The Anti-Inflammatory Function of HDL Is Impaired in Type 2 Diabetes

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The Anti-Inflammatory Function of HDL Is Impaired in Type 2 Diabetes Ebtehaj et al. Cardiovasc Diabetol (2017) 16:132 DOI 10.1186/s12933-017-0613-8 Cardiovascular Diabetology ORIGINAL INVESTIGATION Open Access The anti‑infammatory function of HDL is impaired in type 2 diabetes: role of hyperglycemia, paraoxonase‑1 and low grade infammation Sanam Ebtehaj1, Eke G. Gruppen2, Mojtaba Parvizi3, Uwe J. F. Tietge1*† and Robin P. F. Dullaart2† Abstract Background: Functional properties of high density lipoproteins (HDL) are increasingly recognized to play a physi- ological role in atheroprotection. Type 2 diabetes mellitus (T2DM) is characterized by low HDL cholesterol, but the efect of chronic hyperglycemia on the anti-infammatory capacity of HDL, a metric of HDL function, is unclear. There- fore, the aim of the present study was to establish the impact of T2DM on the HDL anti-infammatory capacity, taking paraoxonase-1 (PON-1) activity and low grade infammation into account. Methods: The HDL anti-infammatory capacity, determined as the ability to suppress tumor necrosis factor-α (TNF-α) induced vascular cell adhesion molecule-1 (VCAM-1) mRNA expression in endothelial cells in vitro (higher values indicate lower anti-infammatory capacity), PON-1 (arylesterase) activity, hs-C-reactive protein (hs-CRP), serum amyloid A (SAA) and TNF-α were compared in 40 subjects with T2DM (no insulin or statin treatment) and 36 non-diabetic subjects. Results: T2DM was associated with impaired HDL anti-infammatory capacity (3.18 vs 1.05 fold increase in VCAM-1 mRNA expression; P < 0.001), coinciding with decreased HDL cholesterol (P 0.001), apolipoprotein A-I (P 0.038) and PON-1 activity (P 0.023), as well as increased hs-CRP (P 0.043) and TNF-α= (P 0.005). In all subjects= combined, age- and sex-adjusted= multivariable linear regression analysis =demonstrated that impaired= HDL anti-infammatory capacity was associated with hyperglycemia (β 0.499, P < 0.001), lower PON-1 activity (β 0.192, P 0.030) and higher hs-CRP (β 0.220, P 0.016). = = − = = = Conclusions: The HDL anti-infammatory capacity is substantially impaired in T2DM, at least partly attributable to the degree of hyperglycemia, decreased PON-1 activity and enhanced low grade chronic infammation. Decreased anti- infammatory protection capacity of HDL conceivably contributes to the increased atherosclerosis risk associated with T2DM. Keywords: High sensitivity C-reactive protein, High density lipoprotein function, Paraoxonase-1, Serum amyloid A, Type 2 diabetes mellitus Introduction disease (CVD) [1]. Tis elevated CVD risk has been, at Patients with type 2 diabetes mellitus (T2DM) have a sub- least in part, attributed to the low high density lipo- stantially increased risk of atherosclerotic cardiovascular protein (HDL) cholesterol levels consistently found in patients with insulin resistance and T2DM [2–4]. How- *Correspondence: [email protected] ever, data from genetic as well as pharmacological inter- †Uwe J. F. Tietge and Robin P. F. Dullaart contributed equally to this work vention studies now suggest that HDL cholesterol levels 1 Department of Pediatrics, University of Groningen, University Medical per se might not be as relevant as a predictive biomarker Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands Full list of author information is available at the end of the article of atherosclerosis as previously thought [5–7]. Instead, © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ebtehaj et al. Cardiovasc Diabetol (2017) 16:132 Page 2 of 9 the functionality of HDL particles could have a more according to guidelines from the Dutch College of Gen- pathophysiologically important impact [8, 9], together eral Practitioners (fasting plasma glucose ≥ 7.0 mmol/L; with determinations of HDL subpopulations and HDL non-fasting plasma glucose ≥ 11.1 mmol/L). Subjects particle numbers [10–14]. HDL may slow the process of with a history of CVD, chronic kidney disease (estimated atherogenesis by several important biological proper- glomerular fltration rate < 60 mL/min/1.73 m2 and/or ties. First, HDL promotes cholesterol efux and reverse proteinuria), liver function abnormalities or thyroid dys- cholesterol transport, thereby removing cholesterol from function, as well as current smokers and subjects who macrophage foam cells in atherosclerotic lesions [8, 9]. used lipid lowering drugs were also excluded. Te use of Variable results have been reported on the impact of dia- metformin, sulfonylurea and antihypertensive medica- betes on HDL-mediated cholesterol efux capacity, likely tion was allowed, but insulin use was an exclusion crite- due to diferent assay conditions employed and refect- rion. Blood pressure was measured after 15 min rest at ing the infuence of the severity of hyperglycemia [15– the left arm in sitting position using a sphygmomanom- 17]. In a recent cross-sectional analysis of the CODAM eter. Body mass index (BMI in kg/m2) was calculated as study including 552 subjects we did not fnd evidence weight divided by height squared. Waist circumference that moderate hyperglycemia as such impairs cholesterol was measured between the 10th rib and the iliac crest. efux capacity [17]. Second, HDL can inhibit the oxida- Te metabolic syndrome (MetS) was defned according tion of native LDL thereby preventing the formation of to the revised NCEP-ATP III criteria [27]. Tree or more pro-atherosclerotic and pro-infammatory LDL particles of the following criteria were required for categorization [18]. Also for the efect of T2DM on the anti-oxidative of subjects with MetS: waist circumference > 102 cm for capacity of HDL opposing data have been reported. men and > 88 cm for women, hypertension (blood pres- In some studies, HDL from T2DM patients exhibited sure ≥ 130/85 mmHg or use of antihypertensive medica- a reduced capacity to protect low density lipoproteins tion), fasting plasma triglycerides ≥ 1.70 mmol/L; HDL (LDL) from oxidation [19–21], whereas we found previ- cholesterol < 1.0 mmol/L for men and < 1.3 mmol/L for ously that the anti-oxidative capacity of HDL is impaired women, fasting glucose ≥ 5.6 mmol/L, or previously in T2DM but only taking account of the diabetes-asso- diagnosed T2DM. Te participants were studied after an ciated decrease in HDL cholesterol [22]. Again, these overnight fast. diferences might be related to the degree of metabolic control in the T2DM patients studied. Tird, HDL has Laboratory analyses potent anti-infammatory activity and can reduce, e.g. Serum and EDTA-anticoagulated plasma samples were endothelial activation [8, 9, 23], thus also interfering stored at − 80 °C until analysis. Plasma glucose was with an early step of atherogenesis. Notably, the anti- measured shortly after blood collection with an APEC infammatory capacity of HDL was found to be impaired glucose analyzer (APEC Inc., Danvers, MA, USA). in acute myocardial infarction patients [24–26], and to Total cholesterol and triglycerides were measured by predict recurrent CVD events even independent of HDL routine enzymatic methods (Roche/Hitachi Cat. Nos cholesterol and apolipoprotein (apo) A-I, the class-defn- 11875540 and 1187602, respectively; Roche Diagnos- ing apolipoprotein of HDL [25]. Much less is currently tics GmBH, Mannheim, Germany). HDL cholesterol known about the potential efect of T2DM specifcally on was assayed by a homogeneous enzymatic colorimetric the anti-infammatory properties of HDL. test (Roche/Hitachi, Cat. No 04713214). Non-HDL cho- In the present cross-sectional study we tested the lesterol was calculated as the diference between total hypothesis that the anti-infammatory function of HDL cholesterol and HDL cholesterol. LDL cholesterol was is impaired in T2DM. Furthermore, we aimed to deline- calculated by the Friedewald formula if triglycerides were ate the relationship of this metric of HDL function with < 4.5 mmol/L. Apolipoprotein A-I (apoA-I) and apolipo- hyperglycemia, PON-1 activity and low grade chronic protein B (apoB) were measured by immunoturbidim- infammation markers. etry (Roche/Cobas Integra Tinaquant Cat No. 03032566, Roche Diagnostics). Glycated hemoglobin (HbA1c) was Methods measured by high-performance liquid chromatography Subjects (Bio-Rad, Veenendaal, the Netherlands; normal range: Te study protocol was approved by the medical eth- 27–43 mmol/mol). ics committee of the University Medical Center Gron- Serum paraoxonase-1 (PON-1) enzymatic activity was ingen. Men and women with and without T2DM, aged measured as arylesterase activity, i.e. as the rate of hydrol- > 18 years, were recruited by advertisement in local news- ysis of phenyl acetate into phenol [28, 29]. Arylesterase papers. Tey participated after written informed consent activity, measured with this assay, is positively correlated had been obtained. T2DM had been diagnosed previously with PON-1 enzymatic activity toward paraoxon [30]. Ebtehaj et al. Cardiovasc Diabetol (2017) 16:132 Page 3 of 9 High sensitivity C-reactive protein (hs-CRP) was anti-infammatory capacity. In addition, under the assay assayed by
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