Elevated cholesteryl ester transfer protein-mediated transfer of cholesteryl ester (CE) from high-density lipoprotein (HDL) to low-density lipoprotein (LDL) may contribute to the atherogenicity of LDL in subjects with familial hypercholesterolemia (FH). To identify the major CE acceptors among LDL subspecies, we investigated the qualitative and quantitative features of CE transfer and exchange to LDL on incubation of plasma under physiological conditions. LDL subspecies were fractionated by density-gradient ultracentrifugation. Both mass transfer and exchange of HDL CE to and with very-low-density lipoprotein plus intermediatedensity lipoprotein and LDL were linear for the first 6 hours of incubation. Thereafter mass transfer ceased, but exchange continued at a comparable rate. In plasma, LDL is distributed as a continuum of particles over the density range between d= 1.019 and d= 1.063 g/mL. In this density interval, multiple LDL subspecies possessing different physical, chemical, hydrodynamic, immunological, and structural properties have been described in the plasma of normolipidemic and hypercholesterolemic subjects. 1219 In this study, we determined both exchange and net mass transfer of CE from HDL to LDL subfractions by a methodology involving the simultaneous determination of CE radioactivity and mass in both normolipidemic and hypercholesterolemic subjects. We investigated possible relations between CE transfer and the establishment of the LDL profile in human plasma. Moreover, we identified which LDL subspecies may represent the preferential CE acceptors in patients with familial hypercholesterolemia (FH) compared with those in normolipidemic subjects. Elevated CE transfer to preferred LDL subspecies may represent a determinant factor in promoting the atherogenic LDL profile generally observed in FH patients.
Methods
Subjects and Blood SamplesApproval by the Human Subjects Review Committee of the hospital and informed consent from all participants was obtained. Six heterozygous FH subjects (4 men and 2 women) by guest on May 9, 2018 http://atvb.ahajournals.org/ Downloaded from