The inhibition of cholesteryl ester transfer protein: a long and winding road

Probucol normalizes cholesteryl ester transfer in type 2 diabetes

AIMS

Accelerated cholesteryl ester transfer (CET) protein (CETP) activity is believed to promote macrovascular disease in patients with type 2 diabetes (T2D) by increasing the cholesterol burden of the apoB - containing triglyceride-rich lipoprotein (TGRLP) CE acceptors and promoting small dense LDL formation. While previous studies have shown that this same abnormality is present in patients with type 1 diabetes (T1D) and was normalized by the anti-oxidant drug probucol, its effects on CET in T2D are unknown.

PATIENTS AND METHODS

The net mass transfer of CE from HDL to the apoB lipoproteins (VLDL+LDL) was studied in intact plasma from seven T2D patients before and two months after treatment with probucol (1g/day).

RESULTS

Before treatment, CET was significantly greater than controls at 1 and 2h (p<.005). Recombination studies showed that this disturbance was attributable to dysfunction of VLDL and not due to altered behavior of HDL or CETP. Probucol treatment normalized CET in all subjects and significantly lowered plasma cholesterol (pre-Rx: 197±4.5 vs post-Rx: 162±27.1mg/dL; mean±S.D.; p<.025) and HDL-C (pre-Rx: 46.4±7.5 vs post-Rx: 39.1±4.0; p<.025) without changing glycemic control.

CONCLUSIONS

By normalizing CET in T2D, probucol likely reduces the formation of atherogenic lipoproteins. This effect on CET is achieved through qualitative alterations in CETP's lipoprotein substrates and not through changes in CETP or HDL. Since probucol also has potent anti-oxidative and anti-inflammatory properties, it may have a new role to play in lipoprotein remodeling that reduce cardiovascular risk in T2D.

New molecular insights into CETP structure and function: a review

Cholesteryl ester transfer protein (CETP) is important clinically and is the current target for new drug development. Its structure and mechanism of action has not been well understood. We have combined current new structural and functional methods to compare with relevant prior data. These analyses have led us to propose several steps in CETP's function at the molecular level, in the context of its interactions with lipoproteins, e.g., sensing, penetration, docking, selectivity, ternary complex formation, lipid transfer, and HDL dissociation. These new molecular insights improve our understanding of CETP's mechanisms of action.