clinical diagnostic biochemistry - 8
DESCRIPTION
Transport of Fat: Lipoproteins Chylomicrons VLDL. IDL. LDL. HDLTRANSCRIPT
![Page 1: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/1.jpg)
Clinical diagnostic biochemistry - 8
Dr. Maha Al-Sedik2015
CLS 334
![Page 2: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/2.jpg)
Transport of Fat: Lipoproteins
Chylomicrons
VLDL.
IDL.
LDL.
HDL
![Page 3: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/3.jpg)
Lipoproteins
Lipids in plasma combined with apo lipoprotein and
transferred as lipoproteins.
Lipoprotein is arranged in the blood to be protein and
phospholipid to the outside and triglyceride and cholesterol to
the inside.
![Page 4: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/4.jpg)
Spherical particles with a hydrophobic core (TG and esterified
cholesterol), and a hydrophilic surface (apoprotein, phospholipids
& free cholesterol).
![Page 5: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/5.jpg)
![Page 6: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/6.jpg)
Like Protein
Water soluble
Precipitated with cold ethanol
Can be separated by electrophoresis
![Page 7: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/7.jpg)
LipoproteinsParticles found in plasma that transport lipids including cholesterol.
lipoprotein classes:• Chylomicrons: take lipids from small intestine to the blood.
• Very low density lipoproteins (VLDL): take endogenous lipid from
the liver.
• Intermediate density lipoproteins (IDL)
• Low density lipoproteins (LDL)
• High density lipoproteins (HDL)
![Page 8: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/8.jpg)
LIPOPROTEINS
HDL
IDL
LDL
VLDL
Chylomicron
Density Electrophoresis
![Page 9: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/9.jpg)
![Page 10: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/10.jpg)
Apolipoproteins: The protein moiety on the surface of lipoproteins.
Major components of lipoproteins.
Classified by alphabetical designation (A to E)
Responsible for transport and redistribution of lipids among
cells.
Strengthen and maintain the lipoprotein structure.
Responsible for recognition of particle by receptors.
Cofactor and activator for enzymes involved in lipid metabolism.
![Page 11: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/11.jpg)
Chylomicron contains the exogenous triglycerides and protein
( Apo B 48 , APO C II and APO E ).
It tends to float even without centrifugation.
High chylomicron leads to milky plasma.
It remains in its origin in electrophoresis.
Chylomicron
![Page 12: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/12.jpg)
VLDL contains the endogenous synthetized cholesterol and
triglycerides and protein ( Apo B 100 , APO C II and APO E ).
It produces pre B band in electrophoresis.
High VLDL leads to turbid plasma.
VLDL
![Page 13: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/13.jpg)
IDL contains equal amounts of cholesterol and triglycerides and
protein ( Apo B 100 , Apo C II and APO E ).
It produces slow pre B band in electrophoresis.
IDL is transformed to LDL by losing APO C II and APO E .
IDL
![Page 14: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/14.jpg)
LDL contains mostly cholesterol ester , little triglycerides and
protein ( Apo B 100 ).
It produces B band in electrophoresis.
High LDL does not alter plasma clarity.
LDL enters the tissues through LDL receptor .
People with high levels of LDL are at high risk of developing
atherosclerosis.
LDL
![Page 15: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/15.jpg)
HDL contains mostly 50 % protein and 20 % cholesterol , 30 %
phospholipid and traces of triglycerides.
It gives Apo C II and Apo E to the nascent chylomicron and
nascent VLDL.
It produces α band in electrophoresis.
High HDL does not alter plasma clarity.
High levels of HDL are good signs .
HDL
![Page 16: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/16.jpg)
Exogenous Lipid Transport
![Page 17: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/17.jpg)
Fatty acids are absorbed by the apical microvilli of mucosal cells.
Apo B48 is the structural protein of the chylomicron.
Now the chylomicron is called Nascent chylomicron.
Then it reaches the blood where it receives Apo C II and Apo E
from HDL.
Apo C II stimulates lipoprotein lipase enzyme.
Lipoprotein lipase digest the triglyceride in the chylomicron
transforming chylomicron to chylomicron remnants.
Chylomicron remnants enter the hepatocyte by Apo E receptor in
the hepatocyte.
![Page 18: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/18.jpg)
Endogenous Lipid Transport
![Page 19: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/19.jpg)
Endogenously synthesized cholesterol and triglyceride combine
with Apo B 100 to form VLDL.
VLDL from liver enters plasma.
VLDL combines with Apo E (binds to hepatocyte receptor) and
Apo C II (activates lipoprotein lipase).
LPL works on VLDL forming IDL.
IDL has two pathway, it may enter the hepatocyte through Apo E.
Or, IDL loses APO E and APO CII to form LDL.
LDL enters the tissues through LDL receptor ( APO B 100 ).
People with high level of LDL are at high risk of having diseases.
![Page 20: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/20.jpg)
Laboratory investigations
for lipids
![Page 21: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/21.jpg)
Important pre analytical considerations:
An individual's lipid and lipoprotein profile should be measured
only when the individual is in a metabolic steady state.
Subjects should maintain their usual diet and weight for at least 2
weeks before the determination of their lipids or lipoproteins.
Repeat sampling : The diagnosis should be confirmed on at least
2 specimens 2 – 4 weeks in between.
![Page 22: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/22.jpg)
Subjects should not perform vigorous physical activity within the
24 hours before testing.
The patient should be fasting except for total cholesterol.
Sampling in sitting position: Individuals should be seated for at
least 5 minutes before.
specimen collection: The tourniquet should not be kept on more
than 1 minute during venipuncture.
Either serum or plasma should be used to measure total
cholesterol, triglyceride, and HDL cholesterol concentrations.
![Page 23: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/23.jpg)
Blood specimens always should be considered potentially
infectious and therefore handled accordingly.
You should wait for at least 3 months after major surgery.
![Page 24: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/24.jpg)
Laboratory investigations
for lipids
![Page 25: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/25.jpg)
Standing plasma tests:
Observing plasma standing sample after 24 hours at 4oC:
Turbid or cloudy ---------------------------- VLDL
Layer of cream and clear below it ----------------------- Chylomicron
Clear ---------------------- LDL or HDL
![Page 26: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/26.jpg)
![Page 27: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/27.jpg)
![Page 28: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/28.jpg)
![Page 29: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/29.jpg)
Lipid profile:After fasting for about 12 hours.
![Page 30: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/30.jpg)
Ultracentrifugation:Ultracentrifuge for 16 – 18 hours at 10 oc
( plasma lipoprotein free fraction ).
![Page 31: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/31.jpg)
This method has been used as the standard by which the accuracy
of other methods are judged . Now it is only used in research.
![Page 32: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/32.jpg)
Electrophoresis.
![Page 33: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/33.jpg)
![Page 34: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/34.jpg)
![Page 35: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/35.jpg)
Chromatography:
Ion exchange and gel permeation chromatography are the most
common types. It is used only for research .
![Page 36: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/36.jpg)
Total cholesterol = HDL + LDL + VLDL
VLDL = Triglyceride / 5
LDL = Total cholesterol – ( HDL + Triglyceride / 5 )
Friedewald formula
![Page 37: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/37.jpg)
Reference: Burtis and Ashwood Saunders, Teitz fundamentals of Clinical Chemistry, 4th edition, 2000.
![Page 38: Clinical diagnostic biochemistry - 8](https://reader035.vdocuments.us/reader035/viewer/2022062223/5a4d1ad67f8b9ab05997307e/html5/thumbnails/38.jpg)
THANK YOU