Simon J.T. Mao

Apolipoprotein A-I as a Marker of Angiographically Assessed Coronary-Artery Disease

This study was designed to determine whether the plasma level of apolipoprotein A-I is a better discriminator of angiographically documented coronary-artery disease than the level of high-density-lipoprotein (HDL) cholesterol in male subjects. The level of plasma apolipoprotein A-I in 83 patients with coronary-artery disease was 96.7 +/- 4.2 mg per deciliter (mean +/- S.E.M.), which was significantly lower (P less than 0.0001) than the level in 25 patients without coronary-artery disease (146.9 +/- 2.1 mg per deciliter). The levels of HDL cholesterol were also lower (P less than 0.0001) in patients with coronary-artery disease (31.9 +/- 1.5 mg per deciliter) than in those without it (45.9 +/- 2.3 mg per deciliter). A stepwise discriminant analysis, however, indicated the superiority of apolipoprotein A-I over HDL cholesterol in detecting coronary-artery disease. Furthermore, a linear discriminant analysis suggested that although HDL cholesterol by itself was a discriminator of coronary-artery disease, it did not provide a substantial increase in discriminatory value over that provided by apolipoprotein A-I; in contrast, apolipoprotein A-I levels added discriminatory value to the information obtained by measuring HDL cholesterol alone. We conclude that apolipoprotein A-I by itself is more useful than HDL cholesterol for identifying patients with coronary-artery disease.

Apolipoproteins and coronary artery disease

In this study, we compared the relative utility of plasma levels of cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and apolipoproteins in identifying men with angiographically significant coronary artery disease in a combined sample of consecutive male patients undergoing coronary angiography (N = 304) and healthy, normal male control subjects (N = 135). The plasma apolipoprotein levels were measured by using specific radioimmunoassays. We found that plasma levels of apolipoprotein A-I, followed by those of apolipoproteins A-II and B, were better discriminators than plasma cholesterol, triglycerides, or HDL cholesterol levels for identifying those with coronary artery disease. In confirmation of previous findings, the presence of coronary artery disease resulted in lower levels of apolipoproteins A-I and A-II and HDL cholesterol and higher levels of apolipoprotein B, cholesterol, and triglycerides. Linear and quadratic discriminant function analysis demonstrated that by using the age of the patients and apolipoprotein A-I, A-II, and B levels, one could correctly classify patients either as being normal or as having angiographically significant coronary artery disease in more than 75% of the cases. Thus, plasma apolipoprotein levels (especially A-I and A-II) may be considerably better markers for coronary artery disease than traditional lipid determinations.

Antithrombin properties of C-terminus of hirudin using synthetic unsulfated Nα-acetyl-hirudin45–65

Unsulfated N α‐acetyl‐hirudin45–65 (MDL 27 589), which corresponds to the C‐terminus of hirudin1–65, was synthesized by solid‐phase methods. The synthetic peptide was able to inhibit fibrin formation and the release of fibrinopeptide A from fibrinogen by thrombin. The catalytic site of thrombin was not perturbed by the synthetic peptide as H‐D‐Phe‐Pip‐Arg‐pNA hydrolysis (amidase activity) was not affected. The binding of synthetic peptide and thrombin was assessed by isolation of the complex on gel‐filtration chromatography. A single binding site with a binding affinity (K a) of approx. 1.0 × 105 M−1 was observed for thrombin‐hirudin45–65 interaction. The data suggest that the C‐terminal residues 45–65 of hirudin contain a binding domain which recognizes thrombin and yet does not bind to the catalytic site of the enzyme.

Analysis of plasma lipids and apolipoproteins in insulin-dependent and noninsulin-dependent diabetics

Plasma triglycerides, cholesterol, high-density lipoprotein (HDL) cholesterol, and apolipoproteins (apo) A-I, A-II, C-II, and C-III were determined and analyzed in 170 diabetic patients and 46 age-matched healthy normal subjects. The diabetics were separated into two groups: insulin-dependent diabetes mellitus (IDDM, n = 78) and noninsulin-dependent diabetes mellitus (NIDDM, n = 92). Significantly increased triglycerides, low HDL cholesterol, and normal cholesterol levels were found in the diabetics. The lipid profiles were similar in the IDDM and NIDDM groups. Plasma apo A-I, but not apo A-II, was low in both groups of diabetics. However, only in the IDDM subjects was there a statistically significant decrease in apo A-I when compared to normal subjects. The decreased apo A-I level negatively correlated with plasma triglycerides. Apo C-II and apo C-III were slightly increased in the diabetics compared to normal subjects. Apo C-II and apo C-III levels significantly correlated with plasma triglycerides (apo C-II, r = 0.70, P less than 0.0001; apo C-III, r = 0.71, P less than 0.0001). Only apo C-II correlated with total cholesterol. Thirty-eight to forty-two percent of the IDDM and NIDDM subjects had a clinical diagnosis of coronary artery disease (CAD) and/or peripheral arteriovascular disease (PAD). In the IDDM subjects, but not in the NIDDM subjects the incidence of CAD and/or PAD was associated with the decreased apo A-I levels as evaluated by a univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid purification and revised amino-terminal sequence of hirudin: a specific thrombin inhibitor of the bloodsucking leech.

Hirudin is a specific polypeptide thrombin inhibitor consisting of 65 amino acids that is produced by the leech, Hirudo medicinalis. We describe a rapid method for the purification of hirudin from a leech extract. Crude hirudin, purchased from a commercial source, was first fractionated on a DEAE-HPLC column using a salt gradient. Hirudin activity was monitored by inhibition of the thrombin-mediated hydrolysis of a synthetic substrate H-D-Phenylalanyl-Pipecolyl-Arginine-p-Nitroanilide. The fractions containing antithrombin activity were pooled and further purified by reverse-phase HPLC. The homogeneity of purified hirudin was confirmed by a single amino-terminal sequence for 43 residues with Val-Val as the first two amino acids. Residue 33 was Asn rather than Asp as reported previously.

Tween-20 increases the immunoreactivity of apolipoprotein A-I in plasma

Tween-20 (polyoxyethylene 20), a trademark for a sorbitan polyoxyalkalene derivative is used as an emulsifier and detergent. In present studies, we report that Tween-20 is able to reduce the nonspecific binding of radiolabeled apolipoprotein A-I to test tubes. It also enhances the specific binding of 125I-labeled apolipoprotein A-I to anti-apolipoprotein A-I antibodies. Maximal enhancement was achieved at a Tween-20 concentration greater than 0.08%. The results were confirmed by using two different antisera raised in rabbits and goats. Since the immunoreactivity of apolipoprotein A-I in plasma cannot be fully detected by a conventional radioimmunoassay procedure, we have, therefore, studied the effect of Tween-20 on the immunoreactivity of apolipoprotein A-I in plasma. As determined by inhibition radioimmunoassay, we found that Tween-20 drastically increased the immunoreactivity of apolipoprotein A-I using both rabbit and goat antisera. The maximal reactivity was achieved at a Tween-20 concentration of 0.32%. However, Tween-20 did not enhance the immunoreactivity of delipidated plasma. Thus, the results indicate that the plasma lipids may hamper apolipoprotein A-I immunoreactivity and suggest that the nonionic detergent, Tween-20, somehow interacted with HDL lipids or the apolipoproteins and then facilitated the reaction of antigenic reactive site(s) of apolipoprotein A-I with their antibodies.

Immunochemical properties of human low density lipoproteins as explored by monoclonal antibodies: Binding characteristics distinct from those of conventional serum antibodies

Spleen cells obtained from mice immunized with human plasma low-density lipoproteins (LDL) were fused with mouse myeloma cells. The resulting hybridoma cells secreting immunoglobulin specific for LDL were screened and scored by radioimmunoassay and cloned by multiple limiting dilutions. Immunochemical properties of the monoclonal antibodies were compared with convential mouse serum antibodies. It was found that conventional antibodies precipitated LDL and bound more than 95% of 125I-labeled LDL and the maximal binding was independent of temperature. The monoclonal antibodies were incapable of precipitating LDL and bound a maximum of only 20% of the total 125I-labeled LDL. The maximal binding between monoclonal antibodies and LDL was extremely temperature-dependent. An optimal degree of binding was observed at 4 degrees C, whereas binding at 37 degrees C was only 30% of that achieved at 4 degrees C. Although the binding at 37 degrees C was low, the maximal binding could be re-established following a subsequent incubation at 4 degrees C, suggesting that the antigenic structure of LDL is reversibly modulated at temperatures between 4 and 37 degrees C. Since the orientation of apolipoprotein B in LDL is known to be dynamic at different temperatures, this result suggests that monoclonal antibodies, but not conventional antibodies, are capable of detecting subtle conformational changes in LDL. In addition, we have determined the binding affinity of LDL to monoclonal antibodies and to conventional antibodies. Only monoclonal antibodies showed a linear Scatchard plot, suggesting that the binding was to a single site with a single affinity. The monoclonal antibodies also possessed high specificity and failed to react with porcine LDL, while serum antibodies could recognize both human and porcine LDL.

Evaluation of monoclonal antibodies to human plasma low density lipoproteins. A requirement for lipids to maintain antigenic structure.

Human plasma low density lipoproteins (LDL) are composed of approximately 25% apoproteins and 75% lipids (w/w). Immunochemical properties of LDL were studied using monoclonal antibodies. BALB/c mice were immunized with LDL and the spleen cells from these mice were then fused with a non-immunoglobulin secreting myeloma cell line (F0). The clones producing desirable antibodies were selected to study the antigenic properties of LDL by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay. First, it was found that the maximal binding of 125I-labeled LDL to polyvinyl chloride microtiter dishes was not temperature dependent. The binding affinity was high with a Ka value of approximately 1.9 X 10(10) M-1 while the monoclonal antibodies possessed an affinity to LDL of 5 X 10(8) M-1 which was 2 orders less than the affinity of LDL to the dishes. The former binding, once established, was irreversible as judged by a subsequent incubation with an excess of unlabeled LDL. The latter binding could be displaced by unlabeled LDL. Therefore, the ELISA technique offered a satisfactory approach to study the interaction between LDL and monoclonal antibodies. Removal of lipids from bound LDL by organic extraction resulted in a 50% loss of immunoreactivity, suggesting that the lipids of LDL are important in maintaining the antigenic structure of LDL. Since the apoprotein of LDL also constitutes approximately 40% of the mass (w/w) of very low density lipoproteins (VLDL), the immunoreactivity of VLDL assessed by LDL-monoclonal antibodies was also carried out. Removal of triglycerides from VLDL by lipoprotein lipase resulted in a substantial loss of immunoreactivity as determined by radioimmunoassay. These findings are consistent with the concept that lipids play a role in maintaining the integrity of the antigenic structure of LDL.

Postprandial distribution of apolipoproteins C-II and C-III in normal subjects and patients with mild hypertriglyceridemia: comparison of meals containing corn oil and medium-chain triglyceride oil

Five healthy male subjects and five patients with mild hypertriglyceridemia were studied following the administration of 800-kcal liquid meals containing 40% of energy from fat, 40% from carbohydrate, and 20% from protein. On the first day of the study, the fat source was corn oil (long-chain triglyceride), whereas medium-chain triglyceride (MCT) oil was used the second day. Meals were infused into the duodenum using a peristaltic pump. Plasma samples, obtained at hourly intervals for 8 hours, were analyzed for glucose, cholesterol, triglyceride, and apolipoproteins C-II and C-III. The distribution of apoC-II and apoC-III between ultracentrifugally-separated triglyceride-rich lipoproteins (TRL) and high-density lipoproteins (HDL) was also evaluated. The patient group had significantly elevated fasting levels of triglyceride, apoC-II and apoC-III, as well as much greater lipemic response to the meal containing corn oil. In both groups, TRL apoC-II and apoC-III levels were positively correlated with the triglyceride level as it increased following the corn oil meal. These correlations were also observed in the normal subjects when the MCT oil meal was administered, even though changes in plasma triglycerides were minimal. In normal subjects, whole plasma levels of apoC-II and apoC-III decreased significantly following the meal containing corn oil, whereas no net changes occurred following the MCT oil meal. In hypertriglyceridemic subjects, small decreases in plasma apoC-II and apoC-III levels occurred after both meals, although the changes in apoC-II were not statistically significant. The tendency for decreased plasma apoC levels following alimentary lipemia confirms previous reports, and provides further data to support the concept that some apoC is cleared from plasma in association with TRL remnants. The finding that mildly hypertriglyceridemic subjects responded similarly to both conventional fat and MCT may indicate that their rates of remnant clearance were similar following the two meals.

Immunochemistry of human plasma apolipoprotein C-II as studied by radioimmunoassay.

The immunoreactivity of human plasma apolipoprotein C-II was investigated using a specific radioimmunoassay. In whole plasma, the mean value quantitated was 2.21 +/- 0.415 mg/dl, while in delipidated plasma, a mean value of 3.84 +/- 1.186 mg/dl was obtained, suggesting that the antigenic sites of the apolipoprotein were not fully detected in unmodified plasma by our antibody preparation. Two detergents, Tween-20 and Triton X-100, were studied to determine if they could enhance the immunoreactivity of apolipoprotein C-II in whole plasma. At concentrations of 0.012-0.06%, Tween-20 markedly increased the immunoreactivity of whole plasma, but not of delipidated plasma, indicating that antigenic sites of plasma apolipoprotein C-II has been exposed by Tween-20. In contrast, Triton X-100 had no effect on the immunoreactivity of whole plasma apolipoprotein C-II. A radioimmunoassay conducted in the presence of 0.06% Tween-20, resulted in a mean value in whole plasma (3.39 +/- 1.11 mg/dl) that was not significantly different from that obtained when the assay was done on delipidated samples. The immunoreactivity of VLDL apolipoprotein C-II was also drastically enhanced following lipolysis by bovine milk lipoprotein lipase, supporting the hypothesis that antigenic sites are masked by the lipids. Finally, the mechanism responsible for the effect of Tween-20 on apolipoprotein C-II immunoreactivity was investigated. The results obtained from circular dichroism and ultracentrifugation suggest that the detergent may dissociate the apolipoprotein from lipoprotein particles, thus fully exposing the antigenic sites for reaction with antibodies.