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1.
Sci Rep ; 5: 15921, 2015 Nov 09.
Article in English | MEDLINE | ID: mdl-26549697

ABSTRACT

We recently reported that circulating apolipoprotein AII (apoAII) isoforms apoAII-ATQ/AT (C-terminal truncations of the apoAII homo-dimer) decline significantly in pancreatic cancer and thus might serve as plasma biomarkers for the early detection of this disease. We report here the development of novel enzyme-linked immunosorbent assays (ELISAs) for measurement of apoAII-ATQ/AT and their clinical applicability for early detection of pancreatic cancer. Plasma and serum concentrations of apoAII-ATQ/AT were measured in three independent cohorts, which comprised healthy control subjects and patients with pancreatic cancer and gastroenterologic diseases (n = 1156). These cohorts included 151 cases of stage I/II pancreatic cancer. ApoAII-ATQ/AT not only distinguished the early stages of pancreatic cancer from healthy controls but also identified patients at high risk for pancreatic malignancy. AUC values of apoAII-ATQ/AT to detect early stage pancreatic cancer were higher than those of CA19-9 in all independent cohorts. ApoAII-ATQ/AT is a potential biomarker for screening patients for the early stage of pancreatic cancer and identifying patients at risk for pancreatic malignancy (161 words).


Subject(s)
Apolipoprotein A-II/blood , Biomarkers, Tumor/blood , Early Detection of Cancer , Pancreatic Neoplasms/blood , Adult , Aged , Antibodies/immunology , Apolipoprotein A-II/immunology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/pathology , Risk Factors
2.
Clin Chem Lab Med ; 47(11): 1389-94, 2009.
Article in English | MEDLINE | ID: mdl-19817643

ABSTRACT

BACKGROUND: We evaluated prospectively the predictive value of serum apolipoprotein (apo) A-II, the second major apolipoprotein of high-density lipoprotein (HDL), for cardiometabolic risk in Turkish adults showing abnormalities in other proteins that normally confer protection. METHODS: Determinants of apoA-II and its associations with coronary heart disease (CHD), metabolic syndrome (MetS) and diabetes were investigated at 4 years follow-up in 193 elderly men and women. RESULTS: ApoA-II concentrations at baseline, in addition to being significantly related to HDL-cholesterol, were directly associated with complement C3 in multivariate linear regression analyses comprising nine variables. Following adjustment for gender, age and HDL-cholesterol (>30/>33 g/L, in men and women, respectively), low serum apoA-II concentrations predicted incident MetS [relative risk (RR) 3.5 (95% CI 1.4; 8.6)] and type 2 diabetes [RR 4.5 (95% CI 1.3; 15.6)] in both genders at an increment of 1 SD. Increased apoA-II values were not associated with prevalent or incident CHD, and tended to be marginally atheroprotective only in males. CONCLUSIONS: Serum apoA-II concentrations confer risk for MetS and diabetes and exhibit evidence of anti-inflammatory properties among Turks. These findings support the effects seen for several other HDL protein constituents. This finding may explain the increased cardiometabolic risk among Turks.


Subject(s)
Apolipoprotein A-II/blood , Coronary Disease/blood , Diabetes Mellitus, Type 2/blood , Metabolic Syndrome/blood , Adult , Aged , Aged, 80 and over , Apolipoprotein A-II/immunology , Biomarkers/blood , Coronary Disease/epidemiology , Coronary Disease/pathology , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/pathology , Female , Follow-Up Studies , Humans , Male , Metabolic Syndrome/epidemiology , Metabolic Syndrome/pathology , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk Factors , Turkey/epidemiology
3.
Innate Immun ; 14(6): 365-74, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19039060

ABSTRACT

Lipopolysaccharide (LPS) binding protein (LBP) plays an important role in regulating leukocyte responses to LPS. Remarkably, it may either augment these responses at low LBP concentrations or inhibit them at high concentrations. We previously reported that native high-density lipoprotein (HDL) augments human monocyte responses to LPS by suppressing the inhibitory activity of high concentrations of LBP, a process that occurs before HDL can inhibit the response by subsequently binding and neutralizing LPS. We now show that this novel activity is conferred largely by an HDL component protein, apolipoprotein (apo)A-II. Purified apoA-II was highly active in our assays. We also found that HDL from apoA-II-deficient mice was almost completely inactive, whereas the activities of HDLs that lacked apoA-I, apoC-I, apoE, or apoC-III were similar to that of wild-type HDL. Decreased activity was also observed in rabbit HDL, which is naturally deficient in apoA-II. Incorporating human apoA-II into rabbit HDL increased its activity to levels found in human HDL. Our investigation of the mechanism of apoA-II activity revealed that LBP promoted the formation of large LPS aggregates with low bioactivity and that apoA-II inhibited the formation of these aggregates without binding and directly inhibiting LPS bioactivity. Our results suggest a novel pro-inflammatory activity of apoA-II that may help maintain sensitive host responses to LPS by suppressing LBP-mediated inhibition. Our findings also raise the possibility that the decline of plasma apoA-II during sepsis may help control the response to LPS.


Subject(s)
Acute-Phase Proteins/immunology , Acute-Phase Proteins/metabolism , Apolipoprotein A-II/immunology , Apolipoprotein A-II/metabolism , Carrier Proteins/immunology , Carrier Proteins/metabolism , Lipopolysaccharides/immunology , Lipopolysaccharides/metabolism , Membrane Glycoproteins/immunology , Membrane Glycoproteins/metabolism , Monocytes/immunology , Acute-Phase Proteins/antagonists & inhibitors , Animals , Apolipoprotein A-II/chemistry , Apolipoprotein A-II/pharmacology , CHO Cells , Carrier Proteins/antagonists & inhibitors , Cell Line , Cholesterol, HDL/chemistry , Cricetinae , Cricetulus , Endotoxins/immunology , Endotoxins/metabolism , Humans , Immunity, Innate , Inflammation/immunology , Inflammation/metabolism , Lipopolysaccharides/pharmacology , Membrane Glycoproteins/antagonists & inhibitors , Mice , Mice, Inbred C57BL , Monocytes/metabolism , Protein Binding , Rabbits
4.
Comp Biochem Physiol B Biochem Mol Biol ; 147(4): 635-44, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17499534

ABSTRACT

First, we attempted to isolate glycosphingolipids from eel serum HDL. A single ganglioside containing N-acetylneuraminic acid (NeuAc), which is positive with resorcinol and orcinol reactions, was purified. The mobilities of the purified ganglioside and its lyso-form on high performance TLC were similar as those of authentic GM4 and its lyso-form, respectively. The mass of the purified ganglioside was determined by TOF mass spectrometer, and the mass of its oligosaccharide was the same as that of authentic GM4 from human brain consisting of disaccharide of NeuAc and galactose. The ganglioside from eel HDL was not hydrolyzed by recombinant endoglycoceramidase II, which cannot hydrolyze between galactose and ceramide of gangliosides, but hydrolyzes between glucose and ceramide. We concluded from these results that the ganglioside purified from eel serum HDL is GM4. Second, we investigated the effects of the ganglioside on binding of HDL labeled with fluorescein isothiocyanate (FITC-HDL) to cultured eel hepatocytes and on FITC-HDL ligand blotting by using plasma membrane proteins of the hepatocytes. Stimulatory effect of GM4 on FITC-HDL binding to the hepatocytes and FITC-HDL ligand blotting suggests strongly that GM4 is a ligand for HDL binding protein of eel hepatocytes.


Subject(s)
Carrier Proteins/metabolism , Eels/blood , Gangliosides/blood , Gangliosides/physiology , Lipoproteins, HDL/chemistry , RNA-Binding Proteins/metabolism , Animals , Antibodies/pharmacology , Apolipoprotein A-I/immunology , Apolipoprotein A-II/immunology , Cattle , Cells, Cultured , Eels/metabolism , Female , G(M1) Ganglioside/pharmacology , Gangliosides/metabolism , Gangliosides/pharmacology , Hepatocytes/metabolism , Humans , Ligands , Lipoproteins, HDL/blood , Lipoproteins, HDL/metabolism , Models, Biological , Protein Binding , Rabbits
5.
Exp Parasitol ; 114(3): 240-5, 2006 Nov.
Article in English | MEDLINE | ID: mdl-16682028

ABSTRACT

In vitro studies have suggested that a fraction of human high density lipoprotein (HDL), termed trypanosome lysis factor (TLF), can protect against trypanosome infection. We examined the involvement of two proteins located in the TLF fraction, apolipoprotein A-II (apoA-II) and paraoxonase 1 (PON1), against trypanosome infection. To test whether PON1 is involved in trypanosome resistance, we infected human PON1 transgenic mice, PON1 knockout mice, and wild-type mice with Trypanosoma congolense. When challenged with the same dosage of trypanosomes, mice overexpressing PON1 lived significantly longer than wild-type mice, and mice deficient in PON1 lived significantly shorter. In contrast, mice overexpressing another HDL associated protein, apoA-II, had the same survival as wild-type mice. Together, these data suggest that PON1 provides protection against trypanosome infection. In vitro studies using T. brucei brucei indicated that HDL particles containing PON1 and those depleted of PON1 did not differ in their lysis ability, suggesting that protection by PON1 is indirect. Our data are consistent with an in vivo role of HDL protection against trypanosome infection.


Subject(s)
Aryldialkylphosphatase/immunology , Trypanosoma congolense/immunology , Trypanosomiasis, African/immunology , Animals , Apolipoprotein A-II/immunology , Aryldialkylphosphatase/genetics , Female , Humans , Lipoproteins, HDL/chemistry , Lipoproteins, HDL/immunology , Male , Mice , Mice, Inbred BALB C , Mice, Inbred C57BL , Mice, Knockout , Mice, Transgenic , Trypanosoma brucei brucei/immunology
6.
Eur J Biochem ; 271(14): 2984-90, 2004 Jul.
Article in English | MEDLINE | ID: mdl-15233794

ABSTRACT

We have previously shown that high density lipoprotein is the most abundant protein in the carp plasma and displays bactericidal activity in vitro. Therefore the aim of this study was to analyze the contribution of its principal apolipoproteins, apoA-I and apoA-II, in defense. Both apolipoproteins were isolated by a two step procedure involving affinity and gel filtration chromatography and were shown to display bactericidal and/or bacteriostatic activity in the micromolar range against Gram-positive and Gram-negative bacteria, including some fish pathogens. In addition, a cationic peptide derived from the C-terminal region of carp apoA-I was synthesized and shown to possess antimicrobial activity (EC(50) = 3-6 micro m) against Planococcus citreus. This peptide was also able to potentiate the inhibitory effect of lysozyme in a radial diffusion assay at subinhibitory concentrations of both effectors. Finally, limited proteolysis of HDL-associated apoA-I with chymotrypsin in vitro was shown to generate a major truncated fragment, which indicates that apoA-I peptides liberated in vivo through a regulated proteolysis could also be involved in innate immunity.


Subject(s)
Apolipoprotein A-II/immunology , Apolipoprotein A-I/immunology , Carps/physiology , Immunity, Innate/physiology , Amino Acid Sequence , Animals , Apolipoprotein A-I/genetics , Apolipoprotein A-II/genetics , Carps/immunology , Lipoproteins, HDL/metabolism , Microbial Sensitivity Tests , Molecular Sequence Data , Peptides/genetics , Peptides/immunology , Peptides/metabolism
7.
Comp Biochem Physiol B Biochem Mol Biol ; 125(4): 473-82, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10904860

ABSTRACT

Six week-old female mice (Balb/c) injected intraperitonealy with 50 micrograms of eel high density lipoprotein (HDL) emulsified with equal volume of adjuvant three times every two weeks. Three weeks after the third injection, hyperimmunized mice were boosted by injection of 100 micrograms of HDL. After 5 days, the best responding mouse to injected HDL was sacrificed, and spleen cells were fused with mouse myeloma cells (Sp2/O-Ag14), and hybridomas were cultured in a selection medium. Monoclonal antibodies specific to apolipoprotein A-I or A-II (apoA-I or apoA-II) of HDL were obtained by cloning and recloning the hybridomas. Eighteen monoclonal antibodies specific to apoA-I and/or apoApII were isolated. Antibodies in the culture medium were purified by a HiTrap Protein G or an eel-HDL column. These purified antibodies belong to the subclass IgG1. The monoclonal antibodies specific to eel apoA-I and apoA-II secreted by clone 10D12 and 2G3, respectively, interact with serum proteins of some fish species such as red-sea bream and carp. The anti-eel apoA-I antibody of 10D12 did not bind to serum proteins of rat, rabbit, and chicken, while the anti-eel apoA-II of 2G3 antibody did.


Subject(s)
Anguilla/immunology , Antibodies, Monoclonal/immunology , Lipoproteins, HDL/immunology , Amino Acid Sequence , Anguilla/blood , Animals , Antibodies, Monoclonal/isolation & purification , Antibodies, Monoclonal/metabolism , Antibody Formation , Antibody Specificity , Apolipoprotein A-I/immunology , Apolipoprotein A-II/immunology , Chickens , Chromatography, Affinity , Female , Fishes/immunology , Hybridomas/immunology , Immune Sera , Immunoglobulin G , Mice , Mice, Inbred BALB C , Molecular Sequence Data , Rabbits , Rats , Sequence Analysis, Protein , Species Specificity
8.
Hybridoma ; 18(6): 513-20, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10626680

ABSTRACT

Two monoclonal antibodies (MAbs) against apolipoprotein A-I (apo A-I), 6B9 and FF9B10, and one MAb against apolipoprotein A-II (apo A-II), 3F5, were characterized. To establish the epitope of apo A-I recognized by these antibodies, different experimental approaches were performed. First, competition between MAbs and the related epitopes on the same antigen was performed using double-determinant tests with previously characterized MAbs. Second, competition of different synthetic peptides of apo A-I in solution with apo A-I immobilized to solid phase was carried out. The MAbs against apo A-I (6B9 and FF9B10) appear to recognize discontinuous epitopes located in the amino-terminal region of the apo A-I. In competition experiments MAb 3F5 did not recognize central- or carboxy-terminal peptides of apo A-II. Furthermore, apo A-II was stronger recognized when it was included in HDL or LpA-I:A-II than in its purified form. So the epitope for 3F5 is better expressed in the lipoprotein structure. Finally, to establish the epitopes expression in different antigens in solution, competition of purified apo A-I, apo A-II, LpA-I, and LpA-I:A-II particles or HDL3, with apo A-I or HDL immobilized to solid phase, was carried out. The results showed that both MAbs against apo A-I reacted with poor affinity against free apo A-I, with high and similar affinities against Lp A-I and Lp A-I:A-II lipoparticles and with the highest affinity against HDL3. The MAb 3F5 against apo A-II recognized only LpA-I:A-II and not LpA-I lipoparticles.


Subject(s)
Antibodies, Monoclonal/immunology , Apolipoprotein A-II/immunology , Apolipoprotein A-I/immunology , Epitopes/immunology , Lipoproteins, HDL/immunology , Animals , Antibodies, Monoclonal/chemistry , Antibodies, Monoclonal/metabolism , Antibody Affinity , Apolipoprotein A-I/chemistry , Apolipoprotein A-I/metabolism , Apolipoprotein A-II/chemistry , Apolipoprotein A-II/metabolism , Binding, Competitive , Enzyme-Linked Immunosorbent Assay , Humans , Lipoproteins, HDL/chemistry , Mice , Mice, Inbred BALB C , Peptides/chemical synthesis , Peptides/chemistry
9.
Biochem J ; 331 ( Pt 1): 185-91, 1998 Apr 01.
Article in English | MEDLINE | ID: mdl-9512478

ABSTRACT

The changes in the immunological properties of apolipoprotein AI (apo-AI) and AII (apo-AII) during the oxidation of the high-density lipoprotein HDL3 and its influence on the binding of heavily oxidized low-density lipoprotein (LDL) to type I and III collagen were investigated. Oxidation of HDL3 or Eu3+-labelled HDL3 was performed with CuSO4, varying the time of oxidation. Oxidation of HDL3 resulted in an increase in lipid hydroperoxides and enhanced the negative charge of this lipoprotein. Immunological studies with a solid-phase sandwich immunoassay revealed a strong increase in binding of Eu3+-labelled HDL3 to polyclonal antibodies against apo-AI and apo-AII within the first 4 h of oxidation. Neo-epitopes were also formed by interaction of the apolipoproteins with degradation products from the lipid peroxidation of polyunsaturated fatty acids, as evidenced by an immunoreaction of oxidized Eu3+-labelled HDL3 with antibodies to 4-hydroxynonenal (4-HNE)- and malondialdehyde (MDA)-protein adducts. Western blot analysis of oxidized HDL3 samples showed, as well as apo-AI and apo-AII bands, larger aggregated apolipoproteins, occurring after 0.5-2.5 h of oxidation. These aggregates were recognized by antibodies to apo-AI and apo-AII as well as by antibodies to 4-HNE- and MDA-protein adducts. Furthermore the original apo-AI monomers and apo-AII dimers decreased during the oxidation. The ability of native and oxidized HDL3 to prevent the binding of Eu3+-labelled 24 h-oxidized LDL to collagen on microtitration plates was estimated. Interestingly, 2 h-oxidized HDL3 competed most with the binding of 24 h-oxidized LDL on collagen type I and type III, followed by native HDL3. However, 24 h-oxidized HDL3 was a weaker competitor. Thus oxidative modification of HDL3 strongly alters the immunological properties of this lipoprotein and its binding affinity for collagen.


Subject(s)
Apolipoprotein A-II/immunology , Apolipoprotein A-I/immunology , Collagen/metabolism , Lipoproteins, HDL/metabolism , Lipoproteins, LDL/metabolism , Aldehydes , Antibodies , Binding, Competitive , Epitopes/immunology , Humans , Lipid Peroxidation , Lipoproteins, HDL/immunology , Lipoproteins, HDL3 , Male
10.
Hybridoma ; 14(6): 603-8, 1995 Dec.
Article in English | MEDLINE | ID: mdl-8770650

ABSTRACT

Monoclonal antibodies (MAbs) to human plasma apolipoprotein A-I (apo A-I), denoted FF9 and 6B9, and apolipoprotein A-II (apo A-II), 3F5, were developed to be used in an immunoaffinity chromatography procedure to isolate lipoprotein particles Lp A-I and Lp A-I:A-II. MAb FF9 and MAb 6B9 reacted with apo A-I and high-density lipoprotein (HDL) while MAb 3F5 was directed to apo A-II and HDL. The apparent affinity constant (Kapp) for apo A-I of the MAb FF9 was higher (2 x 10(7) M-1) than that of 6B9 (5 x 10(6) M-1). MAb 3F5 recognized the apo A-II with a Kapp value of 1 x 10(9) M-1. The isolated lipoparticles Lp A-I and Lp A-I:A-II will be used to standardize an immunoassay for the measurement of these apo A-I-containing lipoprotein particles in human plasma.


Subject(s)
Antibodies, Monoclonal/biosynthesis , Apolipoprotein A-II/blood , Apolipoprotein A-II/immunology , Apolipoprotein A-I/blood , Apolipoprotein A-I/immunology , Animals , Antibodies, Monoclonal/chemistry , Antibody Affinity , Antibody Specificity , Apolipoprotein A-I/isolation & purification , Apolipoprotein A-II/isolation & purification , Female , Humans , Mice , Mice, Inbred BALB C
11.
Yeast ; 10(11): 1421-8, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7871881

ABSTRACT

Lipid particles of the yeast, Saccharomyces cerevisiae, were isolated to high purity and their components were analysed. The hydrophobic core of this organelle consists of triacylglycerols and steryl esters, which are almost exclusively located to that compartment. Lipid particles are stabilized by a surface membrane consisting of phospholipids and proteins. Electron microscopy confirmed the purity of the preparations and the proposed structure deduced from biochemical experiments. Major proteins of lipid particles have molecular weights of 72, 52, 43 and 34 kDa, respectively. The 43 kDa protein reacts with an antiserum against human apolipoprotein AII. In lipid particles of the yeast mutant strain S. cerevisiae erg6, which is deficient in sterol delta 24-methyltransferase, this protein is missing thereby identifying the protein and confirming our previous finding (Zinser et al., 1993) that sterol delta 24-methylation is associated with lipid particles. A possible involvement of surface proteins of lipid particles in the interaction with other organelles is discussed with respect to sterol translocation in yeast.


Subject(s)
Lipids/analysis , Lipoproteins/analysis , Organelles/chemistry , Saccharomyces cerevisiae/chemistry , Apolipoprotein A-II/analysis , Apolipoprotein A-II/immunology , Apolipoproteins/blood , Apolipoproteins/immunology , Cell Fractionation , Lipoproteins/immunology , Lipoproteins/isolation & purification , Methyltransferases/analysis , Methyltransferases/chemistry , Microscopy, Electron , Mutation , Organelles/ultrastructure , Phospholipids/analysis , Saccharomyces cerevisiae/enzymology , Saccharomyces cerevisiae/ultrastructure , Subcellular Fractions/chemistry , Subcellular Fractions/enzymology , Subcellular Fractions/immunology
12.
FEBS Lett ; 303(2-3): 202-4, 1992 Jun 01.
Article in English | MEDLINE | ID: mdl-1607020

ABSTRACT

Treatment of 125I-labelled high-density lipoprotein ([125I]HDL3) with monospecific polyclonal antibodies against apolipoproteins A-I and A-II resulted in a dose-dependent inhibition of the [125I]HDL3 binding to isolated human small intestine epithelial cells by 25% and 50%, respectively. Both antibodies also inhibited intracellular degradation of [125I]HDL3 by 80%. Treatment of enterocytes with polyclonal antibody against apolipoprotein A-I binding protein, a putative HDL receptor, inhibited both binding and degradation of [125I]HDL3 by these cells by 50%. Antibodies to apolipoprotein A-I, A-II and apo A-I-binding protein also inhibited [125I]HDL3 binding to cholesterol-loaded cells.


Subject(s)
Apolipoprotein A-II/metabolism , Apolipoprotein A-I/metabolism , Carrier Proteins/metabolism , Intestine, Small/metabolism , Lipoproteins, HDL/metabolism , Pregnancy Proteins , Antibodies/immunology , Apolipoprotein A-I/immunology , Apolipoprotein A-II/immunology , Carrier Proteins/immunology , Cells, Cultured , Cholesterol/metabolism , Epithelial Cells , Epithelium/metabolism , Humans , Intestine, Small/cytology , Racemases and Epimerases
13.
Nihon Ronen Igakkai Zasshi ; 28(6): 748-54, 1991 Nov.
Article in Japanese | MEDLINE | ID: mdl-1795436

ABSTRACT

An assessment has been made regarding the changes of the particles of lipoprotein A-I without A-II (Lp A-I) and lipoprotein A-I with A-II (LpA-I/A-II) which correspond to HDL subfraction isolated by the use of anti-apo A-I and A-II antibody affinity columns in order to quantitatively and qualitatively investigate the change of HDL caused by administration of probucol and pravastatin which are therapeutic drugs for hypercholesterolemia. Probucol caused significant decreases of HDL-cholesterol, plasma apo A-I/apo A-II ratio and particles larger in diameter than 10.4 nm. Comparing Lp A-I and A-I/A-II ratios with those in normolipidemic controls and the ratios before and after administration of probucol, the decrease of LpA-I ratio was found to be remarkable after prolonged administration of probucol, and it was presumed that the decrease of HDL cholesterol by prolonged administration reflects the decrease of LpA-I particles more than the decrease of LpA-I/A-II. On the other hand, no significant change was seen in HDL cholesterol, plasma apo A-I/apo A-II ratio or HDL particle size in the pravastatin group. It is considered essential to observe HDL from the aspect of apoprotein, which plays an important role in the metabolism of lipoprotein, in the assessment of the anti-atherogenic activity of HDL cholesterol in future. In other words, it is necessary to analyze the change of HDL from the aspect of Lp A-I and Lp A-I/AII and investigate their respective metabolisms and roles.


Subject(s)
Apolipoprotein A-II/immunology , Apolipoprotein A-I/immunology , Lipoproteins, HDL/blood , Probucol/therapeutic use , Adult , Aged , Apolipoprotein A-I/metabolism , Apolipoprotein A-II/metabolism , Chromatography, Affinity , Drug Evaluation , Female , Humans , Hypercholesterolemia/blood , Hypercholesterolemia/drug therapy , Male , Middle Aged
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