Seiji Iwata

Coexisting type III hyperlipoproteinemia and familial hypercholesterolemia: A case report

A 39-year-old man presented with type III hyperlipoproteinemia in association with heterozygous familial hypercholesterolemia (FH). He had extensive tuberous xanthomas over the knees and elbows and xanthomas in the Achilles tendons. He also had palmar xanthomas. He exhibited severe hypercholesterolemia and hypertriglyceridemia. This patient was heterozygous for FH, as evidenced by low low-density lipoprotein (LDL) receptor function on lymphocytes, and had type III hyperlipoproteinemia, as determined by apolipoprotein (apo) E phenotype 2/2 in isoelectric focusing of the E isoproteins and the presence of a broad beta band on electrophoresis. Because therapy consisting of diet restrictions and lipid-lowering agents such as clinofibrate and niceritrol did not decrease serum total cholesterol ([TC] 15.26 mmol/L) and triglyceride ([TG] 10.79 mmol/L) levels effectively, the patient underwent plasmapheresis once every 2 weeks using a dextran sulfate-cellulose column. Repeated plasmapheresis markedly reduced serum TC and TG and induced complete regression of the palmar xanthoma after 6 months. The severity of tuberous xanthomas on the knees and elbows was reduced after 2.5 years. After plasmapheresis, TC decreased to 1.94 mmol/L from 10.40 mmol/L and TG decreased to 0.33 mmol/L from 7.90 mmol/L. Plasmapheresis performed with a dextran sulfate-cellulose column was highly effective in removing the lipoprotein-remnant particles in this patient, leading to generalized improvement in the lipoprotein profile.

Assessment of functional low-density-lipoprotein receptors on lymphocytes by a simplified method using culture medium with lipoprotein-free fetal calf serum and pravastatin

binding by macrophage scavenger receptor type II. Nature 1990; 343: 570-2. 4. Freeman M, Ashkenas J, Rees KJG, et al. An ancient, highly conserved family of cysteine-rich protein domains revealed by cloning type I and type II murine macrophage scavenger receptors. Proc Natl Acad Sci USA 1990; 87: 8810-4. 5. Matsumoto A, Naito M, Itakura H, et al. Human macrophage scavenger receptors: primary structure, expression, and localization in atherosclerotic lesions. Proc Natl Acad Sci USA 1990; 87: 9133-7. 6. Naito M, Kodama T, Matsumoto A, Doi T, Takahashi K. Tissue distribution, intracellular localization, and in vitro expression of bovine macrophage scavenger receptors. A m J Pathol 1991; 139: 1411-23. 7. Yl&-Hettuala S, Rosenfeld ME, Parthasarathy S, et al. Gene expression in macrophage-rich human atherosclerotic lesions. 15-1ipoxygenase and acetyl low density lipoprotein receptor messenger RNA colocalize oxidation specific lipid-protein adducts. J Clin Invest 1991; 87: 1146-52. 8. Naito M, Suzuki H, Mori T, Matsumoto A, Kodama T, Takahashi K. Coexpression of type I and type II human macrophage scavenger receptors in macrophages of various organs and foam cells in atherosclerotic lesions. A m J Pathol (in press).

Effects of vitamin C and vitamin E on plasma levels of lipid hydroperoxides and thiobarbituric acid reactive substance in humans

Abstract A study was conducted to investigate the effects of vitamin C and vitamin E on plasma levels of lipid hydroperoxides (LPO) and thio-barbituric acid reactive substance (TBARS) in human volunteers to identify the step in the lipid peroxidation cascade at which these vitamins act. Forty subjects (20 men and 20 women) were randomly assigned to receive either vitamin C or vitamin E. Twenty subjects received 500 mg of vitamin C daily for 4 weeks, and 20 subjects received 300 mg of vitamin E daily for 4 weeks. Blood samples were collected before and 4 weeks after vitamin treatment, in the morning, after the subjects had fasted for 12 hours. Plasma levels of LPO and TBARS were determined. Plasma levels of lipids, apolipoproteins, vitamin C, and vitamin E were also measured. Vitamin C significantly reduced plasma levels of LPO and TBARS. Vitamin E significantly increased plasma levels of LPO and significantly reduced plasma levels of TBARS. Plasma concentrations of vitamin C and vitamin E significantly increased after 4 weeks of vitamin treatment. There were no significant changes in the plasma levels of lipids except LPO, TBARS, and apolipoproteins. From these results, it was concluded that vitamin C reduced LPO and TBARS levels, and vitamin E increased LPO levels and reduced TBARS levels.

Improvement in hyperchylomicronemia, transient deficiency in lipoprotein lipase and hepatic triglyceride lipase activity, and diabetes mellitus produced by pravastatin and bezafibrate: a case report

Abstract A 50-year-old Japanese woman with type IV hyperlipidemia was placed on a low-fat diet. This regimen was minimally effective, so lipid-lowering drugs (clinofibrate [600 mg/d] and niceritrol [750 mg/d]) were added. However, hypertriglyceridemia worsened and diabetes mellitus appeared. She then developed xanthomatous eruptions, type V hyperlipidemia, reduced postherapin plasma lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) activity. She was admitted to the hospital, and previous drug therapy was stopped. Dietary control and administration of the antihyperlipidemic agents pravastatin (10 mg/d) and bazafibrate (400 mg/d) led to the gradual recovery of postheparin plasma LPL and HTGL activity, conversion of type V hyperlipidemia to type IV hyperlipidemia, the disappearance of xanthomatous eruptions, and concurrent improvement in diabetes mellitus.