Central role of high density lipoprotein in plasma free cholesterol metabolism.

This study was designed to provide direct information on the in vivo metabolism in man of free (unesterified) cholesterol in the major lipoprotein classes. Five human subjects were administered one or two (simultaneous) of the following; [2-(14)C] mevalonic acid, high density lipoprotein (HDL)-free [(14)C] cholesterol, low density lipoprotein (LDL)-free [(14)C] cholesterol, and very low density lipoprotein (VLDL)-free [(3)H]cholesterol. Blood was then obtained at frequent intervals for at least 9 h, and the alpha(HDL) and beta(LDL + VLDL) lipoproteins were quickly separated by heparin-manganese precipitation to prevent ex vivo exchange of free cholesterol. After the administration of [(14)C]mevalonic acid the specific activity (disintegrations per minute/micromole) of free cholesterol in the alpha- and beta-lipoproteins increased for 3 h. During this period the alpha-free cholesterol specific activity was higher than the beta specific activity. After administration of VLDL and LDL labeled with free cholesterol, the alpha-free cholesterol specific activity reached a peak value within 20 min, at which time it was considerably lower than the beta-free cholesterol specific activity. When HDL labeled with free cholesterol was administered, a precursor product relationship was observed between the alpha-free cholesterol (precursor) and beta-free cholesterol (product) specific activities.A multicompartmental model was developed that contained the simplest structure necessary to fit all of the data obtained. The kinetic analysis revealed the presence of extensive exchange (20-85 mumol/min) of free cholesterol between HDL and a tissue pool(s) enriched with newly synthesized free cholesterol. It was found that virtually all (>95%) of the free cholesterol in the beta-lipoproteins (LDL+VLDL) cycles directly through HDL. The free cholesterol in LDL appears to behave in the same fashion as the free cholesterol in VLDL. The results show that there are marked differences in the kinetic behavior of the free cholesterol fractions of alpha- and beta-lipoproteins. There is extensive recycling of free cholesterol between HDL and tissue pools, and between HDL and the beta-lipoproteins; this recycling has been quantitated. The findings support the view that in vivo, the free cholesterol in HDL plays a central role in exchange reactions and in the vascular-tissue cholesterol transport system.

Spontaneous peritonitis due to Hemophilus influenzae in an adult.

Hemophilus influenzae, usually pathogenic in the pediatric population, caused septicemia and peritonitis in the cirrhotic adult described here. Susceptibility to this unusual adult pathogen was perhaps related to liver disease or corticosteroid treatment. This organism has not previously been associated with the syndrome of spontaneous bacterial peritonitis in an adult.