Dissertations / Theses on the topic 'Chylomicron'

A physiologically-based multi-compartment model has been developed which makes a priori predictions of the chylomicron cholesterol distribution in the body of a rat. The model considers each organ to be a separate compartment which interacts with all the other organs/compartments through the blood stream. A particle approach has been used since chylomicron cholesterol distribution is regulated more by the particle concentrations than cholesterol concentrations. The chylomicron cholesterol distribution is coupled to the triglyceride contents of the particle. Unsteady nonlinear differential equations have been developed by making mass balances over all the compartments, and the numerical solution of these dynamic model equations is outlined. Finally, this multi-compartment model was used to predict the distribution of chylomicron cholesterol after a bolus injection of chylomicrons or their continuous infusion into the blood. The model results were then compared with the existing literature data points for such systems.

Dietary fats are mainly transported by the intestine in lipoproteins: chylomicrons (CMs) and very low density lipoproteins (VLDLs). Unfortunately, studies of the intestinal absorption of dietary fat have been hampered by the lack of an adequate in vitro model system. As an in vitro model Caco-2 cells are able to secrete lipoproteins. We investigated the possible factors that may affect the secretion of CMs through the ultracentrifugation technique. The dose-dependent effects of oleic acid, mono-olein, egg lecithin, collagen matrix, and the effect of cell differentiation on CM secretion were then tested. We found that oleic acid, lecithin, and cell differentiation are critical for CM secretion by Caco-2 cells. To further confirm that our optimal condition is, in fact, favorable for efficient CM production, we compared it with control groups. We observed that our condition led to more efficient CM secretion as determined by the TGs, ApoB, and TEM analysis.

Les anomalies du métabolisme des lipoprotéines riches en triglycérides (LRTG), les chylomicrons et les VLDL exposent à des hypocholestérolémies lors d'un défaut de sécrétion et à des hypertriglycéridémies (HTG) majeures entraînant un risque athéromateux et de pancréatites aigües lors de l'altération de leur clairance. Nous avons diagnostiqué des patients présentant un défaut génétique de sécrétion des LRTG au décours de maladie de rétention des chylomicrons, d'abetalipoprotéinémie et d'hypobetalipoprotéinémie homozygote, causées respectivement par des mutations sur les gènes SAR1B, MTTP et APOB. Nous avons étudié le phénotype des 158 patients publiés avec mutation délétère et mis en évidence des différences portant principalement sur la stéatose hépatique, l'insulinorésistance et l'obésité. Nous avons également mis au point une méthode d'évaluation de l'activité post héparinique de la lipoprotéine lipase (LPL) par mesure de la lipolyse des triglycérides des VLDL in vitro, permettant l'exploration phénotypique des patients présentant une HTG sévère. Nous avons mis en évidence des activités LPL augmentées chez des patients présentant pourtant des antécédents d'HTG sévère et des déficits chez des patients ne présentant pas de mutation identifiable du gène LPL, laissant supposer l'existence de facteurs additionnels modulant l'expression ou l'activité de la LPL. Enfin des interrelations des multiples gènes impliqués dans le métabolisme des triglycérides modulent le phénotype. Elles soulèvent l'intérêt de l'exploration simultanée des principaux gènes impliqués dans les dyslipidémies, telle qu'elle sera effectuée par NGS, pour une meilleure compréhension de leur physiopathologie<br>Abnormal metabolism of triglyceride-rich lipoproteins (LRTG), chylomicrons and VLDL, can result in hypocholesterolemia in case of impaired secretion, or severe hypertriglyceridemia (HTG) and increased risk of atheroma and acute pancreatitis if clearance is affected. We explored patients suffering from genetic defect in the LRTG secretion (chylomicron retention disease, abetalipoproteinemia and homozygous hypobetalipoproteinemia) and identified mutations on respectively SAR1B, and MTTP and APOB gene. Then, we analysed the phenotype of 158 previously published patients with deleterious mutation (i.e. reported cases added to our cohort) and were able to highlight some specific differences like hepatic steatosis, insulin resistance and obesity. Furthermore we developed an assay to evaluate the lipoprotein lipase (LPL) functionality by measuring the triglyceride-VLDL lipolysis in vitro, and provide a reliable phenotypic exploration for patients with past history of severe hypertriglyceridemia. We found an increased LPL activity in some patients with severe hypertriglyceridemia but conversely showed deficits in other patients free from mutation on LPL gene. These results lead to hypothesize that additional factors might contribute to modulate the expression or the activity of LPL. Finally multiple genes of triglycerides metabolism interact together to additionally modulate phenotype. Of high interest is therefore the simultaneous exploration of the key genes involved in dyslipidemia, as provided by the new generation sequencing (NGS), for better understanding of all pathophysiological mechanisms

Dietas vegetarianas oferecem baixo conteúdo calórico, baixos níveis de gordura saturada, colesterol, proteína animal e mais altos de gordura polinsaturada, carboidratos, fibras, magnésio, boro, folato e antioxidantes. Todos esses nutrientes influenciam nos fatores de risco de doenças cardiovasculares como hipertensão arterial, diabetes mellitus, obesidade e dislipidemias. Níveis plasmáticos de colesterol total, colesterol de lipoproteína de baixa densidade (LDL), de lipoproteína de densidade muito baixa (VLDL) e triglicérides em indivíduos vegetarianos são menores, em vários estudos, quando comparados a indivíduos onívoros. O metabolismo de quilomícrons (Qm) e dos seus produtos de degradação pela lipase lipoprotéica, os remanescentes, lipoproteínas que transportam os lípides da dieta na circulação sanguínea, não foi avaliado até o momento e está relacionado à aterosclerose. O objetivo deste estudo foi avaliar a cinética plasmática de quilomícrons artificiais marcados com triglicérides (TG-3H) e éster de colesterol (EC-14C) e aspectos qualitativos da HDL, em 18 indivíduos ovolacto-vegetarianos (excluem da alimentação carne, frango e peixe), 21 indivíduos veganos (não consomem nenhum alimento de origem animal), há pelo menos 5 anos e 29 indivíduos onívoros (consomem alimentos de origem animal), todos normolipidêmicos, não diabéticos e sem uso de medicamentos hipolipemiantes. Após a injeção endovenosa dos Qm artificias, foram colhidas amostras de sangue em tempos pré-estabelecidos durante 60 minutos. A radioatividade em cada uma das amostras foi medida para o cálculo da taxa fracional de remoção (TFR) dos lípides radioativos, através de análise compartimental. Foram realizadas as determinações bioquímicas nesses indivíduos e calculada a atividade da lipase lipoprotéica pós-heparina, em ensaio in vitro. Verificou-se também a transferência de lípides de uma nanoemulsão lipídica para a lipoproteína de alta densidade (HDL) e o diâmetro dessa lipoproteína. A remoção plasmática dos remanescentes de quilomícrons avaliada pela taxa fracional de remoção do éster de colesterol da emulsão, foi maior nos veganos (p<0,05) e ovolacto-vegetarianos (p<0,05) comparando-se aos onívoros, enquanto que o processo de lipólise dos quilomícrons, avaliado pela taxa fracional de remoção dos triglicérides da emulsão e pela medida da atividade da lipase lipoprotéica in vitro foi similar nos três grupos avaliados. Não foram encontradas diferenças significativas nas concentrações plasmáticas de HDLC, VLDL e triglicérides entre os grupos estudados .No grupo vegano, as concentrações plasmáticas de LDL-C e glicose foram menores quando comparadas apenas ao grupo dos onívoros (p<0,05, p<0,01; respectivamente). Já em relação ao colesterol total, os indivíduos veganos apresentaram menores níveis quando comparados tanto aos ovolacto-vegetarianos (p<0,05) como aos onívoros (p<0,01). Não observou-se diferença na transferência de lípides da nanoemulsão para a HDL e no tamanho da HDL entre os três grupos. Os resultados do presente estudo sugerem que a dieta vegana e ovolacto-vegetariana aceleram a remoção dos remanescentes de quilomícrons, lipoproteínas aterogênicas, o que pode estar relacionado, aos efeitos benéficos dessa dieta em relação a doenças em relação ao processo aterosclerótico<br>Vegetarian diets provide less caloric content, low levels of saturated fats, cholesterol and animal protein while providing at the same time providing high levels of polyunsaturated fats, carbohydrates, fibers, magnesium, borium, folate and antioxidants. All these nutrients have an influence upon the cardiovascular diseases such as hypertension, diabetes mellitus, obesity and dyslipidemias. Studies have shown that total cholesterol plasmatic levels, low density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglycerides in vegetarian individuals are lower when compared to omnivores individuals. Chylomicron metabolism (Qm) and its lipoprotein lipase degradation products, the remnants, lipoproteins that transport dietary lipids in the blood has not yet been evaluated, although it is related to atherosclerosis. This study evaluated the plasmatic kinetics of artificial chylomicrons marked with triglycerides (3HTG) and cholesterol esters (14C-CE), as well as the qualitative aspects of HDL in 13 ovolacto-vegetarians (no ingestion of meat, chicken or fish), 10 vegan individuals (no ingestion of any food of animal origin) for more than 5 years and 14 omnivores individuals (ingestion of animal origin foods). All participants were normolipidemic, non diabetic and using no hypolipemiants medication. After an intravenous injection containing artificial Qms, blood samples were collected during 60 minutes at predetermined times. The radioactivity of each sample was measured and the fractional clearance rate (FCR) calculated for the radioactive lipids using compartmental analysis. Biochemical determinations were undertaken in order to calculate the post-heparin lipoprotein lipase activity in vitro. Also evaluated were the lipid transfer of the lipid nanoemulsion to the HDL and the diameter of the HDL particles. The plasma removal of the chylomicron remnants evaluated by the fractional clearance rate of the cholesteryl ester of the emulsion was greater in the vegan (p<0,05) and ovolacto-vegetarian (p<0,05) groups when compared to the omnivore group. The lipolysis of the chylomicron evaluated by the fractional clearance rate of the emulsion triglycerides and by the in vitro lipoprotein lipase activity assay was similar in the three studied groups. There were no differences in the plasma concentrations of HDL-C, VLDL-C and triglycerides between the three groups. The plasma concentrations of LDL-C and glucose of the vegan group were lower than omnivore group (p<0.05 and p<0.01, respectively). In regards to total cholesterol, vegans present lower levels when compared to both ovolactovegetarians (p<0.05) and omnivores (p<0.01). No difference was found in the transfer of nanoemulsion lipids to HDL or in the size of the HDL of all three groups. These results suggest that the vegetarian diet can improve the metabolism of chylomicron remnants, atherogenic lipoproteins, which can be related to the beneficial effects of this diet upon the atherosclerosis process.

La mortalité cardiovasculaire représente la première cause de mortalité chez les sujets diabétiques de type 2. La dyslipidémie de ces patients caractérisée par le quatuor : hypertriglycéridémie, baisse du HDL-cholestérol, augmentation du nombre de LDL petites et denses et hyperlipidémie postprandiale, constitue un facteur de risque prépondérant. Cette dyslipidémie est en grande partie expliquée par l’accumulation sanguine des lipoparticules riches en triglycérides (TRL) d’origine hépatique (VLDL) et intestinale (chylomicrons). L’hyperproduction des chylomicrons, déjà connue pour les VLDL, est une composante nouvellement reconnue d’insulinorésistance. L’action inhibitrice aigüe de l’insuline sur la production des VLDL est absente chez le sujet diabétique de type 2. Dans notre étude, nous avons montré l’absence d’effet aigu de l’insuline sur la production des chylomicrons chez les sujets diabétiques de type 2 grâce à une étude cinétique utilisant un isotope stable (D3-leucine)<br>The cardiovascular mortality represents the first cause of mortality in human type 2 diabetes. The typical diabetic dyslipidemia characterized by the quartet: high triglyceride levels, low HDL-cholesterol, increased number of small and dense LDL particles and postprandial hyperlipidemia, is a major cardiovascular risk factor. This dyslipidemia is mainly explained by the accumulation of triglyceride-rich lipoproteins (TRL) from liver (VLDL) and intestine (chylomicrons).The overproduction of chylomicrons, as is known for VLDL, is a newly characteristic of insulin resistant states. The acute inhibitory effect of insulin on VLDL production is absent in type 2 diabetic patients. In our study, we have shown the absence of acute inhibitory effect of insulin on chylomicron production in type 2 diabetic patients, using a kinetic study with stable isotope (D3-leucine)

The absorption, packaging, and delivery of fat to appropriate peripheral tissues is essential for maintaining metabolic homeostasis, and defects or dysregulation of these processes can contribute to metabolic disorders such as diabetes, obesity, and hyperlipidemia. In the intestine, dietary fat is packaged into triglyceride-rich lipoprotein particles and delivered to peripheral tissues through the circulatory system. Lipolysis of lipoprotein triglycerides requires the enzyme lipoprotein lipase (LPL) and takes place on the luminal surface of capillary endothelial cells. Lipolysis by LPL is regulated in part by two proteins, GPIHBP1 and ANGPTL4. GPIHBP1, a GPI-anchored protein of capillary endothelial cells, is responsible for transporting LPL across endothelial cells to the capillary lumen. Without this transport, LPL becomes mislocalized to the interstitial space and cannot access triglyceride-rich lipoproteins, resulting in severe hypertriglyceridemia. Conversely, ANGPTL4 inhibits LPL and ANGPTL4 deficiency results in increased LPL activity and lower plasma triglyceride levels. Our goal is to understand how the interactions between LPL, GPIHBP1, and ANGPTL4 influence the delivery of triglyceride-derived fatty acids to tissues. In this thesis, I (1) use mouse models to elucidate the function of ANGPTL4 in regulating the clearance of diet-derived fat from plasma, (2) describe a mechanism for GPIHBP1-independent plasma triglyceride clearance observed in mice lacking both GPIHBP1 and ANGPTL4, and (3) propose that this GPIHBP1-independent mechanism is also operative in Gpihbp1–/– mice following a high fat diet challenge. The contributions of this thesis are significant because they close a gap in our knowledge of how and where ANGPTL4 functions, as well as indicating that, when ANGPTL4 is suppressed or absent altogether, a GPIHBP1-independent mechanism can function to clear plasma triglycerides.

Thesis (M.A.)--Boston University<br>PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.<br>The low-density lipoprotein receptor-related protein (LRP) is a 4544 amino acid polypeptide with structural similarity to the low-density lipoprotein receptor. LRP contains two subunits, a 515kDa subunit and an 85kDa subunit. LRP is found in a wide range of tissues, although its main function is confined to the liver. LRP is an Apo E binding receptor, which led to the idea that it might serve to clear chylomicron remnants and large Beta-VLDL from the plasma. The majority of research supports this hypothesis, although a small amount of conflicting data exists that will require further explanation. LRP has also been implicated as a receptor for alpha2-macroglobulins, which are protease inhibitors present in the plasma. Therefore, it appears that LRP and the alpha2-macroglobulin receptor are the same molecule.<br>2031-01-01

[Formulae and special characters can only be approximated here. Please see the pdf version of the abstract for an accurate reproduction.] Atherosclerosis is a common degenerative disease in which the clinical manifestations are often through stroke or myocardial infarction. Some of the established risk factors for atherosclerosis include elevated plasma low-density lipoprotein (LDL)-cholesterol levels, obesity, diabetes mellitus (DM) and cigarette smoking. Of the risk factors, an elevation in plasma LDL is one of the most established and the most researched. This is partly a consequence of the deposition of cholesterol within arterial intima being a crucial step in the progression of atherosclerosis, combined with the finding that LDL particles are a major transporter of cholesterol in circulation. Recently there is increasing evidence showing a role of the other major transporter of cholesterol in circulation, chylomicron remnants, in the progression of atherosclerosis. The notion of atherosclerosis as a postprandial phenomenon has been further substantiated by the emergence of evidence showing a direct role of chylomicron remnants in arterial cholesterol deposition. Based on evidence that chylomicron remnants are proatherogenic, the suggestion arises that accumulation of postprandial lipoproteins in plasma may add another dimension of risk to the development of coronary artery disease (CAD). This thesis tests the general hypothesis that individuals with or at high risk of CAD have postprandial dyslipidaemia and that this metabolic abnormality is correctable with a class of lipid-lowering drugs called statins. To test the hypothesis, clinical studies were conducted in normolipidaemic CAD patients, heterozygous familial hypercholesterolaemia (FH) and postmenopausal women with type 2 DM. Determination of postprandial dyslipidaemia by comparison with control populations were conducted initially in each patient group (Studies 1, 3 and 5), followed by intervention studies investigating possible modulation of the dyslipidaemia with a statin (Studies 2, 4 and 6). Six observation statements based on case-control comparisons of postprandial lipaemia in patients with or at risk of CAD and the effects of statins on postprandial dyslipidaemia in the patient groups were derived from the general hypothesis. The observation statements were examined in the individual studies described below. Postprandial lipoprotein metabolism was assessed using a number of methods. For comparison of postprandial lipaemia in Studies 1 and 2, a classic oral fat challenge was utilised. As markers of chylomicrons and chylomicron remnants, retinyl palmitate and triglyceride were measured postprandially as well as apolipoprotein (apo) B48 concentrations, a specific marker of intestinal lipoproteins. ApoB48 was also measured in the fasting state and found to predict the postprandial responses of retinyl palmitate, triglyceride and apoB48. This suggested that fasting measurement of apoB48 could be used as a simple indicator of postprandial dyslipidaemia. Consequently for Studies 3 - 6, fasting apoB48 measurements were used as primary markers of postprandial dyslipidaemia. Other markers for chylomicrons and their remnants utilised were fasting plasma concentrations of remnant-like particle-cholesterol (RLP-C) and apoC-III. As well as these static markers, chylomicron remnant catabolism was measured using a stable isotope breath test. The breath test involves the intravenous injection of a chylomicron remnant-like emulsion labelled with ¹³C-oleate and measurement of enriched ¹³CO2 in expired breath by isotope ratio mass spectrometry. The fractional catabolic rate (FCR) of the injected emulsion was subsequently calculated using multi-compartmental modeling (SAAM II). The studies are presented in this thesis as published and unpublished works. In Study 1, postprandial lipoprotein metabolism was compared between 18 normolipidaemic CAD patients (cholesterol 4.54 ± 0.12 mmol/L, triglyceride 1.09 ± 0.16) with 13 asymptomatic healthy controls using an oral fat challenge. Normolipidaemic CAD patients had higher postprandial area-under-curve (AUC) for triglyceride (+34%, p=0.019), retinyl palmitate (+74%, p=0.032) and apoB48 (+36%, p<0.001). Fasting apoB48 was also higher (+41%, p=0.001) and found to correlate significantly with AUC of triglyceride (p=0.017), retinyl palmitate (p=0.001) and apoB48 (p<0.001). The data suggest that normolipidaemic CAD patients have increased concentrations of intestinal lipoproteins in the fasting and postprandial state. In addition to these findings, significant correlations of fasting apoB48 with postprandial markers (p<0.02) suggests the fasting marker to be a simpler surrogate marker for the degree of total postprandial lipaemia. Study 2 investigated the effect of atorvastatin treatment on postprandial dyslipidaemia found in the 18 near-normolipidaemic CAD patients from Study 1. The trial was conducted in a randomised, placebo-controlled design, using oral fat challenges before and after 12-weeks atorvastatin/placebo treatment. Compared with the placebo group, atorvastatin decreased the total postprandial AUC for iii triglyceride (-22%, p=0.05) and apoB48 (-34%, p=0.013). Fasting markers of apoB48 (-35%, p=0.019) and RLP-C (-36%, p=0.032) also decreased significantly. Atorvastatin was also found to increase LDL-receptor activity by +218% (p<0.001) as reflected in binding studies. The data suggest atorvastatin reduces the fasting levels of intestinal lipoproteins as well as total postprandial lipaemia, but without acute dynamic changes in postprandial lipaemia. The reduction in fasting and total postprandial lipoprotein levels could be partly attributed to an increase in LDL-receptor mediated removal from circulation. In Study 3, postprandial lipaemia was compared in 15 heterozygous FH patients with 15 healthy controls. FH patients had higher fasting concentrations of apoB48 (+56%, p<0.001) and RLP-C (+48%, p=0.003). The elevation in these fasting markers of chylomicrons and their remnants suggests FH patients have postprandial dyslipidaemia due to an accumulation of these particles in plasma. Study 4 examined the effects of long- (> 6 months) and short-term (4 weeks) simvastatin treatment on modulating postprandial dyslipidaemia found in the 15 FH patients from Study 3. Short- and long-term simvastatin treatment decreased the fasting concentrations of apoB48 (-29% and 15% respectively, p<0.05) and RLP-C (both -38%, p<0.001), but did not significantly alter the FCR of the injected chylomicron remnant-like emulsion. The data suggest that in heterozygous FH both long- and short-term simvastatin treatments decrease the fasting markers of postprandial lipoproteins by mechanisms that may not be mediated via processes differentiated by the 13CO2 breath test. This implies that the effect on postprandial lipaemia may be from a decrease in production and/or a possible increase in catabolism of triglyceride-rich lipoproteins (TRLs). In Study 5, postprandial lipaemia was compared in 24 postmenopausal women age and body mass index matched with 14 postmenopausal women with type 2 DM. Postmenopausal diabetic women were found to have higher fasting concentrations of apoB48 (+21%, p=0.021) and apoC-III (+16%, p=0.042) as well as lower FCR of the chylomicron remnant-like emulsion (-50%, p<0.001). The data suggest that postmenopausal diabetic women have postprandial dyslipidaemia, and that this is due to delayed catabolism of chylomicron remnants. Study 6 was an hypothesis-generating exercise examining the effects of 4-weeks pravastatin treatment on postprandial dyslipidaemia found in 7 postmenopausal women with type 2 DM from Study 5. Although plasma LDL-cholesterol was reduced (-19%, p=0.028), there were no significant effects found on fasting apoB48 concentrations (-12%, p=0.116) or the FCR of the chylomicron remnant-like emulsion (+38%, p=0.345). A larger sample size of patients and/or treatment with a more potent statin at a dosage known to affect chylomicron remnant metabolism would be required to demonstrate a significant reduction in postprandial dyslipidaemia in postmenopausal women with type 2 DM. The results of the above mentioned studies combined support the general hypothesis that postprandial dyslipidaemia is a feature of patients with or at risk of CAD. This defect may be demonstrated using fasting apoB48 as an indicator of the degree of postprandial lipaemia. Postprandial dyslipidaemia may reflect a reduction in catabolism, as suggested with the breath test in type 2 DM, and/or an over overproduction of chylomicrons. Both these mechanisms would also increase competition for lipolysis and clearance pathways between hepatically and intestinally-derived lipoproteins. The exact mechanisms by which postprandial dyslipidaemia occurs are yet to be determined. Statins appear to improve defective postprandial lipaemia in patients with or at risk of CAD, which is in agreement with the general hypothesis. The effectiveness of a statin is dependant on their potency in inhibiting cholesterol biosynthesis and increasing receptor mediated clearance of LDL and chylomicron remnants. The studies conducted in this thesis show that postprandial dyslipidaemia can be reduced by statins but not to the extent demonstrated in controls. However, the demonstrated reduction in fasting and total postprandial lipaemia translates to a lowering in overall arterial exposure to circulating proatherogenic particles. The elevation in fasting and postprandial levels of proatherogenic chylomicron remnants found in the patient groups described in this thesis indicates another dimension to their risk of coronary disease. The reductions in the overall levels of proatherogenic particles in patients with or at high CAD risk, infers a possible reduction in the risk of coronary disease in these patients.

Introduction/objectif : La dyslipidémie des sujets obèses insulinorésistants est principalement caractérisée par une augmentation plasmatique des LRT hépatiques (LRT-apo-B100) et intestinales (LRT-apo-B48). La chirurgie bariatrique, largement pratiquée dans le traitement de l'obésité, est associée à l'amélioration de nombreuses anomalies métaboliques. Nous avons étudié l'effet de la chirurgie bariatrique sur le métabolisme des LRT intestinales et hépatiques.Méthodes/résultats : Le métabolisme des LRT de 22 patients obèses non diabétiques bénéficiant d'une chirurgie bariatrique : sleeve gastrectomie (SG ; n=12) ou bypass gastrique (BP ; n=10) a été étudié par une méthode d'enrichissement isotopique stable (D3-L-Leucine) en alimentation continue. Chaque sujet a réalisé deux études cinétiques : une 1 mois avant et une 6 mois après la chirurgie. Le résultat principal est une diminution de la taille du pool de LRT-apo-B100 après une SG et un BP (p&lt;0,01) expliquée par une augmentation du taux de clairance des LRT-apo-B100 (SG : p&lt;0,05) sans diminution du taux de production. Le pool de LRT-apo-B48 est significativement réduit après une SG (p&lt;0,05), sans explication claire à part une tendance à la diminution du taux de production. La diminution du pool de LRT-apo-B100 est significativement corrélée à la diminution de la concentration en apo-CIII dans le groupe entier.Conclusion : Cette étude est la première étude cinétique réalisée chez l'Homme explorant les mécanismes d'amélioration du métabolisme des LRT après une chirurgie bariatrique. Cette amélioration du métabolisme peut contribuer à la diminution de la mortalité cardiovasculaire observée après une chirurgie bariatrique<br>Introduction and objective: The dyslipidemia of insulin-resistant obese patients is widely characterised by the elevation of plasma triglyceride-rich lipoproteins (TRL) of both hepatic (TRL-apoB-100) and intestinal (TRL-apoB-48) origin. Bariatric surgery is a well-established and effective modality for the treatment of obesity, and is associated with improvements in a number of metabolic abnormalities that are associated with obesity. Here, we have investigated the effect of bariatric surgery on intestinal and hepatic TRL metabolism. Approach and Results: Twenty two non-diabetic, obese subjects undergoing bariatric surgery: sleeve gastrectomy (SG; n=12) and gastric bypass (BP; n=10) were studied using a stable isotope (D3-L-Leucine) enrichment methodology, in the constant fed state. Each subject underwent two lipoprotein turnover studies: 1 month before and 6 months after surgery. The main finding was a reduction in TRL-apo-B100 concentration following both SG and BP procedures (P&lt;0.01 for both), explained by an increase in TRL-apo-B100 fractional catabolic rate (P&lt;0.05 for SG) without a reduction in production rate. TRL-apo-B48 concentration was significantly reduced following SG, with no clear explanation other than a trend towards reduction in production rate. The reduction of TRL-apo-B100 concentration was significantly associated with a reduction of plasma apo-CIII in the pooled group of patients undergoing bariatric surgery. Conclusions: This is the first human kinetic study to explore the mechanism of improvement of TRL metabolism following bariatric surgery. These effects may contribute to the decrease of cardiovascular mortality after surgery

Emulsões artificiais sem proteína simulando quilomicrons e remanescentes de quilomícron foram preparadas por sonicalcação de trioleína, lecitina, colesteril oleato e colesterol em solução aquosa. A seguir foram ultracentrifugadas em gradiente descontínuo de densidade. As emulsões, marcadas com 3H-trioleína e 14C-colesteril oleato foram injetadas via intra-arterial em ratos controle e em ratos tratados com Triton WR1339, sulfato de protamina e heparina, medindo-se a seguir a remoção plasmática do colesteril-ester e dos triglicérides, durante dez minutos. O Triton WR 1339 e a protamina inibiram a lipólise dos quilomícrons artificiais, diminuindo a remoção destas partículas do plasma. O Triton WR 1339 mostrou ser mais efetivo que a protamina nestes efeitos. Por outro lado, a heparina promoveu uma lipólise rápida e brusca nos quilomícrons artificiais, assim como uma aceleração na remoção destas partículas do plasma. Em contraste flagrante com esses resultados, o metabolismo dos remanescentes de quilomícron não foi consideravelmente afetado pelo tratamento com Triton e heparina. Estas experiências indicam que as emulsões artificiais reproduzem o comportamento metabólico dos quilomícrons e remanescentes de quilomícron naturais, em condições em que a atividade da lipase lipoproteica esteja alterada.<br>Protein-free emulsions models of chylomicrons and chylomicron remnants were prepared by sonicating triolein, lecithin., cholesteryl oleate and cholesterol in aqueous saline media, followed by ultracentrifugation in density gradient solution. The 3H-triolein and 14C-cholesteryl oleate labeled emulsions were injected into the carotid artery of control rats and rats treated with Triton WR 1339, protamine sulphate and heparin. Plasma removal of both labels was measured during ten minutes in two minutes intervals. Triton WR 1339 and protamine sulphate strongly inhibited lipolysis of chylomicron-like emulsions leading to delayed removal of the particles from blood. Triton WR 1339 de appeared to be more effective than protamine to elicit these effects. On the other hand, heparin produced instantaneous lipolysis of the chylomicron-like particles markedly enhancing its removal from plasma. Contrarily, chylomicron remnant-like emulsions were not considerably affected either by Triton WR 1339 or by heparin treatment. The above described results obtained with artificial emulsions support current concepts on the metabolic behavior of natural chylomicron and remnant submitted to changes in lipoprotein lipase action.

La contribution des lipides alimentaires à la lipémie postprandiale au cours de repas successifs a été peu explorée. Dans l'étude n°1, six sujets sains ont ingéré 2 repas mixtes (déjeuner et dîner). Les lipides du déjeuner contribuaient à la lipémie post-dîner malgré l'intervalle de 7h entre les 2 repas. Dans l'étude n°2, neuf sujets sains ont ingéré un petit déjeuner à 7h30 ainsi qu'un déjeuner (12h00). L'enrichissement en palmitate des TG montrait une participation des lipides du petit déjeuner (suivis par scintigraphie) étaient en partie retenus dans l'estomac et l'intestin grêle avant le déjeuner. Le déjeuner mobilisait ces lipides, par accélération de la vidange intestinale. En conclusion, les lipides ingérés au cours d'un repas contribuent à la lipémie du repas suivant même lorsque l'intervalle entre les deux repas est relativement long (7h). La vidange intestinale est un élément important de la régulation des flux d'entrée plasmatique des chylomicrons lors de repas successifs<br>Contribution of dietary fat to postprandial lipemia during sequential meals has not been extensively investigated. In the first study, six healthy subjects ingested 2 mixed meals (lunch and dinner). Lipids ingested at lunch contributed to post-dinner lipemia, despite the relatively long lasting interval between meals (7h). In the second study, nine healthy subjects ingested subsequently a breakfast (7:30 am) and a lunch (12:00 am). Dietary lipids ingested at breakfast were labelled with palmitate and Lipiodol. Palmitate enrichment confirmed the contribution of fat ingested at breakfast to post-lunch lipemia. Lipiodol dynamics, followed in vivo by scintigraphic imaging, showed that fat ingested at breakfast was retained in part within the gut at lunch time and mobilized following lunch ingestion. In conclusion, dietary lipids ingested at a first meal contribute to subsequent postprandial lipemia, despite a 7h interval between meals. Gastric emptying influences the rate of entry of lipids into the circulation during sequential meals

L’altération du métabolisme postprandial des lipides et l’inflammation chronique associée apparaissent comme des éléments majeurs de la physiopathologie de l’obésité. L’implication de l’absorption intestinale d’endotoxines bactériennes du microbiote au cours de la digestion des lipides a été mise en évidence. Cependant la modulation de ces phénomènes par différentes quantités de lipides différemment structurés reste mal caractérisée, notamment chez les obèses. Nous avons mis en place un protocole clinique, en cross-over randomisé, visant à étudier chez des sujets normo-pondérés et obèses les conséquences de la digestion de matière grasse consommée, soit sous forme tartinée en différentes quantités (10 g ou 40 g), soit sous forme finement émulsionnée (40 g) sur le métabolisme postprandial des lipides et des endotoxines. Nous avons ainsi mis en évidence que l’augmentation plasmatique des chylomicrons, suite à une augmentation de la quantité de matière grasse ingérée, était plus précoce et plus importante chez les normo-pondérés que chez les sujets obèses, avec la sécrétion de plus gros chylomicrons suite à 40 g. Lorsque 40 g de matière grasse est émulsionnée, nous montrons qu’elle aboutit à un pic de triglycérides des chylomicrons plus précoce et plus élevé, reflétant une absorption facilitée des lipides, et de manière plus marquée chez l’obèse. Nous montrons aussi que cet état émulsionné aboutit à une β-oxydation plus élevée des lipides exogènes sur la journée, sans différence de perte fécale. Une endotoxémie postprandiale est également observée suite aux différents repas. L’accumulation postprandiale d’endotoxines, notamment présentes dans les chylomicrons, augmente avec la quantité de matière grasse tartinée en corrélation avec l’aire sous courbe des chylomicrons chez les obèses. En complément, l’absorption lipidique in vitro par des cellules Caco-2 était plus importante suite à l’incubation de milieux de lipolyse d’émulsions stabilisées par du caséinate que de la lécithine. Enfin, un test de digestion a été réalisé avant et après une chirurgie de by-pass gastrique pour identifier si une diminution drastique de l’absorption lipidique modifiait l’endotoxémie. Suite à l’opération, les patients sont davantage exposés aux endotoxines après la prise d’une émulsion au petit-déjeuner. En revanche, la LBP, protéine de transport des endotoxines proinflammatoire, diminue significativement à jeun et en postprandial suite à l’opération. L’ensemble de ces travaux démontrent qu’en plus des effets de la quantité de lipides ingérée sur la lipémie et l’absorption d’endotoxines associée, la structure de la matière grasse joue un rôle important dans la modulation du devenir métabolique des acides gras. La structuration des lipides alimentaires pourrait donc être spécifiquement adaptée afin d’optimiser le métabolisme lipidique postprandial, notamment chez des personnes obèses<br>The alteration of postprandial lipid metabolism and associated chronic inflammation emerge as major elements in the obesity pathophysiology. The involvement of the intestinal absorption of endotoxin from microbiota during lipid digestion was recently highlighted. However, the modulation of these phenomena by different amounts of differently structured lipids remains poorly characterized, especially in obese people. We developed a cross-over randomized clinical study to explore in normal weight and obese subjects the consequences of fat digestion, consumed either spread on bread in different amounts (10 g or 40 g) or finely emulsified (40 g), on postprandial metabolism of lipids and endotoxins. We have demonstrated that the increase in plasma chylomicrons, after increase in the amount of fat ingested, was earlier and greater in normal-weight than in obese subjects, with the secretion of larger chylomicrons after consumption of 40 g of spread fat. When 40 g of fat is emulsified, we show that it leads to an earlier and higher peak of chylomicron triglycerides, reflecting facilitated absorption of fat, and more significantly in obese subjects. We also show that emulsified fat results in higher β-oxidation of exogenous lipids over the day, with no difference in fecal excretion. Postprandial endotoxemia was also observed in response to different meals. The postprandial accumulation of endotoxins, present in chylomicrons, increases with the amount of spread fat ingested and it is correlated with the area under the curve of chylomicrons in obese subjects. In addition, the in vitro lipid absorption by Caco-2 cells was greater following incubation with lipolysis media of emulsions stabilized by caseinate than lecithin. Finally, a digestion test was conducted before and after gastric bypass surgery to identify whether a drastic reduction in lipid absorption altered metabolic endotoxemia. After surgery, patients are more exposed to endotoxins in the morning after emulsion consumption at breakfast. However, LBP, a proinflammatory protein transporting endotoxins, significantly decreases after surgery. Altogether, these studies demonstrate that in addition to the metabolic effects of dietary fat intake on lipemia and associated endotoxemia, the fat structure also plays an important role in the modulation of further fatty acid handling. Structuring of dietary lipids could thus be specifically adapted to optimize postprandial lipid metabolism, especially in obese people

La protéine CD36 est un senseur aux AGLC au niveau des papilles gustatives et des entérocytes, impliqué dans la détection gustative des lipides et dans l’optimisation de la synthèse des CM. Notre 1er objectif a été de déterminer si le syndrome métabolique (MS) était associé à une altération de la détection oro-intestinale des AGLC. A l’aide de modèles murins de MS (régimes riches en AGS), nous avons montré que le MS est associé à une moindre sensibilité gustative aux sucres et aux lipides et à une altération de la synthèse des CM à l’origine d’une hypertriglycéridémie postprandiale. Cette modification est associée à une absence de dégradation de CD36 classiquement médiée par les AGLC. Cette altération conduit à un retard d’induction de l’expression des gènes impliqués dans la synthèse de CM moins bien dégradés au niveau sanguin. Selon nos résultats l’hyperinsulinémie en MS pourrait être à l’origine de l’absence de dégradation de CD36. Au niveau oral il a aussi été montré que l’absence de dégradation de CD36 est associée à une altération de la signalisation calcique probablement à l’origine d’un seuil de détection plus élevé des AGLC. Le MS se caractérise donc par un problème de détection des lipides au niveau de la sphère oro-digestive qui favoriserait hyperphagie et hypertriglycéridémie postprandiale. Le 2e objectif a été de déterminer si le XXS (polyphénols) pouvait prévenir le MS. La supplémentation en XXS diminue la prévalence du MS, du fait d’une action anti-obésité associée à un maintien du seuil de détection des lipides et une augmentation de l’activité. Ainsi, la détection oro-intestinale des lipides semble être une cible pertinente pour lutter contre la mise en place du MS<br>CD36 is a LCFA sensor in gustatory papillae and enterocytes. CD36 is implicated in the gustatory detection of lipids and in optimized CM synthesis. Our first goal was to determine if the metabolic syndrome (MS) was associated with alteration of the oro-intestinal detection of LCFA. Using a murine model of diet induced MS (saturated high fat diets) we shown that the MS is associated with a decrease in lipids and sugar gustatory sensitivity and an alteration in CM synthesis which contributes to the postprandial hypertriglyceridemia. This modification is associated with an absence of CD36 protein degradation classically triggered by LCFA. This alteration leads to a delay in the stimulation of the gene expression involved in the synthesis of CM less well cleared into the blood. Our data shows that the hyperinsulinemia on MS could cause the abolition of CD36 protein degradation. Other data obtained on gustatory papillae demonstrates that the absence of CD36 degradation is associated with an alteration of the LCFA induced calcium-signaling and that probably causes the increase in LCFA detection threshold. Thus, the MS is characterized by an alterated dietary lipids detection by the oro-intestinal tract which could promote overeating and postprandial hypertriglyceridemia. The second goal was to determine if the XXS (polyphenols) could prevent the appearance of the MS. The XXS supplementation decreases the syndrome prevalence, by exerting an anti-obesity activity associated with a LCFA detection threshold preservation and an increased activity. Thus, dietary lipids detection by gustatory papillae and intestine could represent a relevant target in order to prevent MS appearance

L'hyperchylomicronémie est une maladie rare et complexe impliquant plusieurs gènes qui sont eux-mêmes fortement régulés par plusieurs mécanismes et dont les voies métaboliques sont étroitement dépendantes de facteurs environnementaux. La survenue de la pathologie due à la présence de variants ou d'une association de variants sur ces gènes n'est pas toujours clairement définie. Ce qui suggère l'intervention d'autres mécanismes mal élucidés dans le développement des hyperchylomicronémies et la régulation du métabolisme des triglycérides. Nous avons essayé d'appréhender certains mécanismes causals dans la survenue de l hyperchylomicronémie en lien avec la présence de variants sur les gènes régulateurs APOC3 et LMF1 du métabolisme des triglycérides. Le gène APOC3 présente le variant SstI (rs5128) en région 3' non codante associée significativement à l'hypertriglycéridémie dans notre cohorte, nous avons cherché à caractériser sa régulation post-transcriptionnelle éventuelle par des microARN hépatiques ou intestinaux. Nos résultats ne confirment pas l'hypothèse d'une régulation du variant SstI du gène APOC3 par un microARN hépatique ou intestinal ciblant directement l'extrémité 3'UTR du gène APOC3. Le gène LMF1, nouveau gène candidat pour étudier les mécanismes des hyperchylomicronémies, est encore peu investigué. Nous avons mis en place son diagnostic génétique au sein du laboratoire ainsi qu'une technique in vitro permettant d'évaluer l'impact de la présence de certains variants codants de LMF1 sur l'activité post héparinique de la lipoprotéine lipase (LPL) par mesure de la lipolyse des triglycérides des VLDL. Nous avons mis en évidence des activités LPL significativement diminuées suggérant une dysfonction de LMF1 en présence des variants p.Gly172Arg (rs201406396), p.Arg354Trp (rs143076454), p.Arg364Gln (rs35168378), et des deux variants non-sens déjà décrits p.Tyr439Ter (rs121909397) et p.Trp464Ter (rs587777626). Ces travaux permettent de confirmer l'effet fonctionnel des variants LMF1 sur la régulation de la sécrétion de la LPL. Nous avons également retrouvé dans notre cohorte de 385 patients 18 variants sur la région 3' non codante du gène LMF1. Pour les trois variants : c*231C&gt;A (rs75476513), c*512G&gt;A (rs117039680), et c*530G&gt;A (rs139657279), les résultats in vitro suggèrent une régulation post transcriptionnelle par les microARN. Ce qui pourrait ainsi expliquer le mécanisme de l'association de ces variants non traduits à l'hypertriglycéridémie. Ainsi, des interrelations des multiples gènes impliqués dans le métabolisme des triglycérides et leurs régulations à plusieurs niveaux simultanés modulent le phénotype d'hyperchylomicronémie. Il est nécessaire d'étudier tous les mécanismes complexes impliqués dans la régulation de la triglycéridémie afin de mieux appréhender la physiopathologie et de développer de nouvelles cibles thérapeutiques<br>Hyperchylomicronemia is a rare and complex disease involving several genes which are themselves highly regulated by several mechanisms and whose metabolic pathways are closely dependent on environmental factors. The occurrence of this disease due to the presence of variants or a combination of variants on these genes is not always clearly defined. This suggests the intervention of other ill-defined mechanisms in the development of hyperchylomicronemia and the regulation of triglyceride metabolism. We have tried to understand certain causal mechanisms in the occurrence of hyperchylomicronemia in relation to the presence of variants on the APOC3 and LMF1 known regulatory genes of triglyceride metabolism. APOC3 gene carries the SstI variant (rs5128) in the 3' untranslated region significantly associated with hypertriglyceridemia in our cohort. We sought to characterize its possible post-transcriptional regulation by hepatic or intestinal microRNA. Our results obtained in vitro do not support the hypothesis of a regulation of the SstI variant of the APOC3 gene by a hepatic or intestinal microRNA directly targeting the 3'UTR of APOC3 gene. LMF1 gene, a new candidate gene for studying the mechanisms of hyperchylomicronaemias, is still under investigation. We have established its genetic diagnosis in the laboratory and set up an in vitro method to evaluate the impact of LMF1 coding variants by measuring the release of post-heparin lipoprotein lipase (LPL) activity. We found decreased LPL activities suggesting a LMF1 dysfunction in the presence of variants p.Gly172Arg (rs201406396), p.Arg354Trp (rs143076454), p.Arg364Gln (rs35168378), and the two nonsense variants already described p.Tyr439Ter (rs121909397) and p.Trp464Ter (rs587777626). This study confirms the functional effect of LMF1 variants on the regulation of LPL secretion. In addition, we found 18 variants on the 3' untranslated region of LMF1 gene. For three variants : c*231C&gt;A (rs75476513), c*512G&gt;A (rs117039680), and c*530G&gt;A (rs139657279), in vitro results suggest a post-transcriptional regulation by microRNA. These findings are an involvement of these untranslated variants in the occurrence of hypertriglyceridemia.Thus, complex interrelations of multiple genes involved in triglyceride metabolism and their simultaneous multi-level regulation modulate the phenotype of hyperchylomicronemic patients. It is necessary to study all the complex mechanisms involved in the regulation of triglyceridemia in order to better understand pathophysiology of hyperchylomicronemia and to develop new therapeutic targets

Les maladies cardiovasculaires représentent une des principales causes de morbidité et de mortalité dans les pays industrialisés. La nutrition peut largement influencer certaines de ces facteurs de risques. Dans le cadre d'études de mesures de prévention des maladies cardiovasculaires nous avons étudié chez les sujets sains, normalipidémiques,le rôle des acides gras alimentaires dans l'évolution des facteurs de risque plasmatiques à l'état à jeun et en période postprandiale. En parallèle, la capacité d'épuration du cholestérol cellulaire par les lipoprotéines plasmatiques a été évaluée. Les résultats de cette étude montrent que les régimes contenant des apports stables en acides gras mono et poly insaturés (mono insaturés : 11% à 16% d'AET et poly insaturés : 5% à 6% d'AET), permettent de maintenir à un niveau bénéfique,les facteurs plasmatiques<br>Dietary lipids are able to affect fasting and postprandial lipoprotein metabolism in a significant way, thereby modifying the risk of cardiovascular disease, a major cause of morbidity and mortality. The aims of the present study were firstly to evaluate in normolipidemic healthy men, the qualitative effect of dietary fatty acids on fasting and postprandial lipid parameters, in order to define an optimal range of monounsaturated fat supply and secondly to determine the role of postprandial lipoprotein modifications in the mechanisms involved in the reverse cholesterol transport. Our results showed that in conditions of balanced and stabilized dietary fat supply comprising 11% to 16% monounsaturated, associated with 5-6% polyunsaturated fatty acids ( of total energy intake),plasma lipid parameters

Mechanisms involved in the clearance of chylomicrons and aspects of the interactions at the vascular endothelium were studied in the rat. The poly-anion heparin, known to release lipoprotein lipase (LPL) from the vascular endothelium, enhanced the clearance of chylomicrons. Five minutes after heparin injection, the clearance of chylomicron triglycerides and retinyl esters was markedly accelerated. The rapid initial clearance was followed by a slower clearance of heavily lipolyzed chylomicrons. In contrast, one hour after heparin the clearance of both triglycerides and retinyl esters was retarded. This decreased removal of chylomicrons coincided with a decrease in the heparin releasable LPL activity, indicating that the previous release to plasma by heparin had resulted in net loss of functional LPL in the tissues. The poly-cation protamine released hepatic lipase and some LPL from their binding sites to plasma. One hour after protamine, plasma triglyceride levels were increased, indicating that chylomicron removal was impeded. It has been speculated that protamine inactivates LPL in vivo, but this was not the case. Ten minutes after injection of protamine normal amounts of LPL could be released by heparin. Thus, the accumulation of plasma triglycerides was not due to a rapid inactivation of LPL by protamine. LPL has specificity for sn-1,3-ester bonds. To investigate if this specificity is important in vivo, a lipid emulsion containing medium-chain fatty acids (MCFA) in the sn-1,3-position and long-chain fatty acids (LCFA) in the sn-2-position was synthesized, as well as an emulsion containing MCFA-TG mixed with LCFA-TGs (MMM/LLL). In vitro experiments showed large differences in the hydrolysis of the emulsions, but in vivo there were only small differences in the metabolism. To further study if lipid emulsions are cleared by the same mechanisms as chylomicrons, an emulsion was made by the same formulation as Intralipid® with addition of 3H-triolein and ,4C-cholesteryl ester. As measured by the removal of cholesteryl esters, the emulsion was cleared at the same rate as was chylomicrons. The triglyceride label was, however, removed more slowly from the emulsion droplets than from chylomicrons. Together with the lower recirculation of labeled free fatty acids (FFA) in plasma, this suggests that there was less lipolysis of the emulsion. The current view that removal of lipid emulsions in vivo is mainly dependent on LPL-mediated hydrolysis might thus not be correct. To further analyze the metabolism of chylomicrons, a compartmental model was developed. In this process, the distribution volume for chylomicrons was shown to be larger than the blood volume, a model for the metabolism of FFA in the rat was validated, and the full tissue distribution of injected chylomicrons was determined. According to the model, about half of the triglyceride label was removed from the circulation together with the core label while for the emulsion this number was about 80 %. In fasted rats all labeled fatty acids appeared to mix with the plasma FFA pool, while in fed rats about one-fifth of the fatty acids did not mix with the FFA but was apparently channeled directly to tissue metabolism.<br><p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.</p><br>digitalisering@umu.se

La lipémie postprandiale se caractérise par une augmentation des lipoprotéines riches en triglycérides après un repas, et joue un rôle important dans la biodisponibilité des lipides alimentaires pour les tissus périphériques. En effet, une lipémie postprandiale élevée est souvent associée à l'obésité et à une dyslipidémie, deux composantes du syndrome métabolique qui peuvent engendrer des complications médicales, incluant diabète et maladies cardiovasculaires. La lactoferrine (Lf) inhibe l'épuration hépatique des chylomicrons, conduisant à une élévation de la lipémie postprandiale par des mécanismes moléculaires non élucidés. Il est aussi établi que le Lipolysis Stimulated Receptor (LSR) contribuait à l'épuration des lipoprotéines riches en triglycérides pendant la phase postprandiale. L'objectif était de déterminer s'il existait une interaction entre la Lf et le LSR. Les études de cultures cellulaires ont montré que si la Lf n'affectait pas le taux d'expression du LSR dans des cellules Hepa 1-6 de souris, elle co-localisait avec le LSR en présence d'oléate, un composé requis pour l'activation du récepteur. Des expériences de ligand-blotting ont également montré que la Lf se fixait sur le LSR purifié et inhibait la fixation de lipoprotéines riches en triglycérides. Les domaines N et C-terminaux isolés de cette protéine, ainsi qu'un mélange de peptides obtenu après double hydrolyse de la Lf par la trypsine et la chymotrypsine, conservent cette propriété. Nous proposons que l'élévation de la lipémie postprandiale observée in vivo suite à un traitement par la Lf soit médiée par son interaction avec le LSR, inhibant ainsi l'épuration des chylomicrons et de leurs remnants<br>Postprandial lipemia is characterized by an increase in plasma triglyceride-rich lipoproteins after the ingestion of meal, and is important towards determining the bioavailability of dietary lipids amongst the peripheral tissues. Indeed, elevated postprandial lipemia is often observed with obesity and dyslipidemia, two disorders that can lead to health complications including diabetes and cardiovascular diseases. Lactoferrin (Lf), has been shown to inhibit hepatic chylomicron remnant removal, resulting in increased postprandial lipemia, for which the molecular mechanisms remain unclear. The lipolysis stimulated lipoprotein receptor (LSR) has been shown to contribute to the removal of triglycerides-rich lipoproteins during the postprandial phase. The aim was to determine if there was interaction between Lf and LSR. Both Lf and LSR were purified with purities upper to 95% and characterized. Cell culture studies demonstrated that while Lf does not have any significant effect on LSR protein levels in mouse Hepa1-6 cells, it co-localizes with LSR in cells, but only in the presence of oleate, which is needed to obtain LSR in its active form. Ligand blotting using purified LSR revealed that Lf binds directly to the receptor in the presence of oleate and prevents the binding of triglycerides-rich lipoproteins. Both C- and N-lobes of Lf, and a mixture of peptides derived from its tryptic and chymotryptic double hydrolysis retained the ability to bind LSR. We propose that the elevated postprandial lipemia observed upon Lf treatment in vivo is mediated by its direct interaction with LSR, thus preventing clearance of chylomicrons and their remnants through the LSR pathway

Dietary-derived lipoproteins, chylomicrons (CM) and CM remnants (CMR), have been implicated in the progression of cardiovascular disease. Retinyl esters are currently the most widely used method for monitoring CM metabolism. The availability, however, of a specific antisera to apo B-48, the protein uniquely associated with dietary-derived lipoproteins, has allowed more extensive investigation of CM and CMR metabolism. The effect of habitual, moderate levels of exercise (3 to 4 exercise sessions a week) on the lipaemic response to meals of varying fat content was assessed in young male subjects. Apo B-48, triacylglycerol (TAG) and retinyl ester were used as markers for CM particles. Active subjects had a lower response than an inactive group in all parameters measured over time after the meals. Lipoprotein lipase (LPL) activity levels measured at the end of the postprandial period were higher in the active group. The area under the time-response curves (AUC) for apo B-48 in the inactive group increased with increasing fat content of the meals, whereas the AUC for apo B-48 was the same after each meal in the active group. Validation of a specific ELISA for apo B-48 was carried out. Cross-reactivity of the antisera with low levels of apo B-100, the protein present on endogenous lipoproteins, was ruled out. The assay was specific and sensitive for measuring apo B-48 concentrations in the CM-enriched fractions. The use of the assay in the current format for plasma samples could not be fully assessed due to difficulties with isolating a pure, concentrated sample of apo B-100 and problems with reactivity between the secondary antibody used in the assay and plasma proteins. The assay was useful for showing postprandial patterns of changes in apo B-48 levels in plasma. The effects of meal frequency on the lipaemic response to a high fat test meal challenge were assessed in an intervention study. A nibbling diet was found to cause differences between the response of various parameters after the meal (NEFA-AUC, LPL activity, infranatant-TAG AUC and time to peak) compared with the normal meal frequency. The size and density distribution of CMR in plasma were investigated. Apo B-48 was found in the IDL and LDL fractions in both the postabsorptive and postprandial states. A comparison between the retinyl ester and apo B-48 responses in the postprandial studies showed that the time to peak retinyl ester level was delayed compared to apo B-48 and TAG. The importance of apo B-48 for studying the metabolism of CM and CMR metabolism was demonstrated.

L’hypertriglycéridémie post prandiale constitue un facteur de risque des maladies cardiovasculaires et est présente en cas de syndrome métabolique, d’obésité et d’insulino-résistance. L’intestin conditionne la biodisponibilité des lipides et l’hypertriglycéridémie post prandiale. En effet, il contrôle la quantité et la qualité des chylomicrons sécrétés, en adaptant son métabolisme en fonction de la teneur en lipides du régime. Or à l’heure actuelle, le mécanisme de détection des lipides alimentaires par les entérocytes nécessaire à cette adaptation, n’est pas élucidé. Ce travail de thèse a permis de démontrer que la glycoprotéine transmembranaire CD36, est un récepteur aux AGLC qui déclenche l’activation des ERK1/2. Cette activation est responsable de l’induction du taux d’ARNm de 3 protéines clés de l’absorption des lipides (l’Apobec1, la Microsomal Triglyceride Transfer Protein (MTP), la Liver-Fatty Acid Binding Protein (L-FABP)) et de la dégradation post prandiale de CD36. La pertinence physiologique de ce récepteur a été évaluée chez des souris CD36 (-/-) soumises à un régime hyperlipidique riche en AGLC saturés ou insaturés. Nos données démontrent que CD36 intestinal est indispensable à l’absorption de forte quantité de lipides, au contrôle de l’hypertriglycéridémie post prandiale, de l’inflammation intestinale et de l’endotoxémie. Ces effets sont fortement aggravés en cas de régime hyperlipidique riche en AGLC insaturés qui peuvent même être léthal. Le CD36 intestinal pourrait donc être une cible thérapeutique dans le traitement de l’hypertriglycéridémie et de l’endotoxémie post prandiales<br>Post prandial hypertriglyceridemia represents a risk factor for cardio-vascular diseases and it is associated with metabolic syndrom, obesity, and insulino-resistance. The intestine influences lipid bioavailibility and post prandial hypertriglyceridemia. It controls the quantity and the quality of secreted chylomicrons by adapting its metabolism according to the lipid content of the diet. Nevertheless, the mechanism of dietary lipid detection by the enterocyte is not understood. Our work demonstrates that the transmembrane glycoprotein CD36 is a Long Chain Fatty Acid (LCFA) receptor which triggers ERK1/2 activation. This activation is responsible for the induction of mRNA rate of 3 key proteins of lipid absorption (Apobec1, Microsomal Triglyceride Transfer Protein (MTP), Liver-Fatty Acid Binding Protein (L-FABP)) and for CD36 degradation. The physiological relevance of this receptor has been assessed in CD36 (-/-) mice fed with a High Fat Diet (HFD) rich in saturated or unsaturated LCFA. Our data demontstrates that CD36 is crucial for the absorption of an important quantity of lipids, to the control of hypertriglyceridemia, of intestinal inflammation and of endotoxemia. These effects are getting worse in the case of HFD rich in unsaturated LCFA, which can be lethal. Intestinal CD36 could represent a therapeutic target in the treatment of post prandial hypertriglyceridemia and endotoxemia

Os esteróides anabólicos androgênicos (EAA) aumentam a massa muscular e o desempenho físico. O uso abusivo de EAA leva a uma grande diminuição da concentração de HDL-C, podendo ocorrer um aumento nas concentrações de LDL-C e triglicérides. Os efeitos dos EAA na cinética plasmática das lipoproteínas que transportam os lípides da dieta, na circulação sanguínea, os quilomícrons e seus produtos de lipólise, os quilomícrons remanescentes, não foram avaliados e podem estar relacionados com o processo aterosclerótico. No presente estudo, foram estudados 12 indivíduos que realizam exercício de força localizada e admitem fazer uso de EAA (grupo Musculação+EAA), 16 indivíduos que também realizam exercício de força localizada, porém não fazem uso de EAA (grupo Musculação) e 18 indivíduos sedentários e normolipidêmicos (grupo Sedentário). A emulsão de quilomícrons artificiais, marcada com triglicérides radioativos (TG-3H) e éster de colesterol radioativo (EC-14C), foi injetada endovenosamente e amostras de sangue foram colhidas durante intervalos de tempo préestabelecidos. As curvas de decaimento plasmático dos lípides radioativos da emulsão foram traçadas e as taxas fracionais de remoção (TFR) foram calculadas por meio de análise compartimental. A TFR-EC do grupo Musculação+EAA apresentou-se diminuída comparando-se aos grupos Sedentário e Musculação (0,0073± 0,0079 min -1, 0,0155± 0,0100 min -1, 0,0149± 0,0160 min -1, respectivamente; p< 0,05), enquanto que as TFR-TG foram similares. As concentrações plasmáticas de LDL-C foram maiores no grupo Musculação+EAA comparando-se com os grupos Sedentário e Musculação (143±54,101±31, 111±52 mg/dL, respectivamente; p=0,047). As concentrações plasmáticas de HDL-C e de apolipoproteína A1 foram menores no grupo Musculação+EAA quando comparados aos grupos Sedentário e Musculação (HDL-C= 22±13; 41±7; 38±13 mg/dL, respectivamente; p<0,001 e apo A1= 88±50; 156±35; 140±24 mg/dL, respectivamente; p<0,001). As curvas de geração de ácidos graxos livres originados pela hidrólise de triglicérides radioativos dos quilomícrons artificiais na circulação sanguínea foram similares entre os grupos estudados. A atividade da lipase hepática foi maior no grupo Musculação+EAA, comparando-se aos grupos Sedentário e Musculação (7243±1822; 3898±1232; 2058±749, respectivamente; p<0,001), enquanto que a atividade da lipase lipoprotéica não diferiu. O diâmetro da HDL e concentração de triglicérides presentes na HDL também foram similares nos três grupos estudados.<br>Anabolic androgenic steroids (AAS) increase muscle mass and physical performance. Abusive use of AAS has led to a significant reduction of HDL-C concentration in the plasma, which in turn can cause lead to an increase in LDL-C and trigliceride concentrations. The effects of steroids on lipoprotein plasmatic kinetics which transport diet lipids in the blood, the chilomicrons and its lypolisis products, chilomicron reminiscents have not yet been studied and can be contributing factors to the ateroclesrosis process. In this study 12 local weight lifters and admitted steroid users (AAS group), 16 local weight lifters but nonsteroids use (non-user group) and 18 sedentary and normolipidemic individuals (control group) were studied. The artificial chilomicron emulsion, marked with radioactive triglyceride (3H-TG) and radioactive oleate cholesterol (14C-OC) were injected interveneously and blood samples collected during pre-established time intervals. The plasmatic decay curve of the radioactive lipids of the emulsion was traced and fractional clearance rate was calculated (FCR) through compartamental analysis. The FCR-OC of the AAS group when compared to the control and nonuser groups was reduced (0,0073±0,0079 min -1,0,0155±0,0100 min -1, 0,0149± 0,0160 min -1, respectivelly; p< 0,05), while FCR-TG were similar. The LDL-C plasmatic concentration were higher in the AAS group when compared to control and non-user groups (143±54,101±31, 111±52 mg/dL, respectivelly; p=0,047). The HDL-C plasmatic concentration and the apolipoprotein A1 were lower in the AAS group when compared control and non-user groups (HDL-C: 22±13; 41±7; 38±13 mg/dL, respectivelly; p<0,001 e apo A1: 88±50; 156±35; 140±24 mg/dL,respectivelly; p<0,001). No difference was observed of the area under the fatty acid generated curve. Hepatic lipase activity was greater in the AAS group when compared to control and the non-user groups (7243±1822; 3898±1232; 2058±749, respectivelly; p<0,001). However, no difference was observed for lipoproteic lipase activity. The analisys of HDL size and triglyceride concentration in HDL were similar for all three groups.

Dyslipidemia often accompanies metabolic diseases such as obesity and type II diabetes mellitus and represents a risk factor for cardiovascular disease. Clearance of triglycerides from the plasma is mediated by lipoprotein lipase (LPL), which hydrolyzes the triglycerides in chylomicrons and VLDL, liberating fatty acids for tissue uptake. LPL functions in the capillaries of the heart, adipose tissue, and skeletal muscle where LPL is anchored to the capillary wall by its endothelial cell transporter GPIHBP1. LPL activity is regulated by several factors including three members of the angiopoietin-like (ANGPTL) family–ANGPTL3, ANGPTL4, and ANGPTL8. How these proteins interact with LPL, especially in the physiological context of LPL anchored to endothelial cells by GPIHBP1, has not been well characterized. In my studies of ANGPTL4, I found when LPL is bound to GPIHBP1, it is partially, but not completely, protected from inactivation by ANGPTL4. Inactivation of LPL by ANGPTL4 leads to the dissociation of active LPL dimers into inactive monomers and I found that these monomers have a greatly reduced affinity for GPIHBP1. ANGPTL4 can be cleaved in vivo, separating the N-terminal coiled-coil domain from the C-terminal fibrinogen like-domain. I found the N-terminal domain alone is a much more potent LPL inhibitor than the full-length protein, even though both appear to have similar binding affinities for LPL-GPIHBP1 complexes. When I investigated ANGPTL3, I found ANGPTL3 itself is not a potent inhibitor of LPL at physiological concentrations, and unlike ANGPTL4, cleavage of ANGPTL3 does not improve its ability to inhibit LPL. Instead I found that ANGPTL3 forms a complex with ANGPTL8, a complex that only forms efficiently when the two proteins are co-expressed, and that this complex allows ANGPTL3 to bind and inhibit LPL. My data provide new insights into how ANGPTL proteins regulate LPL activity and the delivery of fat to tissues.

Le role de la lipase hepatique (lh) dans le metabolisme des lipoproteines et plus particulierement dans celui des remnants de chylomicrons (rm) est encore mal compris. La premiere partie de cette etude a ete de rechercher si la lh etait impliquee dans le metabolisme des rm. Les rm marques au cholesterol (#3h) ou au cholesteryl-ether (#1#4c) puis co-incubes avec la lh, sont plus efficacement captes par des hepatocytes que les rm temoins (+50% a 100%). L'utilisation d'un anticorps anti-lh nous a permis de confirmer la specificite de la lh dans ce processus. Des rm traites par de la lh, puis injectes a des rats, subissent un captage majore (+36%). Apres immuno-inhibition de la lh, l'epuration des rm est diminuee (t 1/2=5,55 vs 2,98 min) et leur captation hepatique est abaisse (22,8 vs 45%). Le traitement des rm par la lh, s'accompagne d'une baisse des triglycerides (24%) et des phospholipides (36%). L'apo e, principal determinant de la liaison des rm, n'est pas modifiee apres hydrolyse. La liaison de rm traites par la lh, a des membranes plasmiques de foie est majoree (2 a 3 fois) mais avec une plus faible affinite. Ces resultats indiquent clairement que la lh est active dans le captage des rm par le foie. Dans la seconde partie de ce travail, nous avons recherche les effets d'un regime cholesterol sur la regulation de la lh. Apres un tel regime, sont diminuees: l'activite (1,4 fois), la proteine-enzyme (1,7 fois) et les arnm (2 a 4 fois). Ces donnees originales indiquent un effet regulateur du cholesterol alimentaire sur la lh

L'hypertriglycéridémie postprandiale représente un facteur de risque émergent des maladies cardiovasculaires et est retrouvé en cas de syndrome métabolique, d'obésité et d'insulino-résistance. L'intestin grêle conditionne la triglycéridémie postprandiale puisque la taille et de la quantité des chylomicrons sécrétés modulent l'activité de la Lipoprotéine Lipase (LPL). La synthèse des chylomicrons est un mécanisme complexe dont l'étape de lipidation de l'Apolipoprotéine B48 (ApoB48) par la Microsomal Triglyceride Transfert Protein (MTP) et celle de leur transfert du réticulum vers le Golgi dans laquelle intervient la Liver Fatty Acid binding Protein (L-FABP) sont limitantes. Des expériences menées in vivo chez des animaux sauvages et transgéniques et ex vivo sur des segments intestinaux, nous ont permis de démontrer qu'il existe une adaptation postprandiale du métabolisme intestinal des lipides. Cette adaptation postprandiale est déclenchée par la glycoprotéine CD36 qui en présence d'acides gras à longue chaîne (AGLC) régule la voie ERK1/2 et conduit à l'induction de l'ApoB48, de la MTP et de la L-FABP. La dégradation rapide du CD36 par la voie ubiquitine-protéasome en présence d'AGLC, qui conduit à la désactivation de la voie ERK1/2, est typique d'un récepteur. Puisque d'une part les souris invalidées pour le Peroxisome Proliferator Activated receptor (PPAR) présentent une altération de l'adaptation et une hypertriglycéridémie postprandiale et que d'autre part les lipides alimentaires induisent le PPAR via CD36, CD36 et PPAR pourraient faire partie d'un mécanisme commun de régulation. En conclusion, CD36 et PPAR contribuent au sensing entérocytaire des AGLC d'origine alimentaire, responsable de l'adaptation postprandiale du métabolisme des lipides qui favorise la formation de gros chylomicrons efficacement épurés de la circulation sanguine.

L’hypertriglycéridémie (HTG) correspond à une accumulation des lipoprotéines riches en triglycérides (LRTG) dans la circulation plasmatique, conséquence d’une augmentation de leur synthèse ou plus classiquement décrit, d’une diminution de leur catabolisme. Dans près de 50% des cas, aucune cause génétique n’est identifiée chez les patients présentant une présentant une HTG sévère, aussi bien dans le cadre du syndrome de chylomicronémie familiale (FCS) que dans celui du syndrome de chylomicronémie multifactorielle (MCS). Pour améliorer nos connaissances et la caractérisation de ces patients, la conduction de corrélations phénotypes-génotypes précises grâce à une collaboration clinico-biologique étroite, ainsi que le développement d’outils de diagnostic moléculaire performants, demeurent un enjeu majeur. Premièrement, l’évaluation de la concentration pré-héparinique en LPL et l’activité post-héparinique 60 minutes après l’injection d’héparine chez 62 patients MCS caractérises génétiquement a permis la mise en évidence deux sous-groupes chez ces patients. Deuxièmement, le développement d’une stratégie séquençage de nouvelle génération permettant d’explorer simultanément les 9 gènes les plus prévalents dans les hypercholestérolémies, les hypocholestérolémies et les hypertriglycéridémies, a permis de détecter les variants nucléotidiques avec une sensibilité équivalente au séquençage Sanger mais aussi de détecter des grands réarrangements. L’ensemble des résultats souligne la complexité des mécanismes de régulation du métabolisme des LRTG et l’intérêt de l’étude des interactions gène-gène. Ainsi, ces travaux ont permis de mettre en évidence de nouvelles hypothèses à explorer pour la compréhension des mécanismes physiopathologiques des HTG sévères et d’améliorer les outils disponibles pour les études de corrélation génotype-phénotype<br>Hypertriglyceridemia (HTG) correspond to an increase of triglyceride-rich lipoproteins (TGRL) circulating concentration, as a consequence of an increase in the synthesis of or a decrease in their catabolism, most classically described. In nearly 50% of patients with severe hypertriglyceridemia (HTG), no genetic cause is identified, either in familial chylomicronemia syndrome (FCS) or in multifactorial chylomicronemia syndrome (MCS). To gain new insights and to improve patient’s characterization, it remains important to conduct accurate phenotype-genotype association studies through close collaboration with referent lipidologists, and to develop high-performance tools for molecular diagnosis. Firstly, the assessment of pre-heparin LPL concentration as well as LPL activity 60 minutes after heparin injection, enabled the identification of two subgroups within 62 genotyped MCS patients Secondly, the development of a new sequencing generation workflow exploring simultaneously the 9 most prevalent genes in dyslipidemia, allowed the detection of single nucleotide variations with sensitivity equivalent to Sanger sequencing, but also allowed the detection of copy number variations. Collective consideration of the results underlines the complexity of the regulation mechanisms of TGRL metabolism and the interest of gene-gene interactions study. Thus, the studies presented herein bring new hypothesis to explore for understanding the pathophysiological mechanisms of severe HTG and to improve molecular diagnosis tools available for phenotype-genotype association studies

Este estudo teve como objetivos avaliar o metabolismo de quilomícrons utilizando a metodologia da cinética plasmática de uma emulsão de quilomícrons artificiais em pacientes com síndrome dos ovários policísticos (SOP), assim como o impacto da obesidade nesta cinética. Foram estudadas 43 mulheres adultas jovens, subdivididas em 4 grupos, sendo 8 pacientes com SOP e índice de massa corporal normal [SOP-N (IMC = 22,7 ± 1,9 Kg/m2)], e 15 com IMC >=30 kg/m2 [SOP-O (IMC = 33,8 ± 3,3 kg/m2)], pareadas com 20 mulheres controles, sendo 10 com IMC normal [Controle-N (IMC = 21 ± 1,76 kg/m2)] e 10 com IMC obeso [Controle-O (IMC = 33,7± 3,1 kg/m2)]. Quando os grupos foram comparados entre si, com relação às características antropométricas, perfil lipídico e apolipoproteínas; detectou-se diferença estatisticamente significante entre IMC (P < 0,001), circunferência abdominal (CA) (P < 0,001), colesterol total (P = 0,042), HDL-colesterol (P < 0,001), LDL-colesterol (P = 0,009), triglicérides (TG) (P < 0,001) e apolipoproteína B (P < 0,001). As médias destas variáveis foram maiores nos grupos Controle- O e SOP-O, não havendo diferenças entre eles. Com relação à apolipoproteína A1 e ácidos graxos livres não houve diferença entre os grupos. A média da apolipoproteína E foi significativamente maior no grupo Controle-N, não havendo diferença ao compararmos os outros três grupos entre si. Com relação à concentração dos hormônios, as pacientes com SOP tiveram médias significativamente maiores para a testosterona total e testosterona livre (TL) (P < 0,001, P = 0,001), respectivamente. O estradiol foi menor nas pacientes com SOP (P = 0,039), não havendo o impacto da obesidade nestas variáveis hormonais. A média da globulina ligadora dos esteróides (SHBG) foi significativamente maior no grupo Controle-N, não havendo diferença ao compararmos os outros três grupos entre si. Com relação ao modelo homeostático de resistência à insulina (HOMA-IR), houve um impacto significativo da obesidade e da SOP. A média do HOMA-IR foi significativamente maior nas mulheres obesas (Controle e SOP), e nas pacientes com SOP, ao compararmos com as controles pareadas para o IMC. Com relação à cinética plasmática de emulsão de quilomícrons artificiais, não houve diferença estatisticamente significante entre os grupos, da taxa fracional de remoção plasmática de 3H-triglicérides (TFR-TG), que avalia indiretamente a lipólise das partículas de triglicérides dos quilomícrons pela lipase lipoprotéica. Com relação à média da taxa fracional de remoção plasmática de 14C- éster de colesterol (TFR-EC), houve diferenças estatisticamente significantes, sendo as médias das pacientes com SOP menores que as médias das mulheres controles (P = 0,004), sem impacto da obesidade nesta variável. Após a análise de regressão multivariada, não se observou influência de nenhuma das variáveis estudadas na TFR-EC das pacientes com SOP. Na análise de Correlação de Pearson, observamos nas pacientes com SOP, uma correlação direta entre IMC e TG (r = 0,480; P = 0,020), IMC e HOMA-IR (r = 0,687; P < 0,001), CA e TG (r = 0,574; P = 0,004), CA e HOMA-IR (r = 0,634; P = 0,001), HDL e SHBG (r = 0,481; P = 0,020), e correlação inversa entre IMC e SHBG (r = - 0,581; P = 0,004), CA e SHBG (r = - 0,629; P = 0,001), CA e HDL (r = - 0,464; P = 0,016), SHBG e TG (r = - 0,414; P = 0,050), SHBG e HOMA-IR (r = - 0.528; P = 0,010), TL e SHBG (r = - 0.510; P = 0,013). A diminuição da recaptação de remanescentes de quilomícrons, demonstrada através da diminuição da TFR-EC, é compatível com níveis circulantes maiores destes remanescentes, assim como um tempo de permanência maior na circulação, facilitando e progredindo o processo de aterosclerose. A diminuição da TFR-EC está presente na SOP, independentemente do IMC, sendo mais um fator de risco cardiovascular nas portadoras desta síndrome.<br>The aims of this study were to evaluate the chylomicrons metabolism using the method of plasma kinetics of an emulsion of artificial chylomicrons in patients with polycystic ovary syndrome (PCOS), as well as the impact of obesity in this kinetics. Forty-three young adult women were studied , subdivided into 4 groups: 8 of them, with PCOS and normal body mass index [ PCOS-N (BMI = 22.7 ± 1.9 kg/m2)], and 15 with BMI >=30 kg/m2 [PCOS-O (BMI = 33.8 ± 3.3 kg/m2 )] , pairwise matched with 20 controls, being 10 with normal BMI [ Control-N (BMI =21 ± 1.76 kg/m2 )] and 10 with obese BMI [Control-O (BMI = 33.7 ± 3.1 kg/m2 )]. When the groups were compared among themselves, in relation to the antropometric features, lipid profile and apolipoproteins; it was detected a statistically significant difference among BMI (P < 0.001), waist circunference (WC) (P < 0.001), total cholesterol (P = 0.042), HDL-cholesterol (P < 0.001), LDL-cholesterol (P = 0.009), triglycerides (TG) (P < 0.001) and apolipoprotein B (P < 0.001). The means of these variables were higher in the Control-O and PCOS groups and there were no differences among them. In relation to apolipoprotein A1 and to free fatty acids, there was no difference among the groups. The means of apolipoprotein E was significantly higher in the Control-N group and there was no difference when we compared the other three groups among themselves. In relation to hormone concentration, the PCOS patients had means significantly higher for total testosterone and free testosterone (P < 0.001, P = 0.001), respectively. Estradiol was lower in PCOS patients (P = 0.039), and there was no obesity impact in these hormonal variables. The means of sex hormone-binding globulin (SHBG) was significantly higher in the Control-N group, and there was no difference when we compared the other three groups among themselves. In relation to the homeostasis model assessment of insulin resistance (HOMA-IR), there was a significant impact of obesity and of PCOS. The means of HOMA-IR was significantly higher in obese women (Controls and PCOS), and in PCOS patients when compared with pairwise matched controls for BMI. In relation to the plasma kinetics of artificial chylomicrons emulsion, there was no statistically significant difference among the groups, of the plasma 3H-triglyceride fractional clearance rate (TFR-TG) , which evaluates indirectly the lipolysis of triglycerides particles of chylomicrons by the lipoprotein lipase. In relation to the means of plasma fractional clearance rate of 14C-cholesterol ester (TFR-EC), there were statistically significant differences, being the means of PCOS patients, lower than the means of controls (P = 0.004), without obesity impact in this variable. After the multivariate regression analysis, it was not observed influence of any of the variables studied in TFR-EC of PCOS patients. Using the Pearson\'s Correlation analysis, we observed in PCOS patients, a direct correlation between BMI and TG (r = 0.480; P = 0.020), BMI and HOMA-IR (r = 0.687; P < 0.001), CA and TG (r = 0.574; P = 0.004), CA and HOMA-IR (r = 0.634; P = 0.001); HDL and SHBG (r = 0.481; P = 0.020) and inverse correlation between BMI and SHBG ( r = - 0.581; P = 0.004), CA and SHBG (r = - 0.629; P = 0.001), CA and HDL (r = -0.464; P = 0.016), SHBG and TG ( r = - 0.414; P = 0.050), SHBG and HOMA-IR ( r = - 0.528; P = 0.010), TL and SHBG ( r = - 0.510; P = 0.013). The decrease of the uptake of chylomicrons remnants shown through the decrease of TFR-EC, is compatible with higher circular levels of these remnants, as well as a prolonged duration in the circulation, facilitating and proceeding to the atherosclerosis process. The decrease of TFR-EC is present in PCOS, independently of BMI, and it is one more cardiovascular risk factor for PCOS patients.

FINALIDADE: Defeitos na depuração plasmática de quilomícrons e seus remanescentes (QM) predispõem à doença arterial coronária (DAC). QM ligam-se a seus receptores hepáticos específicos (RLP) e aos receptores de LDL (LDL-r). As estatinas reduzem o LDL-colesterol (LDL-C) e melhoram a depuração plasmática de QM, aumentando a expressão hepática do LDL-r. A ezetimiba (EZE), um bloqueador da absorção do colesterol, também aumenta a expressão de LDL-r nos seres humanos. Este estudo avaliou os efeitos isolados da EZE na depuração plasmatica de QM artificial em pacientes DAC. Também foram testados os efeitos da associação da sinvastatina em dose baixa com EZE em comparação com a máxima dose de sinvastatina sobre depuração plasmática de QM. MÉTODOS: 25 pacientes com DAC estável (idade 61 ± 5 anos), após um período de seis semanas de washout de estatinas, foram randomizados para um ou outro tratamento com 10 mg EZE (grupo 1, n = 13) ou sinvastatina 20 mg (grupo 2, n = 12). Os pacientes evoluíram para 10mg + 20mg de sinvastatina com EZE ou sinvastatina 80 mg, respectivamente. Os estudos cinéticos foram realizados no início e após 6 e 12 semanas de cada braço do tratamento. A emulsão lipídica de QM marcada com 14C-CE (que mede a remoção QM e remanescente) e 3H-TG (que mede a lipólise de QM) foi injetada e amostras de sangue foram coletadas durante 60 minutos para determinar taxas de remoção fracionária de radioisótopos (TFR) por análise compartimental. As comparações foram feitas por analise de medidas repetidas (ANOVA). RESULTADOS: Não houve diferenças nas características clínicas e laboratoriais entre os grupos. As TFR de 14C-CE (1/min) no grupo 1 foram 0,005 ± 0,004, 0,011 ± 0,007 e 0,018 ± 0,004 e no grupo 2 foram 0,004 ± 0,002, 0,011 ± 0,008 e 0,019 ± 0,007, respectivamente, à admissão, 6 e 12 semanas ( p <0,05 e ns, respectivamente, para comparações de tempo e grupo). As TFR de 3H-TG (1/min) no grupo 1 foram de 0,017 ± 0,01, 0,024 ± 0,011 e 0,042 ± 0,013 e no grupo 2 foi de 0,01 ± 0,016, 0,022 ± 0,009 e 0,037 ± 0,011, respectivamente, no início do estudo, 6 e 12 semanas ( p <0,05 e ns, respectivamente, para comparações de tempo e grupo). Mudanças semelhantes também foram encontradas para o LDL-C (mg/dL): 142 ± 22,113 ± 19, 74 ± 17 para grupo1 e 119 ± 22, 92 ± 15 e 72 ± 15 para o grupo 2, respectivamente, na admissão, 6 e 12 semanas (p <0,05 para o tempo e ns para o grupo). CONCLUSÃO: EZE isolada aumentou a remoção do plasma de QM e remanescentes e a associação com a sinvastatina aumentou os seus efeitos. A sinvastatina em dose baixa associada à EZE apresentou efeitos favoráveis semelhantes tanto na depuração plasmática de QM quanto na redução de LDL-C em comparação com 80mg de sinvastatina<br>PURPOSE: Defects on plasma clearance of chylomicrons and their remnants (CM) predispose to coronary heart disease (CHD). CM bind both to their specific liver receptors (LRP) and to the LDL receptors (LDL-r). Statins reduce LDL-cholesterol (LDL-C) and improve the plasma clearance of CM by increasing the expression of hepatic LDL-r. Ezetimibe (EZE), a cholesterol absorption blocker, also increases LDL-r expression in humans. This study evaluated the isolated effects of EZE on the plasma clearance of artificial CM in CHD subjects. We also tested the effects of the association of low dose simvastatin with EZE in comparison with maximal simvastatin dose upon CM plasma clearance. METHODS: 25 stable CHD patients (age 61 ± 5 years, 98%men) after a 6 week statin washout period were randomized for either treatment with EZE 10 mg (group 1, n= 13) or simvastatin 20 mg (group 2 n=12). Patients were progressed to 10mg EZE+ simvastatin 20mg or simvastatin 80 mg, respectively. Kinetic studies were done at baseline and after 6 and 12 weeks of each treatment arm. The CM emulsion labelled with 14C-CE (that measures CM and remnant removal) and 3H-TG (that measures CM lipolysis) was injected and blood samples were collected during 60 minutes to determine radioisotopes fractional catabolic rates (FCR) by compartmental analysis. Comparisons were made repeated measurements ANOVA. RESULTS: There were no differences in clinical and laboratory characteristics between the groups. The 14C-CE FCR (1/min) in group 1 were 0.005±0.004, 0.011±0.007 and 0.018±0.004 and in group 2 were 0.004±0.002, 0.011±0.008 and 0.019±0.007 respectively at baseline, 6 and 12 weeks (p<0.05 and n.s respectively for time and group comparisons). The 3H-TG FCR (1/min) in group 1 were 0.017±0.01, 0.024±0.011 and 0.042±0.013 and in group 2 were 0.01± 0.016, 0.022±0.009 and 0.037±0.011 respectively at baseline, 6 and 12 weeks (p <0.05 and n.s respectively for time and group comparisons). Similar changes were also found for LDL-C (mg/dL):142 ± 22,113 ± 19, 74 ± 17 for group1 and 119 ± 22, 92 ± 15, and 72 ± 15 for group 2 respectively at baseline, 6 and 12 weeks (p<0.05 for time and n.s. for group). CONCLUSION: EZE alone increased the removal from plasma of CM and remnants, the association with simvastatin increased its effects. The low dose simvastatin associated with EZE showed similar favourable effects in both CM plasma clearance and LDL-C in comparison with 80 mg simvastatin

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A hipercolesterolemia familiar (HF) é uma doença caracterizada por elevadas concentrações do colesterol das lipoproteínas de baixa densidade (LDL) e doença coronariana (DAC) prematura. Os remanescentes de quilomícrons são removidos principalmente pelo seu receptor específico (RLP), mas também pelo receptor da LDL. Este último encontra-se defeituoso na maior parte dos casos de HF e poderia levar a menor remoção plasmática dos quilomícrons. Há controvérsias se existem distúrbios do metabolismo dos quilomícrons em portadores de HF. Mais ainda não se sabe se estes defeitos poderiam contribuir para o desenvolvimento de DAC na HF. O objetivo deste estudo foi avaliar se portadores de HF apresentam defeitos na remoção plasmática de quilomícrons artificiais e seus remanescentes em relação a indivíduos normolipidêmicos. Foi avaliado também em estudo transversal se existe associação da cinética dos quilomícrons com a presença de DAC subclínica medida pela calcificação da artéria coronária (CAC). Foram estudados 36 pacientes portadores de HF e 50 controles normolipidêmicos pareados para idade e sexo. A remoção plasmática dos quilomícrons foi medida pelo decaimento radioisotópico da emulsão de quilomícrons artificiais injetada após jejum. A CAC foi determinada por tomografia computadorizada cardíaca nos portadores de HF. As taxas fracionais de remoção (TFR) dos quilomícrons e de seus remanescentes representadas pelo decaimento do 14C-éster de colesterol (TFR 14C-CE em min-1) foram menores nos portadores de HF em comparação aos normolipidêmicos: mediana (intervalos) 0,0013 (1,5.10-9;0,082) vs. 0,012 (1,51.10-9;0,017) p= 0,001. Não houve diferença em relação à remoção dos triglicérides da emulsão representada pelo decaimento da 3H-triglicérides (TFR 3H-TG em min-1) entre os grupos: 0,027 (0,0004;0,23) e 0,03 (0,0004;0,4) respectivamente nos grupo HF e controle (p= 0,26). Não foram encontradas diferenças significativas nas TFR tanto do 14C-CE 0,0007 (1,47. 10-9; 0,082) e 0,0013 (1,6. 10-9; 0,038) p= 0,67 como do 3H-TG 0,025 (0,0004; 0,07) e 0,0029 (0,009; 0,23), p=0,80 respectivamente nos portadores de HF apresentando (n=20) ou não CAC (n= 16). Em conclusão os portadores de HF apresentaram diminuição significativa da remoção dos quilomícrons e seus remanescentes em comparação com normolipidêmicos. Contudo, não foi encontrada associação entre esses distúrbios e a presença da DAC subclínica<br>Familial hypercholesterolemia (FH) is characterized by high concentrations of low density lipoproteins (LDL) cholesterol and early onset of coronary artery disease (CAD). Chylomicron remnants are removed mainly by their specific receptors (RLP) but also by the LDL receptor. The latter is defective in most cases of FH and could lead to lower plasma removal of chylomicrons and their remnants. There is controversy whether there are disorders of chylomicron metabolism in patients with FH. Moreover, it is unclear if these defects could contribute to the development of CAD in FH. The aim of this study was to evaluate whether there are defects on the removal from plasma of chylomicrons and their remnants in FH patients in comparison with normolipidemic subjects. We also evaluated in a cross sectional study the association of chylomicron kinetics with the presence of subclinical CAD represented by coronary artery calcification (CAC). We studied 36 patients with FH and 50 normolipidemic controls matched for age and sex. The plasma removal of chylomicrons was measured by isotopic decay of artificial chylomicron emulsion injected after fasting. CAC was determined by cardiac computed tomography in FH patients. The fractional catabolic rates (FCR) of chylomicrons and remnants removal represented by 14C-cholesteryl ester decay (14C-CE FCR in min-1) were lower in FH in comparison with normolipidemics: median (ranges) 0.0013 (1.47.10-9; 0.082) vs. 0.012 (1.51.10-9, 0.169) p = 0.001. There was no difference regarding the removal of emulsion triglyceride represented by 3H-triglyceride decay of ( 3H- TG FCR in min-1) between the groups: 0.026 (0.0004; 0.23) and 0.031 (0.0004; 0.4) respectively in FH and in normolipidemics (p = 0.264). There were no significant differences in both the 14C-CE FCR 0.0007 (1.47.10-9; 0.08) and 0.0013 (1.61.10-9; 0.038) p = 0.67 and in the 3H-TG FCR 0.025 (0.0004; 0.075) and 0.029 (0.0095; 0.23), p = 0.80 respectively in FH patients presenting (n = 20) or not CAC (n = 16). In conclusion patients with FH had a significant decrease on the removal from plasma of chylomicrons and their remnants compared with normolipidemics. However, no association between these disorders and the presence of CAC was found

O principal distúrbio metabólico decorrente do Diabetes mellitus tipo 2 e da Síndrome Metabólica corresponde a alterações no metabolismo lipídico. Portanto, torna-se importante a melhor compreensão de alguns aspectos do metabolismo de lipoproteínas plasmáticas. Nesse sentido, a avaliação do metabolismo dos quilomícrons e da transferência de lípides de lipoproteínas plasmáticas para a lipoproteína de alta densidade (HDL), pode fornecer informações importantes relacionadas com o processo aterogênico. No presente estudo, foram estudados 15 indivíduos portadores de Diabetes mellitus tipo 2, 15 indivíduos com Síndrome Metabólica e 14 controles normolipidêmicos. Foi avaliada a cinética plasmática de uma nanoemulsão lipídica artificial com comportamento metabólico similar ao dos quilomícrons naturais, marcada com triglicérides (TG-3H) e éster de colesterol (EC-14C) radioativos. A nanoemulsão de quilomícrons artificiais foi injetada endovenosamente e amostras de sangue foram coletadas durante intervalos préestabelecidos. As curvas de decaimento plasmático dos lípides radioativos da nanoemulsão foram traçadas e as taxas fracionais de remoção (TFR) foram calculadas por análise compartimental. Para avaliação da transferência de lípides foi utilizada uma nanoemulsão semelhante a LDL (LDE) marcada com TG-3H e colesterol livre-14C (CL-14C) ou fosfolípides-14C (PL-14C) e EC-3H, como doadora de lípides para a HDL. Após incubação in vitro da LDE com o plasma, seguiu-se a precipitação das lipoproteínas que contem apolipoproteína B, restando no sobrenadante apenas a HDL. As taxas de transferência de lípides foram expressas em % de radioatividade encontrada no sobrenadante. Também foi determinado o diâmetro da HDL por espalhamento de luz. A TFR-EC dos grupos DM2 (p <0,05) e SM (p <0,01) comparado ao grupo controle apresentou-se diminuída, enquanto que as TFR-TG foram similares nos três grupos. Houve maior transferência de fosfolípides e colesterol nos grupos DM2 e SM comparando-se com grupo controle (p<0,001) A transferência de triglicérides e de éster de colesterol não diferiu entre os grupos. Não observou-se diferença no diâmetro da HDL nos três grupos. Concluindo, nossos resultados sugerem que a remoção plasmática dos remanescentes de quilomícrons encontra-se alterada em pacientes com SM e com DM2. Além disso, a transferência de lípides presentes na superfície das lipoproteínas para a HDL encontra-se aumentada nesses dois distúrbios metabólicos. Essas alterações podem contribuir com a maior incidência de aterosclerose nesses pacientes.<br>The main metabolic disturbances occurring as a result of type 2 diabetes mellitus (DM2) and Metabolic Syndrome (MetS) are alterations in the metabolism of lipids. It is therefore, important to better understand the aspects by which plasma lipoproteins are metabolized. The evaluation of chylomicron metabolism and lipid transfer of high density lipoprotein (HDL) can thus yield useful information regarding the atherosclerotic process. In this study, 15 Type 2 Diabetes individuals, 15 Metabolic Syndrome individuals and 14 normolipidemic control individuals were studied. The plasmatic kinetics of an artificial lipidic nanoemulsion mimicking the behavior of natural chylomicrons were evaluated. This artificial chylomicron nanoemulsion, labele with radioactive triglycerides (TG-3H) and radioactive cholesteryl oleate (CO-14C) was injected intravenously and blood samples collected at pre-established time intervals. The plasmatic decay curve of the radioactive lipids of the nanoemulsion was traced and the fractional clearance rate calculated (FCR) through compartmental analysis. In order to evaluate the lipid transfer, we used a nanoemulsion similar to LDL., labeled with TG-3H and free cholesterol -14C (CL-14C) or with phospholipids -14C (PL-14C) and CO-3H, as a lipid donator to HDL. After in vitro nanoemulsion incubation with the plasma, the lipoproteins containing apolipoprotein B were precipitated, resulting in a supernatant containing HDL. The lipid transfer rates were expressed in % of radioactivity measured in the supernatant. It was also determined the diameter of the HDL using light scattering technique. The TFR-EC for the DM2 (p <0.05) and MetS (p <0.01) groups when compared to the control group was reduced. The TFR-TG, on the other hand, remained similar in all three groups. The transfer of phospholipids and cholesterol for the DM2 (p<0.001) and MetS groups was greater than that of the control group (p<0.001). The triglycerides and ester cholesteryl transfer showed no differences between the studied groups. Furthermore, no difference in HDL diameter was observed in any of the three groups. In conclusion, our results suggest that the removal of chylomicron remnants from the plasma is altered in SM and DM2 patients. Furthermore, there is an increase in the transfer of lipids located on the surface of lipoproteins to HDL . These alterations may contribute to a higher incidence of atherosclerosis in these patients.