19 - Cholesterol and Triglycerides Flashcards Preview

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Flashcards in 19 - Cholesterol and Triglycerides Deck (40)
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What is the role of albumin?

- In the blood, free fatty acids bind to hydrophobic pockets the surface of albumin
- From albumin, free fatty acids are translo-cated across the plasma membranes into the cytosol where they are activated to fatty-acyl CoA


How do chylomicrons form?

- Dietary fats (free fatty acids, monoacylglycerols and glycerol) and cholesterol are absorbed by the enterocytes
- The enterocytes re-synthesize triacylglycerols and pack them into chylomicrons for distri-bution through the body


What is the function of chylomicrons?

- The function of chylomicrons is the distribution of dietary lipids from enterocytes to the rest of the body
- For transport of dietary lipids - When you consume fat from the diet, they are transported by chylomicrons


What is the relationship between VLDL, IDL and LDL?

Very low density lipoproteins (VLDL), intermediate density lipo-proteins (IDL) and low density lipoproteins (LDL) are maturation stages of the same particle


What is the function of VLDLs?

- VLDLs are used for the transport of endogenous lipids - Made in the liver, liver needs to transport lipids in the form of VLDLs
- VLDLs are synthesized by the liver to distribute endogenously synthesized lipids to peripheral tissues
- Similar to chylomicrons, VLDLs lose lipids and transform into IDLs and then LDLs


How do VLDLs become IDLs and LDLs?

Not all of the VLDL remnants are immediately cleared from the blood - Some stay in circulation, lose more triglycerides and acquire more cholesteryl esters. The physical density of the particles increases, transforming them from very low density (VLDL) to intermediate density (IDL) and finally to low density (LDL) lipoproteins.


What are HDLs?

- Vesicles for reverse lipid transport/excretion - These are particles that are made “empty” - As they circulate, they suck up lipids
- High density lipoproteins (HDL) function in reverse cholesterol transport from the peripheral tissues to the liver
- As the HDL particles circulate, they grow by acquiring triacyl-glycerols from other lipoproteins


How do chylomicrons lose lipids?

Lipoprotein lipases on the surface of target cells cleave triacylglycerols and liberate free fatty acids from the chylomicrons


How do VLDLs lose lipids?

Similar to the situation in chylomicrons, VLDLs gradually lose triacylglycerols from the core of the particle through the action of lipoprotein lipases.


What are the different classes of apoproteins?

- Apoprotein A
- Apoprotein B
- Apoprotein C
- Apoprotein E


What does apoprotein A do?

A = activates lecitin

Activators of lecitin: cholesterol acyltransferase (LCAT). Extract lipids from membranes for reverse transport
Activate an acetyltransferase, making cholesterol very hydrophobic, trapping it in the core – this means they regulate the ENTRY


What does apoprotein B do?

B = building blocks

Structural proteins, interact with lipoprotein receptors and mediate the uptake of the particle into target cells.
Provide structural support for a variety of lipoproteins (scaffold)
If you have faulty apoprotein Bs, it will affect a variety of lipoprotein classes
Also interacts with the receptor
Regulate the EXIT


What do apoprotein Cs do?

C = controllers

Modulate lipoprotein lipase (LPL/HTGL) activity, liberate free fatty acids and glycerol from lipoproteins.
Degrades lipids (make them less hydrophobic)
LPL cleaves the very hydrophobic lipids from the lipoprotein, so they are then allowed to leave the lipoprotein


What do apoprotein Es do?

E = exit regulators

Bind to receptors to allow removal of remnant particles from the circulation.
Mediate the binding of the lipoprotein to the receptor
Triggers the removal of the lipoprotein from the circulation


What types of tests are done to assess blood lipid profiles?

Total serum cholesterol
Fasting lipid profile


Describe the total serum cholesterol test

Total serum cholesterol. Good approximation of serum LDL concentration. Not perfect but pretty good.


Describe the fasting lipid profile test

No dietary lipids (chylomicrons)
Consists of measurements of total cholesterol, total glycerides and HDL cholesterol


How do you determine LDL?

LDL is NOT measured, it is CALCULATED
LDL cholesterol is calculated with the Friedewald formula:
LDL (mg/dL) = Total cholesterol – HDL cholesterol – 20% of triglycerides ***
Need to be able to calculate this!


Describe the ultracentrifugation test

Best way to look at what’s going
You will see how the particles separate – can use this for testing for a very rare lipid disorder or in an academic situation, not really used much in clinical practice


Describe the basics of the Fredrickson classification

The most widely accepted standard, the Fredrickson classifica-tion, categorizes dyslipidemias based on the changes in blood lipid composition.
If the blood in the tube turns yellow/opaque it is bad.


What primary dyslipidemias exist?

Elevated cholesterol, normal triglycerides
Familial hypercholesterolemia
Familial defective ApoB100

Elevated triglycerides
Familial combined hyperlipidemia
Familial dysbetalipoproteinemia


Describe familial hypercholesterolemia

Familial Hypercholesterolemia (FH)(1/500)
results from defects in the ApoE/B (LDL) receptor
autosomal co-dominant trait
FH is classified as dyslipidemia IIa or IIb


Describe familial defective ApoB100

Familial Defective ApoB100 (FDB) (1/10,000)
Similar to FH – defective ApoB100 prevents binding of LDL to receptor


Describe familial combined hyperlipidemia

Familial Combined Hyperlipidemia (FCHL) (1/50)
Variable etiology; may result from overproduction of ApoB100
increased production of VLDL , abundance of VLDL, IDL, LDL


Describe familial dysbetalipoproteinemia

Familial Dysbetalipoproteinemia (FDBL) (1/10,000)
Defective ApoE prevents uptake of remnants by liver
Increase in all ApoB-containing lipoproteins


What are the secondary dyslipidemia?

Liver diseases


Describe the process of obesity causing a secondary dyslipidemia

High insulin (liver produces fatty acids from a lot of glucose)
Large amounts of adipose tissue with decreased insulin sensitivity (lots of fatty acids released, adipose tissue is not very insulin sensitive)
Liver produces large amounts of VLDL (high LDL cholesterol)


Describe how diabetes leads to a secondary dyslipidemia

This does NOT apply to type I diabetes - there are NO abnormalities when patient is under good glycemic control

For type II diabetes…
Inactive lipoprotein lipase (VLDLs and chylomicrons increase)
Active hormone sensitive lipase (lots of fatty acids released)
Active fatty acid synthesis in the liver (VLDL increases)

Free fatty acids will be circulating in Type II
They will be releasing free fatty acids all the time
The liver sees a lot of this
The liver deals with it by making an ester, then making a lot of VLDLs
Even if glucose is well controlled, you can still see a lot of this high fat and VLDLs


What two liver diseases can cause a secondary dyslipidemia?

Liver failure (hepatitis)


Describe how liver failure can cause a dyslipidemia

Liver does not produce enough VLDLs and HDLs - abnormally low cholesterol and triglycerides will be seen