Peter R. Turner

In vitro oxidised HDL is recognised by the scavenger receptor of macrophages: implications for its protective role in vivo

To assess the effects of oxidative modification, human HDL was oxidised in vitro for 12 h (Ox-HDL12) and 24 h (Ox-HDL24) under similar conditions to those commonly used for LDL. The procedure resulted in: an increase in thiobarbituric acid reactive substances but with marginal change in electronegativity; protein denaturation accounting for 16% and 45% loss of immunoreactive apoprotein A-I in the Ox-HDL12 and Ox-HDL24 respectively relative to the non-oxidised, native HDL (Nat-HDL); a decrease in the polyunsaturated fatty acids of the triglyceride, cholesterol ester and phospholipid components of the lipoprotein; an increase in the proportion of short chain saturated fatty acids while the monounsaturated fatty acids remained relatively unchanged. Studies with human macrophages demonstrated: a decrease of 16% and 30% in the capacity of the Ox-HDL12 and Ox-HDL24 respectively to efflux intracellular free cholesterol; 125I-Ox-HDL24 uptake and degradation was directly comparable with that of 125I-Ac-LDL; the addition of excess unlabelled Ox-HDL24, Ac-LDL, Ox-LDL24 and Nat-HDL resulted in 74%, 67%, 69% and 19% displacement of the 125I-Ox-HDL24 respectively; fucoidin and dextran sulphate displaced 125I-Ox-HDL by 20% and 40% respectively; intracellular free and esterified cholesterol was increased 2.5-fold and 4-fold respectively relative to Nat-HDL on incubation with Ox-HDL24. These findings suggest that HDL is susceptible to oxidative modification leading to recognition by the scavenger receptor of macrophages and subsequent intracellular cholesterol accumulation. As such, the in vivo protective role of HDL in cardiovascular disease can be reversed in those circumstances in which HDL, like LDL, undergoes oxidative modification.

DNA polymorphisms of the apoprotein B gene are associated with altered plasma lipoprotein concentrations but not with perceived risk of cardiovascular disease: European Atherosclerosis Research Study

Three polymorphisms of the apoprotein B gene (XbaI, signal peptide insertion/deletion and the 3-variable number of tandem repeats) selected on the basis of previously published reports as likely to be the most informative, were investigated in a cross-cultural study in Europe. Students from 14 universities, grouped for analyses into five regions, were recruited as cases (n = 682) if they had a paternal history of premature myocardial infarction. For comparison, twice the number of age- and sex-matched controls (n = 1312) were recruited from the same student populations. There were significant regional differences in allele frequencies of the XbaI and VNTR polymorphisms but not of the signal peptide. There were no significant differences in allele frequencies between cases and controls. Adjusted for age, gender and region, the lipoprotein concentrations differed significantly with genotype. The XbaI polymorphism was associated with differences in plasma cholesterol (P = 0.007), triglyceride (P = 0.050), apo B (P = 0.001) and LDL cholesterol (P = 0.01). An interaction between XbaI genotype and body mass index was observed on plasma triglyceride (P = 0.015) and apo B (P = 0.005) concentrations. The signal peptide deletion allele was associated with increased plasma cholesterol (P = 0.03), apo B (P = 0.04) and LDL cholesterol (P = 0.02). The VNTR was not significantly associated with any of these variables although there was a significant genotype/status interaction in relation to HDL cholesterol (P = 0.001) and apo AI (P = 0.001) concentrations. We conclude that, although they are associated with significant differences in lipoprotein concentrations within- and between-populations, the apo B DNA polymorphisms studied are of less value as indicators of cardiovascular risk-factor status in the offspring of individuals affected by the disease.

Low-density lipoprotein metabolism in rats treated with cyclosporine☆

Metabolic mechanisms underlying the observations of elevated cholesterol concentration of low-density lipoprotein (LDL) in organ-transplanted patients on long-term immunosuppressant cyclosporine therapy were explored using cyclosporine-treated rats as an experimental model. As in patients, treatment with cyclosporine induced a significant elevation of plasma cholesterol level, mainly in LDL cholesterol, with a decrease in high-density lipoprotein (HDL) cholesterol level. In an in vivo cross-over study design, differentially radioiodinated homologous LDL from donor cyclosporine-treated rats (Cyc-LDL) and excipient-only-treated control rats (Exc-LDL) were injected into recipient cyclosporine-treated rats (Cyc-rats), excipient-only--treated control rats (Exc-rats), and untreated rats (Unt-rats). From the isotope disappearance curves, the fractional catabolic rate (FCR) and production rate were calculated. The results showed that FCR and production rate were significantly reduced in Cyc-rats compared with control Exc-rats and Unt-rats. The decrease was independent of the donor LDL source. In vitro LDL ligand-receptor assays indicated a twofold higher degradation of Cyc-LDL by cultured rat fibroblasts, and hence could not account for the decreased clearance observed in vivo. These results suggest that the elevated concentrations of LDL cholesterol associated with cyclosporine treatment result not from a cyclosporine-induced modification of the LDL molecule, which could diminish its receptor-mediated clearance/catabolism, but possibly from an in vivo pharmacological property of cyclosporine such as an induced hepatic dysfunction.

Plasma lipoprotein alterations in patients with chronic hepatocellular liver disease resulting from alcohol abuse: effects of alcohol intake cessation

Cholesterol and triglyceride in plasma and lipoprotein fractions and serum apoprotein concentrations were measured in 51 chronic alcoholic subjects; 23 had minimal or mild hepatic changes (steatosis and/or fibrosis) and 28 had cirrhosis. Of the latter, 16 had stopped alcohol consumption at least 3 months before the study, while the other 12 and all the mildly affected patients had continued drinking. None of the patients presented with cholestasis or alcoholic hepatitis. The control group was composed of 15 healthy, non-drinking volunteers selected from the hospital staff with an age- and sex-distribution similar to that of the alcoholic group. Patients with minimal hepatic changes had plasma total cholesterol concentrations within the ranges of the normal population but with increased high density lipoprotein and decreased low density lipoprotein fractions. Total plasma triglyceride values were not significantly elevated but the distributions in the low density lipoprotein and high density lipoprotein fractions were significantly increased in patients compared to controls. This alteration was accompanied by a consistent increase in serum apolipoprotein C-III concentration. Conversely, in patients with cirrhosis, serum concentrations of apolipoproteins A-I and B were significantly lower and were reflected in the cholesterol concentrations in the lipoprotein fractions. Comparisons between abstainers and non-abstainers within the group with cirrhosis indicated that cessation of alcohol intake was not sufficient to rectify lipoprotein dysfunction following damage from cirrhosis.

Interaction of oxidized low density lipoproteins with both apo B,E and scavenger receptors. A model for its production in vitro.

Oxidation of low density lipoprotein (LDL) has been demonstrated in vivo and directly implicated in the process of foam cell formation. Consequently, a considerable research effort has been devoted to the assessment of the metabolic behaviour of oxidized LDL. We have developed a simple and reproducible model to obtain oxidized LDL consisting of the dialysis of LDL (4 g/l) contained in a cellulose bag against 5 litres of 0.15 M NaCl, 5 microM CuSO4, 0.6 mM FeCl3, pH 7.4, 37 degrees C with constant oxygen bubbling. While the resulting particles have a number of physicochemical properties suggesting lipid oxidation, neither apo B fragmentation nor modification in the size and shape were observed. This oxidized LDL showed internalization into cells through both the apo B,E and the scavenger receptors and the rate of removal from the plasma in injected rats was faster than that observed for normal LDL. We suggest that these particles may represent an equivalent to the circulating oxidized LDL postulated in humans.

Toxicity of Lovastatin in Rats with Experimentally Induced Nephrotic Syndrome

The effect of lovastatin on the hyperlipidemia induced in rats with experimental nephrotic syndrome was investigated; toxicity and the effects on common blood chemistry parameters were also assessed. Hyperlipoproteinemia in this particular model is associated with an increase in hepatic synthesis of lipoproteins, and treatment with lovastatin could be the most suitable, since the drug inhibits cellular cholesterol synthesis. Lovastatin treatment resulted in a considerable reduction in plasma cholesterol and triglyceride levels. The decrease in cholesterol levels with treatment was mainly confined to the low-density lipoproteins (LDL) although there was a reduction in the nephrotic-syndrome-induced incremental level of high-density lipoprotein cholesterol. Other lipoprotein fractions were unaffected by lovastatin. LDL apoprotein B was increased in both groups of rats, but to a lesser degree in the lovastatin-treated group, suggesting a double effect, inhibition of both, cholesterol and apoprotein synthesis. Both groups of rats showed a certain degree of renal impairment as shown by significant elevations in plasma urea and creatinine levels. Hepatic damage was also observed, chemically and microscopically, in both groups of rats, being more pronounced in those rats treated with lovastatin in which a 50% mortality ensued after 2 weeks of treatment. At the dosage used this may have some implications in its therapeutic use in certain conditions.

Treatment of Diet‐Resistant Polygenic Hypercholesterolaemic Patients with a New Nicotinate Derivative; In Vivo and In Vitro Low Density Lipoprotein Metabolic Studies

Six patients (four women and two men) with mild to moderate hypercholesterolemia, but with no clinical evidence of the disease being monogenic familial hypercholesterolaemia and who, over the previous 3 months on a rigidly controlled hypolipidaemic diet therapy, showed no reduction in plasma cholesterol levels, were recruited into a study to assess the metabolic effects of Pirozadil, a new nicotinic acid derivative. After a 3 month treatment period, a significant reduction in plasma cholesterol from 299.8 ± 31.2 mg/dl (mean ± SD) to 256.8 ± 18.1 mg/dl (P < 0.02) and Low Density Lipoprotein (LDL) cholesterol from 211.7 ± 44.9 mg/dl to 168.8 ± 19.0 mg/dl (P < 0.05) was observed. Although there was a trend toward decreased plasma and Very Low Density Lipoprotein (VLDL) triglyceride, the differences did not reach statistical significance. High Density Lipoprotein (HDL) cholesterol was unchanged. The drug was well tolerated with no side effects noted. To assess the mode of action, autologous125I‐labelled LDL was injected and apoprotein B (apo B) kinetic parameters were measured; production rate (PR) and fractional catabolic rate (FCR). An in vitro measurement of the in vivo catabolism (LDL‐apo B receptor activity in freshly isolated lymphocytes) was also measured pre‐ and post‐treatment. The pharmacological intervention resulted in a significant decrease of 19.9% in PR from 10.5 ± 1.81 mg/kg/d to 8.41 ± 1.13 mg/kg/d (P < 0.05) while the FCR remained relatively unchanged (0.260 ± 0.042 vs 0.248 ± 0.040 pools/d) as did the LDL receptor activity (78.2 ± 20.9 vs 69.3 ± 21.4 ng LDL/mg cell protein/hr). Our data suggest that in polygenic hypercholesterolaemia, a condition in which the LDL receptor and hence catabolism is normal, the alternative therapy to facilitating enhanced catabolism is one that decreases the synthesis of the lipoprotein and, as such, nicotinic acid and its derivatives may be effective hypolipidaemic agents.