Statin treatment increases lipoprotein(a) levels in subjects with low molecular weight apolipoprotein(a) phenotype

BACKGROUND AND AIMS

We aimed to evaluate the effect of statin treatment initiation on lipoprotein(a) [Lp(a)] levels in patients with dyslipidemia, and the interactions with the apolipoprotein(a) [apo(a)] phenotype, LPA single nucleotide polymorphisms (SNPs) and change in LDL cholesterol.

METHODS

The study population consisted of patients with dyslipidemia, predominantly familial hypercholesterolemia, who first initiated statin treatment (initiation group; n = 39) or were already on stable statin treatment for at least 4 months (control group; n = 42). Plasma Lp(a) levels were determined with a particle-enhanced immunoturbidimetric assay before and at least 2 months after start of statin treatment in individuals of the initiation group, and at two time points with an interval of at least 2 months in the control group. High and low molecular weight (HMW and LMW, respectively) apo(a) phenotype was determined by immunoblotting, and the common LPA SNPs rs10455872, rs3798220 and rs41272110 by Taqman assay.

RESULTS

Plasma Lp(a) levels did not increase significantly in the initiation group (median 20.5 (IQR 10.9-80.7) to 23.3 (10.8-71.8) mg/dL; p = 0.09) nor in the control group (30.9 (IQR 9.2-147.0) to 31.7 (IQR 10.9-164.0) mg/dL; p = 0.61). In patients with the LMW apo(a) phenotype, Lp(a) levels increased significantly from 66.4 (IQR 23.5-148.3) to 97.4 (IQR 24.9-160.4) mg/dL (p = 0.026) in the initiation group, but not in the control group and not in patients characterized by the HMW apo(a) phenotype. Interactions with common LPA SNPs and change in LDL cholesterol were not significant.

CONCLUSIONS

Statins affect Lp(a) levels differently in patients with dyslipidemia depending on the apo(a) phenotype. Statins increase Lp(a) levels exclusively in patients with the LMW apo(a) phenotype.

Effect of diet-induced weight loss on lipoprotein(a) levels in obese individuals with and without type 2 diabetes

AIMS/HYPOTHESIS

Elevated levels of lipoprotein(a) [Lp(a)] are an independent risk factor for cardiovascular disease (CVD), particularly in individuals with type 2 diabetes. Although weight loss improves conventional risk factors for CVD in type 2 diabetes, the effects on Lp(a) are unknown and may influence the long-term outcome of CVD after diet-induced weight loss. The aim of this clinical study was to determine the effect of diet-induced weight loss on Lp(a) levels in obese individuals with type 2 diabetes.

METHODS

Plasma Lp(a) levels were determined by immunoturbidimetry in plasma obtained before and after 3-4 months of an energy-restricted diet in four independent study cohorts. The primary cohort consisted of 131 predominantly obese patients with type 2 diabetes (cohort 1), all participants of the Prevention Of Weight Regain in diabetes type 2 (POWER) trial. The secondary cohorts consisted of 30 obese patients with type 2 diabetes (cohort 2), 37 obese individuals without type 2 diabetes (cohort 3) and 26 obese individuals without type 2 diabetes who underwent bariatric surgery (cohort 4).

RESULTS

In the primary cohort, the energy-restricted diet resulted in a weight loss of 9.9% (95% CI 8.9, 10.8) and improved conventional CVD risk factors such as LDL-cholesterol levels. Lp(a) levels increased by 14.8 nmol/l (95% CI 10.2, 20.6). In univariate analysis, the change in Lp(a) correlated with baseline Lp(a) levels (r = 0.38, p < 0.001) and change in LDL-cholesterol (r = 0.19, p = 0.033). In cohorts 2 and 3, the weight loss of 8.5% (95% CI 6.5, 10.6) and 6.5% (95% CI 5.7, 7.2) was accompanied by a median increase in Lp(a) of 13.5 nmol/l (95% CI 2.3, 30.0) and 11.9 nmol/l (95% CI 5.7, 19.0), respectively (all p < 0.05). When cohorts 1-3 were combined, the diet-induced increase in Lp(a) correlated with weight loss (r = 0.178, p = 0.012). In cohort 4, no significant change in Lp(a) was found (-7.0 nmol/l; 95% CI -18.8, 5.3) despite considerable weight loss (14.0%; 95% CI 12.2, 15.7).

CONCLUSIONS/INTERPRETATION

Diet-induced weight loss was accompanied by an increase in Lp(a) levels in obese individuals with and without type 2 diabetes while conventional CVD risk factors for CVD improved. This increase in Lp(a) levels may potentially antagonise the beneficial cardiometabolic effects of diet-induced weight reduction.

Immunoglobulin A (IgA) in nasal washings and saliva of leprosy patients

IgA levels in nasal washings and saliva were determined in leprosy patients and healthy controls. In addition, serum levels of IgA, IgG, and IgM and total serum protein were analyzed. IgA levels in the nasal washings, but not in the salivas, were elevated significantly in the borderline (BL) and lepromatous (LL) groups. In the tuberculoid (TT) and borderline tuberculoid (BT) groups, the IgA levels in both the nasal washings and salivas did not differ from the controls. Total protein was also elevated in the nasal washings in the BL and LL groups. Thus, the IgA expresses as mg/mg protein did not differ significantly from the control group. However, in individual patients the levels of IgA and total protein were not correlated in either the nasal washings or the salivas. The high serum immunoglobulin and protein levels were in accord with the findings of most other workers.

Humoral immunity in leprosy: immunoglobulin G and M antibody responses to Mycobacterium leprae in relation to various disease patterns

A solid-phase radioimmunoassay, applying whole Mycobacterium leprae as antigen and radiolabeled protein A from Staphylococcus aureus as antibody-detecting reagent, was used for the determination of specific immunoglobulin G (IgG) and IgM antibody responses in leprosy patients. High IgG anti-M. leprae antibody levels were found in lepromatous leprosy patients, whereas the antibody response in tuberculoid leprosy patients varied from negative, i.e., comparable with responses measured in normal individuals, to strongly positive. In tuberculoid leprosy patients, a significant increase in IgG anti-M. leprae antibody levels was observed in the more widespread forms of the disease, but positive antibody responses were especially predominant among patients with active lesions. Lepromatous leprosy patients generally demonstrated high levels of both IgG and IgM anti-M. leprae antibodies, but no relation was found between the antibody responses and bacillary load or other clinical parameters. A marked decrease in specific IgG and IgM antibody levels was observed in lepromatous leprosy patients during their first year of treatment. Differences in mechanisms regulating the humoral immune response in tuberculoid and lepromatous leprosy patients were indicated, and the application of antibody assessments in leprosy control programs is discussed.

Studies on the defect in cell-mediated immunity in lepromatous leprosy using HLA-D-identical siblings. Absence of circulating suppressor cells and evidence that the defect is in the T-lymphocyte, rather than the monocyte, population

Sixteen healthy siblings were identified as HLA-D-identical to 12 borderline lepromatous or polar lepromatous leprosy patients by the absence of a mixed lymphocyte reaction (MLR). The peripheral blood mononuclear cells (PBM) of the healthy siblings showed a lymphoproliferative response (delta cpm) to Mycobacterium leprae antigens which was about fivefold or more greater than that of the lepromatous patients. Lepromatous PBM, with or without mitomycin C treatment, were co-cultured with a constant number of normal PBM. In other experiments the two cell types were co-cultured in various proportions, with the total cell number kept constant. Neither approach revealed suppressor cells in lepromatous PBM capable of suppressing the lymphoproliferative response to M. leprae. On the contrary, we found that lepromatous PBM can respond to M. leprae antigens if the sensitized lymphocyte is provided by mitomycin-C treated normal PBM. Additionally, experiments in which isolated adherent cells and non-adherent cells of sibling pairs were recombined failed to reveal a defect in the M. leprae antigen-presenting function of lepromatous adherent cells. Since we found no evidence that sensitized cells are present in lepromatous PBM with their function unexpressed (due to a monocyte defect) or suppressed (due to suppressor cells), we conclude that lepromatous patients simply lack sufficient numbers of antigen-specific T lymphocytes to initiate a lymphoproliferative response to M. leprae antigens. The reason for their absence remains an important unanswered question.

Antigen-specific suppressor cells in subclinical leprosy infection

A two-stage in-vitro culture system was used to assay cells which suppress the lympho-proliferative response to Mycobacterium leprae (ML). Responses to ML, purified protein derivative of tuberculin, and streptokinase-streptodornase were preferentially suppressed by mitomycin-treated cells which had been primed with the same antigen in a 7-day primary culture. Healthy subjects exposed to leprosy for more than 3 years showed strong suppression of the response to ML antigens (11 of 12 showed more than 40% suppression), whereas those exposed for 3 months to 3 years showed much less suppression (12 of 15 showed less than 40% suppression). The in-vitro generation of strong ML-specific suppression may reflect the maturation of a well-regulated and protective immune response. However, premature induction and in-vivo activation of these suppressor cells could predispose to disseminated (lepromatous) forms of leprosy. With this assay it would be possible to assess the ability of proposed leprosy vaccines to engage strongly the regulatory network controlling the immune response to ML in the same way as long-term exposure to the natural infection.

Effect of Mycobacterium leprae on lymphocyte proliferation: suppression of mitogen and antigen responses of human peripheral blood mononuclear cells

Evidence is presented that Mycobacterium leprae suppresses the in vitro proliferative response of human peripheral blood mononuclear cells (PBM) to antigen and mitogen. Lymphoproliferation induced by PPD or alloantigen stimulation was inhibited by concentrations of M. leprae which were not cytotoxic for lymphoblasts. In contrast, the inhibition of mitogen-stimulated PBM was seen only at higher concentrations of M. leprae which proved to be cytotoxic for lymphoblasts. The inhibitory effect was found not to be dependent on a particular cell population present in leprosy patients, as PBM from normal were inhibited similarly. These findings may explain some of the immunological aberrations observed in lepromatous leprosy patients who harbour large numbers of M. leprae bacilli in their tissues.

An assay for antibodies in leprosy sera reacting with ribonucleoprotein (RNP), a mycobacterial ribosomal antigen, using crossed immunoelectrophoresis with intermediate gel

The technique of crossed immunoelectrophoresis with intermediate gel has been adapted to provide a quantitative assay for antibodies to a mycobacterial ribosomal antigen termed ribonucleoprotein (RNP) antigen. This antigen is no. 1 in the M. smegmatis reference system and corresponds to antigen no. 5 of M. leprae. The assay method measures changes in the rate of migration of the reference precipitin peak caused by the addition of serum in the intermediate gel and utilizes a lepromatous serum pool (LSP) both in the reference gel and as a standard in the intermediate gel. The anti-RNP activity in 24 leprosy sera differentiated the pauci-bacillary tuberculoid group (11 of 12 < 35% LSP) from the multi-bacillary lepromatous group (11 of 12 > 35% LSP). These findings confirm the work of others which indicates that assay of anti-RNP activity may have applications in the classification of leprosy patients and in the serodiagnosis of lepromatous leprosy infections. This method should also be applicable in other systems in which an antigen of high electrophoretic mobility forms a major precipitin in crossed immunoelectrophoresis.

Estradiol-induced synthesis of vitellogenin. IV. The isolation of non-degraded polysomes from avian liver using an endogenous ribonuclease inhibitor

A procedure allowing the isolation of intact polysomes from rooster liver is described. Good recovery of polysomes is achieved by the presence of Triton X-100 in the homogenization and centrifugation steps since the detergent prevents the sedimentation of microsomes with the nuclear fraction. This sedimentation of microsomes leads to considerable losses of polysomes, especially the larger ones. In the detergent-treated homogenate the integrity of the polysomes is threatened by various ribonucleases, some of which can be effectively inhibited by the addition of both heparin and yeast RNA. The remaining nuclease activity is counteracted by the endogenous ribonuclease inhibitor of the liver. In estradiol-treated roosters, sufficient endogenous inhibitor is present to inhibit its specific ribonuclease, but in control roosters there is not. This difference is due to a hormone-mediated increase in inhibitor level and decrease in nuclease level. Consequently, for an estrogenized rooster, the addition of both heparin and yeast RNA to the homogenate suffices to stabilize the polysomes, whereas control rooster liver homogenate needs supplementation with endogenous ribonuclease inhibitor. The cytosol of estrogenized rooster liver can be used as a crude inhibitor preparation. Rat liver cytosol is only partially effective; this may indicate a certain degree of species specificity of the inhibitor. The isolation procedure described also yields large polysomes from the livers of duck and Xenopus.

In-vitro lymphoproliferative response to Mycobacterium leprae of HLA-D-identical siblings of lepromatous leprosy patients

Lymphoproliferative responses to Mycobacterium leprae and P.P.D. were measured in 23 lepromatous and borderline lepromatous leprosy patients and in 27 of their normal siblings. At the same time siblings HLA-D-identical with the patients were identified by the absence of a mixed-lymphocyte reaction. The 7 siblings who were HLA-identical to lepromatous patients responded as well to M. leprae as did the 20 HLA-non-identical normal siblings. In contrast, 22 of the 23 lepromatous patients failed to respond to M. leprae but responded normally to P.P.D. The specific unresponsiveness of lepromatous patients thus does not result from an HLA-linked genetic defect and the defective cell-mediated immune response to M. leprae seems to be acquired, not inherited. Lepromatous patients may be high responders to antigens shared by M. leprae and other microorganisms in whom a strong antibody response has blocked the induction of an M. leprae-specific-cell-mediated immune response.