Background: The pattern of lipoproteins and apolipoproteins has been studied in a group of patients with chronic liver disease. The differences in this pattern were analysed in relation with the stage of liver disease and the presence of cholestasis.
Methods: Twenty one patients with hepatic cirrhosis and 12 with primary biliary cirrhosis were studied. Two subgroups were established according to the disease severity and to the Scheuer classification, respectively. Plasma lipoproteins were separated by ultracentrifugation, and the lipid and apolipoprotein composition were determined. Lipoprotein X was identified by means of agarose gel electrophoresis.
Results: In the subgroups with less severe liver disease, only minimal changes were found, such as the decreases in esterified cholesterol and Apo E contents in VLDL in the cirrhotic patients, and the increase of HDL-cholesterol in the patients with primary biliary cirrhosis in the first stages. In patients with severe hepatic cirrhosis, total esterified cholesterol, triglycerides, VLDL and HDL were diminished. Apo E in VLDL was undetectable whereas the different Apo C isoforms were in the normal proportion. Patients with severe biliary cirrhosis showed high levels of total cholesterol and triglycerides, elevated LDL-cholesterol, and decreased HDL-cholesterol and total esterified cholesterol. Apo C-IIO in VLDL was proportionally increased as related to both Apo E and Apo C-III. Lipoprotein X was detected in all these patients and in half of the patients with severe hepatic cirrhosis.
Conclusions: Severe chronic liver disease is associated with a decrease of the concentration of hepatic lipoproteins and the absence of Apo E in VLDL, probably as a result of a defect in their synthesis. The lipid profile found in patients with biliary cirrhosis delineates the pattern of chronic cholestasis, which is characterized by the presence of lipoprotein X, a significant increase of free-cholesterol and a decrease of HDL-cholesterol; VLDL, which are increased, are rich in Apo C-II. Data show the distinct apolipoprotein composition of VLDL in the different hepatic diseases.