Dissertations / Theses on the topic 'Lipoprotein kinetics'

[Truncated abstract] The metabolic syndrome is characterized by cardiovascular risk factors including dyslipidemia, insulin resistance, visceral obesity, hypertension and diabetes. The dyslipidemia of the metabolic syndrome includes elevated plasma triglyceride and apolipoprotein (apo) B levels, accumulation of small, dense low-density lipoprotein (LDL) particles and low high-density lipoprotein (HDL) cholesterol concentration. However, the precise mechanisms for this dyslipoproteinemia, specifically low plasma HDL cholesterol, are not well understood. This thesis therefore, focuses on HDL, its structure, function and metabolism. However, lipoprotein metabolism is a complex interconnected system, which includes forward and reverse cholesterol transport pathways. Hence, this thesis also examines and discusses the metabolism of apoB-containing lipoproteins. This thesis tests the general hypothesis that apolipoprotein kinetics are altered in the metabolic syndrome, and that lipid regulating therapies can improve these kinetic abnormalities. The aims were first, to compare and establish the clinical, metabolic and kinetic differences between metabolic syndrome and lean subjects; and second, to determine the regulatory effects of statin therapy, specifically, rosuvastatin on lipoprotein transport in the metabolic syndrome. Five observation statements were derived from the general hypothesis and examined in the studies described below. The findings are presented separately as a series of original publications. Study 1 Twelve men with the metabolic syndrome and ten lean men were studied in a case-control setting. ... These findings explain the HDL raising effects of rosuvastatin in the metabolic syndrome. Collectively, these studies suggest that the dyslipidemia of the metabolic syndrome results from increased production rates of VLDL and LDL particles, reduced fractional catabolic rates of these lipoproteins, together with accelerated catabolism of HDL particles. Treatment with rosuvastatin increases the catabolic rates of all apoB-containing lipoproteins and at a higher dose, decreases LDL apoB production. These effects are consistent with inhibition of cholesterol synthesis leading to an upregulation of LDL receptors. Rosuvastatin decreases the fractional catabolism of HDL particles. The effects of rosuvastatin on HDL kinetics may be related to a reduction in triglyceride concentration and cholesterol ester transfer protein activity. These findings are consistent with the general hypothesis that apolipoprotein kinetics are altered in the metabolic syndrome, and that statin therapy improves these kinetic abnormalities.

Emerging evidence has shown that an abnormal postprandial accumulation of dietary tat IS atherogenic. The aim of this study is to measure triacylglycerol (TAG) kinetics in endogenous and exogenous lipoproteins in both fed and fasted states using stable isotopes.

High concentrations of large very low density lipoproteins (VLDL1) give rise to atherogenic dyslipidaemia, which is usually associated with insulin resistant conditions (e.g. obesity) and increases the risk for cardiovascular disease (CVD). Isotopic tracer methods for determining VLDL1 kinetics are costly, time-consuming, labour intensive and need experience and skill to calculate the kinetic parameters. The aim of this thesis was to develop a simpler and cost-effective method of obtaining triglyceride-rich lipoproteins (TRL) kinetic data, based on the fact that chylomicrons (CM) or CM-like particles (e.g. Intralipid) compete with large VLDL1 for the same lipoprotein lipase (LPL)-mediated catalytic pathway. From this method, it was possible to determine VLDL1-triglyceride (TG) and -apolipoprotein (apo) B production rates and the Intralipid-TG clearance rate (as a surrogate measure of CM clearance). Kinetic data obtained from this method agreed with values and relationships obtained from stable isotope methods. The protocol is relatively quick, inexpensive, and transferable to non-specialist laboratories. As a first application, the ‘Intralipid method’ was used to investigate the effects of hyperinsulinaemia and hyperglycaemia due to glucose ingestion on VLDL1-TG and -apoB production rates and Intralipid-TG clearance rate. This showed that hepatic VLDL1 production is suppressed in response to hyperinsulinaemia and that the change in Intralipid-TG clearance rate with hyperinsulinaemia correlated significantly with HOMA-estimated insulin resistance (HOMA-IR). In addition, alanine aminotranferase (ALT) concentrations (a marker for liver fat), within normal range, predicted the extent of hepatic VLDL1 suppression. Secondly, the Intralipid method was used to investigate the mechanisms responsible for the hypotriglyceridaemic effect of a moderate exercise session (120 min walking at 50% VO2max) in overweight/obese middle-aged men; the section of the population at high risk of CVD in whom exercise-for-health guidelines are targeted. This showed that the exercise-induced reduction in plasma TG was due to increased VLDL1-TG and -apoB clearance, rather than decreased hepatic production. Exercise also increased Intralipid-TG clearance rate, but to a lesser extent than VLDL1, suggesting an increased affinity of VLDL1 for LPL-mediated lipolysis post-exercise. Taken together, the Intralipid method is a relatively simple, safe and cost-effective method to determine in VLDL1-TG and -apoB production rates and Intralipid-TG clearance rates. It is also sensitive enough to detect physiological changes in TRL kinetics.

A LDL contitui-se de uma fase lipídica, uma esfera composta principalmente de um núcleo de colesterol esterificado envolto por uma camada de fosfolipídeos. A fase lipídica junta-se uma única molécula protéica, a polipoproteina B (apo B). A LDL é removida da circulação por mediação de receptores específicos, os receptores B. E, que reconhecem não só a apo B da LDL mas também a apo E, que está presente em outras lipoproteínas. Estudou-se neste trabalho a influencia da apo B no metabolismo da LDL, através de um modelo de emulsões semelhantes à fase lipídica da LDL, constituídas de oleato de colesterol (29%), fosfatidilcolina (69%) e trioleina (2%), preparadas por sonicação, seguida de ultracentrifugação. As emulsões, com seus componentes lipídicos marcados isotopicamente, foram associadas à apo B e injetadas no rato, determinando-se sua remoção plasmática e captação pelos diversos órgãos do animal. Os resultados foram comparados com o metabolismo da emulsão sem associação da apo B a sua estrutura e com o da LDL natural. Verificou-se que a presença de apo B retardou a remoção plasmática das partículas da emulsão. Por outro lado, o oleato de colesterol da emulsão com apo B foi removido do compartimento plasmático numa taxa semelhante à da LDL natural, o que demonstra a adequação do modelo utilizado à situação fisiológica. Tanto as emulsões quanto a LDL natural foram captadas principalmente pelo fígado. Entretanto, a captação hepática da emulsão sem apo B foi maior a da emulsão com apo B e a da LDL. A incubação das emulsões com HDL do plasma de rato mostrou que a emulsão sem apo B adquiriu mais apo E que a emulsão com apo B. Portanto, essas diferenças de comportamento metabólico provavelmente se devem à maior afinidade dos receptores B, E hepáticos por partículas que contem mais apo E, em comparação às que contêm a apo B. O aumento da atividade dos receptores B, E, induzido pelo tratamento com 17 α-etinil estradiol, resultou no aumento da cinética plasmática das duas emulsões. Porém, à taxa de remoção plasmática da emulsão sem apo B também foi maior no grupo tratado com o estrógeno. Esses dados indicam que as emulsões com apo B associada a sua estrutura apresentam comportamento metabólico muito semelhante ao da LDL. Portanto, o modelo das emulsões análogas à LDL parece ser um instrumento eficiente no estudo do metabolismo daquela lipoproteína.
The effects of apolipoprotein B (apo B) on the metabolism of emulsions constituted of cholesteryl oleate (29%), phosphatidycholine (69%) and triolein (2%) were studied in rats. After intra-arterial injection of the radiolabelled emulsions, plasma removal of the emulsions was reduced in presence of apo B. On the other hand, the cholesteryl ester moiety of the apob B emulsion was removed at the same rate as native LDL. Emulsions and LDL were taken up mainly by the liver 24 h after the injection. However, the hepatic uptake of the apo B emulsion was similar to LDL and lower than that of the apo B-free emulsion. These differences in metabolic behaviour were probably due to the lower hepatic B, E, receptor affinity to apo B contained in the emulsions associated to apo B and in LDL, compared to the apo B-free emulsions. The latter, as confirmed in the in vitro experiments, is capable of adsorbing more apo E, and this apolipoprotein has higher affinity for the receptor. Enhanced receptor activity induced by pre-treatment of the rats with 17 α-ehymylestradiol resulted in augmented plasma removal of both emulsions but nonetheless the cholesteryl ester plasma removal of the apo B-containing particles was still lower, compared to that of the apo B-free emulsion. These data indicate that apo B-containing emulsion exhibits metabolic behaviour similar to that of LDL, and this emulsion can be an adequate tool to test LDL metabolism.

This thesis describes two approaches for studying of lipoprotein metabolism in sheep. The first approach involves the assay of lipoprotein lipase (LPL) activity to determine the role of lipoprotein-triacylglycerol fatty acids in fat deposition in sheep. This enzyme is the rate limiting enzyme in the hydrolysis of fatty acids from lipoprotein-triacylglycerol. The second approach was to characterize and quantify in vivo lipoprotein metabolism using iodinated very low density lipoprotein (¹²⁵I-VLDL) and low density lipoprotein (¹³¹I-LDL). Cross-bred lambs were divided into two treatment groups and either weaned early at 5 weeks of age or remained suckling. Lambs were slaughtered at 12 or 23 weeks at which time the body composition and adipose tissue LPL activity were determined. The differences in rearing led to differences in body composition. The suckled lambs were larger and fatter than weaned lambs. The increased fatness in the suckled lambs was associated with increased LPL activity (U/mg protein) in subcutaneous adipose tissue and was reflected in higher LPL activity in post-heparin plasma (PHP) taken 2 days prior to slaughter. The role of insulin in the regulation of LPL activity was investigated by either infusing a subset of the weaned and suckled lambs with insulin for 7 or 18 weeks or using the euglycemic clamp technique to study the effect of short insulin infusions. The long term infusion of insulin had no significant effect on PHP LPL or on adipose tissue LPL (U/g tissue). However, after infusing insulin for 6h at 6.3 mU.kg⁻·⁷⁵.h⁻¹ during the euglycemic clamps, a two fold increase in LPL activity in biopsied subcutaneous adipose tissue was observed. In the second approach, in vivo lipoprotein metabolism was investigated in 4 lambs using apolipoprotein B as a marker. Following the simultaneous injection of ¹²⁵I VLDL and ¹³¹I VLDL, the specific activities of apoB in VLDL, IDL and LDL fractions were determined. ApoB specific activity curves demonstrated that VLDL is metabolised to IDL and subsequently to LDL. The turnover of VLDL-B (3.45mg.d⁻¹.kg⁻¹) and LDL-B (4.8mg.d⁻¹.kg⁻¹) was calculated by fitting the VLDL-¹²⁵I-B and LDL-¹³¹I-B specific activity data to a mono-exponential equation. The metabolism of lipoproteins, inferred from the study of apoB, was shown to be similar in sheep to that reported in other animals although the amount of lipoprotein synthesised was low. A model to describe the kinetics of apoB metabolism in sheep was developed using SAAM. The proposed model features a three pool delipidation chain for VLDL, and subsystems containing two pools for IDL and LDL. IDL may be catabolised to LDL or cleared directly from the plasma. The developed model can now be used to compare the metabolism of lipoproteins in different physiological states and to design new experiments to study lipoprotein metabolism further.

The anti-atherogenic effects ascribed to a Mediterranean-type diet rich in monounsaturated
fatty acids (MUFAs) from virgin olive oil are due, partly, to an increase in, or maintenance of,
plasma concentrations of high density lipoprotein (HDL) cholesterol. However, the underlying
mechanisms that may explain these concentrations are not well characterised, to-date.
Apolipoprotein (apo) A-I (apoA-I) is the major HDL apo and its kinetic parameters, such as
production rate and catabolic rate, reflect the kinetics of the HDL particle. Our working
hypothesis is as follows: a Mediterranean-type diet rich in MUFAs from virgin olive oil,
compared to a STEP II diet, increases or preserves HDL cholesterol concentrations due to an
increase in apoA-I production and not to a decrease in apoA-I catabolism. Kinetic studies
using stable isotopes are, perhaps, the best approach in physiologically evaluating apo
production and catabolism in humans. This methodology has not as yet been implemented in
Spain. Objectives: to implement the necessary methodology to perform kinetic studies of apo
B-100 and, especially, of apoA-I and apoA-II in volunteers in vivo using stable isotopes to
label proteins in vivo. Further, we used this methodology to analyse the overall effects of a
Mediterranean-type diet rich in monounsaturated fatty acids from virgin olive oil compared
with a low-fat, STEP II diet, on HDL and low density lipoprotein (LDL) metabolism. Design:
we conducted a crossover, randomised study with dietary intervention periods of 4 weeks,
interspersed with a washout period between diets. A total of 10 healthy, moderately
hypercholesterolaemic, male volunteers consumed the two diets. The project was approved
by the Clinical Research Ethical Committee of the Hospital Universitari de Sant Joan, Reus.
Instrumentation: kinetic studies were performed at the end of each diet using a 16h primed
constant infusion of stable isotope
2
H3-L-leucine. Lipoprotein fractions were separated using
ultracentrifugation technique. Stable isotope incorporated into proteins was measured using
GC-MS. The data obtained were analysed applying multi-compartmental modelling technique
with the SAAM II program. ApoA-I and A-II kinetic studies were conducted in our Research
Unit in Reus. Apo B-100 kinetic studies and kinetic parameter modelling were performed in
collaboration with Dr. Caslake and Professor Packard of the Vascular Biochemistry Section,
Division of Cardiovascular & Medical Sciences, Royal Infirmary, University of Glasgow,
Glasgow, Scotland. Results: the Mediterranean diet, compared to the STEP II diet,
significantly increases apoA-I plasma concentrations. A total of 17 kinetic studies have been
performed but, due to methodological complexity, only the results of 7 kinetic studies (4
following a Mediterranean diet and 3 following a STEP II diet) that have been analysed in a
GC-MS to-date, are presented in this thesis. Despite the limitation of the low number of
kinetic studies analysed, we are able to document that the Mediterranean diet induces a high
apoA-I HDL production rate compared to the STEP II diet. Also, the Mediterranean diet
induces a high apo B-100 LDL production rate and fractional catabolic rate compared to the
STEP II diet. Conclusions: we have, for the first time in Spain, implemented the necessary
methodology to perform apo B-100, apoA-I and A-II kinetic studies in vivo using stable
isotopes in human subjects. A high apoA-I production rate is the main determinant of high
plasma concentrations of apoA-I, and not variations in its catabolism. Lipoprotein kinetic
studies enable the monitoring of lipoprotein metabolic parameters and the investigation of
nutritional and pharmacologic interventions in the primary and secondary prevention of
cardiovascular disease targets.
Els efectes antiaterogènics atribuïts a una dieta de tipus mediterrani, rica en àcids grassos
monoinsaturats (AGM), aportats per oli d'oliva verge, són deguts, en part, a l'augment o al
manteniment de les concentracions plasmàtiques de colesterol de les lipoproteïnes d'alta
densitat (HDL). No obstant i fins al moment, no es coneixen del tot els mecanismes que
expliquen aquestes concentracions. L'apolipoproteïna (apo) A-I (apoA-I) és l'apolipoproteïna
majoritària de les HDL i els seus paràmetres cinètics, com ara la taxa de producció i la taxa
de catabolisme, reflexen la cinètica de les partícules d'HDL. La nostra hipòtesi de treball és la
següent: una dieta Mediterrània rica en AGM aportats per oli d'oliva verge, comparada amb
una dieta STEP II, incrementa o manté els nivells de colesterol de les HDL degut a un
augment de la producció i no a una disminució de la degradació d'apoA-I. Possiblement, la
realització d'estudis de cinètiques utilitzant isòtops estables és la forma més fisiològica
d'avaluar la producció i la degradació d'apolipoproteïnes en l'home. Objectiu: Implementar la
metodologia necessària per realitzar cinètiques d'apo B-100 i, especialment, d'apoA-I i
d'apoA-II en voluntaris in vivo utilitzant isòtops estables com a marcatge de les proteïnes.
Aplicar aquesta metodologia per comparar els efectes d'una dieta Mediterrània rica en oli
d'oliva verge amb una dieta pobra en greixos STEP II sobre el metabolisme de les HDL i de
les lipoproteïnes de baixa densitat (LDL). Disseny: Estudi creuat randomitzat de 4 setmanes
d'intervenció dietètica, amb un període de rentat entre elles. 10 voluntaris, homes sans,
moderadament hipercolesterolèmics van seguir ambdues dietes. Aquest estudi va ser
aprovat pel Comitè d'Ètica i d'Investigació Clínica de l'Hospital Universitari de Sant Joan de
Reus. Instrumentalització: Estudi cinètic mitjançant la injecció i perfusió d'isòtop estable 2H3-
L-leucina en forma d'un bolus inicial i de perfusió durant 16h al final de cada dieta. Les
diferents fraccions lipoproteïques es van separar per ultracentrifugació. La detecció d'isòtop
incorporat va ser mitjançant GC-MS. Les dades obtingudes es van analitzar amb models
multicompartimentals i el programa SAAM II. Els estudis cinètics d'apoA-I i d'apoA-II es van
posat a punt i realitzat a la nostra Unitat de Recerca a Reus. Els estudis d'apo B-100 i la
modelització de les dades cinètiques es van realitzar en colClaboració amb el grup de recerca
de la Vascular Biochemistry Section, Division of Cardiovascular & Medical Sciences, Royal
Infirmary, University of Glasgow, Glasgow). Resultats: La dieta Mediterrània, comparada
amb la dieta STEP II, incrementa significativament la concentració plasmàtica d'apoA-I.
S'han realizat 17 cinètiques però, degut a la complexitat de la metodologia, en aquesta tesis
es presenten els resultats de les 7 cinètiques (4 després de la dieta Mediterrània i 3 després
de la dieta STEP II) analitzades per GC-MS fins ara. A pesar de l'escàs nombre de cinètiques,
s'observen certes tendències. La dieta Mediterrània, comparada amb la dieta STEP II,
presenta una major taxa de producció d'apoA-I de les HDL, així com una major taxa de
producció i de catabolisme de l'apo B-100 de les LDL. Conclusions: S'ha implementat la
metodologia dels estudis de cinètiques amb isòtops estables de l'apoA-I i l'apoA-II de les
HDL i de l'apo B-100 de les VLDL1, VLDL2, IDL i LDL. El determinant de les concentracions
més elevades d'apoA-I en plasma és una major taxa de producció d'aquesta apo i no
diferències en el seu catabolisme. Les aportacions de las cinètiques de les lipoproteïnes
permetran avançar en els mecanismes lipídics involucrats en les malalties vasculars i aportar
nous aspectes sobre les dianes nutricionals i farmacològiques.

O indivíduo com diabetes mellitus tipo 2 apresenta um risco de 2 a 4 vezes maior de desenvolver doença cardiovascular (DCV) quando comparado ao não-diabético, sendo que este aumento do risco para o desenvolvimento da DCV também é observado quando na intolerância à glicose (IG) que ocorre em fases mais precoces da história natural do diabetes. Atribui-se ser a presença da síndrome metabólica (SM), que ocorre na maioria dos pacientes com DM2 e IG, um fator importante para o desenvolvimento da DCV nestes indivíduos. Dos componentes da SM, inúmeros estudos destacam a dislipidemia como um dos principais fatores para este risco. A dislipidemia comumente encontrada na IG é caracterizada por hipertrigliceridemia, baixo HDL-C e presença de LDL pequena e densa. Entretanto, como a elevação dos níveis séricos do LDL-C associada ao surgimento de aterosclerose prematura em indivíduos não diabéticos na maioria das vezes não é observada em pacientes com IG, questiona-se se outras alterações do metabolismo lipídico, tais como alterações da cinética do colesterol ou a transferência de lípides das lipoproteínas para a HDL, poderiam estar relacionadas ao maior risco cardiovascular nestes pacientes. Estudo prévio, utilizando uma nanoemulsão lipídica artificial de LDL, verificou uma remoção mais rápida do colesterol na forma livre em pacientes normolipidêmicos com doença arterial coronária (DAC) quando comparada com controles. No presente estudo, utilizou-se a nanoemulsão lipídica artificial para avaliar se esses dois processos envolvidos no metabolismo da LDL e da HDL estão alterados em pacientes com intolerância à glicose que os predispõem à DAC, relacionando estes resultados com fatores de risco cardiovasculares, tais como a resistência à insulina, a obesidade e a dislipidemia. Para tanto, foram estudados 14 pacientes com IG e 15 controles, sem manifestação clínica de DCV, que não utilizam antidiabéticos orais e hipolipemiantes, comparados com controles pareados para idade, sexo, raça, IMC, tabagismo, consumo de álcool, prática de atividade física e doenças associadas. Para o estudo cinético, a nanoemulsão marcada foi injetada endovenosamente e amostras de sangue coletadas ao longo de 24h para a determinação da radioatividade, das curvas de decaimento plasmático e da taxa fracional de remoção (TFR) dos lípides marcados a partir de um modelo de análise compartimental. Foi medida a taxa de esterificação do 3Hcolesterol livre da nanoemulsão no plasma e avaliada a transferência in vitro de lípides da nanoemulsão para a fração HDL. A resistência à insulina foi estimada pelo modelo matemático de homeostase glicêmica (HOMA) e a adiposidade abdominal por tomografia computadorizada de abdômen. A concentração plasmática de colesterol total, LDL-C, HDL-C, triglicérides e de apolipoproteínas não diferiu entre os grupos. O perfil antropométrico relacionado ao peso, IMC e circunferência abdominal foi semelhante entre os grupos. O grupo IG apresentou maior concentração de insulina de jejum (p=0,01), menor sensibilidade à insulina (p<0,01) e maior índice de resistência à insulina (p<0,01). A TFR 14C-EC foi similar nos dois grupos, porém a TFR 3H-CL foi mais rápida no grupo IG comparado com controle (p=0,04). A porcentagem de esterificação do 3H-colesterol da nanoemulsão bem como a transferência de lípides da nanoemulsão para a fração HDL foram semelhantes entre os grupos. A remoção mais rápida do 3H-colesterol livre mostra que ocorreu uma dissociação das partículas de colesterol da nanoemulsão lipídica nos pacientes com intolerância à glicose. Essa dissociação do colesterol pode refletir alterações no metabolismo intravascular da lipoproteína LDL, as quais podem favorecer a aterogênese nesses pacientes
Individuals with diabetes mellitus type 2 are 2 to 4 times more susceptible to cardiovascular disease (CVD) than non-diabetic individuals. This increased risk is also observed for glucose intolerance (GI) which appears in the initial stages of diabetes. The presence of the metabolic syndrome (MS), present in most DM2 and GI patients, is also an important factor contributing to the development of CVD in these individuals. Various MS component studies emphasize dyslipidemia as one of the main contributors for this risk factor. The dyslipidemia commonly associated to GI is characterized by hypertriglyciridemia, low HDL-C and the presence of a small and dense LDL. However, since associated LDL-C levels with the development of premature atherosclerosis in non diabetic individuals is for the most part not observed in GI patients, it is questioned whether other lipid metabolism alterations such as cholesterol kinetics or the lipid transfer to HDL could be related to a greater CVD risk in these individuals. A previous study using an artificial LDL nanoemulsion showed a faster removal rate of the free cholesterol in normolipidemic with coronary artery disease (CAD) patients when compared to control individuals. In this study an artificial lipid nanoemulsion was used to evaluate both these processes involved in the metabolism of LDL and HDL which are both altered in patients with GI that expose them to CAD, and relating the results to CVD factors such as insulin resistance, obesity and dyslipidemia. 14 GI and 15 control individuals participated in this study. All without manifestations of CVD, none using any oral antidiabetic medication or hypolipimeants, paired for age, sex, race, BMI, smoking, alcoholic consumption, physical activity and comorbidities. For the kinetic study, a labeled nanoemulsion was interveneously injected and blood samples collected at determined intervals over a 24 hour period to determine the radiactive plasma decay curves and fractional clearance rate (FCR) of the labeled nanoemulsion lipids through a compartmental analysis model. Plasma esterification rate of the 3H-free cholesterol of the nanoemulsion was measured as was the in vitro transfer from the nanoemulsion to HDL fraction. Insulin resistance was obtained by the glycemic homeostasis mathematical model (HOMA) and abdominal adipose by a computerized tomography of the abdomen. No differences were observed for total cholesterol plasmatic concentrations, LDL-C, HDL-C, triglycerides or apolipoproteins between the two groups. The anthropometric profile related to weight, BMI and abdominal circumference was similar for both groups. The GI group presented higher fasting insulin concentration (p=0.01), less insulin sensitivity (p=0.01) and a greater insulin resistance (p=0.01). The TFR 14C-CE was similar in both groups, although the TFR 3H-CL was faster in the GI group compared to the control group (p=0.04). The esterification percentage of the nanoemulsions 3H-colesterol, as well as the lipid transfer from the nanoemulsion to HDL fraction were similar for both groups. The faster 3H-free cholesterol removal shows that a dissociation of the cholesterol particles of the lipidic nanoemulsion occurred in those patients with GI. This dissociation could possibly reflect alterations in the intravascular LDL lipoprotein metabolism which in turn, may favor atherogenesis in these patients

Estudos anteriores em nosso laboratório demonstraram que pacientes portadores de DAC apresentam diferenças no metabolismo do CL e CE de uma nanoemulsão artificial rica em colesterol (LDE), nos quais o CL apresentou maior remoção plasmática e depósito arterial. Dando continuidade a esta linha de pesquisa, neste trabalho foram avaliadas a cinética plasmática, representada pela taxa fracional de remoção (TFR), e a captação do 3H-colesterol livre (3H - CL) e 14C - colesterol esterificado (14C - CE) da LDE por segmentos arteriais e por órgãos de coelhos normais (n=17) e coelhos submetidos à indução de aterosclerose por dieta rica em colesterol (1%) (n=13). Além disso, avaliou-se a captação in vitro do 3H CL e do 14C CE da LDE por células endoteliais aórticas de coelhos. Por último, foi avaliada a influência da inibição da enzima lecitina-colesterol aciltransferase (LCAT), e indiretamente, a esterificação do CL em ratos normais (n=9) e tratados com diazepam (n=9). Em coelhos que receberam dieta normal, não houve diferença entre a remoção plasmática do 3H - CL e do 14C - CE. Em coelhos que desenvolveram hiperlipidemia e aterosclerose através de dieta rica em colesterol, o 3H - CL foi removido mais rapidamente da circulação do que o 14C - CE (p<0,05), entretanto houve maior captação de 14C - CE do que de 3H - CL no arco aórtico (p<0,05). Em ambos os grupos, os principais órgãos captadores de colesterol da LDE foram fígado, pulmão, adrenais e baço (p<0,05). Tanto a TRF quanto a captação hepática de 3H - CL e 14C - CE foram menores no grupo que recebeu a dieta rica em colesterol. Em células endoteliais aórticas de coelhos, a captação de 3H - CL foi maior que a de 14C CE independente da massa de LDE incubada (p<0,01). Em ratos, não houve diferença entre a captação das duas formas de colesterol da LDE pela aorta no grupo controle, entretanto, quando a atividade da LCAT foi diminuída pelo tratamento com diazepam, a captação arterial de 3H - CL foi maior do que a de 14C - CE (p< 0,01). A hiperlipidemia e distúrbios no processo de estabilização do colesterol, favorecem a dissociação entre o CL e o CE das lipoproteínas, e podem elevar o risco de desenvolvimento da aterosclerose, assim como agravar o processo de aterogênese.
I n previously studies, it was shown that free cholesterol (FC) and cholesterol ester (CE) of a cholesterol-rich nanoemulsion (LDE) behaves differently in patients with coronary artery disease (CAD). The FC plasma clearance and arterial deposition is greater than CE. In the present study we evaluate the plasma kinetics, estimated by the fractional clearance rate (FCR), and the tissue uptake of 3H-free cholesterol (3H FC) and of 14C cholesterol ester (14C - CE) of LDE by arterial segments and organs of rabbits with (n=13) and without atherosclerosis (n=17). Furthermore, it was evaluated the in vitro uptake of 3H FC and 14C - CE by rabbit aortic endothelial cells. Finally, it was evaluated the inhibition of the enzyme lecithin-cholesterol acyltransferase (LCAT), and indirectly, the FC esterification in rats non-treated (n=9) and treated with diazepam (n=9). In rabbits without atherosclerosis that received an standard diet there was no difference between the plasma clearance of 3H FC and 14C CE. In rabbits with hyperlipidemia and atherosclerosis induced by the cholesterol-rich diet the 3H - FC was removed faster than 14C - CE (p<0.05), however the arch aortic uptake of 14C CE was greater than of 3H - FC (0p<0.05). In both groups, liver, lungs, adrenals and spleen were the principal sites of LDE cholesterol uptake. The FCR and tissue uptake were smaller in rabbits with than those without atherosclerosis. In rabbit aortic endothelial cells the 3H - FC uptake was greater than 14C CE independently of incubated LDE mass (p<0.01). In control rats there was no difference on the arterial uptake of both cholesterol forms of LDE, but when the LCAT activity was diminished by the diazepam treatment, the arterial uptake of 3H FC were greater than 14C CE (p< 0.01). The hyperlipidemia and cholesterol stability alterations may lead to dissociation between lipoproteins FC and CE. This dissociation may increase the risk for atherosclerosis and likewise enhance the severity of atherosclerosis.

INTRODUÇÃO:. A dislipidemia diabética é um dos principais fatores de risco para doença arterial coronária (DAC) O uso de uma nanoemulsão LDL-símile para avaliar clearance do éster de colesterol(EC) e colesterol livre(CL) do intravascular mostrou uma remoção acentuada do CL e um maior depósito em vasos sanguíneos de indivíduos com DAC avançada. OBJETIVOS: Identificar em DM2 a cinética plasmática do CL e EC; se há diferença na cinética de CL e EC em DM2 assintomáticos para DAC com e sem aterosclerose subclínica. MÉTODOS: Estudou-se 12 DM2 e 09 controles pareados para idade e sexo. A aterosclerose subclínca foi avaliada pela presença de Calcificação na artéria coronária (CAC). A Nanoemulsão artificial LDLsímile com dupla marcação radioativa 14C-EC, 3H-CL foi utilizada para o estudo cinético do colesterol, sendo injetada nos participantes e amostras de sangue foram coletadas durante 24 horas para mensuração da radioatividade. Remoção dos lípides da circulação foi calculada por análise compartimental. Mediu-se a taxa de esterificação do 3H-CL no plasma e avaliou-se a capacidade in vitro da HDL de receber lípides a partir das LDL-símile. RESULTADOS: Os diabéticos tiveram IMC, CA e CA/CQ maior que os controles, respectivamente: 31,9 ± 4,6 vs. 27,1± 2,4, p<0,05; 104,9 ± 9,8 vs. 94,2 ± 7,3, p<0,05; 0,98 ± 0,09 vs.0,89 ± 0,06, p<0,01. A glicemia de jejum (171 ± 96 vs. 83 ± 7,5 mg/dl, p <0,05) e hemoglobina glicada (8,9 ± 2,1 vs. 5,6 ± 0,4%, p<0,05) também foram maiores no DM2. A concentração de colesterol total, LDL, HDL, Triglicérides e apolipoproteínas A1,B e E não diferiu entre os grupos. A Taxa fracional de remoção (TFR)14C-EC foi 22% maior DM2 que nos controles (0,07 ± 0,02 vs. 0,05 ± 0,01 h-1, p<0.01). A TFR3H- CL foi semelhante entre os dois grupos, bem como a esterificação. A presença de CAC no grupo DM2 não alterou a remoção de EC e CL nesses pacientes. In vitro a capacidade da HDL em receber EC (4,2 ± 0,8vs. 3,5 ± 0,6 %, p=0,03) e TG (6,8 ± 1,6 vs. 5,0 ± 1,1, p=0.03) foi maior nos DM2. CONCLUSÕES: A remoção acelerada do 14C-EC na população DM2 e a remoção semelhante do 3H-CL quando comparado com grupo controle, pode sinalizar alterações na gênese da dislipidemia diabética. O fato dos DM2 com CAC assintomática não apresentam alterações na remoção de colesterol livre sinaliza uma provável relação do CL com a instabilidade da placa aterosclerótica.
INTRODUTION: The diabetic dyslipidemia is one of the most important risk factor in the development of coronary artery disease (CAD). The LDL-like nanoemulsion is being used to study the clearance of cholesteryl ester(CE) and free cholesterol(FC) from intravascular in patients with advanced CAD and it was shown a higher removal of FC and higher deposit in vases. OBJECTIVE: The aim of this study is to analyze the plasma kinetics of FC and CE in Type 2 Diabetes Mellitus (T2DM); and identify if there are any differences in the removal of FC in the presence of subclinical atherosclerosis in asymptomatic patients with T2DM. METHODS: It was studied 12 T2DM and 09 controls paired by age and gender. The LDL-like nanoemulsion labeled with radioactive: 14C- cholesterol ester (CE), 3H-cholesterol free (CF) was used on plasma kinetics. The nanoemulsion was injected intravenously in all participants and blood sample was collected over 24 hours for radioactivity measurement. The intravascular lipid removal was calculated through compartmental analysis. The intravascular esterification of FC contained in the nanoemulsion was calculated. The ability of HDL to received lipids from LDL-simile were observed in vitro essays. Coronary Calcium Score was detected to identify subclinical atherosclerosis. RESULTS: T2DM patients had a bigger BMI, waist and waist/hip than control, respectively 31.9 ± 4.6 vs. 27.1± 2.4, p<0.05; 104.9 ± 9.8 vs. 94.2±7.3, p<0.05; 0.98± 0.09 vs. 0.89 ± 0.06,p<0.01. Fasting glycemia (171 ± 96 vs. 83 ± 7.5 mg/dl, p <0.05) and glycated hemoglobin( 8.9 ± 2.1 vs. 5.6 ± 0.4%,p<0.05) was higher in T2DM, and there was no differences in the concentration of Total cholesterol, HDL, LDL, Triglycerides and apolipoproteins A1, B and E concentrations. The Fractional Clearance rate (FCR) 14C CE in T2DM was 22% bigger than control ( 0.07 ± 0.02 vs. 0.05± 0.01 h-1, p<0.01). FCR 3H-CF was similar between the groups. The CAC in T2DM did not show differents TFR in CE and FC in these group. In Both groups there was no statistical difference in FC esterification rate. The HDL ability to received CE (4.2 ± 0,8vs. 3.5 ± 0,6 %, p=0,03) and TG (6.8 ± 1.6 vs. 5.0 ± 1.1, p=0.03) from LDL-like nanoemulsion was higher in T2DM. CONCLUSIONS: The higher removal of 14C-CE and similar removal of FC in T2DM can be related to the genese of the diabetic dyslipidemia. The similar removal of FC between the control group and T2DM asymptomatic CAD, with and without subclinical atherosclerosis, could possibly signalize to the relation of FC and the atherosclerotic plaque stability.

INTRODUÇÃO: portadores de diabetes mellitus tipo 1 (DM1) apresentam, progressivamente, complicações vásculo-neurais. Os fatores que aumentam o risco de coronariopatia - hipertensão, dislipidemia e idade avançada - explicam, em parte, a alta mortalidade cardiovascular, entretanto diabéticos tipo 1 podem morrer de coronariopatia precoce e não apresentar os fatores de risco clássicos para aterosclerose. Modificações estruturais e funcionais nas lipoproteínas, alterando a sua composição e trocas lipídicas poderiam justificar o aumento de eventos vasculares, entretanto estas alterações podem não ser detectadas através das dosagens rotineiras de lípides plasmáticos. OBJETIVOS: através de nanoemulsão lipídica artificial (LDE) que simula a estrutura lipídica da LDL avaliamos, em portadores de DM1, normolipidêmicos, intensivamente tratados e sem complicações significativas da doença, a taxa de esterificação do colesterol, a remoção da nanoemulsão da circulação, o tamanho da partícula HDL e as transferências de lípides entre a nanoemulsão e as partículas HDL. Secundariamente, determinamos a influência do controle glicêmico, resistência à insulina (RI) e insulinização no metabolismo lipídico. MÉTODOS: estudamos 36 indivíduos diabéticos e 37 controles não-diabéticos pareados para idade, sexo e índice de massa corpórea. Nanoemulsão lipídica artificial com marcação radioativa nos lípides éster de colesterol (CE), colesterol livre (CL), triglicérides (TG) e fosfolípides (PL) foi utilizada para os estudos. Nanoemulsão com marcação 14C-CE e 3H-CL foi injetada nos participantes e amostras de sangue foram coletadas durante 24 horas para mensuração da radioatividade. Remoção dos lípides da circulação foi calculada por análise compartimental. A taxa da esterificação do colesterol livre foi calculada após extração e separação de lípides do plasma por cromatografia em camada delgada. Para estudo da transferência de lípides, nanoemulsões com marcação 14C-CE e 3H-CL ou 14C-PL e 3H-TG foram incubadas com plasma e a radioatividade dos lípides transferidos para as HDL foi contada após a precipitação de lipoproteínas contendo apoB. O diâmetro da HDL foi mensurado por método de dispersão da luz. A RI nos diabéticos foi mensurada por fórmula que estima a taxa de captação da glicose. RESULTADOS: hemoglobina glicada foi de 8,8±1,3 mg/dl e concentrações de LDLc foram menores nos diabéticos (85±22 vs. 98±26 mg/dl), p=0, 035. Não houve diferenças em relação às taxas de esterificação, transferências de lípides da nanoemulsão para as HDL e tamanho da partícula HDL entre os grupos. Não encontramos relação entre as análises cinéticas e HbA1c, glicemia, índices de RI e dose de insulina. A taxa de remoção do 14C-CE foi mais rápida em diabéticos tipo 1 que nos controles (0, 059±0, 022 vs.0, 039±0, 022 h-1), p=0, 019. 16 CONCLUSÕES: apesar de controle glicêmico ruim nos DM1, as transferências de lípides da nanoemulsão para as HDL, a taxa de esterificação e a remoção da 3H-CL são semelhantes às dos controles. O controle glicêmico, perfil lipídico, índices de RI e dose de insulina não influenciaram nas transferências de lípides e na taxa de esterificação. A remoção do 14C-CE é mais rápida em indivíduos diabéticos, o que poderia justificar as concentrações de LDLc mais baixas encontradas nesta população. Acreditamos que a terapia insulínica intensiva pode justificar estes achados
INTRODUTION: people with type 1 diabetes mellitus (DM1) have progressively neuro-vascular complications. Factors that increase the risk of coronary artery disease hypertension, dislipidemia and advanced age explains part of increased cardiovascular mortality, however some DM1 died of early coronary artery disease and often do not have atherosclerosis classical risk factors. Structural and functional changes in lipoproteins, altering their composition and activities of lipid exchange could justify the increase in vascular events but these changes are generally not detected by routine clinical laboratory plasma lipid exams. OBJETIVES: in normolipidemic DM1, intensively treated and without significant complications of disease we evaluated, by an artificial lipid nanoemulsion that resembles the lipid structure of LDL, rates of cholesterol esterification, nanoemulsion removal of the circulation, HDL particle size and lipid transfer from nanoemulsion to HDL. Secondarily, we determine the influence of glycemic control, insulin resistance (IR) and insulinization on lipid metabolism. METHODS: we studied 36 diabetics and 37 non-diabetic controls paired by age, sex and body mass index. Artificial lipid nanoemulsion labeled with radioactive lipids cholesterol ester (CE), cholesterol (CL), phospholipids (PL) and triglycerides (TG) was used for studies. Intravenous infusion of nanoemulsion 14C-CE e 3H-CL was injected in participants and blood was sampled over 24 hours for radioactivity measurement. Circulation lipid removal was calculated through compartmental analysis. Rate of cholesterol esterification was calculated after lipid extraction and separation by thin-layer chromatography. Nanoemulsion was incubated with plasma and radioactivity of lipids 14C-EC, 3H-CL, 14C-PL and 3H-TG transferred to the HDL was quantified after the precipitation of other apoB lipoproteins. The HDL diameter was measured by laser light scattering. The insulin resistance in diabetic patients was measured by formula that estimates the rate of uptake of glucose. RESULTS: glycated hemoglobin was 8,8±1,3 mg/dl and LDL concentrations were lower in diabetic patients (85 ± 22 vs. 98 ± 26 mg / dl), p = 0035. There were no differences between groups regarding rates of cholesterol esterification, lipids transfer from nanoemulsion to HDL and HDL particle size. We found no relationship between the kinetic analyses and HbA1c, blood glucose, measures of IR and dose of insulin. The rate of removal of 14C-EC was faster in diabetics type 1 than controls (0.059 ± 0.022 vs.0.039 ± 0.022 h- 1), p = 0.019. CONCLUSIONS: despite suboptimal glycemic control in diabetics, lipids transfer from nanoemulsion to HDL, rate of cholesterol esterification and removal of 3H-CL are similar to those of non-diabetic individuals. Glycemic control, lipid profile, measures of IR and dose of insulin did not influence lipids transfer and rate of cholesterol esterification. Removal of 14C-EC from diabetic circulation is faster than controls which could justify the 18 lower LDL concentration found in this population. We believe that intensive insulin therapy could explain these findings

Introduction/objectif : La dyslipidémie des sujets obèses insulinorésistants est principalement caractérisée par une augmentation plasmatique des LRT hépatiques (LRT-apo-B100) et intestinales (LRT-apo-B48). La chirurgie bariatrique, largement pratiquée dans le traitement de l'obésité, est associée à l'amélioration de nombreuses anomalies métaboliques. Nous avons étudié l'effet de la chirurgie bariatrique sur le métabolisme des LRT intestinales et hépatiques.Méthodes/résultats : Le métabolisme des LRT de 22 patients obèses non diabétiques bénéficiant d'une chirurgie bariatrique : sleeve gastrectomie (SG ; n=12) ou bypass gastrique (BP ; n=10) a été étudié par une méthode d'enrichissement isotopique stable (D3-L-Leucine) en alimentation continue. Chaque sujet a réalisé deux études cinétiques : une 1 mois avant et une 6 mois après la chirurgie. Le résultat principal est une diminution de la taille du pool de LRT-apo-B100 après une SG et un BP (p<0,01) expliquée par une augmentation du taux de clairance des LRT-apo-B100 (SG : p<0,05) sans diminution du taux de production. Le pool de LRT-apo-B48 est significativement réduit après une SG (p<0,05), sans explication claire à part une tendance à la diminution du taux de production. La diminution du pool de LRT-apo-B100 est significativement corrélée à la diminution de la concentration en apo-CIII dans le groupe entier.Conclusion : Cette étude est la première étude cinétique réalisée chez l'Homme explorant les mécanismes d'amélioration du métabolisme des LRT après une chirurgie bariatrique. Cette amélioration du métabolisme peut contribuer à la diminution de la mortalité cardiovasculaire observée après une chirurgie bariatrique
Introduction and objective: The dyslipidemia of insulin-resistant obese patients is widely characterised by the elevation of plasma triglyceride-rich lipoproteins (TRL) of both hepatic (TRL-apoB-100) and intestinal (TRL-apoB-48) origin. Bariatric surgery is a well-established and effective modality for the treatment of obesity, and is associated with improvements in a number of metabolic abnormalities that are associated with obesity. Here, we have investigated the effect of bariatric surgery on intestinal and hepatic TRL metabolism. Approach and Results: Twenty two non-diabetic, obese subjects undergoing bariatric surgery: sleeve gastrectomy (SG; n=12) and gastric bypass (BP; n=10) were studied using a stable isotope (D3-L-Leucine) enrichment methodology, in the constant fed state. Each subject underwent two lipoprotein turnover studies: 1 month before and 6 months after surgery. The main finding was a reduction in TRL-apo-B100 concentration following both SG and BP procedures (P<0.01 for both), explained by an increase in TRL-apo-B100 fractional catabolic rate (P<0.05 for SG) without a reduction in production rate. TRL-apo-B48 concentration was significantly reduced following SG, with no clear explanation other than a trend towards reduction in production rate. The reduction of TRL-apo-B100 concentration was significantly associated with a reduction of plasma apo-CIII in the pooled group of patients undergoing bariatric surgery. Conclusions: This is the first human kinetic study to explore the mechanism of improvement of TRL metabolism following bariatric surgery. These effects may contribute to the decrease of cardiovascular mortality after surgery

Low-density lipoproteins (LDL) are heterogeneous nanoparticles containing one copy of apolipoprotein B (~550 kDa) and thousands of lipids. LDL are the main plasma carriers of cholesterol and the major risk factor for atherosclerosis, the number one cause of death in the developed world. In atherosclerosis, LDL lipids are deposited in the arterial intima. Fusion of modified LDL in the arterial wall is an important underexplored triggering event in early atherosclerosis. Previous studies from our laboratory showed that thermal denaturation mimics LDL remodeling and fusion, and revealed the kinetic origin of LDL stability. Here, we report the first quantitative kinetic analysis of LDL stability. We show that LDL denaturation monitored by turbidity follows a sigmoidal time course that is unique among lipoproteins, suggesting that slow conformational changes in apoB precede lipoprotein fusion. High activation energy of LDL denaturation, Ea~100 kcal/mol, indicates disruption of extensive protein-protein and protein-lipid interactions involving large apoB domains. Next, we combined size-exclusion chromatography, gel electrophoresis and electron microscopy to show that dimerization is a common early step preceding LDL fusion. Monoclonal antibody binding studies indicated that α-helices in the N-terminal βα1 domain of apoB undergo conformational changes at early stages of LDL aggregation and fusion. Better understanding of these structural changes that prime LDL for fusion is important, as it may help control this pathogenic process before it occurs. We applied the kinetic approach to test how selected factors that are expected to contribute to LDL fusion in vivo affect the rate of LDL fusion and rupture in vitro. The results show that LDL fusion accelerates at pH<7, which may contribute to LDL retention in acidic atherosclerotic lesions. Fusion also accelerates upon increasing LDL concentration in near-physiologic range, which likely contributes to atherogenesis. Further, we showed that thermal stability of LDL decreases with increasing particle size, indicating that the pro-atherogenic properties of small dense LDL do not result from their enhanced fusion. Our work provides the first kinetic approach to measuring LDL stability and suggests that lipid-lowering therapies that reduce LDL concentration but increase the particle size may have opposite effects on LDL fusion.

Thesis (Ph. D.)--University of Georgia, 2004.
Directed by James Price. Includes articles submitted to International journal of pharmaceutics, Journal of pahrmaceutical research, and Journal of pharmaceutical science. Includes bibliographical references.