Lipoprotein composition in insulin-dependent diabetes mellitus with chronic renal failure: effect of kidney and pancreas transplantation

Autor: Rebecca P. Winsett, Suzanne M. Hughes, H S Amiri, X. Wang, A. Osama Gaber, Maher Ghawji, Donna Hathaway, D. S. Elmer, Thomas A. Hughes
Rok vydání: 1994
Předmět:
Adult
Blood Glucose
Male
medicine.medical_specialty
Very low-density lipoprotein
Time Factors
Apolipoprotein B
Endocrinology
Diabetes and Metabolism
Lipoproteins
Phosphatidylcholine-Sterol O-Acyltransferase
chemistry.chemical_compound
Endocrinology
Internal medicine
Diabetes mellitus
medicine
Humans
Diabetic Nephropathies
Chromatography
High Pressure Liquid
Triglycerides
Aged
Kidney
Triglyceride
biology
business.industry
Cholesterol
nutritional and metabolic diseases
Middle Aged
medicine.disease
Kidney Transplantation
Transplantation
Lipoproteins
LDL
medicine.anatomical_structure
Apolipoproteins
Diabetes Mellitus
Type 1
chemistry
biology.protein
Kidney Failure
Chronic
lipids (amino acids
peptides
and proteins)
Female
Cholesterol Esters
Pancreas Transplantation
business
Lipoproteins
HDL
Lipoprotein
Zdroj: Metabolism: clinical and experimental. 43(3)
ISSN: 0026-0495
Popis: Chronic renal failure (CRF) in nondiabetics is associated with a number of lipoprotein abnormalities that place these patients at high risk for atherosclerosis. This study compared the lipoprotein composition of nondiabetic controls (n = 68) with that of patients with insulin-dependent diabetes mellitus ([IDDM] n = 13) and of patients with IDDM and CRF ([IDDM + CRF] n = 74). Six lipoprotein subfractions (very-low-density lipoprotein [VLDL], intermediate-density lipoprotein [IDL], low-density lipoprotein [LDL], high-density lipoprotein-light [HDL-L], HDL-medium [HDL-M], and HDL-dense [HDL-D]) were isolated by rapid gradient ultracentrifugation using a fixed-angle rotor. The apolipoprotein (by reverse-phase high-performance liquid chromatography [HPLC]) and lipid (by enzymatic assays) composition of each subfraction was determined. The only abnormalities found in IDDM patients were increases in IDL and HDL-L triglyceride (TG) levels and an increase in the HDL-L free cholesterol (FC) level. The IDDM + CRF group had multiple abnormalities including (1) elevated TG, apolipoprotein (apo) C-II, and apo C-III levels in all lipid subfractions; (2) elevated VLDL and IDL apo B, TG, FC, cholesterol ester (CE), and phospholipid (PL) levels (with an increased CE/TG ratio in VLDL only); (3) decreased HDL-M apo A-I, apo A-II, CE, and PL levels, but an increased HDL-D apo A-I level; and (4) decreased lecithin:cholesterol acyltransferase (LCAT) activity. Twenty-five of the IDDM + CRF patients underwent combined pancreas and kidney (P + K) transplantation, and 12 patients received only a kidney transplant. Lipoprotein composition was determined at 3, 6, and 12 months posttransplant. Both types of transplantation resulted in similar alterations in lipoprotein composition, even though there was essential normalization of blood glucose levels in most of the patients who received a pancreas transplant (hemoglobin A1C [HbA1C], 9.1% +/- 1.1% v 5.7% +/- 0.3% at 12 months, P < .01). These posttransplant changes included (1) no improvement in the elevated TG level in any lipid subfraction even though there was some reduction in apo C-III levels in VLDL; (2) reductions in levels of VLDL and IDL apo B but increases in LDL apo B; (3) increases in HDL apo C-III and FC concentrations despite an increase in LCAT activity; and (4) increases in apo A-I levels in HDL-L and HDL-M. The addition of a pancreas to a kidney transplant had no obvious impact on the lipoproteins.(ABSTRACT TRUNCATED AT 400 WORDS)
Databáze: OpenAIRE
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