Dietary linolenic acid in man--an overview.

Small amounts of linolenic acid are ubiquitous in human food but only a few foodstuffs contain sizable amounts, namely some plant oils, butter and fish; in marine fish, linolenic acid is accomplished by eicosapaentaenoic acid, highly exceeding linolenic acid in quantity. Of the linolenic acid ingested, some is incorporated into phospholipids and cholesteryl esters, very little is elongated and eventually converted to prostaglandins; probably most linolenic acid is used as fuel. Polyunsaturated fatty acids of the (n-3)-series should no longer be considered to be similar with respect to their metabolic fate and their effects. In particular, results from experiments with "eskimo diets" may not be applied to considerations of linolenic acid. There may be a small dietary requirement for linolenic acid, possibly only for growing children; yet it is prudent to recommend diets which are not devoid of linolenic acid, especially in formula diets or parenteral nutrition. Some experiments suggest that high doses of linolenic acid exert untoward effects by inhibiting prostaglandin synthesis of the 1- and 2-series. The ratio between linoleic and linolenic acid in relevant experiments was such that only excessive use of linseed oil could produce them under conventional dietary conditions. Still it must be considered prudent to keep the linolenic acid content of foods well below that of linoleic acid.

Regulation of lipogenic enzymes in human diploid fibroblasts by hormones.

The hormonal regulation of two regulatory enzymes of fatty acid synthesis acetyl-CoA carboxylase (EC 6.4.1.2) and glucose-6-phosphate dehydrogenase (EC 1.1.1.49), has been investigated in human diploid fibroblasts. There was a 35% increase in acetyl-CoA carboxylase activity, 72 h following addition of 10 microU/ml insulin to the culture medium. Addition of 1 microgram/ml of 3,3'5-triiodothyronine for 72 h resulted in an increase in acetyl-CoA carboxylase activity to 166% of the controls. The simultaneous addition of 1 microgram/ml triiodothyronine and 10 mU/ml insulin caused the enzyme activity to rise to 240% of the controls. A dose-dependent reduction in acetyl-CoA carboxylase activity was brought about by 1 X 10(-4) to 1 X 10(-3) M dibutyryl cyclic AMP. The earliest effect of dibutyryl cyclic AMP was observed within 24 h. Glucose-6-phosphate dehydrogenase followed qualitatively the same pattern of response, whereas the constitutive enzyme, lactate dehydrogenase (EC 1.1.1.27), did not show significant changes in these experiments. The data demonstrate common features of hormonal regulation of lipogenesis in human fibroblasts with liver and adipose tissue and substantiate the growing evidence that thyroid hormones are of major importance for the regulation of this process.

Effects of human low-density lipoproteins on the nucleotide patterns of cultured pig aortic endothelial cells.

Cultured pig aortic endothelial cells display significant changes in their nucleotide patterns after incubation with LDL-cholesterol purified from normal human plasma as determined by HPLC. Incubation at 70 mg/dl LDL-cholesterol for 24 h at 37 degrees C caused a significant decrease (P less than 0.001) in ATP from a control value of 14.0 +/- 0.4 nmol/mg protein to 6.6 +/- 0.9 nmol/mg protein (n = 4) with a concomitant increase in ADP and AMP. At higher LDL concentrations these effects were even more pronounced but still reversible. Akin to adenine nucleotides, the guanosine and uridine phosphates as determined by HPLC were changed. In contrast to LDL, HDL and VLDL were ineffectual.

The treatment of hypercholesterolemia with beta-pyridylcarbinol. Part 5. Report on 16 cases with severe hypercholesterolemia treated for 12 years.

A group of 78 patients with severe hypercholesterolemia (-X = 464 mg/dl) and symptoms of vascular disease of the heart, the extremities, or the brain, started a beta-pyridylcarbinol treatment with an average daily dosage of 1.2 g in 1964. In 1976 we could re-examine 12 patients, still on the same therapy. No myocardial infarction has occurred in this group since 1973, only 2 patients have had more attacks of angina pectoris that 1964. In contrast patients discontinuing therapy or replacing beta-pyridylcarbinol by other hypolipidemic drugs had a higher mortality.

Xeroradiographic determination of Achilles tendon thickness in familial hypercholesterolemia confirmed by tissue cultures.

Twenty-three patients with familial hypercholesterolemia (FHC) confirmed by tissue cultures of skin fibroblasts (2 homozygotes, 21 heterozygotes) and 3 patients with sporadic hypercholesterolemia were evaluated for Achilles tendon (AT) thickness by xeroradiography. Both homozygotes had thick ATs and coronary heart disease (CHD), 20 heterozygotes had thick ATs, but only 8 of them had CHD. One heterozygote had a small AT value, but CHD for a long time. The 3 patients with sporadic hypercholesterolemia, one with CHD, had small AT. There was no correlation between serum cholesterol concentration and AT thickness, between age and AT thickness, nor between AT thickness and CHD.

Effect of plasma exchange with and without concomitant drug treatment on lipids and lipoproteins in patients with familial hypercholesterolemia confirmed by tissue culture.

Repeated plasma exchange is an effective treatment for young patients with familial hypercholesterolemia. We treated 2 homozygous and 1 heterozygous patient with very high cholesterol levels with continuous plasma exchange using human albumin solution as exchange medium. The treatment was repeated every 2 weeks in 2 patients and weekly in the third. Treatment periods of plasma exchange alone and of plasma exchange with concomitant drug therapy were compared. For drug treatment beta-pyridylcarbinol, the alcohol corresponding to nicotinic acid (0.9 g/day equivalent to 3 g of nicotinic acid) and cholestyramine (16 g/day) were used. Plasma exchange alone resulted in a decrease of all lipids by 55% and of apolipoproteins by 50-60% as compared to the plasma levels before exchange. Subsequently all lipoproteins rose again to reach pre-exchange levels within about 2 weeks. There was no difference between the homozygous and the heterozygous patients. Beta-pyridylcarbinol or cholestyramine given concomitantly did not alter the post-exchange increase of total, LDL, HDL cholesterol nor of the corresponding apolipoproteins except of apolipoprotein B.

Relation of lipoprotein(a) to coronary heart disease and duplexsonographic findings of the carotid arteries in heterozygous familial hypercholesterolemia.

In familial hypercholesterolemia (FH) elevated Lp(a) concentrations are more frequent than in the general Caucasian population, but the clinical relevance of Lp(a) as a risk-factor in this group of patients is controversial. In 91 adult patients with heterozygous FH due to LDL-receptor defect we analyzed the correlation between Lp(a) concentrations, presence of coronary heart disease (CHD) and degree of atherosclerosis of the carotid arteries assessed by duplex scan. Coronary heart disease was present in 32 patients (24 males, 8 females). In the group without CHD the median of the Lp(a) distribution was 23 mg/dl, in the group with CHD 43 mg/dl (P < 0.05). The median of Lp(a) was 8 mg/dl in patients without pathological changes in the duplex scan of the carotids, 13 mg/dl in the group with intimal thickening, 25 mg/dl in patients with non-obstructing plaques, and 45 mg/dl in presence of > 30% luminal obstruction (P < 0.01). The role of Lp(a) as an independent risk factor was analyzed by stepwise logistic regression together with age, sex, LDL-, HDL-cholesterol, serum triglycerides, smoking status and presence of hypertension. For the prediction of CHD only age, HDL cholesterol and gender reached statistical significance. Lp(a) was, however, the lipoprotein parameter with the highest discriminative strength for the presence of a pathological duplex scan (P = 0.016), followed by LDL- (P = 0.03), and HDL-cholesterol (P = 0.03). These results provide direct evidence for a close correlation between Lp(a) and the rate of progression of atherosclerosis in FH, already at early, asymtomatic stages.

Familial defective apolipoprotein B-100: haplotype analysis of the arginine(3500)----glutamine mutation.

Familial defective apolipoprotein B-100 (FDB) is a recently identified, dominantly inherited genetic disorder, which leads to an increased serum level of low density lipoprotein (LDL) cholesterol with reduced affinity for the LDL receptor. It is postulated that this disorder results from a G to A mutation at nucleotide 10,708 in exon 26 of the apo B gene creating a substitution of glutamine for arginine in the codon for amino acid 3500. To investigate whether recurrent mutation has contributed to the high frequency of FDB, we have conducted a haplotype analysis in previously reported and newly detected FDB heterozygotes in Germany. 5 FDB families and 6 unrelated FDB heterozygotes were genotypes at 4 polymorphic sites in the 3' end of the apo B gene. These sites consisted of the diallelic markers XbaI, MspI, EcoRI and the hypervariable region (3'HVR). In 5 FDB families and 1 unrelated FDB heterozygote the arginine(3500)----glutamine mutation could be unambiguously assigned to the haplotype XbaI-/MspI+/EcoRI-/3'HVR48, in the other 5 FDB unrelated heterozygotes this finding was consistent with the combination of the genotype. The existence of the arginine(3500)----glutamine mutation on the same and supposedly rare allele suggests that the mutant alleles are identical by descent in our population. The fact that the same mutant allele was identified in North America and Austria suggests a common European origin of the arginine(3500)----glutamine mutation.

Familial defective apolipoprotein B100: clinical characteristics of 54 cases.

Familial defective apolipoprotein B100 (FDB) is a recently identified dominantly inherited genetic disorder, which is characterized by a decreased affinity of low density lipoprotein (LDL) for the LDL receptor. FDB is caused by a G to A mutation at nucleotide 10 708 in exon 26 of the apo B gene creating a substitution of glutamine for arginine in the codon for amino acid 3500. To determine the consequences of the arginine(3500)----glutamine mutation on plasma lipid levels and other clinical features, we have investigated 54 FDB heterozygotes from Germany (24 men, 30 women, mean age 37.2 (4-73) years). The average total cholesterol level in plasma was 308 mg/dl (average LDL-cholesterol 242 mg/dl), which was 116 mg/dl (120 mg/dl) above the 50th percentile of the age and sex-matched controls reported in the LRC population studies (Lipid Research Clinics' Program 1980). Tendon xanthoma and arcus lipoides were present in 25.9% and 22.2% of the patients, respectively. Plaques in the carotid arteries, determined by duplex scanning, were present in 38.9%, and coronary artery disease was present in 22.2%. This study shows that the combination of tendon xanthoma, arcus lipoides and premature atherosclerosis is no longer totally appropriate for the diagnosis of familial hypercholesterolemia (FH). It rather seems that these features are characteristic of a defective LDL receptor pathway, which could be caused by a defective LDL receptor or a defective ligand apo B100. The distinction between FH and FDB may have therapeutic implications, because certain lipid lowering drugs act by stimulation of the LDL receptor, which has a normal function in FDB.

Serum cholesterol levels in patients with familial hypercholesterolemia confirmed by tissue culture.

Sixty-two subjects from 23 families were evaluated by serum lipid analyses and tissue culture biochemistry in skin fibroblasts. In 53 cases from 19 families with proven familial hypercholesterolemia (FHC), fibroblast cultures were successful. In 45 of these cases (85%) the clinical diagnosis of hyper- or normocholesterolemia was in accordance with the tissue culture findings. Four patients 2-38 years old, had hypercholesterolemia but normal tissue culture results. Four patients, 18-44 years old, had normal serum cholesterol levels for their age and sex, but were heterozygotes according to tissue culture results. In the remaining four families only the propositus had hypercholesterolemia. All members of the families including the propositus had normal tissue culture determinations indicating that not all cases of idiopathic hypercholesterolemia are due to the Goldstein-Brown mechanism of defective LDL receptor function.

Genetic evidence from 7 families that the apolipoprotein B gene is not involved in familial combined hyperlipidemia.

Familial combined hyperlipidemia (FCHL) is the most common genetic form of hyperlipidemia in which affected individuals manifest multiple lipoprotein phenotypes. Although the molecular defect is still unknown, several kinetic studies have demonstrated increased turnover rates of apolipoprotein B (apo B) in patients with FCHL, irrespective of their lipoprotein phenotype. Using 3 restriction fragment length polymorphisms (RFLPs) of the apo B gene (XbaI, MspI and EcoRI) we have investigated 33 families which fulfill the diagnostic criteria of FCHL. No significant difference in allele frequency was found between 33 unrelated individuals with FCHL and 107 normolipidemic controls. 3-RFLP haplotypes were constructed in each pedigree. A co-segregation analysis was performed in 7 informative families. In no family was co-segregation observed between the haplotype of the apo B gene and the phenotype of FCHL. These data are not compatible with the hypothesis that FCHL is caused by mutations of the apo B gene acting as a simple mendelian trait.

Effect of triiodothyronine on triglyceride synthesis in human fibroblasts in different types of hypertriglyceridemia.

Fibroblasts from 12 normotriglyceridemic subjects and 30 hypertriglyceridemic patients and family members were used to investigate triglyceride synthesis and the influence of triiodothyronine on it. The monolayers were incubated for 72 hours with and without the thyroid hormone, followed by incorporation studies of radiolabeled acetic acid or palmitic acid into the cellular triglyceride fraction. Triiodothyronine had no influence on triglyceride synthesis of normal cell lines and of cells derived from patients with secondary hypertriglyceridemia, whereas fibroblasts from endogenous type IV patients showed higher rates of triglyceride synthesis under identical conditions. Values for type IV were in the range of 134% to 466% of the hormone-free control incubations. In cultures derived from patients with familial combined hyperlipidemia, no stimulation by triiodothyronine was observed: values were in the range of 64% to 144% of the hormone-free controls. Three out of four lines with type V gave "normal" values and are supposed to represent secondary hypertriglyceridemia, whereas one line may express endogenous type IV. The evidence obtained in vitro with cultured cells indicates different metabolic defects in endogenous type IV and familial combined hyperlipidemia; it also shows the biochemically heterogenous nature of the disease "hypertriglyceridemia."

The influence of dietary purines and pyrimidines on purine and pyrimidine biosynthesis in man.

Allopurinol-induced orotaciduria is reduced by dietary ribonucleic acid (RNA), RNA hydrolysate and different nucleotides. These findings are compatible with feedback regulation of pyrimidine biosynthesis by dietary nucleotides. Serum uric acid and urinary uric acid excretion on a purine-free isoenergetic diet reach a minimum after about 10 days and remain constant thereafter. When purines from different biochemical sources are added to such a diet there is always a linear relationship between dietary purines and serum uric acid level and urinary uric acid excretion. The findings suggest that dietary purines play a minor role if any in the regulation of purine biosynthesis in man.

[Plasma glucose, insulin and increased serum levels during continuous infusion of glucose in low dosages]. / Plasmaspiegel von Glucose, Insulin und weiteren Seruminhaltstoffen während kontinuierlicher Zufuhr kleiner Glucosemengen im Bereich des Grundumsatzes.

Metabolic reactions during long-time intravenous infusion of glucose in dosages according to basal energy requirements of man were investigated. Infusion of 0.2-0.4 g glucose/kg body weight/h led to the typical behaviour of blood glucose with an initial peak and a subsequent steady state. The steady state was dose-dependent and always higher than the starting value. Insulin always rose significantly with increasing scattering of the individual values with higher glucose loads. With 0.1 g glucose/kg/h, the steady state of blood glucose, after a minimal initial peak, was lower than the starting value, and no change of insulin in the peripheral venous blood could be observed. Free fatty acid levels initially always decreased, but rose again under low glucose loads (0.1 and 0.2g/kg/h). In all experiments, with an increase of insulin, a decrease of serum potassium was found. Sodium, calcium, bilirubin, creatinine and urea-N did not show any typical changes.

[Effects of formula diet with varying carbohydrate proportion on gut microflora in man]. / Verhalten der Darmflora des Menschen bei Formeldiäten mit wechselndem Kohlenhydratgehalt

The effects of conventional food and of formula diet on gut microflora were tested in six healthy persons. In comparison with conventional food, the total gut microflora concentrations slightly increased during formula diet with oligosaccharides. During the periods of formula diet rich in sucrose of maltose, total flora concentrations declined. These changes of total gut microflora were especially caused by the increase and decrease of the enterococci and enterobacteria, the bacteroides showing rather small changes. The concentrations of lactobacteria, sporeforming bacilli and yeasts decreased rapidly with formula diet and did not increase again until normal food was supplied.

Utilization of intravenous maltose.

Ten healthy male subjects received an infusion of 10% maltose solution at a rate of 0.5 g/kg body weight/h for 345 min. Blood maltose levels rose continuously for the first hours; after 285 min a constant level was maintained. Concomitantly increasing maltosuria occurred; the total renal maltose excretion averaged 30.4% of the administered dose. In addition to maltose losses, considerable glucosuria (up to 16% of total carbohydrate excretion) was found. The glucosuria occurred in spite of normal blood glucose levels. Serum insulin did rise during maltose infusion.

Acceleration of ethanol elimination with fructose in man.

The elimination of ethanol is known to be accelerated by fructose. Studies of continuous infusions of both ethanol and fructose as the basis for quantitative calculations are not available. In healthy volunteers fructose infusions were given for several hours during and immediately after the end of ethanol infusions. Both increase and elimination of ethanol in blood were effected to the same extent by fructose when compared to control experiments. Average increases in the elimination rates of ethanol were up to 80%; however, each subject displayed individual variations.

Demonstration of a combined deficiency of xanthine oxidase and aldehyde oxidase in xanthinuric patients not forming oxipurinol.

Genetic heterogeneity has been suggested in xanthinuria from the hitherto unexplained ability of some patients with this hereditary disorder to convert allopurinol to its active metabolite oxipurinol--an activity generally attributed to xanthine oxidase. This study provides evidence that the enzyme aldehyde oxidase is also deficient in xanthinuric patients not converting allopurinol to oxipurinol, whereas a xanthinuric patient with normal formation of oxipurinol had normal aldehyde oxidase activity. It is concluded that the enzyme aldehyde oxidase is the principal enzyme responsible for the formation of oxipurinol in man.

1-O-alkyl-2-O-acetyl-sn-glycero-3-phosphocholines: influence on aggregation and [3H]serotonin release of human thrombocytes.

1-O-Alkyl-2-O-acetyl-sn-glycero-3-phosphocholines (platelet activating factor, PAF) aggregate human thrombocytes in a concentration dependent fashion. After a short lag-phase, maximum aggregation is reached within 2 min. PAF releases serotonin from human thrombocytes within 1 min. Indomethacin and creatine phosphate (CP)/creatine phosphokinase (CPK) are able to inhibit the second phase of the aggregation by PAF, while xylocain reduces both the first and second phase of aggregation of human thrombocytes. Hirudine neither influences the first nor the second phase of aggregation by PAF.

Unsaturated 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholines (unsaturated platelet-activating factor): aggregation of human platelets after incubation with indomethacin, creatinephosphate/creatinephosphokinase, xylocain and hirudine, and serotonin release after incubation with indomethacin.

Unsaturated platelet-activating factor (PAF) aggregates thrombocytes of healthy female volunteers and releases within 1 min up to 30.95% of the platelet serotonin. Indomethacin does not inhibit the aggregation but reduces the release of serotonin induced by unsaturated PAF in citrated platelet-rich plasma (PRP). Creatinephosphate combined with creatinephosphokinase (CP/CPK) inhibits the second phase, whereas xylocain inhibits the first and second phase of aggregation induced by unsaturated PAF. Hirudine shows no influence on the aggregation induced by unsaturated PAF.