Objectives-Lecithin:cholesterol acyltransferase deficiency (LCAT-def) is characterized by low levels of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) and the accumulation of lipoprotein-X (LpX). Despite the low HDL, atherosclerosis is uncommon in LCAT-def. The decreased LDL would be a possible explanation but the underlying mechanism is not clear. In addition, the mechanism(s) for LpX accumulation is not known. The aim of the present study is to elucidate the mechanism(s) responsible for the low LDL and determine the plasma kinetics of LpX in LCAT-def. Methods and Results-We conducted a radiotracer study in LCAT-def (nϭ2) and normal controls (nϭ10) and a stable isotope study in one patient and other controls (nϭ7). LCAT-def LDL was catabolized faster than control LDL in the control subjects as well as in LCAT-def patients. Control LDL was catabolized faster in LCAT-def patients than the controls. The production rate of LDL apolipoprotein B-100 was normal in LCAT-def. The increased LDL apoB-100 catabolism was confirmed by a stable isotope study. LpX was catabolized more slowly in LCAT-def. (HDL). Human LCAT deficiency (LCAT-def) is characterized by corneal opacity, anemia, and proteinuria, 1 with low levels of HDL and LDL and the accumulation of lipoprotein-X (LpX). In LCAT-def, HDL is markedly decreased, together with abnormalities in size and lipid composition. 2 Most of the HDL in LCAT-def is small and discoidal, 3 a characteristic resembling newly synthesized HDL. 4,5 In the absence of LCAT, newly synthesized HDL cannot esterify FC to CE in its core so that HDL cannot develop into its mature stable forms of either HDL 3 or HDL 2 . 6 This process of HDL maturation is important for reverse cholesterol transport, a hypothesis that HDL transports CE from peripheral atherosclerotic lesions to the liver. This hypothesis is based on epidemiological studies that indicated an inverse correlation between the HDL cholesterol (HDL-C) levels and the prevalence of coronary heart disease (CHD) as an independent anti-atherogenic factor for CHD. 7 It is therefore interesting to note that despite a markedly low level of HDL-C and a loss of the HDL maturation process, CHD is
Conclusions-The decreased LDL in LCAT-
See page 1201not a common complication in LCAT-def patients. 8,9 Gylling 10 reported the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were decreased in LCAT-def. The accompanying low level of LDL is perhaps the reasonable explanation for the low incidence of CHD in LCAT-def. Studies dealing with abnormalities in LDL lipid composition in LCAT-def reported that LCAT-def LDL (L-LDL) has higher amounts of triglyceride (TG), phospholipids (PL), and FC, and an extremely low amount of CE. 11 In plasma, lipoprotein lipase (LPL) and hepatic lipase (HL) catalyze the lipolysis of TG in TG-rich lipoproteins such as chyromicron and very-low-density lipoprotein (VLDL). L-LDL rich in TG may be also affected by LPL and HL, although the influence of these enzymes on normal LDL (N-...