L ipoprotein levels in plasma are a function of the rate at which they are produced as well as the rate at which they are catabolized. Both processes are critical. Yet the greatest proportion of clinical investigative energy by far has focused on the latter, with relatively little interest, by contrast, in the former. To be sure, considerable work has been done by basic scientists to elucidate the steps involved in the formation and secretion of a hepatic particle (for a general review, see Reference 1). However, for the most part, this knowledge has not yet altered our approach to the classification and therapy of dyslipoproteinemias in humans. This situation stands in marked contrast to the errors of catabolism, in which advances in basic knowledge have been tightly coupled to a better understanding of the pathogenesis of distinct clinical disorders. As a result, among physicians there is a widespread failure to appreciate that not only can hepatocytes vary the composition of the apolipoprotein (apo)B particles that they secrete but even more importantly, that they can also vary the rate at which such particles emerge into the circulation. The purpose of this review is to demonstrate that such differences can be related in large degree to differences in the delivery of various substrates to the liver, and if this is recognized, how our understanding of the pathophysiology of a number of human dyslipoproteinemias can be increased.
Effect of Carbohydrate on the Assembly, Secretion,and Plasma Metabolism of VLDL Perhaps because triglycerides are the major lipid component of very low density lipoprotein (VLDL), the general view appears to be that the rate of secretion of such particles is merely a simple and direct function of the corresponding rate of triglyceride synthesis within the hepatocyte. Experimentally, however, this does not appear to be the case. For example, increasing the glucose concentration in the medium surrounding HepG2 cells results in increased intracellular triglyceride synthesis and secretion but does not alter the rate of apoB secretion.2 The effect of glucose under these circumstances, therefore, is to alter the composition of the secreted apoB particles so that they contain more