Proof of concept studies for tissue-protective agents in multiple sclerosis.

BACKGROUND: There is considerable interest in tissue-protective treatments for multiple sclerosis (MS). METHODS AND OBJECTIVES: We convened a group of MS clinical trialists and related researchers to discuss designs for proof of concept studies utilizing currently available data and assessment methods. RESULTS: Our favored design was a randomized, double-blind, parallel-group study of active treatment versus placebo focusing on changes in brain volume from a post-baseline scan (3-6 months after starting treatment) to the final visit 1 year later. Study designs aimed at reducing residual deficits following acute exacerbations are less straightforward, depending greatly on the anticipated rapidity of treatment effect onset. CONCLUSIONS: The next step would be to perform one or more studies of potential tissue-protective agents with these designs in mind, creating the longitudinal data necessary to refine endpoint selection, eligibility criteria, and sample size estimates for future trials.

Lipoprotein composition as a component in the lipoprotein clearance defect in experimental diabetes.

The hypertriglyceridemia associated with streptozotocin-induced diabetes in rats is largely reflected in the plasma lipoproteins of density less than 1.006 g/ml. Analysis of the plasma apolipoproteins of these rats indicated marked alterations in both the total levels and in the lipoprotein distribution of the major apolipoproteins. In whole plasma, diabetes was associated with significant increases in apolipoprotein (apo)-AIV, apo-AI, and apo-B (mainly in the intestinally derived apo-B240) and a marked decrease in apo-E. In the d less than 1.006 g/ml lipoprotein fraction (very-low-density lipoproteins (VLDL], there were significant increases in apo-B240, apo-AI, and apo-AIV and decreased levels of apo-E and the C apolipoproteins. The decrease in apo-C was primarily due to lower levels of apo-CII, and the ratio of the lipoprotein lipase inhibitor, apo-CIII, to the lipoprotein lipase activator, apo CII, was significantly increased over that in controls. The comparative clearance of triglycerides of VLDL particles from control and diabetic rat plasma was tested in recirculating heart perfusion in vitro. During 45-min perfusions of hearts from control donor rats, lipolysis of triglycerides of VLDL from diabetic rats was only 63-64% of that using plasma VLDL from control rats. Perfusion of hearts from diabetic rats with VLDL from control rats gave lipolysis values of only 53% of that obtained with normal hearts. Where both the VLDL and hearts were obtained from diabetic rats, lipolysis was 23% of that observed when both the lipoprotein and the organ were from control rats. The data suggest that in addition to depressed lipoprotein lipase activity in the tissue from diabetic rats, there are also major compositional changes in circulating lipoproteins which may contribute to defective triglyceride clearance from the circulation.

Application of SDS gradient polyacrylamide slab gel electrophoresis to analysis of apolipoprotein mass and radioactivity of rat lipoproteins.

An application of SDS gradient polyacrylamide slab gel electrophoresis to the analysis of lipoprotein polypeptides is described. The 10-15% polyacrylamide gradient provides a high degree of resolution and sensitivity resulting in a single separation of the major apoproteins which can be easily visualized. When combined with autofluorography, individual protein mass and radioactivity can be determined densitometrically while still retaining excellent resolution. Examples of rat lymph and plasma apolipoproteins are shown, and apparent heterogeneity of certain apoprotein subgroups is described.

Insulin-mediated modifications of myocardial lipoprotein lipase and lipoprotein metabolism.

Recirculating organ perfusion in vitro was conducted with hearts from control rats, animals given a single dose of streptozotocin (65 mg/kg) 48 h earlier, and streptozotocin-treated rats administered insulin (5 units), 2 h prior to organ perfusion. During 45-min perfusions, the lipolysis of very low density lipoprotein (VLDL) triglyceride was significantly less in hearts from diabetics than in controls (41.9 +/- 7.3% of control). This was associated with significant reductions in heparin-releasable (functional) lipoprotein lipase and tissue lipoprotein lipase of perfused hearts. The decreases in VLDL triglyceride metabolism and the levels of myocardial lipoprotein lipase were completely reversed by treatment of diabetic rats with insulin 2 h prior to study. Similar improvement of VLDL triglyceride metabolism and increases in myocardial lipoprotein lipase activity were observed in hearts from diabetic rats by direct addition of 100 milliunits/ml of insulin to the recirculating perfusion media. Under these conditions, the increase in both fractions of lipoprotein lipase in response to insulin was completely inhibited, and utilization of VLDL triglyceride was partially inhibited by pre-perfusion with cycloheximide for 10 min. The data derived from either VLDL triglyceride lipolysis in organ perfusion or direct measurement of myocardial lipoprotein lipase demonstrate a direct effect of insulin on myocardial lipoprotein lipase activity, and suggest that the response to insulin may be due in part to effects on protein synthesis.

Metabolism of fatty acid, glycerol and a monoglyceride analogue by rat cardiac myocytes and perfused hearts.

Studies have been conducted on the uptake and metabolism of unesterified fatty acid, free glycerol and 1-hexadecyl glyceryl ether by rat cardiac myocytes, and of fatty acid, intact triglyceride and the glyceryl ether by perfused rat hearts. Cardiac myocytes efficiently extracted, oxidized and esterified oleic acid, but demonstrated little ability to utilize free glycerol. Although the glyceryl ether was efficiently extracted by myocytes, it was neither hydrolyzed or esterified. The perfused heart also extracted and metabolized unesterified fatty acid, and the fatty acid released during lipolysis of circulating lipoprotein triglyceride. The glyceride glycerol, however, was largely recovered (90%) in the perfusate suggesting inefficient myocardial utilization of either free glycerol or partial glycerides. Myocardial extraction of glyceryl monoether was demonstrated, but the monoglyceride analogue was also unmetabolized by intact heart tissue. The results suggest that if monoglycerides are produced by the action of lipoprotein lipase on circulating triglycerides, reutilization of intact monoglycerides for higher glyceride synthesis is not a major fate of these products.

Role of high density lipoproteins in regulation of hepatic fatty acid synthesis by chylomicron and very low density lipoprotein remnants.

High density lipoproteins (HDL) have been implicated in the transformation of native triglyceride-rich lipoproteins into their corresponding remnant particles during the action of peripheral lipoprotein lipase. The subsequent metabolism of these remnant particles by the liver results in the inhibition of hepatic lipogenesis. In the present study, remnant particles of chylomicrons or very low density lipoproteins (VLDL) have been generated in the perfused heart system both in the absence and presence of HDL. These have been characterized chemically, and the effects of both native lipoproteins and their respective remnants on fatty acid synthetic rates of hepatocytes have been assessed. Thirty to sixty-six per cent of the triglyceride moieties of native lymph chylomicrons or VLDL were hydrolyzed during a 45-min heart perfusion whether or not HDL was present in the perfusion media. Chylomicron remnants produced in the absence of HDL (25-300 micrograms/ml) caused only 10-20% inhibition of hepatic fatty acid synthesis, whereas remnants produced in the presence of HDL caused up to 78% inhibition at equivalent protein concentrations. The nonsuppressive remnants (produced in the absence of HDL) were converted to suppressive remnants upon incubation with HDL. Similar results were obtained with VLDL remnants produced in the absence and presence of HDL. The sodium dodecyl sulfate-polyacrylamide gel electrophoresis apoprotein profiles of the nonsuppressive and suppressive remnants indicated a marked loss of the C apoproteins during the conversion of native chylomicrons or the nonsuppressive remnants to the suppressive remnants. Thus, HDL seems to be required for the removal of apoprotein C during the transformation of triglyceride-rich lipoproteins to the suppressive remnants. There was, however, no enrichment of apo-E on the suppressive remnant particles. We, thus, could not verify the suggested role of HDL in enriching the suppressive remnants with apoproteins E.

Comparative metabolism of free and esterified fatty acids by the perfused rat heart and rat cardiac myocytes.

Studies have been conducted on the uptake and metabolism of unesterified oleic acid and lipoprotein triacylglycerol by the perfused rat heart, and of oleic acid, free glycerol and lipoprotein triacylglycerol by rat cardiac myocytes. The perfused heart efficiently extracted and metabolized unesterified fatty acid and the fatty acid released during lipolysis of the recirculating triacylglycerol. The released glyceride glycerol, however, was largely accumulated in the perfusion media. Cardiac myocytes also extracted and rapidly metabolized unesterified fatty acid. As with the intact heart, free glycerol was poorly utilized by cardiac myocytes. Although the cells appeared to extract a small amount of available extracellular triacylglycerol presented as very low density lipoprotein, this was shown to be unmetabolized, suggesting adsorption rather than surface lipolysis and uptake of the released fatty acid. The data suggest that myocytes are unable to metabolize triacylglycerol fatty acids without prior lipolysis by extracellular (capillary endothelial) lipoprotein lipase.