Claude Delcroix

Effects of fenofibrate on high and low density lipoprotein metabolism in heterozygous familial hypercholesterolemia

This study investigates the influence of pharmacological doses of fenofibrate on HDL and LDL metabolism in 5 familial hypercholesterolemia heterozygotes. Fenofibrate lowered plasma low density lipoprotein cholesterol (20%, P less than 0.025), triglycerides (37%: P less than 0.005) and apolipoprotein B (14%: P less than 0.05) but increased apo A-I (20%; P = 0.01). Kinetic studies showed that the drug markedly increased the fractional catabolic rate of LDL-apo B by 59% and its synthetic rate by 36%. Fractional catabolic rate of apo A-I was also increased by 26% but accompanied by a much greater increase of its synthetic rate (49%). Thus the change in balance between catabolism and synthesis of both apoproteins affected by fenofibrate accounts for the observed plasma concentration changes, which may be considered as favourable with regard to the management of atherosclerosis.

Apolipoproteins C-II and C-III metabolism in hypertriglyceridemic patients Effect of a drastic triglyceride reduction by combined diet restriction and fenofibrate administration

Four hypertriglyceridemic patients, who had received an equilibrated high calorie diet and no lipid lowering drug for 1 month, were injected intravenously with 125I-apo C-II and 131I-apo C-III labeled homologous lipoproteins. Plasma and urine radioactivity, lipid and apolipoprotein levels were followed at regular intervals for 15 days. At the end of this first kinetic study the patients were advised to adhere for 1 month to a more restricted diet, limited in fat, and were given additionally 300 mg fenofibrate daily. After this treatment, a new kinetic study involving intravenous injection (similar to the first one) was performed. The protocols of both studies were identical. Treatment (diet plus drug) (1) reduced total cholesterol by 26 +/- 8%, triglycerides by 56 +/- 15%, apo C-II by 36 +/- 14%, and apo C-III by 48 +/- 10%; (2) modified the distribution of radioactivity between lipoproteins proportionally to the change in their mass ratio (decrease in VLDL and increase in HDL); (3) changed the kinetics of both apoproteins by rising the fractional removal rate, shortening residence time and decreasing the synthesis rate of both apolipoproteins C-II and C-III. The treatment was, however, unable to reduce the synthesis rate of apo C-III to normal, suggesting a major role of the apoprotein overproduction in the triggering of hypertriglyceridemia.

Effect of alcohol intake on high and low density lipoprotein metabolism in healthy volunteers

To determine the effect of moderate doses of ethanol on lipoprotein metabolism, the kinetics of [125I]high density apolipoprotein (Apo) A-I and [131I]low density Apo B were examined in 9 normal volunteers before and after regular intake of 60-70 g of ethanol/day. Plasma levels of Apo B and Apo A-I were significantly increased but remained in the normal range. Mean synthesis of Apo A-I and B were increased, respectively, from 12.6 and 13.7 mg/kg per day in the absence of ethanol to 18.8 and 17.1 mg/kg/day after 2 wk of ethanol intake. Fractional catabolic rates for Apo A-I and B increased respectively from 0.204 and 0.340 in the period without ethanol to 0.266 and 0.372 after ethanol. These findings indicate that despite rather moderate increase in both Apo plasma levels, ethanol produced profound alterations in their metabolism, namely increased turnovers.

Blood Cholesterol and Hydrocortisone Production in Man: Quantitative Aspects of the Utilization of Circulating Cholesterol by the Adrenals at Rest and under Adrenocorticotropin Stimulation*

A kinetic study of the conversion of blood cholesterol into hydrocortisone was carried out in two patients through prolonged infusions of cholesterol-4-(14)C. The following points appear to be established by our observations:1) The infused tracer behaved metabolically like endogenous cholesterol; it could therefore serve as a means of labeling plasma cholesterol for investigating its utilization by the adrenal cortex.2) At rest, about 80% of hydrocortisone derived from plasma cholesterol, the other 20% thus being synthesized in situ from acetate and other unlabeled precursors.3) Under ACTH stimulation the participation of plasma cholesterol in the synthesis of hydrocortisone was the same as at rest; the conversion of plasma cholesterol into hydrocortisone was thus proportional to the production of glucocorticosteroids by the adrenal glands.4) The specific activities of hydrocortisone allowed us to trace its adrenal precursors including adrenal cholesterol. The kinetics of the replacement of adrenal cholesterol by plasma cholesterol underlined the functional heterogeneity of the former. The experimental data were compatible with the following model: A fraction of plasma cholesterol entering the adrenal cell is immediately available for metabolism and conversion into steroid hormones, and another fraction turns over slowly, representing some form of storage.

Effect of simvastatin on receptor-dependent low density lipoprotein catabolism in normocholesterolemic human volunteers

Simvastatin, an inhibitor of HMG-CoA reductase was given to 7 normolipidemic healthy volunteers for 1 month at a dose of 20 mg/day. Measurements of turnover of low density lipoprotein apolipoprotein B (LDL-apo B) were determined before and after drug treatment using intravenous injection of 125I-labeled LDL and 131I-labeled cyclohexanedione-treated LDL to quantify the receptor pathway. In addition to a 13% increase in HDL cholesterol and apolipoprotein A-I concentrations, plasma cholesterol was reduced by 20%, LDL-cholesterol by 32%, and apolipoprotein B by 23%. Assuming a heterogeneous pool of LDL, the new model presented in the companion paper was built to calculate the contribution of the receptor-dependent and the receptor-independent pathways and the corresponding fractional catabolic rates. Simvastatin did not modify constantly the synthetic rate of LDL-apo B but increased the fractional catabolic rate of the receptor-dependent pathway and the contribution of this pathway in the catabolism. The fall in LDL plasma levels observed in normocholesterolemic subjects can be then entirely explained by an enhanced fractional removal of LDL from the circulation by the receptor route.

Interrelations in the Oxidative Metabolism of Free Fatty Acids, Glucose, and Glycerol in Normal and Hyperlipemic Patients A COMPARTMENTAL MODEL

Palmitate, glucose, and glycerol oxidation to CO(2) have been investigated in the fasted state in ten normal subjects and nine patients (six hyperlipoproteinemias, one xanthomatosis, and two glycogenosis) after intravenous injection of [1-(14)C]palmitate, [1-(14)C]glucose, or [1-(14)C]glycerol in tracer amounts. The specific activities and concentrations of plasma palmitate, glycerol, or glucose and expired CO(2) were measured at various intervals after the injection for a period of 24 h. All the studies were analyzed in terms of a multicompartment model describing the structure for each of the subsystems, the transfer of carbon label between subsystems, and the oxidation to CO(2). A bicarbonate subsystem was also included in the model to account for its role in shaping the CO(2) curves. All the CO(2) activity following a palmitate injection could be accounted for by a direct oxidative pathway from plasm FFA with the addition of a 20-min delay compartment. The same also applied to glucose, except that the delay compartment had a mean time of about 150 min. Only about a third of the injected glycerol was directly oxidized to CO(2) from plasma; the delay time was about 4 min. Most of the remainder was converted to glucose. In normals about 45% of the FFA is oxidized to CO(2) directly. This constitutes about 30% of the total CO(2) output. In hyperlipemia the CO(2) output is nearly unchanged and the contribution from FFA is nearly the same. There is a considerable increase (factor of 2), however, in FFA mobilization, most of which is probably diverted to triglyceride synthesis. The glucose and glycerol subsystems are roughly the same in normals and hyperlipemics. About 50% of glucose is oxidized by the direct pathways which accounts for about 35% of the CO(2) output. Glycerol accounts for only 1.5% of the CO(2) produced. Major changes occurred in the glycerol and glucose subsystems in glycogenosis. The changes are consistent with the known deficiency in glucose-6-phosphatase in this disorder. There is a considerable reduction (factor of 2 or more) in the release of glucose to plasma (gluconeogenesis) and in the conversion of glycerol to glucose. Despite the integration of the kinetics of the glucose, glycerol, and FFA subsystems over a 24-h period, 36% of the CO(2) production was still unaccounted for in normals and 50% in hyperlipemics. Thus, some of the carbon must wind up in very slowly turning-over pools which supply CO(2) through subsystems not covered in these studies (triglycerides, glycogen, amino acids, etc.). All the modeling was carried out with the aid of the SAAM25 computer program.

Metabolism of apolipoprotein C-III in normolipemic human subjects

Radioiodinated apolipoprotein C-III labeled either by the iodine monochloride procedure or by the Bolton-Hunter reagent were incubated in vitro with normal HDL. The labeled HDL-apo C-III, after ultracentrifugation and dialysis, was injected intravenously in 8 normolipidemic subjects. The label was followed in VLDL, IDL + LDL, HDL, d = 1.225 g/ml infranate as well as in total plasma and urine for the first time over a period of 2 weeks. Apolipoprotein C-III distributes readily between the different lipoprotein classes, only a small amount being present in the non-lipoprotein fraction. The percent distribution of apo C-III radioactivity and mass was found similar in VLDL, IDL and HDL using 3 different separation methods. Residence time in the whole system was 2.45 +/- 0.33 days. Fractional catabolic rates calculated from the urine/plasma radioactivity ratios or from the plasma curve were 0.731 +/- 0.096 and 0.767 +/- 0.125 pools/day. Synthetic rate was 2.28 +/- 0.32 mg/day/kg. The parameters seem not affected by the labeling procedure. The shapes of the plasma curve and of the urine/plasma ratio curve suggest a kinetic heterogeneity in the metabolism of apo C-III-containing particles.

In vivo metabolism of human apoprotein A-I-phospholipid complexes. Comparison with human high density lipoprotein-apoprotein A-I metabolism.

The metabolism of apolipoprotein A-I was investigated in healthy young adults. The apoprotein was injected intravenously in one of the four following forms: radiolabelled high density lipoproteins, HDL incubated with labelled apo A-I, labelled A-I-dipalmitoyl- or dimyristoylphosphatidylcholine complexes or free apoprotein A-I. The radioactivity-time curves of high density lipoproteins were followed for 15 days. The kinetic studies demonstrate similar fractional catabolic rates, half-lifes and rates of synthesis. Fractional catabolic rate calculated from plasma data was in reasonable agreement with the value derived from the urine/plasma activity ratio. When free apo A-I was injected, the unusual form of the U/P ratio curve is interpreted as the result of different fates of the injected molecules. This study indicates that the half-life of apo A-I seems not to be affected by the form in which the apoprotein is injected and that kinetics of apo A-I-phospholipid complexes may be used as a valid index of apoprotein A-I/HDL metabolism.

Effect of sialic acid removal on human low density lipoprotein catabolism in vivo

This study was undertaken to determine whether sialic acid removal alters the catabolism of low density lipoprotein in humans. Human low density lipoproteins labeled in vitro with 125I were incubated in the presence (termed desialylated) or absence (sialylated) of neuraminidase. The treatment with neuraminidase from Clostridium perfringens removed 90% of the sialic acid residues which did not change the chemical composition of the lipoproteins. Sialylated or desialylated LDL were injected intravenously into normal human subjects. The mathematical analysis of the plasma radioactivity decay curves (followed for 220 h) of desialylated low density lipoproteins, when compared with sialylated LDL, showed a shorter mean transit time (51 h vs 60 h), a 52% faster metabolic catabolic rate and an increased volume of distribution. The data are consistent with a proposed metabolism of low density lipoproteins: in humans, desialylation appears to accelerate the first step of the low density lipoprotein conversion but not to alter its final catabolism.

Metabolism of Apolipoprotein C-I in Normolipoproteinemic Human Subjects

Labeling of apolipoprotein C-I by the Bolton and Hunter reagent allowed a study of the kinetics of this peptide in normolipidemic human volunteers. After its intravenous injection the appearance of radioactivity of the labeled apoprotein was followed in plasma, lipoprotein fractions, and urine for 15 days. Apolipoprotein C-I was quickly associated with HDL and to a smaller extent with VLDL in in vitro and in vivo incubation. Kinetic parameters of apolipoprotein C-I were compared with those of apo A-I. Fractional catabolic rates are respectively 0.422 +/- 0.044 vs 0.240 +/- 0.003 pools/day, residence times through the whole system 3.24 +/- 0.27 vs 6.31 +/- 0.27 days and production rates 1.79 +/- 0.18 vs 13.2 +/- 2.1 mg/kg X day. Two explanations for these differences are proposed.