Thesis (M. S.)--Biology, Georgia Institute of Technology, 2007. / Alfred H. Merrill, Jr., Committee Chair ; Marion B. Sewer, Committee Member ; Eva K. Lee, Committee Member.

Background & Aims: The 'high-density lipoprotein (HDL) hypothesis', that therapeutic interventions directed at raising HDL cholesterol might translate into improved cardiovascular outcomes, has been confounded by recent reports from genetic and pharmacological studies. HDL functionality may be more important than cholesterol cargo. HDL cholesterol levels are normal or even high in Type 1 Diabetes (T1DM) but do not seem to protect against atherosclerosis as might be expected; this thesis aims to offer new insight into HDL functionality through examination of these patients. This thesis also aims to improve understanding of the qualitative changes in lipoproteins associated with diabetes and increased cardiovascular morbidity, with emphasis on atherogenic modifications of apolipoprotein B and sphingolipids, and consideration of the relationship between these changes, novel and established biomarkers, and macrovascular and microvascular diabetic complications. Materials & Methods: Patients with Type 1 (n = 91) and Type 2 (n = 40) Diabetes Mellitus and healthy volunteers (n = 104) attended for fasting blood tests, urinalysis, and examination including cardiac computed tomography, carotid doppler studies and assessments of nerve function. In vitro studies of lipoprotein modification used pooled human plasma. Results: Lipoprotein glycation represents an atherogenic modification. In vitro glycation occurs more readily in the presence of physiological concentrations of copper. HDL and copper-selective chelation with triethylenetetramine prevents glycation. Glycated apolipoprotein B, oxidized LDL and small-dense LDL levels were significantly higher in T1DM; HDL cholesterol levels were also significantly higher, but with altered apolipoprotein distribution, and significantly lower cholesterol efflux capacity and PON1 activity than in healthy controls. Significant changes were also observed in cystatin C, advanced glycation end-products, leucine-rich alpha-2-glycoprotein, lipoprotein-associated phospholipase A2, a variety of inflammatory markers, and sphingolipid and ceramide profiles. Discussion: Cardiovascular disease is the leading cause of death and disability in diabetes. Patients with diabetes show qualitative and kinetic lipoprotein abnormalities, and any cardiovascular benefit associated with intensive glucose lowering may be related to effects on lipoprotein metabolism rather than directly through altered glycaemia. The apparently relatively undisturbed lipid profile observed in many patients with diabetes hides major atherogenic changes and altered HDL functionality, which may be at least partially responsible for the persistent increased risk of cardiovascular disease in patients with diabetes. HDL-based therapy remains a largely unfulfilled promise, but there may be a role for copper-selective chelation and more aggressive low-density lipoprotein lowering in the reduction of diabetic complications.

Les acides gras saturés (AGS) altèrent la fonctionnalité des organites dans de nombreux types cellulaires. Il a été proposé que ce processus, également nommé lipointoxication, puisse être responsable de plusieurs pathologies humaines telles que le diabète de Type 2.Au niveau cellulaire, l'accumulation d'AGS est associée à une augmentation du taux de saturation des phospholipides (PL) membranaires, les composants majoritaires des membranes des organites, mais également du taux de céramides, impliqués dans l'induction de l'apoptose.Dans une première partie de ce travail, nous avons étudié, chez le modèle cellulaire simple Saccharomyces cerevisiae, la contribution relative des PL saturés et des céramides à la cytotoxicité des AGS. Nous avons pu démontrer que les céramides agissaient à des étapes précoces de la voie de sécrétion, alors que les PL saturés impactaient des étapes plus tardives en altérant en particulier la formation de vésicules de sécrétion.Parallèlement, nous avons également constaté que le taux d'AGS était significativement augmenté dans les PL membranaires des patients atteints d'une maladie génétique, la mucoviscidose. La mutation la plus fréquente responsable de cette maladie, résulte en la rétention de la protéine correspondante dans le réticulum endoplasmique. Des molécules pharmacologiques, capables de corriger le trafic de la protéine à sa destination finale ont été isolées in vitro, mais des limitations importantes ont pu être observées lors des tests cliniques. Nous proposons dans le présent manuscrit que la lipointoxication liée aux AGS pourrait être un écueil important à l'utilisation des correcteurs actuels pour le traitement de la mucoviscidose. / Saturated fatty acids (SFA) have been reported to alter organelle integrity in many cell types. This process, also known as lipotoxicity, has been proposed to be responsible for several human pathologies such as type 2 diabetes.At the cellular level, SFA accumulation is associated with an increase of the saturation rate of membrane phospholipids (PL), the major components of organelle membranes, and an increase of ceramides levels, implicated in apoptosis induction.In the first part of this work, we took advantage of a simple yeast-based model to study the relative contributions of saturated PL and ceramides to SFA cytotoxicity. We demonstrated that ceramides act early in the secretory pathway, while saturated PL impact the later steps, and particularly the formation of secretory vesicles.In parallel, we observed that SFA amounts were significantly increased in the membrane PL of cystic fibrosis (CF) patient cells. The most common mutation responsible for this genetic disease results in the retention of the corresponding protein in the endoplasmic reticulum. Pharmacological agents, which correct the mistrafficking of the protein, have been isolated in vitro, but they did not show significant improvements in clinical trials. We propose in the present manuscript, that SFA-related lipointoxication could be an important bottleneck for the use of these pharmacological agents in clinical trials.