title: Lipid composition and lipopolysaccharide binding capacity of lipoproteins in plasma and lymph of patients with systemic inflammatory response syndrome and multiple organ failure.
abstract: BACKGROUND
  Lipopolysaccharide (LPS), the major glycolipid component of Gram-negative bacterial outer membranes, is a potent endotoxin responsible for many of the directly or indirectly induced symptoms of infection. Lipoproteins (in particular, high-density lipoproteins) sequester LPS, thereby acting as a humoral detoxification mechanism.
  
  
  METHODS
  Differences in the lipoprotein composition in human plasma and lymph of a control patient group (n = 5) without systemic inflammatory response syndrome (non-SIRS/MOF) and patients with SIRS and multiple organ failure (MOF, n = 9) were studied. The LPS binding capacity of the lipoproteins in SIRS/MOF and non-SIRS/MOF patients was investigated by rechallenge of the plasma and lymph with fluorescently labeled LPS ex vivo. The lipoprotein composition was analyzed using immunochemical techniques and high-performance gel permeation chromatography.
  
  
  RESULTS
  In the non-SIRS/MOF patient group, plasma and lymph levels of apolipoprotein A-I (600 and 450 mg/L, respectively), apolipoprotein B (440 and 280 mg/L, respectively), total cholesterol (2.88 and 1.05 mM, respectively), and total triglycerides (0.67 and 0.97 mM, respectively) were observed. In the SIRS/MOF group, a decrease of apolipoprotein A-I (-55% in plasma and lymph), a decrease of apolipoprotein B (-43% in plasma and -38% in lymph), and a decrease of total cholesterol levels (-54% in plasma and -37% in lymph) were demonstrated. However, the triglyceride levels in the SIRS/MOF group showed a 30% increase in plasma and a 47% decrease in lymph compared with the non-SIRS/MOF patients. In SIRS/MOF patients, a 2.8-fold increase in plasma and a 1.8-fold increase in lymph of the LPS low-density lipoprotein/high-density lipoprotein ratio was observed, indicating that the relative LPS binding capacity of the lipoproteins in the SIRS/MOF patient group showed a trend to be shifted mainly toward low-density lipoproteins. Furthermore, in plasma and lymph of four SIRS/MOF patients, a novel cholesterol-containing high-density lipoprotein-like particle was found that barely had LPS binding capacity (<5%).
  
  
  CONCLUSIONS
  In the SIRS/MOF patients, the changes in lipoprotein composition in lymph are a reflection of those in plasma, except for the triglyceride levels. In comparison with the non-SIRS/MOF patients, the SIRS/MOF patients show a shifted LPS binding capacity of high-density lipoproteins toward low-density lipoproteins in plasma and in lymph. Moreover, in plasma and lymph, novel cholesterol-containing particles, resembling high-density lipoprotein, were identified in the SIRS/MOF patient group.
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Johannes H M
authors.initials: JH
authors.lastname: Levels
authors.forename: Luciënne C J M
authors.initials: LC
authors.lastname: Lemaire
authors.forename: Abraham E
authors.initials: AE
authors.lastname: van den Ende
authors.forename: Sander J H
authors.initials: SJ
authors.lastname: van Deventer
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000378:metabolism; D001055:Apolipoproteins B / Q000378:metabolism; D016022:Case-Control Studies; D002784:Cholesterol / Q000378:metabolism; D005260:Female; D006706:Homeostasis; D006801:Humans; D008070:Lipopolysaccharides / Q000378:metabolism*; D008074:Lipoproteins / Q000378:metabolism*; D008196:Lymph / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000276:immunology* / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology* / Q000378:metabolism; D014280:Triglycerides / Q000378:metabolism
chemical_list: D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008070:Lipopolysaccharides; D008074:Lipoproteins; D014280:Triglycerides; D002784:Cholesterol