a Biotechnology Research Center , Mashhad University of Medical Sciences , Mashhad , Iran.
b Biomedical Research Unit , Mexican Social Security Institute , Durango , Mexico.
Ann Med. 2018 Nov;50(7):565-575. doi: 10.1080/07853890.2018.1511919. Epub 2018 Sep 29.
Apolipoprotein C-III (apo C-III) is a key regulator of triglycerides metabolism. The aim of this meta-analysis was to assess the effect of fish omega-3 polyunsaturated fatty acids (PUFAs) on apo C-III levels.
Randomized placebo-controlled trials investigating the impact of omega-3 on apo C-III levels were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar. A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on glycemic parameters.
This meta-analysis comprising 2062 subjects showed a significant reduction of apo C-III concentrations following treatment with omega-3 (WMD: -22.18 mg/L, 95% confidence interval: -31.61, -12.75, p < .001; I: 88.24%). Subgroup analysis showed a significant reduction of plasma apo C-III concentrations by eicosapentaenoic acid (EPA) ethyl esters but not omega-3 carboxylic acids or omega-3 ethyl esters. There was a greater apo C-III reduction with only EPA as compared with supplements containing EPA and docosahexaenoic acid (DHA) or only DHA. A positive association between the apo C-III-lowering effect of omega-3 with baseline apo C-III concentrations and treatment duration was found.
This meta-analysis has shown that omega-3 PUFAs might significantly decrease apo C-III. Key messages Omega-3 PUFA supplements significantly reduce apo C-III plasma levels, particularly in hypertriglyceridemic patients when applied in appropriate dose (more than 2 g/day) Triglyceride (TG)-lowering effect is achieved via peroxisome proliferator-activated receptors α Further studies should address the effect of omega-3 PUFAs alone or with other lipid-lowering drugs in order to provide a final answer whether apo C-III could be an important target for prevention of cardiovascular disease New apo C-III antisense oligonucleotide drug (Volanesorsen) showed to be promising in decreasing elevated TGs by reducing levels of apo C-III mRNA.
载脂蛋白 C-III（apo C-III）是甘油三酯代谢的关键调节因子。本荟萃分析旨在评估鱼类 ω-3 多不饱和脂肪酸（PUFA）对 apo C-III 水平的影响。
在 PubMed-Medline、SCOPUS、Web of Science 和 Google Scholar 中搜索了研究 ω-3 对 apo C-III 水平影响的随机安慰剂对照试验。使用随机效应模型和通用倒数方差法进行定量数据合并。使用逐一剔除法进行敏感性分析。进行加权随机效应荟萃回归分析，以评估潜在混杂因素对血糖参数的影响。
该荟萃分析共纳入 2062 名受试者，结果显示 ω-3 治疗后 apo C-III 浓度显著降低（WMD：-22.18mg/L，95%置信区间：-31.61，-12.75，p<0.001；I：88.24%）。亚组分析显示，二十碳五烯酸（EPA）乙酯可显著降低血浆 apo C-III 浓度，但 ω-3 羧酸或 ω-3 乙酯则不然。仅 EPA 与含有 EPA 和二十二碳六烯酸（DHA）或仅 DHA 的补充剂相比，apo C-III 降低更为明显。还发现 ω-3 降低 apo C-III 的效果与基线 apo C-III 浓度和治疗持续时间呈正相关。
本荟萃分析表明，ω-3 PUFA 可能显著降低 apo C-III。关键信息 ω-3 PUFA 补充剂可显著降低 apo C-III 血浆水平，特别是在高甘油三酯血症患者中，当以适当剂量（>2g/天）应用时可降低甘油三酯（TG）。通过过氧化物酶体增殖物激活受体-α实现 TG 降低作用。进一步的研究应关注 ω-3 PUFA 单独或与其他降脂药物联合应用的效果，以提供 apo C-III 是否可作为预防心血管疾病的重要靶点的最终答案。新型 apo C-III 反义寡核苷酸药物（Volanesorsen）通过降低 apo C-III mRNA 水平，显示出降低升高的 TG 的潜力。
