts ER morphology and results in ER stress. Principal conclusionsThe results suggest that FITM2 contributes to VLDL lipidation, especially when newly synthesized hepatic TG is in abundance. In addition to its fundamental importance in VLDL assembly, the results also suggest that under dysmetabolic conditions, FITM2 may be an important factor in the partitioning of TG between cytosolic LDs and VLDL particles.

EVALUATION OF LIPID PROFILE OF HYPERTENSIVE PREGNANT WOMEN ATTENDING MGBAKWU PRIMARY HEALTH CARE CENTRE, ANAMBRA STATE

Hypertension is a serious global public health problem. Serum lipid alteration is a pivotal factor that births hypertension during pregnancy and has been implicated in diverse deleterious health outcomes. Thus, the aim of this study was to evaluate the lipid profiles of hypertensive pregnant women attending Mgbaukwu Primary Health Care (PHC) Centre. A total of 70 pregnant women who had consented were recruited to participate. While thirty five (35) pregnant women were hypertensive, the other remaining 35 pregnant women were not hypertensive (normotensive) and thus, were considered the control group. Socio-demographic characteristics of the participants were generated using structured questionnaire, while lipid profiles of the participants were determined using standard procedures. Results obtained from this study shows that 80% and 34.28% of the hypertensive and normotensive pregnant women respectively were within the age range of 32-37 years old, while 68.6% and 48.57% of the hypertensive and normotensive pregnant women respectively were traders and had completed only secondary school education. The value recorded on Total Cholesterol (TC) , Very Low Density Lipoprotein (VLDL), Low Density Lipoprotein (LDL), and Triglycerol (TG) in Hypertensive Pregnant Women (HYPW) were significantly (p&lt;0.05) higher than those reported for their normotensive counterparts. In conclusion, it can be deduced from this study that pregnant women who are within 32-37 years of age are prone to hypertension during pregnancy, while social determinants of health (SDOH) can support incidence of hypertension.

The Association Between Type 2 Diabetes Mellitus and Levels of Total Cholesterol, Low-Density Lipoprotein (LDL) Cholesterol, Very Low-Density Lipoprotein (VLDL) and the Role of Dehydrated Vegetables in Glycemic Control

Objective: This study aimed to assess Total Cholesterol, Low-Density Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL) Levels, identify specific lipid markers altered in individuals with type 2 diabetes mellitus (T2DM), and evaluate the correlation between HbA1C and total cholesterol, LDL cholesterol, and VLDL levels. Materials and Methods: Ninety-six volunteers aged 35-72 with confirmed T2DM underwent total cholesterol, LDL, VLDL and HbA1c testing using the COBAS INTEGRA 400 PLUS device. Data on age, gender, diabetes status, and lipid profiles were collected in November 2023 to April 2024 from Layla Qasim Health Center located in Erbil, Iraq and then analyzed. Results: Result: In our study, the prevalence of dyslipidemia among type 2 diabetes mellitus (T2DM) patients was 50.88%. This varied regionally, from 59.3% in China to 83.9% in Saudi Arabia. Dyslipidemia was more common in patients with poor blood glucose control. Weight and waist circumference were positively correlated with HbA1c levels, while age showed no significant effect on glycemic control. Women showed higher LDL and HbA1c levels than men. Although weak correlations were observed between HbA1c and LDL cholesterol, LDL was strongly correlated with total cholesterol and moderately with VLDL. Early detection and management of dyslipidemia is important to reduce the risk of cardiovascular disease in patients with T2DM. Conclusion: Our study highlights the significant prevalence of dyslipidemia among patients with type 2 diabetes mellitus (T2DM), emphasizing the importance of lipid profile management to reduce the risk of cardiovascular disease. We found associations between weight, waist circumference and HbA1c levels, with gender differences in lipid profiles. While the association between HbA1c and LDL cholesterol was weak, early diagnosis and management of dyslipidemia could significantly reduce CVD risk, advocating a comprehensive strategy targeting both glycemic control and lipid management in T2DM patients.

Enhanced Antidiabetic Effects of Gymnema sylvestre and Probiotics in Alloxan-Induced Diabetic Rats

Abstract Introduction/Objective Introduction: Gymnema sylvestre is a well-known herbal remedy for diabetes, with its anti-diabetic properties attributed to gymnemic acids isolated from its leaves. Probiotics, such as Lactobacillus acidophilus and Lactobacillus casei, have also shown potential in managing diabetes. This study aims to evaluate the combined antidiabetic effects of G. sylvestre and probiotics in alloxan-induced diabetic rats. Methods/Case Report Methods: Experimental rats were divided into seven groups: negative control, untreated diabetic control, L. acidophilus-treated, L. casei-treated, G. sylvestre-treated, a combination of L. casei and G. sylvestre-treated, and a combination of L. acidophilus and G. sylvestre-treated. Blood glucose levels, lipid profiles, and reduced glutathione levels were measured, and histopathological examination of pancreas and kidney tissues was performed. Results (if a Case Study enter NA) Results: In the third week of the experiment, the combined administration of G. sylvestre and probiotics showed the most significant reductions in glucose levels (250 mg/dL), alkaline phosphatase (ALP) (613.3 U/L), urea (31 U/L), serum creatinine (0.77 U/L), and superoxide dismutase (SOD) (854.7 UMOL). G. sylvestre alone exhibited the lowest levels of glutamate pyruvate transaminase (GPT) (30 U/L), cholesterol (41 mg/dL), triglycerides (101.3 mg/dL), very-low-density lipoprotein (VLDL) (22.9 mg/dL), and malondialdehyde (MDA) (119.3 U MOL/SEC). Probiotic treatment alone resulted in the lowest levels of uric acid (UA) (4.4 U/L) and low-density lipoprotein (LDL) (95.06 mg/dL). G. sylvestre demonstrated the highest level of high-density lipoprotein (HDL) (44 mg/dL), while probiotics exhibited the highest catalase (CAT) activity (92 UMOL/SEC). Histopathological examination revealed the preservation of normal pancreatic and renal tissue morphology with G. sylvestre treatment. Conclusion Conclusion: The combination of G. sylvestre and probiotics enhances the antidiabetic activity compared to G. sylvestre alone in alloxan-induced diabetic rats. These findings suggest a potential synergistic effect of combining herbal and probiotic therapy for diabetes management.

Examination of Lipoprotein and Lipid Levels of Adult Patients With Atherosclerosis, Myocardial Infarction, and Stroke: A Narrative Review.

The literature revealed correlations between high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) and vaso-occlusive disease. Specifically, positive linear relationships exist between LDL and VLDL and the development of vaso-occlusive disease. Alternatively, a U-shaped relationship between HDL and vaso-occlusive disease exists where both low and high levels of HDL increase the risk of developing conditions such as myocardial infarction and atherosclerosis. These results align with the National Institute of Health's lipoprotein targets. Recent literature postulates that the adverse effects associated with lipoproteins may be attributable to commonalities between the structures of HDL, LDL, and VLDL, such as apolipoprotein subunits and molecular sizes that are not commonly analyzed in clinical lab tests. Nonetheless, additional research remains ongoing to further understand the role of lipoproteins in atherogenesis and vaso-occlusive disease.

ASGR1 Deficiency Inhibits Atherosclerosis in Western Diet-Fed ApoE-/- Mice by Regulating Lipoprotein Metabolism and Promoting Cholesterol Efflux.

Atherosclerosis is the most common cause of cardiovascular diseases. Clinical studies indicate that loss-of-function ASGR1 (asialoglycoprotein receptor 1) is significantly associated with lower plasma cholesterol levels and reduces cardiovascular disease risk. However, the effect of ASGR1 on atherosclerosis remains incompletely understood; whether inhibition of ASGR1 causes liver injury remains controversial. Here, we comprehensively investigated the effects and the underlying molecular mechanisms of ASGR1 deficiency and overexpression on atherosclerosis and liver injury in mice. We engineered Asgr1 knockout mice (Asgr1-/-), Asgr1 and ApoE double-knockout mice (Asgr1-/-ApoE-/-), and ASGR1-overexpressing mice on an ApoE-/- background and then fed them different diets to assess the role of ASGR1 in atherosclerosis and liver injury. After being fed a Western diet for 12 weeks, Asgr1-/-ApoE-/- mice exhibited significantly decreased atherosclerotic lesion areas in the aorta and aortic root sections, reduced plasma VLDL (very-low-density lipoprotein) cholesterol and LDL (low-density lipoprotein) cholesterol levels, decreased VLDL production, and increased fecal cholesterol contents. Conversely, ASGR1 overexpression in ApoE-/- mice increased atherosclerotic lesions in the aorta and aortic root sections, augmented plasma VLDL cholesterol and LDL cholesterol levels and VLDL production, and decreased fecal cholesterol contents. Mechanistically, ASGR1 deficiency reduced VLDL production by inhibiting the expression of MTTP (microsomal triglyceride transfer protein) and ANGPTL3 (angiopoietin-like protein 3)/ANGPTL8 (angiopoietin-like protein 8) but increasing LPL (lipoprotein lipase) activity, increased LDL uptake by increasing LDLR (LDL receptor) expression, and promoted cholesterol efflux through increasing expression of LXRα (liver X receptor-α), ABCA1 (ATP-binding cassette subfamily A member 1), ABCG5 (ATP-binding cassette subfamily G member 5), and CYP7A1 (cytochrome P450 family 7 subfamily A member 1). These underlying alterations were confirmed in ASGR1-overexpressing ApoE-/- mice. In addition, ASGR1 deficiency exacerbated liver injury in Western diet-induced Asgr1-/-ApoE-/- mice and high-fat diet-induced but not normal laboratory diet-induced and high-fat and high-cholesterol diet-induced Asgr1-/- mice, while its overexpression mitigated liver injury in Western diet-induced ASGR1-overexpressing ApoE-/- mice. Inhibition of ASGR1 inhibits atherosclerosis in Western diet-fed ApoE-/- mice, suggesting that inhibiting ASGR1 may serve as a novel therapeutic strategy to treat atherosclerosis and cardiovascular diseases.

The association between retinol binding protein 4 and peripheral neuropathy in type 2 diabetic patient

Background &amp; Objective: The most common microvascular consequence of diabetes is peripheral neuropathy. A very common ailment that has a significant impact on a patient's quality of life is peripheral neuropathy (PN). The purpose of this study was to look into the possible link between retinol binding protein 4 (RBP4) and peripheral neuropathy in individuals with type 2 diabetes mellitus (T2D), as the relationship between RBP4 and PN is still unclear. Methodology: We enrolled 152 participants who were matched for age and sex in a case control study during August and December 2023. There were 50 healthy controls, 50 diabetic patients without PN, and 52 diabetic patients with PN. ELISA was used to measure serum RBP4. Results: Diabetic individuals with PN had significantly greater serum levels of RBP4 than diabetic patients without PN (P ˂ 0.001). Increased age (r = 0.262, P ˂ 0.01), DM duration (r = 0.565, P ˂ 0.01), and BMI (r = 0.183, P ˂ 0.05) were all substantially linked with RBP4 levels. RBP4 levels exhibited a negative correlation with high-density lipoproteins (HDL) and a positive correlation with total cholesterol, triglycerides, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL). Conclusion: Elevated RBP4 level is strongly and independently linked with PN in type 2 diabetic patients, and may play an important role in PN progression. Abbreviations: DM - Diabetes mellitus; PN - peripheral neuropathy; PBP4 - retinol binding protein 4; T2D - type 2 diabetes mellitus Keywords: diabetes mellitus; peripheral neuropathy; retinol binding protein 4. Citation: Nafakhi IA, Abdalsada NH. The association between retinol binding protein 4 and peripheral neuropathy in type 2 diabetic patient. Anaesth. pain intensive care 2024;28(5):908−913; DOI: 10.35975/apic.v28i5.2563 Received: May 03, 2024; Reviewed: June 04, 2024; Accepted: August 23, 2024

7005 Characterization of Clinical Candidate Miricorilant in Preclinical Models for NASH

Abstract Disclosure: T.J. Moll: None. E.M. Viho: None. M. Gentenaar: None. H. Hunt: Employee; Self; Corcept Therapeutics. O.C. Meijer: Grant Recipient; Self; Corcept Therapeutics. J. Kroon: Research Investigator; Self; Corcept Therapeutics. Background and aim: Miricorilant (CORT118335) is a selective glucocorticoid receptor (GR) modulator that is under clinical development for the treatment of non-alcohol steatohepatitis (NASH). It was previously shown that miricorilant treatment effectively lowers hepatic lipid content in mouse models of NASH. The aim of this study is to further characterize the effects of miricorilant in the mouse liver and in human liver tissue. Methods: In mouse liver tissue, we investigated the agonistic and antagonistic properties of miricorilant on GR activity. Eight-week-old male C57BL/6J mice were fed with a control diet or miricorilant-supplemented diet (resulting in an estimated dose of 60 mg/kg/day) for 6 days and 1.5 mg/kg corticosterone was injected to monitor the effects of miricorilant on GR-responsive gene expression. We next accessed the time-dependency of the lipid-lowering effects of miricorilant in the mouse liver. Mice were fed with a high-fat, high-fructose diet (HFHFD) for 3 weeks before treatment with 60 mg/kg/day miricorilant for one, three or six days by oral gavage, and triglyceride content in the liver was measured at endpoint. In human liver tissue, we investigated the effects of miricorilant on precision-cut liver slices (PCLS) obtained from two independent donors with pre-existing steatosis. PCLS were cultured for a total of 168 hours in the presence of 100 nM hydrocortisone, and with or without an exogenous lipid challenge. PCLS were treated with 200-600 nM miricorilant for 96 hours before triglyceride content was measured. RNA-sequencing was performed on PCLS after 24 hours of 200-400 nM miricorilant exposure. Results: In the mouse liver, miricorilant exhibited a unique combination of agonistic and antagonistic properties on GR-responsive gene expression. Miricorilant effectively lowered HFHFD-induced lipid accumulation in the mouse liver as soon as three days after treatment. In human PCLS, miricorilant treatment lowered triglyceride content in both donors. RNA-sequencing revealed respectively 40 and 128 differentially expressed genes after 200 and 400 nM miricorilant treatment. Pathway analysis revealed very-low-density lipoprotein (VLDL) particle remodeling as a significant enriched pathway, providing a possible explanation for the lowered triglyceride content upon miricorilant treatment. Conclusion: Miricorilant rapidly and effectively lowers hepatic lipid content in the mouse liver and in human PCLS, possibly via modulation of VLDL remodeling. Presentation: 6/2/2024

A-210 Ldl-c to non-hdl-c ratio method: a simple way to determine bias for ldl-c methods on hypertriglyceridemic samples

Abstract Background Beta-quantification (BQ) is the reference method for LDL-C but is not widely available. It is difficult, therefore, for clinical laboratories to independently assess the accuracy of their methods for either calculating or directly measuring LDL-C. Our goal was to investigate if an interrelationship between the tests in the standard lipid panel could be used to compare the performance of different LDL-C methods against BQ, specifically in samples with hypertriglyceridemia, a major cause of bias for LDL-C testing. Methods BQ results from Mayo Medical Labs (n=39,667) and the NIH (n=18,338) were used to identify a linear relationship by least-squares regression analysis between lipid panel test results and LDL-C to facilitate a statistical comparison between different LDL-C methods. Results It is well established that the number of VLDL particles increases as TG increases, because VLDL is the main carrier of TG. As a consequence, the ratio of LDL-C to non-HDL-C is inversely related to TG, which can be made linear by taking the square root of TG (Figure). Nearly identical regression equations were found for this relationship, using two different BQ datasets. When LDL-C was calculated by either Sampson equation, the LDL-C/non-HDL-C regression lines nearly overlapped with the one for BQ. In contrast, the Martin equation showed a positive bias with increasing TG, whereas the Friedewald equation showed a negative bias, consistent with past reports on their LDL-C biases with hypertriglyceridemia. In the UKBiobank, the Beckman direct LDL-C showed a positive bias for TG, which was confirmed in CAP proficiency test surveys. By simulation analysis, approximately 80 samples with high (&amp;gt;200 mg/dL) and low (&amp;lt;100 mg/dL) TG is statistically sufficient to assess if the LDL-C/non-HDL-C regressions lines of LDL-C methods differ from BQ. Conclusions The LDL-C/non-HDL-C ratio method is a simple way to examine LDL-C methods for bias on hypertriglyceridemic samples.

Discordance Analysis of VLDL-C and ApoB in UK Biobank and Framingham Study: A Prospective Observational Study.

Recent observational and Mendelian randomization analyses have reported significant effects of VLDL-C (very-low density lipoprotein cholesterol) on risk that is independent of ApoB (apolipoprotein B). We aim to determine the independent association of VLDL-C and ApoB with the risk of new onset cardiovascular events in the UK Biobank and Framingham Heart Study cohorts. We included 294 289 UK Biobank participants with a median age of 56 years, 42% men, and 2865 Framingham Heart Study participants (median age, 53 years; 47% men). The residual resulting from regressing VLDL-C on ApoB expresses the portion of VLDL-C not explained by ApoB, while the residual from regressing ApoB on VLDL-C expresses the portion of ApoB not explained by VLDL-C. Cox proportional hazards models for atherosclerotic cardiovascular disease incidence were created for residual VLDL-C and residual ApoB. Models were analyzed with and without high-density lipoprotein cholesterol (HDL-C). Furthermore, we investigated the independent effects of VLDL-C after accounting for ApoB and HDL-C and of HDL-C after accounting for ApoB and VLDL-C. In the UK Biobank, ApoB was highly correlated with VLDL-C (r=0.70; P<0.001) but weakly negatively correlated with HDL-C (r=-0.11; P<0.001). The ApoB residual and the VLDL-C residual were significantly associated with new-onset atherosclerotic cardiovascular disease (hazard ratio [HR], 1.08 and 1.05, respectively; P<0.001). After adjusting for HDL-C, the ApoB residual remained similar in magnitude (HR, 1.10; P<0.001), whereas the effect size of the VLDL-C residual was reduced (HR, 1.02; P=0.029). The independent effect of HDL-C (after accounting for ApoB and VLDL-C) remained robust (HR, 0.86; P<0.0001), while the independent effect of VLDL-C (after accounting for ApoB and HDL-C) was modest (HR, 1.02; P=0.029). All results were consistent in the Framingham cohort. When adjusted for HDL-C, the association of VLDL-C with cardiovascular risk was no longer clinically meaningful. Our residual discordance analysis suggests that adjustment for HDL-C cannot be ignored.

Lomitapide for the treatment of paediatric patients with homozygous familial hypercholesterolaemia (APH-19): results from the efficacy phase of an open-label, multicentre, phase 3 study

Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder characterised by extremely high concentrations of LDL cholesterol, leading to early-onset atherosclerosis. Lomitapide is an orally administered microsomal triglyceride transfer protein (MTP) inhibitor that effectively lowers LDL cholesterol and is approved for adults with HoFH. We aimed to investigate the efficacy and safety of lomitapide in paediatric patients with HoFH receiving standard-of-care lipid-lowering therapy. APH-19 is an open-label, single-arm, phase 3 trial performed at 12 study centres in Germany, Israel, Italy, Saudi Arabia, Spain, and Tunisia. A 6-week run-in period was followed by a 24-week efficacy phase and an 80-week safety phase. Patients aged 5-17 years, on stable lipid-lowering therapy, with HoFH diagnosed using the criteria from the 2014 European Atherosclerosis Society Consensus Panel on HoFH were titrated to maximum tolerated doses of oral lomitapide, starting at 2 mg (patients aged 5-15 years) or 5 mg (patients aged 16-17 years). The primary endpoint was the percentage change from baseline to week 24 in LDL cholesterol, which was assessed in patients who had received at least one dose of lomitapide, and who had a baseline and at least one post-baseline measurement. The secondary outcomes were the percentage change from baseline at week 24 in total cholesterol, non-HDL cholesterol, VLDL cholesterol, apolipoprotein B, triglycerides, and lipoprotein(a). Safety was assessed in patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT04681170. Between Dec 20, 2020, and Oct 16, 2022, 43 patients were included and treated (24 [56%] were female and 19 [44%] were male, and median age was 10·7 years [7·0-14·0]). Mean change from baseline in LDL cholesterol at week 24 was -53·5% (95% CI -61·6 to -45·4, p<0·0001). Mean percentage reductions were observed at week 24 for non-HDL cholesterol (-53·9%, 95% CI -61·7 to -46·1, p<0·0001), total cholesterol (-50·0%, 95% CI -57·6 to -42·4, p<0·0001), VLDL cholesterol (-50·2%, -59·1 to -41·2, p<0·0001), apolipoprotein B (-52·4%, -60·3 to -44·5, p<0·0001), triglycerides was -49·9% (-58·8 to -41·0, p<0·0001), and lipoprotein(a) (-11·3%, -32·9 to 10·3 [in 21 patients with measurements in mg/dL]; -23·6%, -38·2 to -9·0 [in 22 patients with measurements in nmol/L]; p=0·0070 combined). Adverse events were mostly mild, and gastrointestinal and hepatic in nature. Adverse events of special interest were reported for five (12%) patients (gastrointestinal in two patients and hepatic in three). One serious treatment-emergent adverse event was reported (also classed as an adverse event of special interest): an increase in hepatic enzymes, resulting in two dose interruptions, two dose reductions, and a repeated dose escalation. Lomitapide provided a significant, clinically meaningful LDL cholesterol reduction and has the potential to be an efficient, LDL receptor-independent option for paediatric patients with HoFH. Amryt Pharmaceuticals.

A metabolome-derived score predicts metabolic dysfunction-associated steatohepatitis and mortality from liver disease

BackgroundMetabolic dysfunction-associated steatohepatitis (MASH) is associated with more than a 10-fold increase in liver-related mortality. However, biomarkers predicting both MASH and mortality are missing. We developed a metabolome-derived prediction score for MASH and examined whether it predicts mortality in Chinese and European cohorts. MethodsThe MASH prediction score was developed using a multi-step machine learning strategy, based on 44 clinical parameters and 250 plasma metabolites measured by proton nuclear magnetic resonance (1H-NMR) in 311 Chinese adults undergoing a liver biopsy. External validation was conducted in a Finnish liver biopsy cohort (n=305). We investigated association of the score with all-cause and cause-specific mortality in the population-based Shanghai Changfeng Study (n=5,893) and the UK Biobank (n=111,673). ResultsA total of 24 clinical parameters and 194 1H-NMR metabolites were significantly associated with MASH in the Chinese liver biopsy cohort. The final MASH score included body mass index, aspartate transaminase, tyrosine, and the phospholipids-to-total lipids ratio in very-low density lipoprotein. The score identified patients with MASH with AUROCs of 0.87 (95% CI, 0.83-0.91) and 0.81 (95% CI, 0.75-0.87) in the Chinese and Finnish cohorts, with high negative predictive values. Participants with a high or intermediate risk of MASH based on the score had a markedly higher risk of MASLD-related mortality than those with a low risk in Chinese (HR, 23.19; 95%CI, 4.80-111.97) and European individuals (HR, 27.80; 95%CI, 15.08-51.26) after 7.4 and 12.6 years of follow-up. The MASH prediction score was superior to the FIB-4 index and the NAFLD Fibrosis Score in predicting MASLD-related mortality. ConclusionThe metabolome-derived MASH prediction score accurately predicts risk of MASH and MASLD-related mortality in both Chinese and European individuals. Impact and implicationsMetabolic dysfunction-associated steatohepatitis (MASH) is associated with more than a 10-fold increase in liver-related death. However, biomarkers predicting not only MASH, but also death due to liver disease, are missing. We established a MASH prediction score based on 44 clinical parameters and 250 plasma metabolites using a machine learning strategy. This metabolome-derived MASH prediction score could accurately identify patients with MASH among both Chinese and Finnish individuals, and it was superior to the FIB-4 index and the NAFLD Fibrosis Score in predicting MASLD-related death in the general population. Thus, the new MASH prediction score is a useful tool for identifying individuals with a markedly increased risk of serious liver-related outcomes among at-risk and general populations.

Shining a light on fluorescent EV dyes: Evaluating efficacy, specificity and suitability by nano-flow cytometry.

Extracellular vesicles (EVs) are mediators of intercellular communication, recently recognised for their clinical applications. Accurate characterisation and quantification of EVs are critical for understanding of their function and clinical relevance. Many platforms utilise fluorescence for EV characterisation, frequently labelling surface proteins to identify EVs. The heterogeneity of EVs and the lack of a universal protein marker encourages the use of generic EV labelling methods, including membrane labelling. Using nano-flow cytometry, we evaluated six membrane dyes, including MemGlow and CellMask. Evaluation criteria included EV labelling efficacy, non-specific labelling of very low-density lipoproteins (VLDLs), brightness and dye aggregation. Significant variation was observed in dye performance, with certain dyes showing poor EV labelling efficacy or high affinity to VLDLs. Importantly, several promising candidates were identified for further investigation. Overall, this study highlights the importance of selecting appropriate membrane dyes for EV staining tailored to the aims of the study and the EV origin. MemGlow and CellMask proved favourable, allowing bright, sensitive staining of EV membranes with minimal aggregation. However, MemGlow showed an affinity to VLDLs, and CellMask requires additional sample handling for optimal labelling. These results contribute to deepening our understanding of EV membrane dyes, allowing for better dye selection and EV identification in future studies.

Curcumin and its combination with a reduced dose of rosuvastatin: A promising therapy for chronic kidney disease and associated dyslipidemia in rat animal models.

The objective of this study was to confirm the effects of curcumin and to investigate the effects of its combination with a reduced dose of rosuvastatin in an adenine-induced model of chronic kidney disease (CKD) and associated dyslipidemia in rats. Renal function and morphology, as well as lipid status, were assessed using laboratory parameters and histopathological analysis. Male Wistar rats (n=36) randomly divided into six groups, were treated for 24 days: normal control (standard diet), CKD control (adenine diet, 0.75% w/w adenine-supplemented diet), curcumin (100 mg/kg/day + adenine diet), rosuvastatin minimal therapeutic dose (MTD) (5 mg/day + adenine diet), rosuvastatin reduced dose (RD, 25% of rosuvastatin MTD + adenine diet), and rosuvastatin RD + curcumin (25% of rosuvastatin MTD + curcumin 100 mg/kg/day + adenine diet) group. While rosuvastatin alone showed only antilipemic action, both curcumin alone and its combination with a reduced dose of rosuvastatin showed better renal protection with lower serum creatinine levels and milder renal morphological alterations, as well as better antilipemic action with lower levels of triglycerides, very low-density lipoprotein (VLDL), and low-density lipoprotein (LDL) cholesterols compared with the levels in CKD control rats. Treatment with curcumin alone also resulted in a significantly higher estimated glomerular filtration rate, lower uric acid levels, and higher high-density lipoprotein (HDL) cholesterol, while the combined therapy additionally resulted in higher serum albumin levels, lower total cholesterol, and both atherogenic and coronary risk indexes compared with CKD control rats. The results of this study confirmed the beneficial effects of curcumin alone and provided new evidence for the beneficial effects of its combination with a reduced dose of rosuvastatin in rats with CKD and associated dyslipidemia.

The Role of Arginase and some Parameters in Diabetic Type 2 Patients with and without Retinopathy

Background: Oxidative stress plays a major role in the pathogenesis of diabetes mellitus by damaging cellular organelles and enzymes in blood such as arginase1, insulin and glutathione s-transferase; increasing lipid peroxidation such as malondialdehyde and increasing insulin resistance which can lead to diabetic complications such as diabetic retinopathy. Objectives: To explore the relationship of oxidative stress to the development of diabetic retinopathy by measuring the levels of Arginase1, the activity of glutathione s-transferase enzyme, and the levels of malondialdehyde as a secondary product of lipid peroxidation (biomarker for oxidative stress). Patients and MethodsThis study was conducted from November 2022 to January 2023 at the Ibn Al-Haitham Teaching Eye Hospital in Baghdad, the University of Baghdad / Department of Chemistry and the National Diabetes Centre for Treatment and Research at Al-Mustansyrriah University. This study was conducted on 120 subjects distributed as follows: 40 non-diabetic obese controls, 40 type 2 diabetics with no retinopathy, and 40 type 2 diabetic retinopathy patients, between 30 and 65 years of age. All groups were subjected to tests: measuring fasting blood glucose (FBG), HbA1c, lipid profile (cholesterol, triglycerides, HDL- cholesterol, LDL- cholesterol, and VLDL cholesterol), serum total arginase1, malondialdehyde glutathione s -transferase, body mass index (BMI), and waist-to-hip ratio. Results: Mean arginase1 levels were significantly higher in diabetic patients than in diabetic retinopathy and control groups (p ≤ 0.05). The mean xidative stress marker malondialdehyde concentration was significantly higher in diabetic retinopathy patients than in type 2 diabetics and the control group (P ≤ 0.05). The mean glutathione s-transferase activity in diabetic retinopathy patients was significantly higher than in the control group and type 2 diabetics (P ≤ 0.05). Conclusion: There is a relationship between oxidative stress and the development of diabetic retinopathy, where the levels of arginase1 and malondialdehyde increased and the activity of glutathione s –transferase enzyme increased as a result of oxidative stress and inflammation associated with complications of type 2 diabetes.