High carbohydrate fat-free diet modulates epitope expression of LDL-apoB-100 and interaction of LDL with human fibroblasts

Structure of the LDL receptor extracellular domain at endosomal pH

The low-density lipoprotein receptor mediates cholesterol homeostasis through endocytosis of lipoproteins. It discharges its ligand in the endosome at pH < 6. In the crystal structure at pH = 5.3, the ligand-binding domain (modules R2 to R7) folds back as an arc over the epidermal growth factor precursor homology domain (the modules A, B, beta propeller, and C). The modules R4 and R5, which are critical for lipoprotein binding, associate with the beta propeller via their calcium-binding loop. We propose a mechanism for lipoprotein release in the endosome whereby the beta propeller functions as an alternate substrate for the ligand-binding domain, binding in a calcium-dependent way and promoting lipoprotein release.

Effect of n-3 fatty acids on the composition and binding properties of lipoproteins in hypertriglyceridemic patients

BACKGROUND

Treatment of hyperlipidemic patients with fish oil results in an increase in plasma LDL cholesterol despite a marked decrease in the LDL precursor, VLDL.

OBJECTIVE

We studied the relation between VLDL composition and LDL concentrations.

DESIGN

Fourteen hypertriglyceridemic patients were treated with encapsulated fish oil (containing 1.45 g eicosapentaenoic acid and 1. 55 g docosahexaenoic acid/d) for 4 wk. Venous blood samples were collected before and after treatment. Eleven normolipidemic subjects served as a control group.

RESULTS

Fish oil effectively lowered plasma lipid and apolipoprotein (apo) E concentrations in the hypertriglyceridemic patients, whereas apo B concentrations increased. The lipid and apolipoprotein content of VLDL decreased, whereas LDL cholesterol and LDL apo B increased. Fractionation of VLDL by heparin-affinity chromatography showed that before treatment hypertriglyceridemic patients had more VLDL in the 0.05-mol NaCl/L subfraction and less in the 0.20-mol/L subfraction than did control subjects (P < 0.05), whereas the subfraction distribution pattern was normalized after fish-oil treatment. Nevertheless, plasma concentrations of the 0.05-mol NaCl/L subfraction were decreased and those of the 0.20-mol/L subfraction were increased in hypertriglyceridemic patients after fish-oil treatment (P < 0.05). Fish-oil treatment both enhanced VLDL binding and lowered LDL binding to fibroblasts.

CONCLUSION

Treatment of hypertriglyceridemic patients with fish oil caused differential effects on VLDL subfractions and decreased LDL binding to fibroblast receptors, which may have contributed to the paradoxical increase in LDL-cholesterol concentrations.

A very low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins

BACKGROUND

We found previously that men with a predominance of large LDL particles (phenotype A) consuming high-fat diets (40-46% fat) show less lipoprotein benefits of low-fat diets (20-24% fat) than do men with a high-risk lipoprotein profile characterized by a predominance of small LDL (phenotype B). Furthermore, one-third of men with phenotype A consuming a high-fat diet converted to phenotype B with a low-fat diet.

OBJECTIVE

We investigated effects of further reduction in dietary fat in men with persistence of LDL subclass phenotype A during both high- and low-fat diets.

DESIGN

Thirty-eight men who had shown phenotype A after 4-6 wk of both high- and low-fat diets consumed for 10 d a 10%-fat diet (2.7% saturates) with replacement of fat with carbohydrate and no change in cholesterol content or ratio of polyunsaturates to saturates.

RESULTS

In 26 men, phenotype A persisted (stable A group) whereas 12 converted to phenotype B (change group). LDL cholesterol did not differ from previous values for 20-24%-fat diets in either group, whereas in the change group there were higher concentrations of triacylglycerol and apolipoprotein B; greater mass of HDL, large LDL-I, small LDL-III and LDL-IV, and HDL3; lower concentrations of HDL cholesterol, apolipoprotein A-I; and lower mass of large LDL-I and HDL2.

CONCLUSIONS

There is no apparent lipoprotein benefit of reduction in dietary fat from 20-24% to 10% in men with large LDL particles: LDL-cholesterol concentration was not reduced, and in a subset of subjects there was a shift to small LDL along with increased triacylglycerol and reduced HDL-cholesterol concentrations.

High fat, high cholesterol diets alter low density lipoprotein size and binding affinity in monkeys

The purpose of this study was to examine the effects of various dietary fats on low density lipoprotein (LDL) binding in an in vitro system where receptor number is not regulated. Cynomolgus monkeys were fed diets containing 37% of energy from fat, with various degrees of saturation, and 0.4 mg/kcal cholesterol or low-fat (13% of energy), low cholesterol (0.03 mg/kcal) chow. Plasma LDL was isolated after 16 weeks. The fatty acid composition of LDL showed enrichment corresponding to the dietary fats consumed, and the high fat, high cholesterol diets produced marked hypercholesterolemia compared to chow feeding. Of those fed the high fat diets, monkeys fed the fish oil diet had the highest LDL cholesterol concentrations, 13.25 +/- 0.77 mmol/l, while those fed the safflower oil diet had the lowest, 7.51 +/- 3.31. LDL from chow fed monkeys had the lowest binding affinity; the Kd was 26.2 +/- 8.7 microg/ml, nearly twice that of the high fat diets (P = 0.003). No significant differences in binding were found between the different high fat diets, although there was a trend toward lower affinity in the diets enriched in polyunsaturated fat. LDL size was affected by diet with chow fed monkeys having the smallest average LDL, 259.3 +/- 1.7 A compared to the other groups (P = 0.03). Monkeys fed the fish oil diet tended to have smaller LDL, but this was not significantly different from the other high fat diets. Binding affinity was correlated with LDL size, r = 0.54, P < 0.01. LDL composition, as measured by apo B/cholesterol ratio, was altered by feeding a high fat, high cholesterol diet. The ratio was reduced in the LDL samples from monkeys fed the high fat diets compared to those fed chow, but this ratio was not significantly correlated with binding. Thus, it appears that increasing dietary fat and cholesterol intake increases LDL size and binding affinity, such that LDL metabolism may be altered independently from effects on receptor number; the type of dietary fat does not seem to influence this process when fat and cholesterol content is very high.

Carbohydrate-fat exchange and regulation of hepatic cholesterol and plasma lipoprotein metabolism in the guinea pig

Adult female guinea pigs were fed semipurified diets containing increasing concentrations of saturated fat (2.5%, 7.5%, 15%, and 25% wt/wt) to determine effects of exchanging fat-carbohydrate calories on lipoprotein metabolism. Plasma very-low-density lipoprotein (VLDL) and high-density lipoprotein (HDL) did not vary but plasma low-density lipoprotein (LDL) concentrations increased with increasing fat calories. LDL cholesterol values were 42 +/- 25, 61 +/- 17, 92 +/- 25, and 98 +/- 21 mg/dL (mean +/- SD, n = 5), respectively. The relative proportion of cholesteryl ester increased and triacylglycerol (TAG) decreased for VLDL, LDL, and HDL as dietary fat increased. Plasma lecithin cholesterol acyltransferase (LCAT) activity was positively correlated with HDL cholesteryl ester content. Hepatic cholesterol and TAG concentrations were highest in animals fed 25% fat (P < .01). Hepatic apolipoprotein (apo) B/E receptor maximal binding capacity (Bmax) was 30% higher in animals fed 2.5% and 7.5% fat as compared with those fed 15% and 25% fat (P < .01) and inversely correlated with plasma LDL (r = -.85, P < .01). In contrast, HDL binding to guinea pig hepatic membranes exhibited a significant positive correlation with dietary fat quantity (r = .98, P < .001), consistent with a dose-response with increasing fat calories. The activity of hepatic 3-hydroxy-3-methyl glutaryl coenzyme A (HMG CoA) reductase was not affected by the amount of dietary fat, whereas the activity of acyl CoA:cholesterol acyltransferase (ACAT) was significantly increased in animals fed 25% fat (P < .05). Hepatic free-cholesterol and ACAT activity exhibited a positive correlation for all dietary groups (r = .75, P < .001). These results demonstrate that exchange of saturated dietary fat for carbohydrate calories results in significant modifications in the regulation of metabolic pathways that determine plasma LDL concentrations and hepatic cholesterol homeostasis.

Low density lipoprotein isolated from patients with essential hypertension exhibits increased propensity for oxidation and enhanced uptake by macrophages: a possible role for angiotensin II

In patients with essential hypertension, the increased risk for atherosclerosis is related not only to the blood pressure levels per se, but also to other, unknown, factors. Recent observations have indicated that oxidation of low density lipoprotein (LDL) and macrophage uptake of oxidized LDL are implicated in human atherosclerosis. We tested both the susceptibility of LDL, derived from hypertensive patients, to lipid peroxidation as well as its uptake by macrophages, in comparison with control LDL obtained from healthy subjects. The LDL that was derived from 25 patients with essential hypertension demonstrated increased propensity for lipid peroxidation with a 63%, 91% and 69% elevation in the content of the lipoprotein malondialdehyde, peroxides and conjugated dienes, respectively, in comparison with control LDL. Minimally modified LDL (MM-LDL) (prepared by 6 months' storage of the LDL at 4 degrees C) derived from the hypertensive patients also demonstrated increased lipid peroxidation with a 94%, 130% and 96% elevation in lipoprotein malondialdehyde, peroxides and conjugated dienes, respectively, compared with the control LDL. The susceptibility of the patients' LDL to lipid peroxidation decreased by 32% and 44% (measured as malondialdehyde) after 3 weeks of therapy with the angiotensin converting enzyme inhibitors captopril and enalapril, respectively, with no parallel reduction in the patients' blood pressure. The patients' LDL was shown to contain increased content of lipid peroxides and unsaturated fatty acids, which may explain its increased susceptibility to lipid peroxidation. In vitro experiments revealed that LDL can bind angiotensin II, and that angiotensin II has a stimulatory effect on copper-mediated oxidation of LDL, as well as on LDL degradation by macrophages. These results were secondary to cell-mediated oxidation of the LDL and to its cellular uptake via the scavenger receptor. We conclude that LDL derived from patients with essential hypertension is more susceptible to lipid peroxidation than control LDL, and this may be secondary to angiotensin II stimulation of LDL lipid peroxidation in these patients. Furthermore, this LDL demonstrates enhanced cellular uptake by macrophages in comparison with normal LDL which can also be related to angiotensin II-mediated LDL oxidation. Both these phenomena have been shown to be associated with accelerated atherosclerosis, and thus suggest a new mechanism for increased atherogenecity in hypertensive patients.

Modulation of the expression of human LDL-Apo B-100 epitopes by lipids and apolipoproteins

The purpose of the present study was to determine the immunochemical properties of apolipoprotein (apo) B-100 associated with low density lipoprotein (LDL) in relation to lipid and apolipoprotein composition. LDLs were isolated by sequential ultracentrifugation (1.019 < d < 1.050 g/mL) from two healthy volunteers and 21 dyslipidemic patients to obtain heterogeneous samples of LDL. Lipid (free cholesterol, cholesteryl esters, triglycerides, and phospholipids) and apolipoprotein contents (apo B, apo C-III, apo E) were determined in each LDL sample. Immunoreactivities of apo B were tested in solid-phase competitive-binding radioimmunoassays using seven monoclonal anti-LDL antibodies that reacted with defined epitopes of apo B-100. The relation between lipid and/or protein variables and the immunoreactivity of apo B was evaluated by successive use of Spearman's rank simple correlation, partial correlation, and canonical correlation analyses. The canonical correlation analysis showed that apo B-100 immunoreactivity on LDL is highly dependent on lipid and apolipoprotein composition simultaneously. The results confirmed the influence of surface and core lipids on the expression of the apo B-100 epitopes, independent of their location on the molecule. However, the lipid requirement of LDL strongly influences the expression of epitopes mapped in the LDL receptor-recognition domain. In contrast to apo E, apo C-III does not seem to influence the expression of the apo B-100 epitopes in the LDL range studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased receptor binding of low-density lipoprotein from individuals consuming a high-carbohydrate, low-saturated-fat diet

The substitution of saturated fat by complex carbohydrate, according to current dietary recommendations, results in a decrease of plasma and low-density lipoprotein (LDL) cholesterol levels. To determine whether this decrease might result from structural and thus functional changes in LDL particles, the binding internalization and degradation of 125I-LDL were measured using TR715-19 cells, a mutant CHO line into which has been transfected the human LDL receptor, and in which measurements of binding are highly reproducible. Eleven nondiabetic subjects (35 +/- 4 years, 27% +/- 3% body fat) were studied after they had 15% protein, and 560 mg cholesterol/d and the other containing 21% fat (6% saturated), 65% carbohydrate, 14% protein, and 524 mg cholesterol/d.LDL cholesterol levels decreased form 125 +/- 6 to 108 +/- 5 mg/dl (P < .01) on the high-carbohydrate diet. There was an increase in the binding affinity of LDL (Kd 6.6 +/- 2.6 v 7.3 +/- 2.7 micrograms/mL +/- SD; P < .02), and internalization (P < .10), and degradation (P < .05) were also higher. The data suggest that decreasing dietary saturated fat may cause alterations in LDL composition that result in increased receptor clearance; this may partially explain the LDL-decreasing effect of this dietary change.

The effect of interferon on the metabolism of LDLs

Interferons have been shown to lower low density lipoprotein (LDL) cholesterol concentrations by 20-50%. To evaluate the effect of interferons on LDL metabolic behavior in individuals with normal and mildly elevated LDL cholesterol levels, autologous LDL labeled with 125I was administered to subjects at baseline and during interferon treatment. Interferon beta serine (IFN-beta serine) was administered intravenously at 4.5 x 10(6) units daily for at least 3 weeks before the start of kinetic study and continued for an additional 2 weeks. Results were analyzed by using a multicompartmental model that allows for two intravascular LDL compartments. In normal subjects, IFN-beta serine reduced LDL cholesterol and apolipoprotein (apo) B levels by 25% and 27%, respectively (p less than 0.05); LDL apo B synthesis was decreased by 59% (p less than 0.05). In hypercholesterolemic subjects, IFN-beta serine reduced LDL cholesterol levels by 38% (p less than 0.05); however, apo B concentrations and production rates were not significantly decreased. Clearance of LDL from the first intravascular apo B pool was markedly reduced in these subjects, resulting in a shift in the distribution of LDL apo B from the second to the first intravascular LDL apo B pool. We conclude that interferon's actions on LDL metabolism differ in normocholesterolemic and hypercholesterolemic subjects. In normal subjects, interferon decreased LDL cholesterol and apo B levels through a reduction in the LDL apo B production rate. However, in hypercholesterolemic subjects, interferon reduced LDL cholesterol by altering the distribution of apo B mass between LDL subspecies.

Moderate oxidation of hypertriglyceridemic low-density lipoprotein causes apolipoprotein B epitope change and enhances its uptake by macrophages

We prepared monoclonal antibody (MabB4) that selectively binds to acetylated low-density lipoprotein (LDL). Native hypertriglyceridemic LDL (HT-LDL) obtained from IIb and native normotriglyceridemic LDL (NT-LDL) from type IIa scarcely bound with MabB4. When these LDL were oxidized moderately by incubation with copper ions, the binding of MabB4 to HT-LDL was enhanced compared to that of NT-LDL, although the contents of the hydroperoxide they produced were the same. The incorporation of moderately oxidized HT-LDL into macrophages was enhanced compared to that of NT-LDL, and the rate of incorporation parallel the binding of LDL for MabB4. These results suggested that moderate oxidation of HT-LDL expressed some apolipoprotein B epitope on the surface of acetylated LDL to a much greater degree than NT-LDL, and that this expressed epitope might work as a ligand of moderately oxidized HT-LDL for the recognition by macrophages.

Involvement of the macrophage low density lipoprotein receptor-binding domains in the uptake of oxidized low density lipoprotein

Macrophages, unlike most other cells, possess both low density lipoprotein (LDL) and scavenger receptors. The scavenger receptor has been shown to mediate the uptake of oxidized LDL (ox-LDL), which ultimately leads to cholesterol loading of the macrophages. The present study was undertaken to define epitopes on ox-LDL that are important for lipoprotein binding to macrophages and to ascertain whether ox-LDL can bind to the LDL receptor. Monoclonal antibodies (Mabs) directed against several epitopes along the apolipoprotein B-100 (apo B-100) molecule were used. LDL (300 micrograms/ml) was oxidized by incubation with 10 microM CuSO4 for 24 hours. Ox-LDL, as opposed to acetylated LDL (ac-LDL), reacted with Mabs directed against the LDL receptor-binding domains (Mabs B1B6 and B1B3). Similarly, uptake of ox-LDL but not ac-LDL by a murine J774 macrophage-like cell line was inhibited by as much as 40% after using Mab B1B6. The anti-LDL receptor antibody IgG-C7 also inhibited 125I-ox-LDL uptake by macrophages by 60%. Chromatography on heparin-Sepharose columns of LDL that was partially oxidized for only 3 hours resulted in two fractions: an unbound fraction with characteristics similar to those of ox-LDL and a bound fraction similar to native LDL. Macrophage degradation of the unbound fraction was inhibited by Mab IgG-C7 and Mab B1B6, which are directed toward the LDL receptor and the LDL receptor-binding domains on apo B-100, respectively. When incubated with three types of macrophages, J774 macrophage cells, mouse peritoneal macrophages, and human monocyte-derived macrophages, excess amounts of unlabeled ox-LDL, like native LDL but unlike ac-LDL, substantially suppressed the uptake and degradation of 125I-labeled LDL. Similar studies with fibroblasts, however, revealed that unlabeled LDL but not unlabeled ox-LDL or ac-LDL competed with 125I-LDL for cellular uptake and degradation. Mab directed against epitopes on the amino terminus domain of apo B-100 (C14) demonstrates a similar immunoreactivity with ox-LDL and native LDL but a much lower reactivity with ac-LDL. Mab C14 inhibited macrophage degradation of ox-LDL by 34% but had no inhibitory effect on the uptake of native LDL or ac-LDL. Thus, the ac-LDL and LDL receptor-binding domains as well as a unique epitope on the amino terminus of apo B-100 may be involved in macrophage binding of ox-LDL.(ABSTRACT TRUNCATED AT 400 WORDS)

Dietary fatty acids, lipoproteins, and cardiovascular disease

Dietary fat quality and quantity significantly affect the metabolism of all the plasma lipoproteins and probably constitute the most significant dietary determinants of plasma lipoprotein levels. Since the major role of the plasma lipoproteins is the transport of exogenous and endogenous fat, this would be expected of a highly regulated, metabolically homeostatic system. The data clearly show that dietary fat saturation affects all aspects of lipoprotein metabolism, from synthesis to intravascular remodeling and exchanges to receptor-mediated and nonspecific catabolism. The experimental data regarding dietary fatty acid effects on lipoprotein metabolism are complicated and at times contradictory due to the large degree of metabolic heterogeneity in the population, which, when coupled with the known abnormalities of lipoprotein metabolism associated with certain types of hyperlipoproteinemia, can present responses from A to Z. It is clear that the same dietary pattern has different effects in different individuals and that complicating factors of individuality raise some concerns regarding generalized dietary recommendations. As new knowledge of the role of dietary factors and CVD risk develops, and our abilities to characterize the individual patient's response to dietary interventions become more refined, it may be possible to specify dietary fat intervention from a patient-oriented concept rather than a single all-purpose diet approach. Thus it would be possible to design dietary interventions to match patient needs and gain both efficacy and compliance. With the spectrum of approaches possible--low fat, moderate fat with MUFA, n-3 PUFA, etc.--we should be able to approach dietary interventions to reduce CVD risk at both a population-based level and a patient-specific level. There remains much to learn regarding the effects of dietary fatty acids on the synthesis, intravascular modifications, and eventual catabolism of the plasma lipoproteins. The area of lipoprotein metabolism in health and disease, of its modifications by diets and drugs, and of the contributions of genetic heterogeneity to these processes is one of notable advances over the past two decades and continues to be an area of intense investigation.

Differential low density lipoprotein hydrated density distribution in female and male patients with familial hypercholesterolemia

The low density lipoprotein (LDL) hydrated density distribution and composition was studied by using density gradient ultracentrifugation in 26 heterozygous familial hypercholesterolemia patients (FH) (13 females and 13 males) and 28 normolipidemic subjects (14 females and 14 males). The average peak hydrated density of LDL mass in female FH patients was 1.0301 g/ml as compared with 1.0333 g/ml in male FH patients (P less than 0.01) indicating less dense LDL particles in females. A similar difference in the average peak density was observed between normolipidemic females and males (1.0315 g/ml and 1.0342 g/ml, respectively; P less than 0.001). The FH males had a significantly lower mean triglyceride (Tg) content in their LDL (4.8%), lower Tg to apolipoprotein B (Apo B) weight ratio (0.24) and higher cholesteryl ester (CE) to triglyceride weight ratio (9.11) in comparison to FH females (Tg 6.2%; Tg/Apo B 0.31; CE/Tg 5.99), P less than 0.05 in all. Similar LDL composition differences were also observed between normolipidemic males and females.

Dietary fat and plasma lipid physical properties in swine

Changes in the lipid composition of swine lipoprotein were induced by feeding highly saturated or highly unsaturated diets. The diet higher in oleic acid, even when this was a highly unsaturated diet, resulted in a lower order parameter (more fluid) than in the other diets, as has been observed by others. This difference could be detected in whole unfractionated lipoprotein and in isolated high-density lipoprotein. Changes in order parameter with changes in cholesterol/triglyceride, reported by others, were not observed, possibly because of the weighted average effect of measuring whole plasma lipoprotein.

The effect of lovastatin treatment on low-density lipoprotein hydrated density distribution and composition in patients with intermittent claudication and primary hypercholesterolemia

The effects of lovastatin treatment on density distribution and composition of low-density lipoproteins (LDL) were studied using a density gradient ultracentrifugation method in 35 hypercholesterolemic patients with severe peripheral vascular disease. Lovastatin caused a 32% mean reduction in LDL particle mass and a 36% reduction in LDL cholesterol. The cholesteryl ester to apolipoprotein (apo) B, free cholesterol to apo B, and phospholipid to apo B weight ratios in LDL decreased significantly during treatment (P less than .01, P less than .01, and P less than .001, respectively). The effect on plasma triglycerides (Tg) was not uniform. Plasma Tg levels decreased in 25 patients, but increased in 10 patients. Since plasma Tg level influences the LDL density distribution and composition, the patients were also subgrouped and analyzed according to change in plasma Tg. In those with increased plasma Tg, the light LDL particles were reduced more and the dense particles less compared with patients with decreased Tg. The mean Tg content of LDL increased (from 7.7% to 9.3%; P less than .05) and the weight ratio of core lipids (cholesteryl ester/Tg) in LDL decreased (from 4.57 to 3.44; P less than .01) in patients with increased plasma Tg during treatment. The results indicate that the change in plasma Tg (decrease or increase) determined the qualitative changes in LDL observed during lovastatin treatment.