Reduced regulatory capacity of low density lipoproteins from patients with coronary artery disease.

To test the hypothesis whether low density lipoprotein (LDL) poor in cholesteryl ester from patients with coronary artery disease (CAD) express reduced capacity to regulate cellular sterol and lipoprotein metabolism, we compared the abilities of CAD-LDL and control-LDL to suppress receptor-mediated LDL degradation; activate acyl-CoA: cholesterol acyltransferase (ACAT); and regulate sterol synthesis rates in HL-60 promyelocytic leukemic cells. The ratio of apolipoprotein B to cholesteryl ester was 23% higher for CAD-LDL than control-LDL (P less than 0.01), whereby CAD-LDL contained less cholesterol per particle than control-LDL and would be predicted to exert a reduced regulatory effect on sterol and lipoprotein metabolism than control-LDL at the same level of apo B protein. The results indicate that receptor-mediated 125I-LDL degradation rates were 43% higher for cells pre-incubated with CAD-LDL than with control-LDL (P less than 0.04), consistent with CAD-LDL having a lower ability to down-regulate LDL (apo B/E) receptor expression. When LDL degradation rates were expressed as a percentage of the rate of HL-60 cells incubated in lipoprotein-free medium, the mean LDL degradation rate for cells pre-incubated with CAD-LDL was 56% of untreated cells, while for cells incubated with control-LDL the average value was 41%. The data indicate that the suppression of receptor-mediated LDL degradation was proportional to the LDL cholesterol concentration in the medium. ACAT activity was 42% lower in cells pre-incubated with CAD-LDL as compared to control-LDL (P = 0.002), suggesting that the entry of cholesterol into the ACAT substrate pool was lower in cells pre-incubated with CAD-LDL. There was no significant difference in the rate of sterol synthesis from [14C]acetate between cells pre-incubated with CAD-LDL versus control-LDL. The data support the hypothesis that LDL from CAD patients exhibit a decreased ability to down-regulate apo B/E receptor activity which could in part account for the previously observed increase in LDL degradation by mononuclear leukocytes from CAD patients (Shi et al., Atherosclerosis, 85 (1990) 127).