Impact of sample selection on APOE epsilon 4 allele frequency: a comparison of two Alzheimer's disease samples.

OBJECTIVE: In a highly selected sample of unrelated Alzheimer's disease (AD) patients, we found that the APOE epsilon 4 allele frequency was higher than previously reported. Differing selection and ascertainment criteria may lead to these differences. To address this possibility, we compared the epsilon 4 allele frequency in two samples of AD patients selected from the same geographical area. SETTING AND PARTICIPANTS: Cases (n = 55) and controls (n = 99) from a research clinic-based sample were compared with subjects (n = 537) from a community-based AD patient sample. The samples consisted of unrelated cases who met NINCDS/ADRDA criteria for probable AD. DESIGN AND MEASUREMENTS: Clinical characteristics and APOE genotype data were obtained from AD cases and controls from both samples. RESULTS: Frequency of APOE epsilon 4 allele in the research cases compared with the community cases (0.45 vs 0.36) was nearly significant. We compared demographic and clinical characteristics that might account for this difference and found that the research cases were younger, had an earlier age of onset, and had more advanced disease than the community cases. After onset age was controlled, there was no overall difference between epsilon 4 allele frequency of the two samples. CONCLUSIONS: We found that the epsilon 4 allele frequency tended to be higher in the research AD sample compared the community-based sample. The two samples differed in several demographic and clinical characteristics. We conclude that research-based samples may lead to enrollment of younger patients with more severe disease who have higher APOE epsilon 4 allele load. This potential selection bias must be considered in the interpretation of studies of APOE allele frequency.

Geographically overlapping Alzheimer's disease registries: comparisons and implications.

In the medical and epidemiologic literature, a registry denotes a data base in which registrants share some common characteristic such as disease category. One criticism of registries is that they frequently collect subjects in a haphazard fashion and, hence, are "nonrepresentative of the population purportedly being represented." In this report, we compare two registries: an incident-based Alzheimer's Disease Patient Registry (ADPR) recruiting subjects for epidemiologic studies from a large health maintenance organization; and an Alzheimer's Disease Research Center (ADRC) registry recruiting subjects for phenomenologic, biologic, and pharmacologic studies. While these registries share personnel, overlap geographically, and use similar diagnostic procedures, they differ substantially in their missions and resulting recruitment strategies. We compared these registries with respect to demographic characteristics and cognitive features at subject entry. Subjects enrolled in the incident-based registry are older and report shorter time between symptom onset and recruitment. They are less demented and mirror the general population demographically more closely than do subjects in the other registry. The ADRC registry contains a much greater proportion of subjects with higher educational attainment.

Human hepatic triglyceride lipase expression reduces high density lipoprotein and aortic cholesterol in cholesterol-fed transgenic mice.

We have produced a line of transgenic mice expressing human hepatic triglyceride lipase (hH-TGL) to examine the in vivo effects of hepatic lipase expression on high density lipoprotein catabolism. Activation of metallothionine I promoter-hH-TGL cDNA transgene produced high levels of lipase mRNA in liver, heart, and kidney and elevated enzyme activity as assayed in post-heparin plasma. In a series of hyperlipidemic diet studies in which zinc was included in the diet to induce the transgene, hH-TGL expression was associated with a 34% lowering of plasma HDL-cholesterol levels (p < 0.01) when compared with animals on the same hyperlipidemic diet without zinc. This lowering of HDL cholesterol was paralleled by a decrease in total cholesterol and a decrease in HDL particle size. SDS-polyacrylamide gel electrophoresis analysis of the smaller HDL particles revealed that apolipoprotein AI was still the major apoprotein associated with the HDL. Quantitative analysis of abdominal aortic cholesterol content from the same animals suggests that the observed changes in plasma HDL by hH-TGL over-expression correlated with a decrease in the accumulation of aortic cholesterol (42%, p < 0.01). These data support the hypothesis that hH-TGL mediates a non-receptor pathway for the clearance of cholesterol from the plasma compartment.

MDL 29311, an analog of probucol, decreases triglycerides in rats by increasing hepatic clearance of very-low-density lipoprotein.

MDL 29311 is an analog of probucol that shares probucol's antioxidant and antiatherogenic properties. When fed to rats as a 1% dietary admixture, MDL 29311 decreased triglyceride levels by 65% without affecting total or high-density lipoprotein (HDL) cholesterol levels. Under the same conditions, probucol decreased triglyceride levels by 23% and total cholesterol levels by 29% (with a corresponding decrease in HDL cholesterol level). MDL 29311 treatment did not affect the rate of triglyceride entry into the plasma. However, MDL 29311-treated rats cleared in vivo-labeled very-low-density lipoprotein (VLDL)-associated [3H]-triglyceride ([3H]-VLDL) over threefold faster than control rats. This increase in clearance led to increased levels of [3H]-lipid in liver and decreased [3H]-lipid in fat, muscle, diaphragm, and kidney of MDL 29311-treated rats 1.5 to 2.0 minutes after injection of [3H]-VLDL. MDL 29311 treatment had no effect on lipoprotein lipase (LPL) or hepatic triglyceride lipase (H-TGL) activities, or on plasma apolipoprotein (apo) C-II-dependent LPL activation. Intravenously injected [3H]-VLDL was allowed to circulate in MDL 29311-treated or control rats for 1 minute, and the undiluted plasma was then perfused through rat livers in a recirculating system. The [3H] in MDL 29311 plasma was cleared threefold faster (t1/2, 1.3 v 3.8 minutes) than the [3H] in control plasma by control livers. Conversely, the [3H] in control plasma was cleared slowly (t1/2 = 3.5 minutes) by the livers of MDL 29311-treated rats.(ABSTRACT TRUNCATED AT 250 WORDS)

MDL 29311. Antioxidant with marked lipid- and glucose-lowering activity in diabetic rats and mice.

MDL 29311, an analogue of probucol, administered to rats as a 1% dietary admixture for 2 wk before and 5 days after intravenous injection of 40 mg/kg of ALX significantly (P < 0.05) reduced plasma glucose (6.9 +/- 0.3 vs. 19.2 +/- 1.3 mM) and serum triglyceride (0.17 +/- 0.01 vs. 1.82 +/- 0.39 mM) levels in overnight-fasted ALX-plus-MDL 29311-administered rats vs. ALX-administered rats. A cross-over study indicated that MDL 29311 did not attenuate the diabetogenic action of ALX, but rather, directly lowered glucose and triglycerides. In rats injected intravenously with 45, 65, or 85 mg/kg of STZ and then administered control or MDL 29311 diet for 7 days, MDL 29311 decreased fasted plasma glucose to nondiabetic levels, decreased fasted and nonfasted plasma triglycerides by 49-79%, but did not affect plasma insulin levels. In STZ-induced (65 mg/kg) diabetic rats, MDL 29311 attenuated the increase in plasma nonesterified fatty acids during an 18-h fast; had little or no effect on glucagon, pyruvate, lactate, beta-hydroxybutyrate, acetoacetate, or cholesterol; and did not induce hypoglycemia in rats fasted up to 64 h. In nonfasted hyperinsulinemic db/db mice treated for 10 wk, MDL 29311 significantly lowered glucose levels by 14-40%, triglyceride levels by 31-63% and GHb from 8.0 to 5.4%, and had no consistent effect on plasma insulin levels. Because of its marked glucose- and lipid-lowering activity in both nonfasted hyperinsulinemic and fasted insulinopenic animals, MDL 29311 merits additional investigation as a potential antidiabetic agent.

Effects of probucol on plasma lipids, lipoproteins and parameters of high density lipoprotein metabolism.

Eight patients with primary hypercholesterolemia were treated with probucol for 17 weeks. Plasma total cholesterol, low density lipoprotein (LDL)-cholesterol, and high density lipoprotein (HDL)-cholesterol decreased by 16.6, 15.0 and 25.7%, respectively, in response to probucol treatment. Plasma levels of apolipoprotein B and apolipoprotein A-I also decreased, while apolipoprotein A-II concentrations were unchanged. The decrease in HDL-cholesterol levels was associated with a reduction in HDL particle size. No changes in the plasma lecithin:cholesterol acyltransferase activity or mass occurred in response to probucol treatment. In contrast, a significant 25% increase in plasma cholesteryl ester and triglyceride transfer activity occurred following probucol treatment. There was a positive correlation (R = 0.94) between cholesterol ester and triglyceride transfer. We propose that the increase in lipid transfer activity may in part explain the changes in HDL concentration and size, as well as the previously reported effect probucol has on reducing atherosclerosis in animal models.

Trans-repressor activity of nuclear glycosaminoglycans on Fos and Jun/AP-1 oncoprotein-mediated transcription.

Heparin blocks the phorbol ester-induced progression of nontransformed cells through the G0/G1 phase (Wright, T.C., L.A. Pukac, J.J. Castellot, M.J. Karnovsky, R.A. Levine, H.-Y. Kim-Park, and J. Campisi. 1989. Proc. Natl. Acad. Sci. USA. 86: 3199-3203) or G1 to S phase (Reilly, C. F., M. S. Kindy, K. E. Brown, R. D. Rosenberg, and G. E Sonenshein. 1989. J. Biol. Chem. 264:6990-6995) of the cell cycle. Cell cycle arrest was associated with decreased levels of stage-specific mRNAs suggesting transcriptional regulation of cell growth. In the present report, we show that heparin selectively repressed TPA-inducible AP-1-mediated gene expression. Heparin-induced trans-repression was observed in primary vascular smooth muscle cells, as well as in the transformed HeLa cell line and in nondifferentiated F9 teratocarcinoma cells. Inhibition of AP-1-mediated trans-activation occurred with heparin and pentosan polysulfate but not with chondroitin sulfate A or C. Heparin-binding peptides or heparitinase I addition to nuclear lysates of heparin-treated cells allowed enhanced recovery of endogenous AP-1-specific DNA binding activity. We propose a model in which nuclear glycosaminoglycans play a trans-regulatory role in altering the patterns of inducible gene expression.

Differential regulation of hepatic triglyceride lipase and 3-hydroxy-3-methylglutaryl-CoA reductase gene expression in a human hepatoma cell line, HepG2.

The level of hepatic triglyceride lipase (H-TGL) synthesis and secretion was examined in response to changes in cholesterol biosynthesis in the human hepatoma cell line HepG2. Cells were first fed a lipoprotein-deficient serum-supplemented medium to eliminate exogenous cholesterol. Mevinolin, a 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitor, was then added at a concentration (37 microM) which inhibited cholesterol biosynthesis by greater than 85% and decreased total cell cholesterol from 36.1 to 27.4 micrograms/ml of cell protein. Mevinolin treatment caused a 4.9 +/- 0.8-fold increase in the amount of H-TGL activity secreted into the medium, a 1.8 +/- 0.4-fold rise in H-TGL-specific mRNA, and a concurrent 14-fold increase in HMG-CoA reductase mRNA. Addition of 1 mM mevalonic acid to normal or mevinolin-treated cells raised the cellular cholesterol content and decreased the amount of secreted H-TGL activity to levels below control values. Mevalonic acid also prevented mevinolin-induction of H-TGL and HMG-CoA reductase mRNA, suggesting a common regulatory step for H-TGL and HMG-CoA reductase. Exposure of cells to mevinolin and 25-hydroxycholesterol together resulted in a marked repression of HMG-CoA reductase mRNA levels, whereas these conditions further enhanced the secretion of H-TGL activity and the expression of H-TGL mRNA. These results demonstrate a differential role for 25-hydroxycholesterol in the regulation of H-TGL and HMG-CoA reductase expression.

Concentration-dependent antioxidant activity of probucol in low density lipoproteins in vitro: probucol degradation precedes lipoprotein oxidation.

The ability of probucol, a lipid-lowering drug with antioxidant properties, to prevent the Cu2+-induced oxidation of human plasma low density lipoproteins (LDL) was examined as a function of the concentration of probucol in LDL. In the absence of probucol, 3 microM Cu2+ induced half-maximal LDL lipid oxidation, as determined by the formation of thiobarbituric acid reactive substances (TBARS). Oxidation was associated with a loss of apolipoprotein B-100 and the appearance of higher molecular weight forms of the protein. In the presence of 0.6 mol% probucol (relative to phospholipid) and with 3 microM Cu2+, the time required to obtain half-maximal LDL lipid oxidation increased from 130 to 270 min and was explained by an increase in the lag time prior to LDL lipid oxidation. Once rapid oxidation of LDL had begun, the rate of TBARS formation was similar to that for LDL containing no probucol. At a probucol concentration of 4.2 mol%, the antioxidant prevented the oxidation of LDL-lipids. The delay in Cu2+-induced LDL oxidation with probucol corresponded to the time required for free radical-mediated processes to convert probucol to a spiroquinone and a diphenoquinone. These in vitro findings suggest that the potent antioxidant property of probucol is directly related to the amount of drug in the LDL particle and may have relevance to its antiatherosclerotic effects observed in vivo.

Heparin induces the expression of hepatic triglyceride lipase in a human hepatoma (HepG2) cell line.

Hepatic triglyceride lipase (H-TGL) is a key lipolytic enzyme in the metabolism of human plasma high density lipoproteins. The enzyme is bound to glycosaminoglycans on endothelial cells in the liver and is immediately released into the circulation after heparin administration. In addition to releasing H-TGL, heparin-like glycosaminoglycans have also been shown to suppress hepatocyte proliferation and to alter tissue-specific gene expression. In the present study, the effects of heparin exposure on the secretion of H-TGL were examined in a human parenchymal hepatoma (HepG2) cell line. The addition of heparin to serum-supplemented medium induced the secretion of H-TGL in a time- and concentration-dependent manner. At 5.4 micrograms/ml heparin, H-TGL levels, as determined by triacyglycerol hydrolase activity, increased 7-fold after a 44-h incubation. Heparin exposure decreased intracellular H-TGL activity from 21.3 to 4.8 nmol of oleic acids released/h/10(8) cells and increased enzyme activity in the medium from 16.2 to 165.3 nmol of oleic acids released/h/10(8) cells. The heparin-induced secretion of H-TGL was associated with increased levels of H-TGL-specific mRNA. The addition of actinomycin D or cycloheximide reversed the heparin-induced increase in H-TGL activity and mRNA. Heparin treatment did not increase the level of actin mRNA suggesting that elevated H-TGL mRNA is due to enhanced tissue-specific expression of H-TGL. Expression of apolipoprotein E, another protein involved in lipoprotein metabolism, also showed induced levels of mRNA by heparin but to a lesser extent than that for H-TGL. We conclude that heparin stimulates the de novo synthesis of H-TGL in liver parenchymal cells in vivo by influencing both transcriptional and post-transcriptional events.

Biliary secretion of organic anions in the dog: association with defined lipid particles.

Organic anions have recently been found to partition in vitro into various biliary lipid particulate species according to their relative hydrophobicities. To establish the physiological relevance of these observations, we intravenously injected various radiolabeled organic anions and assessed the distributions of parent compounds and their metabolites to lipid particles in canine bile. Partitioning into various biliary lipid particles was determined by gel permeation chromatography. Relative hydrophobicities of the various organic anions and their radiolabeled conjugates were determined by reverse-phase high-pressure liquid chromatography. A strong positive correlation (P less than 0.001) was found between percent vesicular association and degree of hydrophobicity for a given organic anion and/or its more polar conjugate. We conclude that 1) the hydrophobic-hydrophilic balance of organic anions is a key factor governing their partitioning to lipid particles secreted in bile; 2) the present study agrees well with our previously published in vitro observations; and 3) other chemical constituents, e.g., proteins, mucin, etc., appear to have little or no effect on organic anion transport in bile.

Characterization of high density lipoproteins from patients with severe hypertriglyceridemia.

High density lipoproteins (HDL) were isolated by zonal ultracentrifugation from 6 subjects with severe hypertriglyceridemia. Four subjects had familial endogenous hypertriglyceridemia with fasting chylomicronemia; 2 subjects were non-insulin-dependent diabetics. Plasma triglycerides ranged from 920 to 5440 mg/dl and HDL-cholesterol from 12 to 23 mg/dl. The major HDL from these hypertriglyceridemic subjects had a peak mean density of 1.153 g/ml as compared to 1.140 g/ml for HDL3 from normal subjects. None of the subjects had significant amounts of HDL corresponding to normal HDL2. The major subpopulation of hypertriglyceridemic HDL had a mean diameter of 8.4 +/- 0.1 nm (range 7.6-9.0 nm). The HDL were enriched in triacylglycerols and depleted in cholesteryl esters and the C apoproteins as compared to control HDL3. The mass ratio of triacylglycerols to cholesteryl esters ranged from 4.00 to 5.22 for the patients versus 0.41 for normal HDL3. The increased content of triacylglycerols partially explains the decreased amount of cholesterol associated with these hypertriglyceridemic HDL.

Comparison of gradient gel electrophoresis and zonal ultracentrifugation for quantitation of high density lipoproteins.

The study was conducted to compare gradient gel electrophoresis (GGE) and zonal ultracentrifugation for quantitation of human plasma high density lipoproteins (HDL). Plasma samples were obtained from seven normal subjects consuming a high fat diet (65% total calories) followed by a high carbohydrate diet (65% total calories). HDL were fractionated into HDL2 and HDL3 by zonal ultracentrifugation and lipid and protein mass were determined. HDL were also fractionated by GGE and the results were compared to the zonal method. Zonally isolated HDL2 represented a homogeneous particle population that was equivalent to HDL2b as determined by GGE. By the zonal method, HDL2 accounted for 27 +/- 4% (mean +/- SEM) of total HDL mass in subjects on the high fat diet as compared to 16 +/- 2% in subjects fed the high carbohydrate diet; by GGE, the HDL2b values were 27 +/- 4% and 14 +/- 1%, respectively. The coefficient of correlation (n = 25) for the two methods was 0.894 (P less than 0.001).

Reactivity of heparin with the human plasma heparin-binding proteins thrombin, antithrombin III, and apolipoproteins E and B-100.

The heparin-binding properties of human plasma apolipoproteins B-100 and E (apoB-100 and E) of low density lipoproteins (LDL), thrombin, and antithrombin-III (AT-III) were investigated. A highly reactive heparin (HRH) to apoB-100 was isolated by chromatography of crude heparin on a column of LDL immobilized to Affi-Gel 10. This HRH showed a high, Ca2+-dependent precipitating activity towards LDL; 1 microgram HRH uronic acid precipitated 50-70 micrograms LDL-protein. HRH was fractionated further by chromatography on a column of AT-III bound to concanavalin A-Sepharose. The unretained fraction of heparin (HRH1) had a low affinity for AT-III. The bound heparin (HRH2) had a high affinity for AT-III and precipitated LDL in the presence of Ca2+. To assess further their heparin-binding properties, the proteins were subjected to gradient-gel electrophoresis under denaturing conditions, transferred to nitrocellulose by electrophoresis, and then assayed for their ability to bind [125I]-labeled HRH2. Autoradiographic analysis showed that thrombin, apolipoproteins E and B-100, and the AT-III . thrombin covalent complex bound HRH2. Denatured AT-III did not bind HRH2, indicating that its heparin recognition site may depend on conformation.

Influence of polyunsaturated and saturated fats on plasma lipids and lipoproteins in man.

The effects of varying polyunsaturated/saturated (P/S) fat ratios on the plasma levels of lipids, lipoproteins, and apolipoprotein A-I were assessed in six normal healthy subjects (three males, three females) with a particular focus on the P/S ratio which would offer optimal concentrations of both low-(LDL) and high-density lipoproteins (HDL). The isocaloric experimental diets contained 40% of calories as carbohydrate, 40% fat, and 20% protein; dietary cholesterol was 400 mg/day. The P/S ratio for the diets was 0.4, 1.0, or 2.0. Each diet was sequentially consumed for periods of 2 wk each. At the end of each 2-wk study period, plasma lipid, apolipoprotein A-I, and LDL and HDL cholesterol concentrations were determined; HDL were fractionated by zonal ultracentrifugation and lipid and protein composition determined. Compared to the P/S = 0.4 diet, mean plasma total cholesterol fell by approximately 6 and 12% on the P/S = 1.0 or P/S = 2.0 diets, respectively; plasma concentrations of LDL-cholesterol, HDL-cholesterol, and apolipoprotein A-I were also decreased on the polyunsaturated fat diets. The mean +/- SEM concentration (mg/dl) of HDL-cholesterol was 49.0 +/- 5.2 (P/S = 0.4), 44.0 +/- 3.8, (P/S = 1.0) and 41.0 +/- 3.7 (P/S = 2.0). As a result of a reduction in both LDL- and HDL-cholesterol on the polyunsaturate-rich diets, the ratios of HDL-cholesterol to plasma total cholesterol and HDL- to LDL-cholesterol were not significantly changed on the three diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a high carbohydrate diet on the content of apolipoproteins C-II, C-III and E in human plasma high density lipoprotein subfractions.

The effect of isocaloric high and low carbohydrate (Carb) diets on the structure and apoprotein composition of plasma high density lipoproteins (HDL) was assessed in four healthy men. The high Carb diet contained 65% calories as Carb and 15% as fat; the low Carb was 15% and 65%, respectively, with protein fixed at 20% of calories in each case. Cholesterol was 400 mg/day and the P/S ratio of the fat was 0.4. Each diet was sequentially consumed for periods of 3 weeks. At the end of each 3-week study period, plasma HDL2 and HDL3 were isolated by zonal ultracentrifugation and their apoprotein and lipid compositions were determined. Compared to the low Carb diet, the high Carb diet was associated with an increase in the size of HDL2 (116.0 +/- 1.8 vs. 109.1 +/- 1.8 A) and in the content (mean weight % +/- SEM) of apoE (2.81 +/- 0.71 vs. 1.79 +/- 0.49, P less than 0.01) and of apoC-II (1.73 +/- 0.09 vs. 1.11 +/- 0.12, P less than 0.01). HDL2 apoC-III content was not significantly different on the two diets (6.49 +/- 0.50 vs. 7.42 +/- 1.21). On the two diets, HDL3 size and HDL3 apoE content were not significantly changed. HDL3 apoC-II and apoC-III, however, were higher on the high Carb diet, P less than 0.05. The ratio (by weight) of HDL2 apoE/HDL2 apoC-II + C-III increased on the high Carb diet compared to the low Carb diet (0.344 +/- 0.058 vs. 0.228 +/- 0.053, P less than 0.01). We suggest that the increased amount of apolipoprotein E in HDL2 may influence its rate of catabolic clearance and may account for the well-known decrease in plasma HDL-cholesterol in subjects on high Carb diets.