Die Doppelfiltrationsapherese stellt eine Therapieform zur extrakorporalen Entfernung von atherogenen Lipoproteinen bei Patienten mit schweren Lipidstoffwechselstörungen und konsekutiven kardiovaskulären Erkrankungen dar. Das Ziel der vorliegenden Studie bestand darin, optimale Behandlungsbedingungen für eine neuere synthetische Fraktionierungsmembran (FractioPESTM 200; 3M Deutschland GmbH, Neuss) für die Doppelfiltrations-Lipoproteinapherese im Rahmen eines In-vivo-Modells am Schaf zu definieren. In einer prospektiven und randomisierten "Crossover–Studie" an vier Schafen wurde hierzu die Permselektivität der Fraktionierungsmembran unter unterschiedlichen Plasmaflussraten (PF 30, 36 und 42 ml/min), umgekehrter Plasmaflussrichtung (Outside- In-Filtration) und erhöhter Plasmatemperatur untersucht. Nach definierten behandelten Plasmavolumina wurde dafür die In-vivo-Performance der Fraktionierungsmembran anhand von Reduktionsrationes und Siebkoeffizienten für die relevanten Moleküle LDL, HDL, Fibrinogen, Albumin und IgG gemessen. Entsprechend des Therapieziels war die Fraktionierungsmembran für LDL-Cholesterin während aller Behandlungseinstellungen nahezu undurchlässig, was sich an niedrigen SK und statistisch sich nicht unterscheidenden Reduktionsrationes (49,0 ± 8,9 (Outside-In) bis 60,6 ± 9,7 % (PF 36)) zeigte. Lediglich bei 600 ml behandeltem Plasmavolumen wurde unter PF 42 und Outside-In ein signifikant höherer LDL-SK (0,165 ± 0,022 bzw. 0,194 ± 0,068) im Vergleich zu PF 30 und 36 (p < 0,05) bestimmt. Eine gewünschte geringe Membrandurchlässigkeit fand sich ebenfalls für Fibrinogen, wobei signifikant höhere und damit ungünstigere SK für Outside-In nach 600 ml (0,229 ± 0,03 (p < 0,05)) gegenüber allen anderen Behandlungsmethoden und nach 900 ml (SK 0,369 ± 0,12 (p < 0,05)) im Vergleich zu PF 30 und PF 42 gemessen wurden. Bezüglich der unerwünscht entfernten Substanzen waren zwischen den Behandlungsmethoden keine Unterschiede bei HDL-Cholesterin und Albumin nachweisbar. Lediglich für IgG lag nach 900 ml ein höherer SK (1,047 ± 0,070 (p = 0,049)) bei PF 42 im Vergleich zu PF 30 (0,573 ± 0,321) vor.Grundsätzlich stiegen bei allen Behandlungsarten die SK für alle Substanzen mit zunehmendem Plasmavolumen teilweise signifikant an. Eine Ausnahme stellte der Outside-In-Modus dar, bei dem es nach 600 ml zu einem Abfall der SK kam. Bei PF 42 war die günstigste HDL/LDL-Ratio der Reduktionsrationes nachweisbar, d.h. die höchste Retention atherogenen LDL bei geringster Entfernung des vasoprotektiven HDL. Die Anwendung verschiedener Behandlungsbedingungen bei Verwendung der FractioPESTM 200-Membran führte nur zu geringen Unterschieden bei der Entfernung der Zielsubstanzen. Als günstigste Einstellung erwies sich die höchste Plasmaflussrate, PF 42 ml/min, in standardmäßiger Flussrichtung, während sich die Outside-In-Filtration nachteilig auswirkte. Der Grund dafür dürfte im asymmetrischen Wandaufbau der Fraktionierungsmembran mit den kleinsten Poren, d.h. der Separationsschicht, innen liegen, der zu Unterschieden beim Verstopfen („Clogging“) der Membranporen führt. Das Schafsmodell erwies sich erneut als zuverlässiges und auf die klinische Doppelfiltrations-Lipoproteinapherese übertragbares In-vivo-Experiment. / Double filtration apheresis is a form of therapy for the extracorporeal removal of atherogenic lipoproteins in patients with severe lipid metabolism disorders and consecutive cardiovascular diseases. The aim of this study was to define optimal treatment conditions for a newer synthetic fractionation membrane (FractioPESTM 200; 3M Germany GmbH, Neuss) for double filtration plasmapheresis within a setting of an in-vivo model on a sheep. In a prospective and randomized "crossover study" on four sheeps, the permselectivity of the fractionation membrane was investigated during different plasma flow rates (PF 30, 36 and 42 ml/min), reverse plasma flow direction (outside-in filtration) and increased plasma temperature. After defined treated plasma volumes, the in-vivo performance of the fractionation membrane was measured based on reduction rations and sieving coefficients for relevant molecules LDL, HDL, fibrinogen, albumin and IgG. Accordingly the therapy goal, the fractionation membrane was nearly impermeable to LDL-cholesterol during all treatment settings, evidenced by low SK and statistically indistinguishable reduction rations (49.0 ± 8.9 (outside-in) to 60.6 ± 9.7% (PF 36)). Only at 600 ml treated plasma a significantly higher LDL-SK (0.165 ± 0.022 and 0.194 ± 0.068) during PF 42 and outside-in compared to PF 30 and 36 (p < 0.05) was determined. A desired low membrane permeability was also found for fibrinogen, shown by the significantly higher and thus less favorable SK for outside-in after 600 ml (0.229 ± 0.03 (p < 0.05)) compared to all other treatment methods and after 900 ml (SK 0.369 ± 0.12 (p<0.05)) compared to PF 30 and PF 42. Regarding the undesirably removed substances, no differences in HDL-cholesterol and albumin could be detected between the treatment methods. Only for IgG there was a higher SK (1.047 ± 0.070 (p = 0.049)) at PF 42 compared to PF 30 (0.573 ± 0.321) after 900 ml. Basically, with all types of treatment, the SK for all substances increased, partially significant, with increasing plasma volume. The outside-in mode was an exception, in which there was a decrease in the SK after 600 ml. At PF 42, the most favorable HDL/LDL ratio of the reduction ration was detectable, i.e. the highest retention of atherogenic LDL with the lowest removal of the vasoprotective HDL. The application of different treatment conditions when using the FractioPESTM 200 membrane resulted in only minor differences in the removal of the target substances. The best setting proved to be the highest plasma flow rate, PF 42 mL/min, in the standard flow direction, while outside-in filtration had a disadvantageous effect. The reason for this may be the asymmetrical wall structure of the fractionation membrane and the small pores, i.e. a separation layer lying inside, which leads to differences in clogging of the membrane pores. The sheep model again proved to be a reliable in-vivo experiment transferable to clinical double filtration lipoprotein apheresis.

A newly discovered activity in human serum protects porcine aortic endothelial cells in culture from injury by very low density lipoproteins (VLDL). This factor, toxicity-preventing activity (TxPA), was measured in 29 relatively young men (43 ± 8 years) who had undergone coronary angiography. The level of TxPA was found to be significantly reduced (P < 0.001) in men who demonstrated more than 15% narrowing of their coronary arteries. Men (n = 18) who had 15% or less narrowing were found to have 104 ± 48 units of TxPA while men (n = 11) with coronary artery disease had 48 ± 24 units of TxPA. A value derived from the product of TxPA and the high density lipoprotein cholesterol (HDL-C) level divided by the non-HDL-C (total cholesterol-HDL-C) accurately separated 97% of the men into 2 groups. TxPA thus appears to be a new protective factor in coronary artery disease, which, when combined with total cholesterol and high density lipoprotein cholesterol values, provides an accurate classification of established coronary artery disease in these subjects.

Development of atherosclerosis, the hardening of the arteries, is dependent on levels of serum cholesterol, which is regulated by the liver via LDL receptors (LDLR). The expression and internalization of LDL receptors depend on several proteins including PCSK9. In fact, previous studies in our laboratory have shown that NEU1 down regulation leads to LDLR hypersialylation which results in its stabilization via reduced interactions with PCSK9. New evidence suggests that NEU1 which de-sialylates LDLR, may affect the ability of another hepatic receptor, the asialoglycoprotein receptor (ASGR), which is comprised of ASGR1 and ASGR2, to interact with LDLR potentially causing its internalization and therefore reduced ability to take up LDL. We investigated how sialidase plays a role in the interaction of ASGR with LDLR. Knockdown and overexpression experiments suggest that NEU1 allows stabilization of LDLR at the cell membrane via ASGR interactions. Treatment of HepG2 cells with monensin which inhibits recycling from the early endosome, unveiled a new truncated ASGR1 isoform potentially lacking its lectin motif. This may be a novel regulatory step in ASGR biosynthesis that warrants further studies. Lysosomal inhibition with chloroquine resulted in concurrent accumulations of NEU1, LDLR and ASGR1, further suggesting these proteins are biosynthetically connected. Our studies revealed a novel isoform of ASGR1 in membrane fractions of HepG2 cell lysates that can associate with NEU1 and LDLR. The impact of NEU1 and ASGR1 on the function and stability of LDLR might lead to new clues for lowering serum cholesterol and reducing atherosclerosis. / Thesis / Master of Science (MSc)

The effects of polyethylene, (PE), type, compatibilizer type and organoclay type on the morphology, rheological, thermal, and mechanical properties of ternary low density polyethylene (LDPE), high density polyethylene (HDPE), and linear low density polyethylene (LLDPE), matrix nanocomposites were investigated in this study. Ethylene &ndash / Methyl acrylate &ndash / Glycidyl methacrylate terpolymer (E-MAGMA) and Ethylene &ndash / Butyl acrylate- Maleic anhydrate terpolymer (E-BA-MAH) were used as the compatibilizers. The organoclays selected for the study were Cloisite 30B and Nanofil 8. Nanocomposites were prepared by means of melt blending via co-rotating twin screw extrusion process. Extruded samples were injection molded to be used for material characterization tests. Optimum amounts of ingredients of ternary nanocomposites were determined based on to the mechanical test results of binary blends of PE/Compatibilizer and binary nanocomposites of PE/Organoclay. Based on the tensile test results, the optimum contents of compatibilizer and organoclay were determined as 5 wt % and 2 wt %, respectively. XRD and TEM analysis results indicated that intercalated and partially exfoliated structures were obtained in the ternary nanocomposites. In these nanocomposites E-MA-GMA compatibilizer produced higher d-spacing in comparison to E-BA-MAH, owing to its higher reactivity. HDPE exhibited the highest basal spacing among all the nanocomposite types with E-MA-GMA/30B system. Considering the polymer type, better dispersion was achieved in the order of LDPE&lt / LLDPE&lt / HDPE, owing to the linearity of HDPE, and short branches of LLDPE. MFI values were decreased by the addition of compatibilizer and organoclay to the matrix polymers. Compatibilizers imparted the effect of sticking the polymer blends on the walls of test apparatus, and addition of organoclay showed the filler effect and increased the viscosity. DSC analysis showed that addition of compatibilizer or organoclay did not significantly affect the melting behavior of the nanocomposites. Degree of crystallinity of polyethylene matrices decreased with organoclay addition. Nanoscale organoclays prevented the alignment of polyethylene chains and reduced the degree of crystallinity. Ternary nanocomposites had improved tensile properties. Effect of compatibilizer on property enhancement was observed in mechanical results. Tensile strength and Young&rsquo / s modulus of nanocomposites increased significantly in the presence of compatibilizers.

AIMS: Macrophages (MPs) and vascular smooth muscle cells (VSMCs) closely interact within the growing atherosclerotic plaque. An in vitro co-culture model was established to study how MPs modulate VSMC behaviour. METHODS AND RESULTS: MPs were exposed to fluorescence-labelled-acetylated LDL (FL-acLDL) prior to co-culture with VSMCs. Fluorescence microscopy visualized first transport of FL-acLDL within 6 h after co-culture implementation. When MPs had been fed with FL-acLDL in complex with fluorescence-labelled cholesterol (FL-Chol), these complexes were also transferred during co-culture and resulted in cholesterol positive lipid droplet formation in VSMCs. When infected with a virus coding for a fusion protein of Rab5a and fluorescent protein reporter (FP) to mark early endosomes, no co-localization between Rab5a-FP and the transported FL-acLDL within VSMCs was detected implying a mechanism independent of phagocytosis. Next, expression of lysosome-associated membrane glycoprotein 1 (LAMP1)-FP, marking all lysosomes in VSMCs, revealed that the FL-acLDL was located in non-acidic lysosomes. MPs infected with virus encoding for LAMP1-FP prior to co-culture demonstrated that intact fluorescence-marked lysosomes were transported into the VSMC, instead. Xenogenic cell composition (rat VSMC, human MP) and subsequent quantitative RT-PCR with rat-specific primers rendered induction of genes typical for MPs and down-regulation of the cholesterol sensitive HMG-CoA reductase. CONCLUSION: Our results demonstrate that acLDL/cholesterol-loaded lysosomes are transported from MPs into VSMCs in vitro. Lysosomal transfer results in a phenotypic alteration of the VSMC towards a foam cell-like cell. This way VSMCs may lose their plaque stabilizing properties and rather contribute to plaque destabilization and rupture.

C-reactive protein (CRP) is secreted by hepatocytes as a pentameric molecule made up of identical monomers, circulates in the plasma as pentamers, and localizes in atherosclerotic lesions. In some cases, localized CRP was detected by using monoclonal antibodies that did not react with native pentameric CRP but were specific for isolated monomeric CRP. It has been reported that, once CRP is bound to certain ligands, the pentameric structure of CRP is altered so that it can dissociate into monomers. Accordingly, the monomeric CRP found in atherosclerotic lesions may be a stationary, ligand-bound, by-product of a ligand-binding function of CRP. CRP binds to modified forms of low-density lipoprotein (LDL). The binding of CRP to oxidized LDL requires acidic pH conditions; the binding at physiological pH is controversial. The binding of CRP to enzymatically-modified LDL occurs at physiological pH; however, the binding is enhanced at acidic pH. Using enzymatically-modified LDL, CRP has been shown to prevent the formation of enzymatically-modified LDL-loaded macrophage foam cells. CRP is neither pro-atherogenic nor atheroprotective in ApoE-/-and ApoB100/100Ldlr-/-murine models of atherosclerosis, except in one study where CRP was found to be slightly atheroprotective in ApoB100/100Ldlr-/-mice. The reasons for the ineffectiveness of human CRP in murine models of atherosclerosis are not defined. It is possible that an inflammatory environment, such as those characterized by acidic pH, is needed for efficient interaction between CRP and atherogenic LDL during the development of atherosclerosis and to observe the possible atheroprotective function of CRP in animal models.

Of the challenges facing the improvement of human health, none has taken the forefront quite like the endeavor to discover novel treatments for heart disease. As heart disease has now become the leading cause of death throughout the world [1], the medical community has made incredible strides in the mission to treat atherosclerosis which is the major contributor to heart disease. Very Low Density Lipoproteins (VLDL) are secreted by the liver and subsequently converted to Low Density Lipoproteins (LDL). Many factors contribute to the narrowing of the arterial walls, however oxidized LDL is the main factor that leads to the deposition of plaque, leading to atherosclerosis pathologies. Recently, a main focus of research into atherosclerotic processes has been the synthesis and trafficking of VLDL in hepatocytes. The rate-limiting step for the secretion of VLDL from the liver has been determined to be the transport of VLDL from the endoplasmic reticulum (ER) to the Golgi apparatus. VLDL molecules are transported in a specialized transport vesicle the Very Low Density Lipoprotein Transport Vesicle (VTV) [2]. VLDL’s core protein, apolipoproteinB-100 (apoB100), is initially lipidated in the ER, and then subsequently delivered to the Golgi apparatus where the VLDL molecule undergoes maturation involving further lipidation and glycosylation of apoB100. Oxysterol Binding Proteins (OSBP) and the sub family OSBP Related Proteins (ORP) have been implicated in many different trafficking processes, mainly the trafficking of sterols, cholesterol, and lipids. Recently, ORP 10 was shown to be a negative regulator of apoB100 secretion in growth medium [3]. Using co-immunoprecipitation, the current study shows that ORP 10 interacts with VLDL’s core protein apoB100 directly. Employing an in vitro budding assay, we show that the blocking of ORP 10 with a specific antibody against ORP10 increases VTV formation from the ER. Given that the ER to Golgi pathway is the rate-limiting step in overall VLDL secretion, these findings support the conclusion that ORP 10 is a negative regulator of VLDL trafficking between the ER and Golgi, and that this process is mediated by the ORP 10 protein binding with apoB100.

AIMS: Macrophages (MPs) and vascular smooth muscle cells (VSMCs) closely interact within the growing atherosclerotic plaque. An in vitro co-culture model was established to study how MPs modulate VSMC behaviour. METHODS AND RESULTS: MPs were exposed to fluorescence-labelled-acetylated LDL (FL-acLDL) prior to co-culture with VSMCs. Fluorescence microscopy visualized first transport of FL-acLDL within 6 h after co-culture implementation. When MPs had been fed with FL-acLDL in complex with fluorescence-labelled cholesterol (FL-Chol), these complexes were also transferred during co-culture and resulted in cholesterol positive lipid droplet formation in VSMCs. When infected with a virus coding for a fusion protein of Rab5a and fluorescent protein reporter (FP) to mark early endosomes, no co-localization between Rab5a-FP and the transported FL-acLDL within VSMCs was detected implying a mechanism independent of phagocytosis. Next, expression of lysosome-associated membrane glycoprotein 1 (LAMP1)-FP, marking all lysosomes in VSMCs, revealed that the FL-acLDL was located in non-acidic lysosomes. MPs infected with virus encoding for LAMP1-FP prior to co-culture demonstrated that intact fluorescence-marked lysosomes were transported into the VSMC, instead. Xenogenic cell composition (rat VSMC, human MP) and subsequent quantitative RT-PCR with rat-specific primers rendered induction of genes typical for MPs and down-regulation of the cholesterol sensitive HMG-CoA reductase. CONCLUSION: Our results demonstrate that acLDL/cholesterol-loaded lysosomes are transported from MPs into VSMCs in vitro. Lysosomal transfer results in a phenotypic alteration of the VSMC towards a foam cell-like cell. This way VSMCs may lose their plaque stabilizing properties and rather contribute to plaque destabilization and rupture.

Methods Three hundred thirty-nine patients (230 men, 109 women) treated with lipoprotein apheresis in Saxony, Germany, in 2018 are described in terms of age, lipid pattern, risk factors, cardiovascular events, medication, and number of new admissions since 2014, and the data are compared with figures from 2010 to 2013. Results Patients were treated by 45.5 physicians in 16 lipoprotein apheresis centers. With about 10 patients per 100 000 inhabitants, the number of patients treated with lipoprotein apheresis in Saxony is twice as high as in Germany as a whole. The median treatment time was 3 years. Almost all patients had hypertension; type 2 diabetes mellitus was seen significantly more often in patients with low Lipoprotein(a). Cardiovascular events occurred in almost all patients before initiation of lipoprotein apheresis, under apheresis therapy the cardiovascular events rate was very low in this high-risk group. For some cardiovascular regions even no events could be observed. Conclusions The importance of lipoprotein apheresis in Saxony had been increasing from 2010 to 2018.

ITC/USA 2007 Conference Proceedings / The Forty-Third Annual International Telemetering Conference and Technical Exhibition / October 22-25, 2007 / Riviera Hotel & Convention Center, Las Vegas, Nevada / Next generation satellite communication systems require efficient coding schemes that enable high data rates, require low overhead, and have excellent bit error rate performance. A newly rediscovered class of block codes called Low Density Parity Check (LDPC) codes has the potential to revolutionize forward error correction (FEC) because of the very high coding rates. This paper presents a brief overview of LDPC coding and decoding. An LDPC algorithm developed by Goddard Space Flight Center is discussed, and an overview of an accompanying VHDL development by L-3 Communications Cincinnati Electronics is presented.