Plasma apolipoprotein E, high density lipoprotein1 (HDL1) and urinary mevalonate excretion in pancreatectomized diabetic dogs: effects of insulin and lovastatin.

Hypercholesterolemia and increased concentrations of an apolipoprotein E (apoE)-containing HDL subclass, high density lipoprotein1 (HDL1) have been observed in streptozocin-alloxan diabetic dogs consuming normal amounts of dietary cholesterol. The aim of this study was to characterize the response of HDL1 and its targeting ligand, apoE, to insulin and HMG-CoA reductase inhibitor treatment in pancreatectomized diabetic dogs. Following induction of diabetes, plasma total cholesterol, HDL1, and apoE concentrations were all increased. Urinary mevalonate excretion, an index of cholesterol synthesis in humans, was 6-fold that of nondiabetic controls. Lipoprotein fractionation by Pevikon block electrophoresis and gel filtration chromatography showed that the increased cholesterol and apoE were associated with alpha 2-migrating particles corresponding to HDL1. Insulin treatment, resulting in near normal fasting blood glucose concentrations in the group as a whole (average 5.1 mM, 92 mg/dl), led to variable reductions in apoE, total plasma cholesterol, and HDL1. Uncorrected dyslipidemia during intensified insulin treatment appeared to be related to failure to achieve euglycemia. Despite unremitting hyperglycemia, treatment with lovastatin resulted in pronounced decreases in plasma cholesterol, HDL1 and apoE to concentrations below those observed in nondiabetic animals. Mevalonate excretion also fell, but remained twice normal. Thus neither modality corrected all of the abnormalities in canine diabetic dyslipidemia. Since apoE-containing HDL1 may mediate cholesterol traffic between the periphery and the liver (reverse cholesterol transport), the present observations suggest that increased cholesterol synthesis is accompanied by parallel abnormalities in cholesterol flux through the reverse transport pathway in the canine model.

Novel aspects of vitamin A metabolism in the dog: distribution of lipoprotein retinyl esters in vitamin A-deprived and cholesterol-fed animals.

Retinyl ester concentrations in plasma from fasting humans, rabbits and rats are usually negligible. In contrast, plasma from fasting dogs contains appreciable amounts of retinyl esters, associated almost entirely with the low-density lipoproteins. This study was undertaken to gather additional information about the nature and origin of canine retinyl ester-containing lipoproteins. We examined the metabolism of endogenous lipoprotein retinyl esters in adult mongrel dogs with moderate vitamin A deficiency. Four animals were fed a diet of oatmeal and tuna fish that provided only 4% of the vitamin A contained in their control rations (15 vs. 367% of the canine recommended daily intake). There was an initial rapid decline in plasma retinyl esters. However, measurable concentrations persisted in plasma for up to 1 year of restricted vitamin A intake. Total plasma retinyl ester concentrations after 6 months of vitamin A deprivation, extrapolated from best-fit monoexponential decay curves for each animal, ranged from 11 to 89% of control, suggesting that there was sustained secretion of retinyl esters from endogenous stores. Density gradient ultracentrifugation of plasma from fasting vitamin A-deprived dogs showed retinyl esters in the very-low- and low-density lipoproteins. After fat and vitamin A feeding retinyl esters appeared among the very-low-, intermediate- and low-density lipoproteins, consistent with the suggestion that chylomicron retinyl esters are first taken up by the liver, and then resecreted as density less than 1.006-1.063 g/ml lipoproteins. Maximal incorporation of dietary retinyl esters into low-density lipoproteins was not reached until 24-48 h. Intermediate-density and beta-migrating low-density lipoprotein retinyl esters were increased markedly in fasting animals maintained on cholesterol- and saturated fat-enriched diets. These observations provide further evidence for the proposal that the canine liver secretes retinyl ester-containing particles, in amounts governed by dietary composition and vitamin A content. What selective advantage this unusual transport pathway might provide is not apparent.

Relationship of organ lipoprotein lipase activity and ketonuria to hypertriglyceridemia in starved and streptozocin-induced diabetic rats.

Although lipoprotein lipase (LPL) is believed to be rate limiting in the catabolism of triglyceride-rich lipoproteins, LPL activity has not correlated with plasma triglyceride concentrations in experimental rat diabetes. To gather more information about this enzyme system in diabetes, LPL activities were measured in representative tissues from control and streptozocin-induced diabetic rats fed fat-free chow and in 48-h-starved animals. The DNA content of each tissue was determined so that LPL activity could be expressed in a way that was unaffected by tissue wasting. Diabetic animals lost approximately 20% of their body mass. Adipose tissue and soleus muscle cell masses were reduced, and there was marked fat atrophy at necropsy. Adipose tissue LPL was decreased in both starved and diabetic animals, whereas skeletal muscle activities were variably affected. Lipase content and distribution among the individual organs were calculated with published data for rat carcass composition. In diabetic rats, total LPL (adipose tissue, muscle, and parenchymal organs) was reduced by nearly two-thirds so that skeletal muscle became the predominant source of LPL. Ketonuria was less frequent in diabetic than in starved rats (P less than .018) despite their severe wasting. Serum triglyceride concentrations were higher in ketonuric than nonketonuric diabetic animals, and severe hypertriglyceridemia was seen exclusively in heavily ketonuric animals. These observations together with published information suggest that plasma triglyceride concentrations in the rat model are determined by a complex interplay between very-low-density lipoprotein synthesis, the capacity of the LPL removal system, properties of the lipoprotein substrate, and other unidentified factors.

Effects of estrogen/progestin agents on plasma retinoids and chylomicron remnant metabolism.

Women using estrogen-progestin oral contraceptive agents have a marked decrease in the activity of hepatic triglyceride lipase, an enzyme believed to be involved in the catabolism of lipoprotein remnants. The hypothesis that women receiving these agents have defective remnant processing resulting in elevated chylomicron remnant concentrations in plasma was tested. Retinyl esters, which in humans are transported by intestinally-derived lipoproteins, were used to estimate chylomicron and chylomicron remnant concentrations. Women on a variety of oral contraceptive agents had increased plasma triglyceride concentrations, but only minimally increased fasting retinyl ester concentrations. Retinol and retinyl binding protein were elevated to about 150% of controls (p less than 0.001). Retinyl ester concentrations during active fat absorption were then measured in a second group of women taking a single preparation. Three-hour retinyl ester levels were lower in the treated group than control (p less than 0.05), but the difference had disappeared at six hours. Postheparin plasma hepatic triglyceride lipase was reduced by 46% in the treated group (p less than 0.05). Thus despite reduction in hepatic lipase activity, there was no accumulation of retinyl esters in the contraceptive-treated women to suggest impaired remnant processing.

PIP: Women using estrogen-progestin oral contraceptive agents have a marked decrease in the activity of hepatic triglyceride lipase, an enzyme believed to be involved in the catabolism of lipoprotein remnants. The hypothesis that women receiving these agents have defective remnant processing resulting in elevated chylomicron remnant concentrations in plasma was tested. Retinyl esters, which in humans are transported by intestinally-derived lipoproteins, were used to estimate chylomicron and chylomicron remnant concentrations. Women on a variety of oral contraceptive agents had increased plasma triglyceride concentrations, but only minimally increased fasting retinyl ester concentrations. Retinol and retinyl binding protein were elevated to about 150% of controls (cr 0.001). Retinyl ester concentrations during active fat absorption were than measured in a 2nd group of women taking a single preparation. 3 hour retinyl ester levels were lower in the treated group than control (p 0.05), but the difference had disappeared at 6 hours. Postheparin plasma hepatic triglyceride lipase was reduced by 46% in the treated group (p 0.05). Thus despite reduction in hepatic lipase activity, there was no accumulation of retinyl esters in the contraceptive-treated women to suggest impaired remnant processing.

Apolipoprotein E-containing lipoproteins and lipoprotein remnants in experimental canine diabetes.

The effects of diabetes on plasma lipoproteins were examined in a cohort of control and streptozocin-alloxan diabetic beagles fed either standard rations or an atherogenic cholesterol-supplemented diet. Lipoprotein cholesterol, triglyceride, and retinyl ester concentrations were measured in fractions separated by density gradient ultracentrifugation. Individual lipoprotein classes and apolipoproteins were assessed by electrophoresis. Postheparin plasma lipoprotein triglyceride lipase activities were also examined. In the absence of added dietary cholesterol, diabetic animals became hypercholesterolemic with relatively increased low-density (LDL) and decreased high-density (HDL) lipoprotein cholesterol concentrations. Apolipoprotein E-containing beta- to alpha 2-migrating HDL1 (HDLc) appeared in rho = 1.020-1.080 g/ml subfractions, whereas alpha 1-migrating typical HDL (rho = 1.06-1.21 g/ml) was reduced. In comparison to nondiabetic cholesterol-fed animals, diabetic cholesterol-fed animals had increased cholesterol (but not triglyceride) concentrations in very-low- and intermediate-density classes. These classes contained retinyl esters and low-molecular-weight apolipoprotein B (components of intestinal lipoprotein remnants) as well as apolipoprotein E and high-molecular-weight apolipoprotein B. These findings could not be explained by decreased postheparin plasma lipoprotein lipolytic activities. Increased plasma concentrations of HDLc in poorly controlled diabetic dogs may reflect a pathologic disturbance in the excretory limb of cholesterol transport from peripheral cells to the liver. In addition, exaggerated retention of lipoprotein remnants in cholesterol-fed diabetic dogs may contribute to increased delivery of cholesterol to extrahepatic tissues. This model appears to be suitable for physiologic studies of the effects of diabetes on reverse cholesterol transport.

Retinyl ester retention in chronic renal failure. Further evidence for a defect in chylomicron remnant metabolism.

The metabolic remnants of triglyceride-rich lipoproteins are atherogenic in man and experimental animals. Particles resembling lipoprotein remnants have been found in plasma from patients with chronic renal failure (CRF). In this study we took advantage of the observation that retinyl esters are transported only by lipoproteins that originate in the intestine, that is, by chylomicrons (CM) and their remnants. To investigate further remnant metabolism in CRF, plasma RE were measured by reverse-phase high performance liquid chromatography in 20 non-diabetic hemodialyzed patients with CRF and 20 hospitalized non-diabetic control subjects 12-15 h after the administration of retinyl ester, 25000 IU orally. Total plasma RE were increased 3-fold in the CRF patients (P less than 0.001). Quantitative analysis of retinoids and lipids in fractions separated by unit-gravity flotation and flocculation in 3% polyvinylpyrrolidone indicated that the plasma RE were not contained among intact CM. Mean plasma retinol in CRF was also elevated consistent with previous observations and the known role of the kidney in retinol-binding protein metabolism. Although postabsorptive RE concentration was correlated positively and significantly with plasma triglyceride concentration in both groups, RE were higher in CRF patients at comparable plasma triglyceride concentrations. These data support the proposal that atherogenic lipoprotein remnants accumulate in the plasma of patients with CRF.

Postchallenge plasma lipoprotein retinoids: chylomicron remnants in endogenous hypertriglyceridemia.

This study was conducted to determine whether chylomicron remnants accumulate in the plasma of patients with "endogenous" hypertriglyceridemia. Retinyl esters were used as markers of chylomicrons and chylomicron remnants since they are carried mainly if not exclusively by lipoproteins of intestinal origin. Seventy-six fasting normotriglyceridemic and hypertriglyceridemic patients were studied 12 to 15 hours after ingesting 25,000 IU of vitamin A. Plasma retinol and retinyl esters were measured by reversed-phase high-performance liquid chromatography. Chylomicronemia was assessed by flotation at unit gravity and by chylomicron flocculation in 3% polyvinylpyrrolidone. Plasma lipids, retinoids, lipoprotein cholesterol, and the electrophoretic mobility of very-low density lipoproteins were determined in a subset of 36 subjects. Progressively elevated plasma retinyl ester concentrations were observed among patients with mild, moderate, and severe hypertriglyceridemia. All subjects with fasting chylomicronemia had retinyl ester retention. The majority of subjects with mild or moderate hypertriglyceridemia (predominantly type IV hyperlipoproteinemia) also had elevated plasma concentrations of retinyl esters. Total plasma retinyl ester and plasma triglyceride concentrations correlated significantly (rs = 0.721, P less than 0.001) in nonchylomicronemic subjects. In addition, total plasma retinol concentrations were mildly elevated among hypertriglyceridemic subjects because retinol, as well as retinyl esters, is transported by triglyceride-rich lipoproteins. If lipoprotein remnants are atherogenic in man, then chylomicron remnant retention may accelerate atherogenesis in hypertriglyceridemic individuals.

Phenotypic heterogeneity in the extended pedigree of a proband with lipoprotein lipase deficiency.

We have studied the large nonconsanguineous pedigree of a proband with Type I hyperlipoproteinemia (HL) and lipoprotein lipase (LPL) deficiency. Within the nuclear family, the mother and two of the proband's five siblings had fasting hypertriglyceridemia or low-normal tissue adipose LPL activities or both. Retention of lipoprotein retinyl esters after vitamin A feeding was present only in the propositus. The maternal side of the extended pedigree contained individuals with Types IIA, IV, and V hyperlipoproteinemia, findings most consistent with autosomal dominant multiple lipoprotein-type hyperlipidemia (familial combined hyperlipidemia). This family and previously reported pedigrees of Type I HL probands have demonstrated phenotypic heterogeneity. Without specific genetic markers, homozygous LPL deficiency and complex multiple-gene mechanisms cannot be distinguished unambiguously. Parental hyperlipidemia in nuclear pedigrees of Type I HL probands should not be equated with heterozygous LPL deficiency in the absence of extended pedigree data or more informative markers. The possibility that the complex inheritance of two different genetic defects in lipoprotein transport can produce the Type I HL phenotype must be considered.

Eucaloric substitution of medium chain triglycerides for dietary long chain fatty acids in acquired total lipodystrophy: effects on hyperlipoproteinemia and endogenous insulin resistance.

Previous studies have suggested that reduction of dietary fat intake, with or without caloric restriction, may lead to improvement in certain of the characteristic abnormalities that accompany total lipodystrophy (TLD). We have studied the effects of eucaloric medium chain triglyceride (MCT) substitution for dietary long chain fatty acids in a patient with acquired total lipodystrophy and unusual somatic and visceral anomalies. The patient exhibited insulin resistance, carbohydrate intolerance, striking fasting- and glucose-stimulated hyperinsulinemia, hyperglucagonemia, type V hyperlipoproteinemia, and lipoprotein lipase deficiency on a normal diet. Improvement in chylomicronemia, hypertriglyceridemia, and xanthomatosis occurred during eucaloric MCT substitution. Carbohydrate intolerance decreased and fasting immunoreactive glucagon and insulin concentrations fell 37% and 83%, respectively. Plasma triglyceride polyunsaturated fatty acid concentrations decreased to very low levels. With long term MCT feeding supplemented by polyunsaturated fatty acids, hepatomegaly has gradually decreased, while body weight has remained stable. The patient has not yet required insulin therapy. These observations suggest that the abnormalities in carbohydrate metabolism are closely linked to, and perhaps dependent on, the abnormalities in lipoprotein transport in TLD. Long chain triglyceride restriction and MCT supplementation should be attempted in additional patients with the features of TLD to determine whether this is a generally effective therapeutic approach.

In vitro transfer of chylomicron retinol and retinyl esters.

The redistribution of rat chylomicron retinoids following incubation with fasting- or postheparin human plasma was investigated. With fasting plasma, chylomicron retinol appeared among higher density lipoprotein acceptors and density greater than 1.21 gm/ml plasma proteins; only small amounts of retinyl ester were found therein. With postheparin plasma, retinyl ester-containing chylomicron remnants with densities spanning the low- and high density lipoprotein distributions were generated; appreciable quantities of retinyl esters appeared among rho greater than 1.019 lipoproteins only in the presence of postheparin plasma. These observations are consistent with the conservation of retinyl esters, but not retinol, among chylomicrons and their catabolic products.

Plasma lipoprotein retinoids after vitamin A feeding in normal man: minimal appearance of retinyl esters among low-density lipoproteins.

Retinyl esters have been thought to be carried solely by lipoproteins of intestinal origin (chylomicrons and their catabolic derivatives). Recent reports, however, have indicated that there may be significant transfer of retinyl esters from chylomicrons to low-density lipoproteins (LDL) in vitro, and that in other species, substantial amounts of retinyl esters may appear in LDL. Since in man lipoproteins of intestinal origin are not considered to contribute to a quantitatively significant extent to circulating LDL, we have examined this issue further. The distribution of retinol and retinyl esters within the plasma lipoproteins of eight normal human volunteers was measured following the ingestion of vitamin A along with a mixed meal. Retinyl esters appeared in the chylomicrons and very-low-density lipoproteins. Small amounts of retinyl esters were also detected in the intermediate- and low-density lipoprotein (LDL) classes. Estimates of the masses of retinyl esters, however, indicated that 5% or less of chylomicron retinyl esters appeared in the LDL. These observations are consistent with orderly chylomicron delipidation and provide further evidence that chylomicron-derived components do not contribute directly or to a quantitatively significant extent to circulating LDL.