Unusual familial lipoprotein C-III associated with apolipoprotein C-III-O preponderance.

Among 256 consecutive subjects so far studied in our laboratory, we found one subject (a 63-year-old female) whose very low density lipoprotein (VLDL) and high density lipoprotein (HDL) contained unusually high amounts of apolipoprotein C-III-O among apolipoprotein C-III polymorphic forms. Identification of apolipoprotein C-III-O was achieved by a combination of basic polyacrylamide gel electrophoresis, isoelectric focusing and sialidase treatment of plasma apolipoproteins. This unusual lipoprotein was inherited by two of her four children without the manifestation of clinical symptoms. Triacylglycerols and cholesterol concentrations of VLDL, low density lipoprotein (LDL) and HDL fractions, and serum apolipoprotein C-III levels of the three subjects with apolipoprotein C-III-O were within the normal range, as estimated by rocket immunoelectrophoresis. Our results clearly demonstrated that the unusual lipoproteins with the preponderance of apolipoprotein C-III-O among apolipoprotein C-III polymorphic forms were genetically determined. These cases may be a new type of genetic lipoprotein disorder.

Determination of the lipase stereoselectivities using circular dichroism (CD); lipases produce chiral di-O-acylglycerols from achiral tri-O-acylglycerols.

A general method was described to determine the optical purity of 1,2 (or 2,3)-di-O-acylglycerols via a key compound, 3 (or dibenzoyl-sn-glycerol (3 or 3'). The chiral di-O-acylglycerols were first silylated and the acyl groups were removed by the Grignard degradation to 3 (or 1) O-tert-butyldimethylsilyl-sn-glycerol and subsequent benzoylation lead to the key compound 3 or 3' without racemization. The optical purity was determined from the strong exciton Cotton effect of 3 (+) or 3' (-) at 238 nm in the concentration of ca. 1 mM. The method was successfully applied to determine the stereoselectivities of lipases (EC 3.1.1.3) from three origins, bacteria, mammal and fungus such as Pseudomonas (AP, 89% optical purity, sn-1 preference), porcine pancreatin (PPL, 9.3% optical purity, sn-3 preference) and Candida (CC, sn-2 preference) using tripalmitin. The similar studies were extended to tri-O-benzoylglycerol (6) and tri-O-(cyclohexanecarbonyl)glycerol (5). All the enzymes showed high stereoselectivities with tri-O-benzoylglycerol. PPL and AP showed high and low stereoselectivities with tri-O-(cyclohexanecarbonyl)glycerol, while low and high stereoselectivities with tri-O-palmitoylglycerol, respectively. The results show that the stereoselectivities are ruled by the origins of lipases and acyl groups. The structures of the recognition site might be associated with enantioselectivities of the enzymes.

A convenient evaluation of the stereoselectivity of lipase-catalyzed hydrolysis of tri-O-acylglycerols on a chiral-phase liquid chromatography.

A general method was developed using chiral-phase chromatography in order to evaluate the stereoselectivities of lipases-catalyzed hydrolysis of tri-O-acylglycerols independent of acyl groups. 1,2-Di-O-acyl-sn-glycerols or its enantiomer 2,3-di-O-acyl-sn-glycerols in the enzymatic reaction mixtures were derivatized to the key compound, 1,2-di-O-benzoyl-3-O-tert-butyldimethylsilyl-sn-glycerol 2 (+) or its enantiomer 2' (-), respectively. The enantiomers were separated on a chiral-phase HPLC, and the method was highly sensitive to determine the stereoselectivities of lipases.

Role of alpha 2-adrenergic receptor in platelet activation during insulin-induced hypoglycemia in normal subjects.

The effects of alpha 2-adrenergic-receptor blocker mianserin on the responses of blood glucose, plasma beta-thromboglobulin (beta-TG), and various counterregulatory hormones to insulin-induced hypoglycemia were studied in nine healthy male subjects. The alpha 2-adrenoceptor-blocking action of mianserin was confirmed by its inhibitory effect on platelet activation in vitro. Mianserin was given orally 90 min before insulin injection; the same study without mianserin was performed on another day as the control study. The time courses of blood glucose and serum C-peptide (0, 20, 45, and 180 min after the insulin injection) were identical in both studies, indicating that mianserin has no effect on these parameters. However, a significant increase of beta-TG at 45 min after insulin injection was completely suppressed by the administration of mianserin (mean +/- SE, 68.5 +/- 6.0 vs. 28.8 +/- 7.6 ng/ml, n = 6, P less than .05). No significant differences were obtained between the two studies in the responses of plasma or serum catecholamines, cortisol, glucagon, growth hormone, thromboxane B2, and 6-ketoprostaglandin F1 alpha. These results suggest that epinephrine is responsible for some, if not all, of the beta-TG release from the platelets during insulin-induced hypoglycemia.

Blocking 3-hydroxy-3-methylglutaryl coenzyme A reductase with ML-236B enhances the plasma cortisol response to adrenocorticotropin in patients with hypercholesterolemia.

The effect of ML-236B, a specific inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, on serum lipids and plasma cortisol responses to ACTH were studied in 11 hypercholesterolemic patients. Mean serum total cholesterol decreased significantly [279 +/- 57 (SD) mg/dl to 213 +/- 48 mg/dl], as did serum triglycerides (211 +/- 140 mg/dl to 166 +/- 125 mg/dl) and low density lipoprotein cholesterol (195 +/- 49 mg/dl to 139 +/- 47 mg/dl), after ML-236B treatment for 12 weeks in doses ranging from 15-60 mg/day. The mean basal plasma cortisol level was not changed after ML-236B treatment, but the mean absolute increment in plasma cortisol increased from 15.4 +/- 3.4 to 26.7 +/- 8.4 micrograms/dl (P less than 0.005) after treatment. These data demonstrate a new effect of a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase in human adrenal tissue.

Physical fitness. Its contribution to serum high density lipoprotein.

The effects of exercise conditioning on serum high density lipoprotein cholesterol (HDL-C) were studied using 20 members of a regular joggers club and other healthy non-member subjects of varying degrees of habitual physical activity (253 males and 391 females). Both the HDL-C and HDL-C/serum total cholesterol (TC) levels were significantly higher with the 20 regular joggers than with the sedentary controls matched for age, TC, serum triglycerides (TG) and weight index (WI). A significant correlation was found between HDL-C/TC and the exercise conditioning value obtained by using the results of the 12-min performance test as an index among the non-member subjects. In order to ascertain the relative significance of exercise conditioning in influencing HDL-C/TC, a multiple regression analysis was conducted using HDL-C/TC as the variable criterion. The results showed that TG affected HDL-C/TC the most among both males and females, while exercise conditioning affected it second among males and fourth among females.

Influence of apolipoprotein E polymorphism on plasma lipid and apolipoprotein levels, and clinical characteristics of type III hyperlipoproteinemia due to apolipoprotein E phenotype E2/2 in Japan.

Apolipoprotein (apo) E phenotype was examined in 188 healthy subjects and in 447 patients seen between 1984 and 1986. The frequency of the apo E2, 3, and 4 genes in the clinically healthy subjects was 0.035 +/- 0.0288, 0.872 +/- 0.0310, and 0.093 +/- 0.0152, respectively. The frequency of the apo E3 gene was higher and that of the apo E genes 2 and 4 lower than that reported in western countries. Clinical features and apo E phenotype are presented from the 5 patients with type III hyperlipoproteinemia (HLP) due to apo E phenotype E2/2 (E2-III); all patients in E2-III were post-menopausal women. In contrast to the clinical characteristics so far reported, no notable findings of atherosclerosis, such as coronary angiographic findings or xanthoma, were evident in any of these 5 patients. Glucose intolerance was seen in 4 of them. Four patients were normolipidemic with apo E phenotype E2/2 (E2-N). In addition, plasma lipid and apolipoprotein concentrations were determined in patients with different apo E phenotypes. Plasma total cholesterol (TC) and apo B levels were elevated in the order of E2-N, E2/3, E2/4, E3/3, E3/4 and E4/4 except for E2-III. The plasma apo E level was highest in E2-III but was not significantly different from other phenotypes. The apo B/apo E and apo C-III/apo E ratios were significantly lower in E2/2 than in other phenotypes. The TC/apo B ratio was significantly higher in E2/2 than in other phenotypes.

Cerebral and aortic atherosclerosis in Hisayama, Japan.

This study of autopsy cases in the general population of the town, Hisayama, describes the incidence and severity of aortic and cerebral atherosclerosis in Japan. Atherosclerosis was more severe in the aorta than in the cerebral arteries of all age groups and its disparity became more conspicuous with age. In hypertensive cases, atherosclerosis was more severe in both the aorta and the cerebral arteries from and beyond the 6th decade of age. The severity of atherosclerosis in the aorta in those with systolic hypertension was lower under the age of 79 and higher after the age of 80 than in diastolic hypertension; the cerebral arteries were afflicted similarly by the two forms of hypertension. The serum cholesterol level correlated better with the severity of aortic than cerebral atherosclerosis.

Effects of plasmapheresis on familial type III hyperlipoproteinemia associated with glomerular lipidosis, nephrotic syndrome and diabetes mellitus.

A 59-year-old woman, one of 5 cases with familial type III hyperlipoproteinemia reported at our clinic to date, had nephrotic syndrome and diabetes mellitus, but had neither coronary atherosclerosis nor xanthoma. A renal biopsy specimen revealed a massive cluster of foam cells containing apolipoprotein B and E in the mesangial region of the kidney. A restricted diet intake combined with lipid-lowering drugs such as cholestyramine, clinofibrate, and bezafibrate, in addition to methylprednisolone was not very effective in lowering serum triglyceride and cholesterol levels within physiological ranges. Therefore, plasmapheresis, using a dextran sulfate-cellulose column, was performed. Repeated plasmapheresis resulted in a marked decrease in both serum total cholesterol and triglyceride. A second renal biopsy specimen performed 2 years later revealed a marked reduction in foam cells with concurrent improvement in her nephrotic syndrome and glucose intolerance. These results suggest that familial type III hyperlipoproteinemia may be responsible for glomerular lipidosis resulting in nephrotic syndrome. They also indicate that plasmapheresis using a dextran sulfate-cellulose column is very effective in the removal of abnormal lipoproteins such as beta-very low density lipoprotein and intermediate density lipoprotein in a case of familial type III hyperlipoproteinemia.

Proteolytic digestion of human serum apolipoproteins by porcine pancreatic elastase.

We studied the proteolytic action in vitro of free and alpha 2-macroglobulin-bound porcine pancreatic elastase [EC 3.4.21.11] on the apolipoproteins of plasma: very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL). Polyacrylamide gel electrophoresis, isoelectric focusing and immunodiffusion tests of elastase-treated plasma lipoproteins revealed that apolipoprotein C-II and C-III polypeptides were more susceptible to elastase in free form than plasma apolipoproteins (A-I, A-II, B, and E). Elastase bound to alpha 2-macroglobulin did not show any such activities.

Relationship between platelet phospholipase activity and plasma in ischemic heart disease.

Platelet phospholipase plays an important role in the metabolic responses of platelets to exogenous stimuli. The platelet phospholipase activity (PLA) was therefore studied in 38 patients with ischemic heart disease (IHD) and in 26 age-matched normal subjects who served as controls. The mean platelet PLA in the IHD group was 12.72 +/- 1.03 nmol/mg protein/30 sec which was significantly (p less than 0.005) higher than that of the normal controls (8.72 +/- 0.76). When they were classified into acute stage, such as unstable angina or acute myocardial infarction (AMI), and chronic stage, such as stable angina or old myocardial infarction (OMI), there was no significant difference between them. On the other hand, about two-fold activation of platelet PLA was observed in acute stage IHD, and 20-30% inhibition of it was demonstrated in chronic stage IHD following the addition of autologous plasma to washed platelet suspensions, suggesting that certain plasma factor(s) are responsible for such phenomena. In an attempt to identify these plasma factor(s), various substances such as serum albumin, high density lipoprotein, prostaglandin E1 (PGE1) and E2 (PGE2), and platelet activating factor were assessed by in vitro experiments. Only PGE1 and PGE2 revealed a significant effect on the platelet PLA. The relationship between plasma and platelet activity in terms of platelet PLA deserves attention since it varies according to the type and stage of IHD.

Idiopathic thrombocytopenic purpura subsequent to Graves' disease and insulin-dependent diabetes mellitus.

We report a woman with idiopathic thrombocytopenic purpura (ITP) subsequent to Graves' disease and insulin-dependent diabetes mellitus (IDDM). The patient was affected by Graves' disease at the age of 29 and developed IDDM the following year. The ITP occurred after 8 years of well-controlled Graves' disease and IDDM with appropriate treatment, but subsided with prednisolone therapy, followed by splenectomy. Graves' disease was observed also in the parents. The serum anti-thyroid-microsome antibody, anti-parietal-cell antibody, anti-pancreas-islet-cell antibody and anti-platelet antibody were all positive. HLA analysis revealed that haplotypes including DR4, DRw9 and DRw53 were positive in both the patient and her mother. In Japanese IDDM patients with autoimmune diseases, these three haplotypes have been reported to be significantly frequent. These findings indicate that the patient of this study is a typical case of the primary autoimmune type of diabetes mellitus proposed by Irvine and Bottazzo. However, the combination of Graves' disease, IDDM and ITP has not been hitherto reported to our knowledge.

Localized pericarditis with calcifications mimicking a pericardial tumor.

A 62-year-old man was admitted with increasing palpitations. Radiography of the chest demonstrated a calcified mass. Magnetic resonance imaging revealed compression of the right ventricle by a tumor. At the time of cardiac catheterization, the coronary arteries were found not to supply blood flow of the mass, and no dip-and-plateau pattern was seen in the right ventricular pressure measurements. At the time of surgery, the mass was found to be a focal calcified thickening of the pericardium containing only pus. The thickening resembled an oval pericardial tumor. Microbiologic examination of the pus revealed Propionibacterium acnes.