C-reactive Protein Level, Apolipoprotein B-to-apolipoprotein A-1 Ratio, and Risks of Ischemic Stroke and Coronary Heart Disease among Inner Mongolians in China.

OBJECTIVE: We aimed to investigate the cumulative effect of high CRP level and apolipoprotein B-to-apolipoprotein A-1 (ApoB/ApoA-1) ratio on the incidence of ischemic stroke (IS) or coronary heart disease (CHD) in a Mongolian population in China. METHODS: From June 2003 to July 2012, 2589 Mongolian participants were followed up for IS and CHD events based on baseline investigation. All the participants were divided into four subgroups according to C-reactive protein (CRP) level and ApoB/ApoA-1 ratio. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the IS and CHD events in all the subgroups. RESULTS: The HRs (95% CI) for IS and CHD were 1.33 (0.84-2.12), 1.14 (0.69-1.88), and 1.91 (1.17-3.11) in the 'low CRP level with high ApoB/ApoA-1', 'high CRP level with low ApoB/ApoA-1', and 'high CRP level with high ApoB/ApoA-1' subgroups, respectively, in comparison with the 'low CRP level with low ApoB/ApoA-1' subgroup. The risks of IS and CHD events was highest in the 'high CRP level with high ApoB/ApoA-1' subgroup, with statistical significance. CONCLUSION: High CRP level with high ApoB/ApoA-1 ratio was associated with the highest risks of IS and CHD in the Mongolian population. This study suggests that the combination of high CRP and ApoB/ApoA-1 ratio may improve the assessment of future risk of developing IS and CHD in the general population.

Local effect of lung contusion on lung surfactant composition in multiple trauma patients.

OBJECTIVE: The aim of this study was to investigate the direct influence of lung contusion on pulmonary surfactant in multiple trauma patients. DESIGN: Prospective, nonrandomized study. SETTING: University hospital, trauma intensive care unit. PATIENTS: Eighteen multiple trauma patients with unilateral lung contusions and Injury Severity Scores >19 were studied prospectively. INTERVENTIONS: Bronchoalveolar lavage was performed daily until either day 7 or extubation. Samples from the side of lung contusion (n = 62) and the contralateral, uninjured side (n = 62) were obtained at the same time in 14 patients. Total phospholipids, total phospholipid classes, and surfactant apoprotein A were quantified. Additionally, surfactant function was measured with a pulsating bubble surfactometer in four patients. All data are presented as mean +/- SEM. Statistical analyses were performed using programs of SPSS for Windows 6.1.3 (SPSS Inc., Chicago, IL) (Student's t-test; p < .05). MEASUREMENTS AND MAIN RESULTS: Total phospholipids were significantly increased on the side of lung contusion (contusion side, 40+/-7 microg/mL; contralateral side, 21+/-3 microg/mL; p = .004). The percentage contents of phosphatidylcholine (contusion side, 87.1%+/-1.0%; contralateral side, 84.3%+/-1.0%; p = .04) and sphingomyelin (contusion side, 2.9%+/-0.3%; contralateral side, 1.9%+/-0.2%; p = .004) were significantly higher. In contrast, the percentage content of phosphatidylglycerol was significantly decreased (contusion side, 4.1%+/-0.1%; contralateral side, 6.9%+/-0.6%; p = .001). No alterations were found for the relative contents of phosphatidylethanolamine (contusion side, 2.4%+/-0.2%; contralateral side, 2.2%+/-0.2%; p = .47), phosphatidylinositol (contusion side, 3.5%+/-0.4%; contralateral side, 4.6%+/-0.5%; p = .06), and surfactant apoprotein A (contusion side, 7177+/-1404 ng/mL; contralateral side, 4513+/-787 ng/mL, p = .10). There was no statistical difference for minimal surface tension measured with the pulsating bubble surfactometer after 5 mins of oscillation (contusion side, 29.5+/-2.3 mN/m; contralateral side, 23.7+/-2.1 mN/m; p = .08). CONCLUSIONS: Direct damage of lung parenchyma by lung contusion alters the composition of surfactant. No additional changes in surfactant function were observed that would argue in favor of functional compensation.

Serum apolipoprotein(a) concentrations and Apo(a) phenotypes in patients with liver cirrhosis.

OBJECTIVE: The liver is the major site of apolipoprotein(a) synthesis, and an inverse correlation between the size of apolipoprotein(a) isoforms and its serum levels have been described. We evaluated the Apo(a) serum levels and its isoforms in patients with liver cirrhosis at different stages of the disease (Childe Turcotte classification), and during the characteristic phase of liver synthesis decline. METHODS: We studied 84 patients with liver cirrhosis and 185 control subjects with normal liver function. RESULTS: Apo(a) serum levels were significantly lower (p < 0.01) in cirrhotic patients and, after 24 months, six patients showing a change from class A to class B had a statistically significant decrease in Apo(a) concentrations (p = 0.0313). Moreover, our data showed an inversion of the small/large isoforms ratio in patient with cirrhosis in spite of the reduction in plasma concentration. CONCLUSION: We showed a reduction of Apo(a) serum concentrations in a large number of patients with cirrhosis and, for the first time, during the characteristic phase of liver synthesis decline, confirming the liver as the major site of Apolipoprotein(a) synthesis. Moreover we showed in the cirrhotic patients that the normal correlation between Apo(a) isoforms and Apo(a) concentrations is not conserved and the low levels are not dependent upon a high prevalence of large isoforms.

Identification of apo(a) phenotypes in a Korean population using a standardized nomenclature system based on the number of kringle IV repeats.

We determined serum lipoprotein(a) [Lp(a)] concentrations and apolipoprotein(a) [apo(a)] phenotypes in 193 healthy Koreans. We analysed the apo(a) phenotypes by a simplified sodium dodecyl sulphate-polyacrylamide gel electrophoresis method and classified apo(a) isoforms objectively using an apo(a) phenotype standard with a known number of kringle IV repeats. The frequency distribution of Lp(a) levels showed marked positive skew with a mean of 0.143 g/L and a median of 0.052 g/L. Of the 193 subjects tested, no bands were detected in three, and single- and double-band phenotypes were observed in 103 and 87, respectively. Among the Koreans, the most frequent phenotype was S5(39.4%), followed by S4S5(17.1%), S5S5(14.0%), S4(11.4%), S3S5(5.2%), and the remaining phenotypes (13.0%). The calculated apo(a) allele frequencies were LpF, 0.003; LpS1, 0.013; LpS2, 0.010; LpS3, 0.048; LpS4, 0.198; LpS5, 0.563 and Lp0, 0.165. We found that the serum Lp(a) concentration in Koreans was similar to that of Caucasians, but the apo(a) allele size distribution was shifted toward higher molecular weights.

The relative electrophoretic mobility of apo(a) isoforms depends on the gel system: proposal of a nomenclature for apo(a) phenotypes.

Genetic apo(a) isoforms were originally defined according to their relative mobility in SDS-PAGE compared to apoB-100 and were designated as F, B or S1-S4 isotypes. This widely accepted nomenclature does not accommodate the broad spectrum of apo(a) isoforms (> 30) detected by high resolution SDS-agarose gel electrophoresis. Moreover we here show that the relative mobilities of apo(a) isoforms depend on the SDS-gel system used. Comparison of the SDS-PAGE system originally used for phenotyping with SDS-agarose gel electrophoresis and two commercial SDS-PAGE systems (PhastGel, Pharmacia, Sweden and NOVEX, USA) demonstrated marked differences in resolving power and resulted in very different Rf values for identical isoforms. Hence phenotyping results from laboratories using different systems are not comparable. We therefore propose a nomenclature of apo(a) isoforms which reports the number of kringle IV repeats in the apo(a) allele (e.g. apo(a) K-IV20 would designate an isoform with 20 K-IV repeats). This is achieved by using standards in which the number of kringle IV repeats has been determined by pulsed field gel electrophoresis of genomic DNA. The proposed nomenclature (i) accounts for the increased resolution of apo(a) phenotyping methods: (ii) is flexible to the introduction of smaller or larger isoforms; (iii) allows to report data from systems with lower resolution as 'binned' isoform categories; (iv) allows the comparison of phenotyping results between different investigators; and (v) can be applied on DNA as well as on protein based apo(a) phenotyping.

Decreased plasma levels of lipoprotein(a) in patients with hypertriglyceridemia.

Lipoprotein(a) (Lp(a)) is an atherogenic lipoprotein which is similar in structure to, but metabolically distinct from, LDL. Factors modulating plasma Lp(a) concentrations are poorly understood. To investigate the possible interaction of Lp(a) with triglycerides, we determined the apo(a) phenotype, Lp(a) concentration, and distribution of Lp(a) in a group of patients with triglycerides > 400 mg/dl (n = 60) compared with a control group (n = 128). Lp(a) concentrations were significantly lower in hypertriglyceridemic patients (mean +/- S.E., 13 +/- 4 mg/dl; median, 6 mg/dl; 25/75 percentile, 2-13 mg/dl) as compared with the controls (mean, 22 +/- 2 mg/dl; median, 10 mg/dl; 25/75 percentile, 7-30 mg/dl). Plasma Lp(a) concentrations in the hypertriglyceridemic patients correlated negatively with triglyceride levels (r = -0.69, P = 0.03). The difference in Lp(a) levels between patients and controls was maintained when subjects were stratified by apo(a) phenotype and type of hyperlipidemia. After subdividing the hypertriglyceridemic patients into one group with apo(a) isoforms < or = S2 and one group with apo(a) isoforms > or = S3, we found that the differences in plasma Lp(a) concentrations between patients and controls were more pronounced in the group with the lower molecular weight apo(a) isoforms. These data indicate that hypertriglyceridemia is associated with lower plasma Lp(a) concentrations and suggest that increased levels of triglyceride-rich lipoproteins may influence the metabolism of Lp(a).

Association of elevated lipoprotein(a) levels and coronary heart disease in NIDDM patients. Relationship with apolipoprotein(a) phenotypes.

Non-insulin-dependent diabetes mellitus (NIDDM) is a strong and independent risk factor for coronary heart disease. We assessed the potential relationship between plasma Lp(a) levels, apo(a) phenotypes and coronary heart disease in a population of NIDDM patients. Seventy-one patients with coronary heart disease, who previously have had transmural myocardial infarction, or significant stenosis on coronary angiography, or positive myocardial thallium scintigraphy, or in combination, were compared with 67 patients without coronary heart disease, who tested negatively upon either coronary angiography, myocardial thallium scintigraphy or a maximal exercise test. The prevalence of plasma Lp(a) levels elevated above the threshold for increased cardiovascular risk (> 0.30 g/l) was significantly higher (p = 0.005) in patients with coronary heart disease (33.8%) compared to the control group (13.4%). The relative risk (odds ratio) of coronary heart disease among patients with high Lp(a) concentrations was 3.1 (95% confidence interval, 1.31-7.34; p = 0.01). The overall frequency distribution of apo(a) phenotypes differed significantly between the two groups (p = 0.043). However, the frequency of apo(a) isoforms of low apparent molecular mass (< or = 700 kDa) was of borderline significance (p = 0.067) between patients with or without coronary heart disease (29.6% and 16.4%, respectively). In this Caucasian population of NIDDM patients, elevated Lp(a) levels were associated with coronary heart disease, an association which was partially accounted for by the higher frequency of apo(a) isoforms of small size. In multivariate analyses, elevated levels of Lp(a) were independently associated with coronary heart disease (odds ratio 3.48, p = 0.0233).

Partículas lipoproteicas: concepto, aislamiento e implicancias clínicas / Lipoprotein particles: concept, isolation and clinical significance

La utilización de la cromatografía de afinidad con concanavalina A o de cromatografía de inmunoafinidad con anticuerpos anti apoB permite obtener dos grupos de lipoproteínas: las que contienen apoA y las que contienen apoB. El subfraccionamiento por cromatografía de inmunoafinidad secuencial de las partículas lipoproteicas que contienen apoA permite obtener a su vez tres mayores partículas lipoproteicas: LP-A-I, LP-A-I:A-II y LP-A-II. El subfraccionamiento a través de inmunoprecipitación secuencial o cromatografía de inmunoafinidad secuencial de las partículas lipoproteicas que contienen apoB permite obtener cinco mayores grupos de partículas: LP-B, LP-B:C, LP-B:E, LP-B:C:E y LP-A-II:B. La diferencia entre normo e hiperlipoproteinémicos sería el resultado de cambios cuantitativos (y no cualitativos) de las partículas lipoproteicas. En hipercolesterolémicos se destaca un aumento de LP-B en tanto que en hipertrigliceridémicos aumentan la LP-B-C y LP-B:C:E. Las drogas hipolipemiantes, independientemente de su mecanismo de acción, afectan en diferentes sentidos las concentraciones de las partículas lipoproteicas que contienen apoA y apoB. Bajas concentraciones de LP-A-I y elevadas de LP-B:C y LP-B:C:E se asocian con riesgo aterogénico

Partículas lipoproteicas: concepto, aislamiento e implicancias clínicas / Lipoprotein particles: concept, isolation and clinical significance

La utilización de la cromatografía de afinidad con concanavalina A o de cromatografía de inmunoafinidad con anticuerpos anti apoB permite obtener dos grupos de lipoproteínas: las que contienen apoA y las que contienen apoB. El subfraccionamiento por cromatografía de inmunoafinidad secuencial de las partículas lipoproteicas que contienen apoA permite obtener a su vez tres mayores partículas lipoproteicas: LP-A-I, LP-A-I:A-II y LP-A-II. El subfraccionamiento a través de inmunoprecipitación secuencial o cromatografía de inmunoafinidad secuencial de las partículas lipoproteicas que contienen apoB permite obtener cinco mayores grupos de partículas: LP-B, LP-B:C, LP-B:E, LP-B:C:E y LP-A-II:B. La diferencia entre normo e hiperlipoproteinémicos sería el resultado de cambios cuantitativos (y no cualitativos) de las partículas lipoproteicas. En hipercolesterolémicos se destaca un aumento de LP-B en tanto que en hipertrigliceridémicos aumentan la LP-B-C y LP-B:C:E. Las drogas hipolipemiantes, independientemente de su mecanismo de acción, afectan en diferentes sentidos las concentraciones de las partículas lipoproteicas que contienen apoA y apoB. Bajas concentraciones de LP-A-I y elevadas de LP-B:C y LP-B:C:E se asocian con riesgo aterogénico

A simple, sensitive technique for classification of apolipoprotein(a) isoforms by sodium dodecyl sulphate-polyacrylamide gel electrophoresis.

Lipoprotein(a) (Lp(a)) is a lipoprotein containing a unique glycoprotein, apolipoprotein(a) (apo(a)), which shows considerable heterogeneity of apparent molecular mass on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). A unifying classification of isoform has been lacking. A simple sensitive procedure for classifying apo(a) isoforms was developed in which the relative mobility of apo(a) on SDS-PAGE was related to that of apolipoprotein (apo) B-100 (Rf vs B). After Western blotting apo(a) bands were visualised by a sensitive double antibody technique employing commercial polyclonal antibodies (sheep antihuman Lp(a) antibody, alkaline phosphatase-linked donkey antisheep antibody). The technique was sensitive (lower limit of detection 0.02 micrograms apo(a)) and had good reproducibility (coefficient of variation 0.9-6.4%). Ten isoform mobilities are described (less than 0.35, 0.40, 0.50, 0.60, 0.70, 0.80, 1.0, 1.10, greater than 1.15). Individuals may have single or double band phenotypes. This classification is compatible with those previously described and the method is suitable for many laboratories, as it employs standard equipment and commercially available materials.

[What do we know about lipoproteins containing apo A-I?]. / Que savons-nous des lipoprotéines contenant l'apo A-I?

Since the Alaupovic's original concept, the lipoproteins were more and more classified according to their biochemical composition. Between the different and well identified lipoproteins particles, those containing apo A-I were particularly studied. These particles had a very great heterogeneity with respect to both their physicochemical properties and their apolipoproteins composition especially if they had or not the apo A-II. This criterion was frequently used for their classification in two different populations: the lipoproteins which contained both apo A-I and apo A-II (Lp A-I:A-II) and the other lipoproteins which contained apo A-I but no apo A-II (Lp A-I). All the two lipoprotein populations could be divided in several subpopulations. Among the two categories of lipoprotein particles, those devoid of apo A-II were described as the actual anti-atherogenic ones. Indeed, the Lp A-I population appeared as the only lipoproteins which decreased in serum during an atherosclerotic affection, this phenomenon being related to the favourable role of the Lp A-I population in the normal metabolism of lipids. Only the Lp A-I were demonstrated be able to induce and enhance the cholesterol efflux from culture cells. The Lp A-I:A-II function remained unknown, but the hypothesis is raised of a possible regulatory role which could be related to the high concentration of LpA-I in the cholesterol reverse transport.

In vitro transformation of apoA-I-containing lipoprotein subpopulations: role of lecithin:cholesterol acyltransferase and apoB-containing lipoproteins.

Two populations of apoA-I-containing lipoproteins are found in plasma: particles with apoA-II [Lp(AI w AII)] and particles without apoA-II [Lp(AI w/o AII)]. Both are heterogeneous in size. However, their size subpopulation distributions differ considerably between healthy subjects and patients with coronary artery diseases. The metabolic basis for such alterations was studied by determining the role of lecithin:cholesterol acyltransferase (LCAT) and apoB-containing lipoproteins (LpB) in the size subpopulation distributions of Lp(AI w AII) and Lp(AI w/o AII). ApoB-free and LCAT-free plasmas, prepared by affinity chromatography, and whole plasma were incubated at 4 degrees C and 37 degrees C for 24 hr. After incubation, Lp(AI w AII) and Lp(AI w/o AII) were isolated by anti-A-II and anti-A-I immunosorbents. Their size subpopulation distributions were studied by nondenaturing gradient polyacrylamide gel electrophoresis. At 4 degrees C most Lp(AI w AII) particles were in the range of 7.0-9.2 nm Stokes diameter. Incubation of plasma at 37 degrees C resulted in an overall enlargement of particles up to 11.2 nm and larger. These particles were enriched with cholesteryl ester and triglyceride and depleted of phospholipids and free cholesterol. Removal of LpB or LCAT from plasma prior to incubation greatly reduced their enlargement. At 4 degrees C, Lp(AI w/o AII) contained mostly particles of 8.5 and 10.1 nm. Incubation at 37 degrees C abolished both subpopulations with the formation of a new subpopulation of 9.2 nm. This transformation was identical in apoB-free plasma but was not seen in LCAT-free plasma. Our study shows that transformation of Lp(AI w AII) requires both LCAT and LpB. However, LpB is not necessary for the transformation of Lp(AI w/o AII) in vitro. The relevance of these in vitro studies to in vivo lipoprotein metabolism was demonstrated in a subject with hepatic triglyceride lipase deficiency.

Partial purification of lymphoblasts after in vitro immunization increases the yield in Ig-producing hybridomas.

Using in vitro immunization with a human plasma protein (apolipoprotein-A1) as antigen, we have shown that it is possible to prepare more monoclonal antibodies using a ten-fold lower concentration of antigen compared to in vivo immunization procedures (Weech et al., 1985). In addition, we can increase the number of Ig-producing hybridomas after in vitro immunization by a simple one-step separation of the lymphoblasts on a Percoll gradient before the fusion procedure. In order to apply this procedure to in vivo immunization techniques, it is necessary to expand the B-blast/plasma cell population by culturing the spleen cells for 4-6 days before fusion. Only antibodies of the IgM class were produced with the in vitro technique. However, by combining in vivo priming with in vitro immunization, it is possible to produce specific antibodies to both IgG and IgM classes.