Alterations in cholesteryl ester transfer, lipoprotein lipase, and lipoprotein composition after combined pancreas-kidney transplantation

Diabetes
J D BagdadeR P Robertson

Abstract

IDDM patients treated with conventional subcutaneous insulin have an abnormal increase in cholesteryl ester transfer (CET), the proatherogenic step in reverse-cholesterol transport that results in the enrichment of the apolipoprotein (apo) B-containing lipoproteins (VLDL, LDL) with cholesteryl ester (CE). This disturbance is closely linked to iatrogenic hyperinsulinemia and the nonphysiologic stimulation of lipoprotein lipase (LpL), a physiologic activator of CET, because lowering systemic insulin levels by administering insulin through the intraperitoneal insulin route normalizes LpL and CET. Hyperinsulinemia persists in IDDM patients who undergo successful pancreas-kidney transplantation (PKT) when their allografts are placed in the pelvis and drain into the iliac vein. Therefore, to determine whether hyperinsulinemia promotes CET in this setting, we studied CET, LpL, and insulin levels in 14 euglycemic normolipidemic IDDM PKT patients with near-normal kidney function (creatinine 1.5 +/- 0.4 mg/dl). Consistent with our prediction, the net mass of CE transferred from HDL to VLDL + LDL was significantly increased in the PKT group (P < 0.001) compared with nondiabetic renal transplant patients receiving the same immunosuppressiv...Continue Reading

Citations

Apr 2, 2009·Current Opinion in Organ Transplantation·Carlton J Young
Apr 24, 2007·Diabetes Research and Clinical Practice·Tomohiko SasaseMutsuyoshi Matsushita
Nov 7, 2007·Endocrinology and Metabolism Clinics of North America·Gerald S Lipshutz, Alan H Wilkinson
Jul 14, 2017·Clinical Diabetes and Endocrinology·Marcio W Lauria, Antonio Ribeiro-Oliveira
Apr 7, 2009·Arquivos brasileiros de endocrinologia e metabologia·Alina Coutinho Rodrigues FeitosaBernardo Léo Wajchenberg

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