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1Department of Internal Medicine and 2Department of Applied Science, University of California, Davis, California
Submitted 26 November 2007 ; accepted in final form 14 May 2008
| ABSTRACT |
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endothelial dysfunction; free fatty acids; oxidative stress
An increased plasma TG concentration has been shown to be associated with impaired endothelial function in vitro (25) and in vivo (23, 24). Data from our laboratory and others indicate that TGRL lipolysis has significant biological effects on endothelial cell plasma membranes. Specifically, increased endothelial layer permeability was found in TGRL lipolysis perfused rat arteries (36). Furthermore, recent data show that TGRL lipolysis-mediated increases in permeability result from active rearrangement and dissolution of the junctional barrier in human aortic endothelial cells (HAEC), as well as induction of the apoptotic cascade (7). However, the mechanism of TGRL lipolysis-induced endothelial cell dysfunction is not clear.
FFA released during TGRL lipolysis may contribute to TGRL lipolysis-induced endothelial cell dysfunction. FFA have been shown to play an important role in endothelial dysfunction (42), and Hennig et al. (13–15) have shown that exposure of cultured endothelial cells to oleic acid decreases endothelial barrier function expressed as increased transfer of both albumin and LDL across the endothelium. Furthermore, hypertriglyceridemia can lead to endothelial cell dysfunction associated with increased superoxide anion production and a subsequent decrease in nitric oxide (NO) bioavailability. Recently, Halle et al. (11) showed that palmitic acid and oleic acid decreased endothelial nitric oxide synthase (eNOS) activity, whereas linolenic acid did not influence eNOS activity. These results demonstrate that elevation of FFA may contribute to endothelial dysfunction and emphasize that FFA affect the endothelium differently. However, these studies were limited to investigation of one or two kinds of FFA, and the results were not consistent. It is not clear whether TGRL lipolysis affects eNOS activity and superoxide anion production. Furthermore, the exact mechanisms of how fatty acids affect eNOS activity and endothelial function have not been elucidated.
Lipid rafts are dynamic, detergent-resistant plasma membrane microdomains that are highly enriched in cholesterol and sphingolipids (40). These domains appear to facilitate interactions among the protein and lipid component of the signal pathway and participate in cell signaling processes (40). The fatty acid side chains of the phospholipids present in lipid rafts tend to be more highly saturated than those in the surrounding membrane (31, 40). These lipid microdomains sequester proteins that mediate signal transduction in a variety of cell types, including endothelial cells and myocytes (40). As a result, lipid rafts play an important role in cell signal transduction, endocytosis, cholesterol trafficking, and membrane skeleton integrity (20). A number of studies have demonstrated that lipid rafts differ with regard to shape, size, localization, protein, and/or lipid composition based on their functional state (38). In such studies, the biophysical and biochemical microenvironments of the rafts influence the function of the raft proteins.
Compared with the intensive study of LDL-cholesterol and lipid rafts, there is less known of the effects of TGRL and their lipolysis on lipid rafts. Fatty acids have been reported to incorporate into lipids of the cytoplasmic leaflet in rafts and change the lipid composition of rafts (43). Cells incubated with polyunsaturated fatty acids show replacement of saturated fatty acids with unsaturated ones in acylated proteins, causing these proteins to dissociate from rafts (46). Li et al. (21) demonstrated that dietary polyunsaturated fatty acids remodel mouse T-cell lipid rafts. Furthermore, a detrimental effect of fatty acids on T-cell lipid rafts, which inhibits Jurkat cells proliferation and IL-2 receptor
expression on the surface of T cells has been reported (21). While cholesterol and LDL have been associated with abnormal NO metabolism and endothelial dysfunction as a result of change of lipid rafts (2), it is not clear whether TGRL and their lipolysis also affect lipid rafts, and whether there are any consequences in cell signaling or endothelial dysfunction.
Endothelial injury in hypertriglyceridemia is caused, at least in part, by high concentrations of lipolysis products, but the mechanism of this effect is still not clear. In the present study, we sought to understand the mechanisms of TGRL and their lipolysis products in the pathogenesis of endothelial injury associated with endothelial cell membrane microdomains.
| MATERIALS AND METHODS |
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Lipoprotein isolation and characterization. Postprandial blood samples were obtained from healthy volunteers 3.5 h after a moderately high-fat meal, which is the period of peak elevation in plasma triglyceride concentrations in normal individuals. TGRL isolated from these healthy volunteers during this time frame, and to which endothelial cells are exposed, will primarily consist of VLDL and VLDL remnant particles and to a significantly lesser extent CM and CM remnant particles (7). All procedures were conducted under a protocol approved by the Human Subject Review Committee at the University of California Davis, and all volunteers gave informed consent. TGRL were isolated from human plasma at a density of <1.0063 g/ml by aspiration with a narrow-bore pipette after 18 h centrifugation at 40,000 rpm in a SW41 Ti swinging bucket rotor (Beckman Coulter, Sunnyvale, CA) held at 14°C within a Beckman L8-70M ultracentrifuge (7). The top fraction (TGRL) was collected and exhaustively dialyzed in Spectrapor membrane tubing (mol wt cutoff 3,500; Spectrum Medical Industries, Los Angeles, CA) at 4°C overnight against a saline solution containing 0.01% EDTA. The purity of TGRL was confirmed by analytical sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with Coomassie staining and lipid analysis. SDS electrophoresis showed the presence of apoB48 and apoB100 in TGRL. Plasma TG and cholesterol levels were determined enzymatically with kits (Sigma, St. Louis, MO).
Lipoprotein labeling and treatments.
The isolated lipoprotein subfractions were concentrated and subsequently analyzed by modified Lowry assay (Sigma) (22). Samples containing 1 mg of protein (at the concentration of 2 mg/ml) were labeled by Atto565 NHS ester with an excitation wavelength of 561 nm and emission at 585 nm (Sigma). NHS ester readily reacts with
-amino groups of lysines of the amine terminus, forming a chemically stable amide bond between the dye and the protein. The labeled protein was separated from unreacted dye by P-10 column (Amersham Bioscience, Piscataway, NJ). The conjugates were stored at 4°C, protected from light, and used within 3 days.
HAEC were treated with serum-free medium (untreated cells) as a control, LpL only (2 U/ml), or TGRL (456 µmol/l TG) with or without LpL (2 U/ml). For LpL-dependent TGRL lipolysis, LpL was preincubated with TGRL for 30 min at 37°C before cell treatment.
Localization of lipid rafts and TGRL by confocal microscopy. For the localization studies, HAEC were plated at a density of 5 x 105 cells/ml in four-well lab-Tek glass chamber slides (Nunc). HAEC were treated with Atto565-labeled TGRL with or without LpL for 20 min at 37°C. After incubation with labeled lipoproteins, cells were washed twice with PBS, followed by incubation in cell culture medium for 30 min. HAEC were then incubated for 15 min at room temperature with a lipid raft marker, FITC-labeled cholera toxin B subunits (FITC-CTB; 5 µg/ml), which is known to bind to the pentasaccharides of the plasma membrane ganglioside Gm1. The cells were rinsed three times with PBS and visualized in a LSM 5 PASCAL laser scanning microscope (Axiovert 200M/LSM 510, Carl Zeiss). For visualization of lipid rafts, imaging was performed with a fluorescence microscope at FITC excitation of 494-nm and 518-nm emission filters. TGRL were visualized with an Atto filter at excitation of 561 nm and emission at 585 nm.
Isolation of lipid rafts from HAEC. On reaching confluence, HAEC (2 x 107) were treated with TGRL with or without LpL for 3 h at 37°C. Control cells were left untreated. At the end of incubation, cells were removed from culture dishes with a trypsin-EDTA solution followed by a trypsin neutralizer and pelleted by centrifugation. Lipid rafts were prepared according to the method of Prinetti et al. (32). Briefly, the cell pellet was rinsed twice with PBS and sonicated three times for 20 s in 1 ml of Tris-buffered saline (TBS; 25 mM Tris·HCl, pH 7.4, 150 mM NaCl) containing 1% (vol/vol) Triton X-100, 5 mM EDTA, 10 mg/ml aprotinin, 10 mg/ml leupeptin, 10 mM phenylmethylsulfonyl fluoride, and 5 mM DTT. The cells were lysed in TBS-Triton X-100 buffer for 30 min on ice. The homogenized cell lysates were mixed with 2 ml of 60% OptiPrep gradient (Sigma), and a discontinuous 5–30% OptiPrep gradient was layered on the top of the cell lysates. The resulting gradient was subjected to ultracentrifugation at 40,000 rpm for 16–20 h at 4°C with a Beckman SW41 Ti rotor. After centrifugation, 12 density fractions of 840 µl each were collected from top to bottom; density fractions were either used immediately for Western blotting or snap-frozen in dry ice and stored at –80°C until use.
Gel electrophoresis and Western blotting. To characterize lipid rafts, caveolin-1, an essential structural component of caveolae that is a subset of the lipid raft, was used as a lipid raft marker and quantified by Western blotting. Gradient fractions (25 µl) were mixed with 25 µl of Laemmli denaturing sample buffer. Equal volumes of each density fraction were loaded on to each lane of 4–15% polyacrylamide gels. After electrophoresis, separated proteins were transferred to nitrocellulose membranes, which then were incubated in blocking buffer BLOTTO (TBS containing 0.1% Tween 20 and 5% nonfat dry milk) for 1 h, followed by incubation with rabbit anti-caveolin-1 (molecular mass 22 kDa, 1:1,000; Santa Cruz Biotechnology, Santa Cruz, CA) at 4°C overnight. Membranes were washed four times with TBS containing 0.1% Tween 20 and subsequently incubated in BLOTTO with horseradish peroxidase-conjugated goat anti-rabbit secondary antibodies (1:2,000; Amersham Bioscience) at room temperature for 1 h. Membranes were washed again four times with TBS containing 0.1% Tween 20 before incubation with ECL plus Western blotting detection reagents (Amersham) and then exposed to ECL hyperfilm (Amersham). The identities of the bands visualized in the Western blots were confirmed by comparison with the molecular mass standard and positive controls provided by the manufacturer of the antibody. Gradient fractions 5–7 corresponded to lipid raft-rich membrane.
To analyze the effect of lipolysis products on lipid raft-associated proteins, raft fractions were pooled and protein was determined by the modified Lowry assay (22). Protein (20 µg) from raft fraction protein and nonraft fraction protein (supernatant) was loaded onto and separated by 4–15% SDS-PAGE. The procedure for blotting was the same as above, with primary antibodies mouse anti-eNOS (molecular mass 144 kDa, 1:750), rabbit anti-caveolin-1 (molecular mass 22 kDa, 1:1,000), rabbit LDL receptor-related protein (LRP) (molecular mass 504 kDa, 1:1,000), and horseradish peroxidase-conjugated secondary antibodies to either mouse (eNOS) or rabbit (caveolin-1, LRP). Densitometric analyses were performed with UN-SCAN-IT gel software (Silk Scientific).
Lipid analysis. TG and phospholipid concentrations were determined enzymatically with kits (WAKO, Richmond, VA). The amount of total cholesterol in the lipid raft fraction and cell lysate and FFA in TGRL and TGRL lipolysis were determined by the Nutritional Assessment Lab (Davis, CA).
Measurement of reactive oxygen species. Reactive oxygen species (ROS) generation was determined based on the oxidation of 2',7'-dichlorofluorescein diacetate (DCFDA, Molecular Probes) by superoxide and hydrogen peroxide, forming the highly fluorescent derivative dichlorofluorescein (DCF) (5). Confluent HAEC (104 cells/well) in 96-well plates were preincubated with the fluorescence probe DCFDA (10 µM) for 30 min. After the cells were washed in PBS twice, they were incubated with TGRL with or without LpL for 2 h. After removal of medium from wells, cells were washed three times in PBS, followed by measurement of fluorescence intensity at 485-nm excitation and 538-nm emission spectra with a fluorescence microplate reader (FUJIFLIM FLA 5100). Furthermore, the effects of inhibitors for NADPH oxidase and CYP 2C9, an isoform of cytochrome P-450, on TGRL + LpL-induced ROS generation were determined with apocynin (NADPH oxidase inhibitor, 100 µM; Ref. 12), diphenyleneiodonium (DPI; NADPH oxidase inhibitor, 50 µM; Ref. 48), or sulfaphenazole (SP; cytochrome P-450 inhibitor, 10 µM; Ref. 44) (Sigma). The doses of these inhibitors were based on those reported in previous studies that effectively blocked enzyme activity. 4β-Phorbol 12-myristate 13-acetate (10 µM; Sigma) was used to stimulate oxidative activity as a positive control.
Measurement of intracellular superoxide anions. Intracellular superoxide anions in HAEC were measured by dihydroethidium (DHE, Molecular Probes), a cell-permeant dye that is oxidized by superoxide anions to yield the fluorescent ethidium cation (3, 4). Confluent HAEC (104 cells/well) in 96-well plates were stained with DHE (10 µg/ml) for 15 min at 37°C. After washing, the cells were incubated with TGRL with or without LpL for 2 h at 37°C. DHE fluorescence was quantified with a fluorescence microplate reader (FUJIFLIM FLA 5100) set with excitation at 392 nm and emission at 410 nm. H2O2 (50 µM) was used as a positive control.
Statistical analysis. All experiments were performed in triplicate in at least three independent trials. Values are expressed as means ± SE unless otherwise noted. Comparisons among treatments were performed with one-way ANOVA. Differences in mean values were tested by a least-squares means procedure. P < 0.05 was considered statistically significant.
| RESULTS |
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Next, we directly visualized TGRL distribution on HAEC after 20-min incubation by confocal microscopy with an Atto565 excitation filter at 561 nm and an emission filter at 585 nm. Figure 2 shows the TGRL localization (red color) on HAEC. Round, punctate areas of fluorescence, which represent TGRL particles, are distributed in the perinuclear area, and especially at the apical region. TGRL had a distribution pattern similar to that of lipid rafts.
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TGRL lipolysis products increase aggregation of lipid rafts in HAEC.
HAEC were treated with labeled TGRL in the presence or absence of LpL for 20 min, followed by confocal fluorescence imaging of lipid rafts in HAEC. Distribution patterns of TGRL and lipid rafts on HAEC were observed by laser scanning confocal microscopy and are shown in Fig. 2. Treatment of TGRL with LpL for 20 min before incubation with cells resulted in increased TGRL fluorescent signal (Fig. 2). Atto NHS esters readily react with amino groups of proteins, in particular the
-amino groups of lysine. Compared with apoC and apoE, there are >10-fold more lysines on apoB than apoC or apoE. Therefore, most Atto labeled apoB rather than apoC or apoE. The enhanced fluorescent signal found in TGRL lipolysis-treated HAEC compared with TGRL-treated cells indicates that more TGRL remnants were associated with endothelial cells. Labeling of living cells with FITC-CTB revealed multiple areas of lipid raft aggregation in the plasma membrane of TGRL + LpL-treated cells (Fig. 2). Moreover, there was more colocalization of TGRL remnant particles and lipid rafts in the lipolysis-treated group compared with the TGRL-only group. These results show increased remnant accumulation, lipid raft clustering, and colocalization of remnants and lipid rafts on endothelial cells when treated with TGRL lipolysis products.
Effects of TGRL lipolysis products on composition of HAEC lipid rafts. To investigate how TGRL lipolysis products affect the composition of lipid rafts, we conducted experiments to study the biochemical changes of lipid rafts in HAEC. First, detergent-resistant microdomains were isolated from HAEC by extraction with cold 1% Triton X-100, followed by density gradient sedimentation. A total of 12 fractions were collected and analyzed for total protein content (modified Lowry assay), cholesterol level (colorimetric method), and the raft marker caveolin-1 (Western blot). Caveolin is the major structural protein in caveolae, specialized domains of the plasma membrane. Several tissue-specific isoforms were found, whereas caveolin-1 is prominent in the vascular endothelium (8). Combined caveolin-1, cholesterol, and protein analyses confirmed that fractions 5–7 represented the detergent-resistant microdomains (lipid rafts). We used fractions 5–7 to conduct the following experiment.
To determine whether the membrane localization of eNOS, LRP, and caveolin-1 were altered by TGRL lipolysis products, HAEC were grown to confluence before treatment with TGRL (456 µmol/l TG) or TGRL + LpL (2 U/ml) for 3 h. Cells were lysed in hypotonic buffer, and lipid raft-enriched membranes were prepared as described in MATERIALS AND METHODS. Western blot analyses for caveolin-1, eNOS, and LRP were conducted in density gradients from HAEC. A large amount of caveolin-1 was found in low-density fractions 5–7; no caveolin-1 was found in the lower-density fractions 1–4. Both eNOS and LRP were found in fractions 5–7, demonstrating that these proteins localize to lipid raft fractions. Compared with TGRL treatment, HAEC treated with TGRL + LpL (Fig. 3) showed substantial changes in the amount of caveolin-1, eNOS, and LRP associated with the lipid raft fraction and the nonraft fraction (low-density fraction), although no change was noted in the amount of these proteins in the total cell lysate. After treatment with TGRL lipolysis, significant amounts of caveolin-1 and LRP were found in the nonraft low-density fraction. Lipolysis product treatment of HAEC significantly decreased caveolin-1, as determined by densitometric analyses (UN-SCAN-IT gel software, Silk Scientific) (875,352 ± 67,523 vs. 303,284 ± 15,934 pix), LRP (1,661,483 ± 10,023 vs. 1,070,035 ± 21,936 pix), and eNOS (404,933 ± 36,524 vs. 251,984 ± 25,934 pix) associated with lipid raft-enriched membranes by 65.6%, 35.6%, and 37.8% (P < 0.05), respectively, compared with TGRL treatment. These findings indicate that lipolysis products caused raft-associated protein redistribution in the cell membrane.
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Lipid analysis of TGRL and TGRL lipolysis products. To explore the mechanism by which TGRL lipolysis affects endothelial cell lipid rafts, we compared the lipid composition of freshly isolated postprandial TGRL and TGRL lipolysis by enzymatic assay. After incubation with LpL for 30 min, there was a slight decrease in the concentrations of TG, phospholipid, and total cholesterol compared with TGRL treatment only, which was not statistically significant. However, there was a significant increase in FFA concentration (10-fold; P < 0.001; Fig. 4) in TGRL lipolysis products.
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| DISCUSSION |
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Using confocal fluorescence microscopic analysis, we were able to visualize the interactions of lipid rafts and TGRL in living HAEC. Currently, lipid raft microdomains can be morphologically identified by electron microscopy (33) and various fluorescence methods (10, 17, 18, 39). Compared with these techniques, our approach using a combination of fluorescence double labeling and confocal microscopic approaches allows us to visualize proteins colocalizing with lipid rafts and other morphologically featureless microdomains within living cells (30) and to monitor the dynamics of the proteins and lipids. This approach provides direct observation of the interaction between lipoproteins and specific membrane domains and does not require highly specialized equipment or technical expertise. Therefore, dual fluorescent labeling of lipid rafts and proteins (e.g., lipoproteins) has the potential to determine plasma membrane organization and the spatial dynamics of regulated signaling and membrane trafficking events associated with the cell surface.
Our localization studies indicate that TGRL remnant particles colocalize with plasma membrane lipid rafts. LRP is a multifunctional receptor that mediates uptake of TGRL and their remnant particles. Western blot showed that LRP was associated with lipid raft fractions before lipolysis, and treatment with TGRL lipolysis products caused LRP to move from detergent-resistant membrane fractions to low-density, detergent-soluble membrane fractions. This result demonstrates that LRP is dynamically associated with lipid rafts, which is consistent with a recent study (1). LRP could be exported from rafts to the detergent-soluble fractions, such as clathrin-coated pits where endocytosis occurs. Additional time course experiments are needed to determine when LRP moves from rafts to the detergent-soluble fractions and whether this occurs after LRP has bound TGRL remnant particles.
One of the important observations in the present study is that TGRL lipolysis products cause lipid raft clustering or aggregation. Our study shows that lipid rafts randomly distribute in the cell surface membrane and perinuclear region, whereas stimulation by TGRL lipolysis products results in the formation of multiple "nonpolarized" CTB aggregates. The clustering or aggregation of cell membrane lipid rafts in response to different stimuli exerts an important signaling action of many cell types (6, 41). It has been shown that clustering of rafts forms membrane platforms, which serve to recruit various signaling molecules such as sphingomyelinase, ceramide, and CD95, resulting in activation of signaling pathways (6, 9). Zhang et al. (47) demonstrated that lipid raft clustering on the HAEC plasma membrane increased NADPH oxidase, which is a major enzymatic source of superoxide in vascular endothelial cells. Using tumor necrosis factor-
and Fas ligand to stimulate the lipid raft clustering on the HAEC, the authors showed that the clustered rafts contained high NADPH oxidase in vascular endothelial cells. This study indicates that lipid raft clustering may play a role in redox transmembrane signaling.
ROS play an important role in the development of vascular disease, including atherosclerosis, hypertension, and restenosis after angioplasty. Excessive ROS generation has been associated with endothelial dysfunction and accelerated atherogenesis (27). ROS can induce oxidative modification of LDL, expression of adhesion molecules, such as intercellular adhesion molecule-1 and vascular cell adhesion molecule (VCAM)-1, and receptors for oxidized lipid particles, as well as the activation of transcriptional factors (26), which in turn facilitate inflammatory cell recruitment as well as lipid deposition in the intimal layer (29). There are various sources of ROS, such as mitochondrial respiration, purine metabolism and the xanthine oxidase pathway, the NOS pathway, and the NADPH oxidase pathway (27); however, the main source of ROS production in vascular endothelial cells is the NADPH oxidase pathway. Our study shows that TGRL lipolysis induces ROS generation, and we also confirm that superoxide anion, an important ROS, is generated from endothelial cells as a result of TGRL lipolysis product effects on endothelial cells. TGRL lipolysis-induced ROS can be blocked by NADPH oxidase inhibitors DPI and apocynin. DPI is an inhibitor of flavin-containing oxidases, including NADPH oxidase. The vascular NADPH oxidase consists of at least five subunits, which assemble membrane-bound cytochrome b558, p22phox, and gp91phox and are important for electron transport and the reduction of molecular oxygen to O2–. Apocynin acts by interfering with NADPH subunit assembly in the membrane and is therefore a more specific inhibitor than DPI. Taken together, the inhibition of O2– production induced by TGRL lipolysis indicates that TGRL lipolysis-induced oxidative stress is mediated by the NADPH oxidase pathway.
Recent evidence indicates that oxidized LDL (oxLDL) could act as a proatherogenic stimulus by activating NADPH oxidase, thus promoting the production of superoxide anion, which in turn has a positive feedback effect on further oxLDL production (34). Our study shows that TGRL lipolysis products, which cause lipid raft clustering, significantly increase the production of ROS in endothelial cells, and NADPH oxidase inhibitors suppress the lipolysis-induced ROS generation. This result demonstrates that TGRL lipolysis products induce NADPH oxidase activity. Furthermore, a recent study (47) demonstrated that the clustering of rafts results in the activation of NADPH oxidase and consequent endothelial dysfunction. That study and our study indicate that the formation of redox signaling platforms on endothelial cell membranes may contribute to endothelial injury and that lipid raft clustering may serve as a common mechanism for transmembrane signaling, which mediates the actions of these agonists.
We propose that TGRL lipolysis products stimulate lipid raft clustering, which provides a platform for NADPH oxidase and increases enzyme activity (47) and thereby stimulates the production of ROS. As a result, excessive ROS disrupts lipid rafts and affects raft function (e.g., eNOS), which may contribute to endothelial injury. Furthermore, TGRL lipolysis products induce increased accumulation of TGRL remnant particles in the plasma membrane in association with lipid rafts. The mechanism for the association of the TGRL remnant particle and the lipid raft is not known.
The purpose of this study was to investigate whether postprandial TGRL lipolysis affects the endothelial cell lipid raft and ROS production. Thus we incubated freshly isolated human postprandial TGRL with LpL to generate a mixture of lipolysis products, which is a setting similar to physiological TGRL lipolysis mediated by LpL that the vascular endothelium would encounter after a meal. LpL, an enzyme anchored to endothelial cells, primarily hydrolyzes triglycerides in TGRL. LpL can have either pro- or anti-inflammatory effects dependent on the cytokine stimulus (19) and dose (51). We previously showed (7, 35–37) that LpL had no direct effects on endothelial cells when we used a small amount of LpL to minimize any direct LpL effect. The present preliminary study also showed that there was no significant effect of LpL alone on HAEC compared with the control. Our study demonstrated that postprandial TGRL lipolysis mediated by LpL affects endothelial cell lipid raft and ROS production. In future studies, we will further explore which lipid fraction and which specific lipids (e.g., fatty acids) will cause raft and ROS changes by separating remnant particles, FFA, phospholipids, monoglycerides, and diglycerides from the TGRL lipolysis mixture.
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| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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