Nature Volume: 472, Pages: 57–63 Date published: (07 April 2011) Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease Zeneng Wang,1, 2 Elizabeth Klipfell,1, 2 Brian J. Bennett,3 Robert Koeth,1 Bruce S. Levison,1, 2 Brandon DuGar,1 Ariel E. Feldstein,1, 2 Earl B. Britt,1, 2 Xiaoming Fu,1, 2 Yoon-Mi Chung,1, 2 Yuping Wu,4 Phil Schauer,5 Jonathan D. Smith,1, 6 Hooman Allayee,7 W. H. Wilson Tang,1, 2, 6 Joseph A. DiDonato,1, 2 Aldons J. Lusis3 & Stanley L. Hazen1, 2, 6 Department of Cell Biology, Cleveland Clinic, Cleveland, Ohio 44195, USA, Center for Cardiovascular Diagnostics and Prevention, Cleveland Clinic, Cleveland, Ohio 44195, USA, Department of Medicine/Division of Cardiology, BH-307 Center for the Health Sciences, University of California, Los Angeles, California 90095, USA, Department of Mathematics, Cleveland State University, Cleveland, Ohio 44115, USA, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA, Department of Preventive Medicine and Institute for Genetic Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA Abstract: Metabolomics studies hold promise for the discovery of pathways linked to disease processes. Cardiovascular disease (CVD) represents the leading cause of death and morbidity worldwide. Here we used a metabolomics approach to generate unbiased small-molecule metabolic profiles in plasma that predict risk for CVD. Three metabolites of the dietary lipid phosphatidylcholine—choline, trimethylamine N-oxide (TMAO) and betaine—were identified and then shown to predict risk for CVD in an independent large clinical cohort. Dietary supplementation of mice with choline, TMAO or betaine promoted upregulation of multiple macrophage scavenger receptors linked to atherosclerosis, and supplementation with choline or TMAO promoted atherosclerosis. Studies using germ-free mice confirmed a critical role for dietary choline and gut flora in TMAO production, augmented macrophage cholesterol accumulation and foam cell formation. Suppression of intestinal microflora in atherosclerosis-prone mice inhibited dietary-choline-enhanced atherosclerosis. Genetic variations controlling expression of flavin monooxygenases, an enzymatic source of TMAO, segregated with atherosclerosis in hyperlipidaemic mice. Discovery of a relationship between gut-flora-dependent metabolism of dietary phosphatidylcholine and CVD pathogenesis provides opportunities for the development of new diagnostic tests and therapeutic approaches for atherosclerotic heart disease. Fed Proc. 1982 Dec;41(14):3015-21. Effects of consumption of choline and lecithin on neurological and cardiovascular systems. Wood JL, Allison RG. This report concerns possible adverse health effects and benefits that might result from consumption of large amounts of choline, lecithin, or phosphatidylcholine. Indications from preliminary investigations that administration of choline or lecithin might alleviate some neurological disturbances, prevent hypercholesteremia and atherosclerosis, and restore memory and cognition have resulted in much research and public interest. Symptoms of tardive dyskinesia and Alzheimer’s disease have been ameliorated in some patients and varied responses have been observed in the treatment of Gilles de la Tourette’s disease, Friedreich’s ataxia, levodopa-induced dyskinesia, mania, Huntington’s disease, and myasthenic syndrome. Further clinical trials, especially in conjunction with cholinergic drugs, are considered worthwhile but will require sufficient amounts of pure phosphatidylcholine. The public has access to large amounts of commercial lecithin. Because high intakes of lecithin or choline produce acute gastrointestinal distress, sweating, salivation, and anorexia, it is improbable that individuals will incur lasting health hazards from self-administration of either compound. Development of depression or supersensitivity of dopamine receptors and disturbance of the cholinergic-dopaminergic-serotinergic balance is a concern with prolonged, repeated intakes of large amounts of lecithin. Circulation. 2003;108:1735-9 Oral Synthetic Phospholipid (DMPC) Raises High-Density Lipoprotein Cholesterol Levels, Improves High-Density Lipoprotein Function, and Markedly Reduces Atherosclerosis in Apolipoprotein E–Null Mice Mohamad Navab, PhD; Susan Hama, BSc; Greg Hough, MS; Alan M. Fogelman, MD From the Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif. Background: Lecithin has been widely sold as a dietary supplement. 1,2-Dimyristoyl-sn-glycero-3-phosphocholine (DMPC) is a phospholipid that does not exist in nature and has been used in vitro to study lipid binding. We tested DMPC in vivo in apolipoprotein (apo) E–null mice. Methods and Results: DMPC or soy or egg lecithin at 1.0 mg/mL was added to the drinking water of 4-week-old apoE-null female mice. Eight weeks later, HDL cholesterol levels and apoA-I levels were markedly increased in the mice that received DMPC. HDL function was also dramatically improved in the mice receiving DMPC, and there was a significant reduction in aortic lesions (P=0.021) in the DMPC mice but not in those receiving lecithin. Adding 1.0 mg/mL of DMPC to the drinking water of 10-month-old apoE-null female mice for 5 weeks caused regression of aortic sinus lesions (P=0.003). Adding 1.0 mg/mL DMPC to the drinking water of 6-month-old apoE-null male mice for 8 weeks significantly reduced aortic sinus lesion area (P=0.0031) and en face whole aorta lesion area (P=0.001), whereas adding the same concentrations of soy or egg lecithin did not significantly alter lesion area. Jejunal apoA-I synthesis and plasma apoA-I levels were increased 2- to 3-fold in mice receiving DMPC but not soy or egg lecithin. Conclusions: DMPC (but not lecithin) raises HDL cholesterol and apoA-I, improves HDL function, and prevents lesions or causes their regression in apoE-null mice. Exp Biol Med (Maywood). 2010 Oct;235(10):1194-203. Synthetic dimyristoylphosphatidylcholine liposomes assimilating into high-density lipoprotein promote regression of atherosclerotic lesions in cholesterol-fed rabbits. Cho BH, Park JR, Nakamura MT, Odintsov BM, Wallig MA, Chung BH. Harlan E Moore Heart Research Foundation, Champaign, IL 61820, USA. bhcho@illinois.edu Abstract: We have reported recently that enrichment of high-density lipoprotein (HDL) with phosphatidylcholine (PC) liposomes is effective in solubilizing cholesterol from isolated human atherosclerotic plaques. In the present study, we investigated the in vivo effect of enrichment of HDL with PC on regression of diet-induced atherosclerosis in rabbits. As part of the study, a preliminary in vitro study on blood collected from the cholesterol-fed rabbits was performed to assess the capacity of the HDL density (d > 1.063 g/mL) plasma fraction from cholesterol-fed rabbits to assimilate multilamellar liposomes of synthetic dimyristoylphosphatidylcholine (DMPC). This was compared with the capacities of egg- and soy-PC liposomes to be assimilated into the HDL density plasma fraction. The capacity of the HDL density fraction to absorb PC from DMPC liposomes (11.5 mg/mL) was more than 10 times greater than egg or soy liposomes. Therefore, DMPC liposomes were chosen to infuse into cholesterol-fed rabbits. Cholesterol-fed rabbits infused weekly with DMPC liposomes (300 mg/kg body weight) for five weeks had significantly decreased aortic cholesterol contents (P < 0.05) compared with saline-infused cholesterol-fed controls. Atherosclerotic plaque volume, as measured by a type of new magnetic resonance imaging analysis, also decreased significantly (P < 0.05) after DMPC treatment. The present findings suggest that the enrichment of HDL with PC via intravenous infusion of synthetic DMPC liposomes could be a potential therapeutic approach for atherosclerotic plaque regression. Circulation. 2003 Oct 7;108(14):1735-9. Oral synthetic phospholipid (DMPC) raises high-density lipoprotein cholesterol levels, improves high-density lipoprotein function, and markedly reduces atherosclerosis in apolipoprotein E-null mice. Navab M, Hama S, Hough G, Fogelman AM. Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Room 47-123 CHS, 10833 Le Conte Ave, Los Angeles, Calif 90095-1679, USA. mnavab@mednet.ucla.edu BACKGROUND: Lecithin has been widely sold as a dietary supplement. 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) is a phospholipid that does not exist in nature and has been used in vitro to study lipid binding. We tested DMPC in vivo in apolipoprotein (apo) E-null mice. METHODS AND RESULTS: DMPC or soy or egg lecithin at 1.0 mg/mL was added to the drinking water of 4-week-old apoE-null female mice. Eight weeks later, HDL cholesterol levels and apoA-I levels were markedly increased in the mice that received DMPC. HDL function was also dramatically improved in the mice receiving DMPC, and there was a significant reduction in aortic lesions (P=0.021) in the DMPC mice but not in those receiving lecithin. Adding 1.0 mg/mL of DMPC to the drinking water of 10-month-old apoE-null female mice for 5 weeks caused regression of aortic sinus lesions (P=0.003). Adding 1.0 mg/mL DMPC to the drinking water of 6-month-old apoE-null male mice for 8 weeks significantly reduced aortic sinus lesion area (P=0.0031) and en face whole aorta lesion area (P=0.001), whereas adding the same concentrations of soy or egg lecithin did not significantly alter lesion area. Jejunal apoA-I synthesis and plasma apoA-I levels were increased 2- to 3-fold in mice receiving DMPC but not soy or egg lecithin. CONCLUSIONS: DMPC (but not lecithin) raises HDL cholesterol and apoA-I, improves HDL function, and prevents lesions or causes their regression in apoE-null mice. Biochim Biophys Acta. 2005 Mar 21;1733(1):76-89. Phosphatidylcholine-rich acceptors, but not native HDL or its apolipoproteins, mobilize cholesterol from cholesterol-rich insoluble components of human atherosclerotic plaques. Chung BH, Franklin F, Liang P, Doran S, Cho BH, Curcio CA. Gerontology Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA. bhchung@uab.edu Abstract: To examine the potential of high density lipoproteins (HDL) to ameliorate atherosclerotic plaques in vivo, we examined the ability of native HDL, lipid-free HDL apolipoproteins (apo HDL), cholesterol-free discoidal reconstituted HDL (R-HDL) comprised of apo HDL and phosphatidylcholine (PC) and PC liposomes to release cholesterol from cholesterol-rich insoluble components of plaques (ICP) isolated from atherosclerotic human aorta. Isolated ICP had a free cholesterol (FC) to phospholipid (PL) mass ratio (0.8-3.1) and a sphingomyelin (SPM) to PC mass ratio (1.2-4.2) that exceeded those of plasma membranes of cultured cells. Surprisingly, native HDL and its apolipoproteins were not able to release cholesterol from ICP. However, R-HDL and PC liposomes were effectively released cholesterol from ICP. The release of ICP cholesterol by R-HDL was dose-dependent and accompanied by the transfer of > 8 x more PC in the reverse direction (i.e., from R-HDL to ICP), resulting in a marked enrichment of ICP with PC. Compared to R-HDL, PC liposomes were significantly less effective in releasing cholesterol from ICP but were somewhat more effective in enriching ICP with PC. Native HDL was minimally effective in enriching ICP with PC, but became effective after prior in vitro enrichment of HDL with PC from multilamellar PC liposomes. The enrichment of ICP with PC resulted in the dissolution of cholesterol crystals on ICP and allowed the removal of ICP cholesterol by apo HDL and plasma. Our study revealed that the removal of cholesterol from ICP in vivo will be possible through a change in the level, composition, and physical state of ICP lipids mediated by PC-enriched HDL. J Lipid Res. 2005 Jul;46(7):1457-65. Structural modification of plasma HDL by phospholipids promotes efficient ABCA1-mediated cholesterol release. Hajj Hassan H, Blain S, Boucher B, Denis M, Krimbou L, Genest J. Cardiovascular Genetics Laboratory, Cardiology Division, McGill University Health Center/Royal Victoria Hospital, Montréal, Québec H3A 1A1, Canada. Abstract: It has been suggested that ABCA1 interacts preferentially with lipid-poor apolipoprotein A-I (apoA-I). Here, we show that treatment of plasma with dimyristoyl phosphatidylcholine (DMPC) multilamellar vesicles generates prebeta(1)-apoA-I-containing lipoproteins (LpA-I)-like particles similar to those of native plasma. Isolated prebeta(1)-LpA-I-like particles inhibited the binding of (125)I-apoA-I to ABCA1 more efficiently than HDL(3) (IC(50) = 2.20 +/- 0.35 vs. 37.60 +/- 4.78 microg/ml). We next investigated the ability of DMPC-treated plasma to promote phospholipid and unesterified (free) cholesterol efflux from J774 macrophages stimulated or not with cAMP. At 2 mg DMPC/ml plasma, both phospholipid and free cholesterol efflux were increased ( approximately 50% and 40%, respectively) in cAMP-stimulated cells compared with unstimulated cells. Similarly, both phospholipid and free cholesterol efflux to either isolated native prebeta(1)-LpA-I and prebeta(1)-LpA-I-like particles were increased significantly in stimulated cells. Furthermore, glyburide significantly inhibited phospholipid and free cholesterol efflux to DMPC-treated plasma. Removal of apoA-I-containing lipoproteins from normolipidemic plasma drastically reduced free cholesterol efflux mediated by DMPC-treated plasma. Finally, treatment of Tangier disease plasma with DMPC affected the amount of neither prebeta(1)-LpA-I nor free cholesterol efflux. These results indicate that DMPC enrichment of normal plasma resulted in the redistribution of apoA-I from alpha-HDL to prebeta-HDL, allowing for more efficient ABCA1-mediated cellular lipid release. Increasing the plasma prebeta(1)-LpA-I level by either pharmacological agents or direct infusions might prevent foam cell formation and reduce atherosclerotic vascular disease. J Lipid Res. 1988 Nov;29(11):1405-15. Behavior of human apolipoprotein A-I: phospholipid and apoHDL: phospholipid complexes in vitro and after injection into rabbits. Koizumi J, Kano M, Okabayashi K, Jadhav A, Thompson GR. MRC Lipoprotein Team, Hammersmith Hospital, London, U.K. Abstract: Apolipoprotein A-I was purified from human high density lipoprotein and complexed with polyunsaturated phosphatidylcholine (PC) in deoxycholate (Lipostabil); the bile salt was removed subsequently by dialysis. The behavior of the resultant apoA-I/PC complexes was compared with that of Lipostabil in vitro and after injection into rabbits. In vivo apoA-I/PC complexes had the density of HDL throughout but had both alpha and pre beta electrophoretic mobility, the latter probably reflecting dissociation of apoA-I from PC. Lipostabil initially behaved like LDL but gradually acquired the density of HDL after incubation with plasma and in vivo. Both preparations increased plasma total phospholipids in normolipidemic rabbits to a similar extent, but, increments in HDL phospholipid were greater after apoA-I/PC complexes were injected. ApoHDL/PC complexes, prepared in a similar manner, appeared to promote efflux of cholesterol from perfused rabbit aortas in the presence of lecithin:cholesterol acyltransferase (LCAT) activity, consistent with a stimulatory effect on cholesterol mobilization. Injection of apoHDL/PC complexes into hyperlipidemic rabbits decreased plasma cholesterol but increased HDL cholesterol, whereas Lipostabil decreased both. These findings suggest that human apoA-I/PC complexes resemble HDL in their behavior more closely than does Lipostabil, and show that both types of liposome undergo modification upon interaction with plasma. It remains to be shown whether they possess any therapeutic potential. Zhonghua Nei Ke Za Zhi. 1996 May;35(5):313-6. . He Y, Xu N, Liu X. Department of Cardiology, General Hospital of Beijing Command. Abstract: In order to study the effect of oral phospholipid liposomes on regression of atherosclerosis process, serum total cholesterol triglyceride, lipoprotein cholesterol and atherosclerotic lesion on the aorta wall in different groups of 20 New Zealand rabbits were observed. Results showed that phospholipid liposomes could obviously increase high density lipoprorein cholesterol concentration and decrease serum total cholesterol triglyceride and very low density lipoprorein cholesterol concentration. Phospholipid liposomes could also reduce the size of atherosclerotic lesion on the aortic wall. In comparision with the results observed in phospholipid group, there was significant difference (P < 0.05, P < 0.01 or P < 0.001). It suggested that oral phospholipid liposomes could effectively regress atherosclerotic lesion on the arterial wall and regulate serum lipid to reduce cholesterol deposit on the arterial wall in experimental rabbits. It might provide some experimental basis for human being to prevent and treat atherosclerosis. JPEN J Parenter Enteral Nutr. 1985 Nov-Dec;9(6):716-9. The effects of oral soybean phospholipid on serum total cholesterol, plasma triglyceride, and serum high-density lipoprotein cholesterol concentrations in hyperlipidemia. Ovesen L, Ebbesen K, Olesen ES. Abstract: In a randomized, double-blind, cross-over trial soybean phospholipid and placebo, 18 g daily for 6 wk, were given orally to 20 patients on long-term treatment with standard lipid lowering diets. The effect of this treatment on serum total cholesterol and high-density lipoprotein cholesterol and plasma triglyceride was studied. After 6 wk mean (+/- SE) cholesterol concentration was decreased by 0.54 (+/- 0.19) mmol/liter in phospholipid-treated as compared to placebo-treated patients (p less than 0.02). The decrease in serum cholesterol was significant (p less than 0.02) only in patients assigned to receive phospholipid before placebo. A highly significant increase (p less than 0.001) followed the withdrawal of phospholipid. No effect on triglyceride and high-density lipoprotein cholesterol concentrations was demonstrated. Clinica Chimica Acta, Volume 383, Issues 1-2, August 2007, Pages 103-109 Whole blood choline and plasma choline in acute coronary syndromes: Prognostic and pathophysiological implications Oliver Danne, Christian Lueders, Christian Storm, Ulrich Frei, Martin Möckel Background: Whole blood choline (WBCHO) and plasma choline (PLCHO) concentrations increase rapidly after stimulation of phospholipase D in acute coronary syndromes (ACS). Early risk-stratification was analyzed in 217 patients with suspected ACS and a negative admission troponin T (< 0.03 µg/L). Methods: WBCHO and PLCHO were measured using high-performance-liquid-chromatography mass spectrometry. Major cardiac events (MACE) were defined as cardiac death/arrest, coronary intervention or myocardial infarction (MI). Results: WBCHO (≥ 28.2 µmol/L) was predictive for MACE (hazard ratio 2.7; p < 0.001), cardiac death/arrest (HR 4.2; p = 0.015), heart failure (HR 2.8; p = 0.003), coronary intervention (HR 2.1; p = 0.01) and MI (HR 8.4; p = 0.002) after 30 days. PLCHO (≥ 25.0 µmol/L) was predictive for MACE (HR 2.6; p = 0.005), cardiac death/arrest (HR 15.7; p < 0.001), heart failure (HR 6.0; p < 0.001) but not for coronary intervention and MI. WBCHO and PLCHO were predictive for MACE in multivariate analysis (Odds ratio 2.7, p = 0.009 and OR 3.3, p = 0.03) independently of age, gender, prior MI, coronary risk factors and ECG. Conclusions: WBCHO and PLCHO are significant and independent predictors of major cardiac events in admission troponin T negative acute coronary syndromes. Both are predictive for events related to tissue ischemia and WBCHO is capable of detecting risks associated with coronary plaque instability. Additional References Bidulescu A, Chambless LE, Siega-Riz AM, Zeisel SH, Heiss G. Usual choline and betaine dietary intake and incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. BMC Cardiovasc Disord. 2007 Jul 13;7:20. Cho BH, Park JR, Nakamura MT, Odintsov BM, Wallig MA, Chung BH. Synthetic dimyristoylphosphatidylcholine liposomes assimilating into high-density lipoprotein promote regression of atherosclerotic lesions in cholesterol-fed rabbits. Exp Biol Med (Maywood). 2010 Oct;235(10):1194-203. Chung BH, Franklin F, Liang P, Doran S, Cho BH, Curcio CA. Phosphatidylcholine-rich acceptors, but not native HDL or its apolipoproteins, mobilize cholesterol from cholesterol-rich insoluble components of human atherosclerotic plaques. Biochim Biophys Acta. 2005 Mar 21;1733(1):76-89. Danne O, Lueders C, Storm C, Frei U, Möckel M. Whole blood choline and plasma choline in acute coronary syndromes: prognostic and pathophysiological implications. Clin Chim Acta. 2007 Aug;383(1-2):103-9. Gundermann KJ, PhD, MD, Associate Professor at the Institute of Pharmacology and Toxicology, Medical Academy, Szczecin, Poland. “The Essential Phospholipids as a Membrane Therapeutic” 1993. Hajj Hassan H, Blain S, Boucher B, Denis M, Krimbou L, Genest J. Structural modification of plasma HDL by phospholipids promotes efficient ABCA1-mediated cholesterol release. J Lipid Res. 2005 Jul;46(7):1457-65. He Y, Xu N, Liu X. . Zhonghua Nei Ke Za Zhi. 1996 May;35(5):313-6. Koizumi J, Kano M, Okabayashi K, Jadhav A, Thompson GR. Behavior of human apolipoprotein A-I: phospholipid and apoHDL:phospholipid complexes in vitro and after injection into rabbits. J Lipid Res. 1988 Nov;29(11):1405-15. Navab M, Hama S, Hough G, Fogelman AM. Oral synthetic phospholipid (DMPC) raises high-density lipoprotein cholesterol levels, improves high-density lipoprotein function, and markedly reduces atherosclerosis in apolipoprotein E-null mice. Circulation. 2003 Oct 7;108(14):1735-9. Ovesen L, Ebbesen K, Olesen ES. The effects of oral soybean phospholipid on serum total cholesterol, plasma triglyceride, and serum high-density lipoprotein cholesterol concentrations. JPEN J Parenter Enteral Nutr. 1985 Nov-Dec;9(6):716-9. Wood JL, Allison RG. Effects of consumption of choline and lecithin on neurological and cardiovascular systems. Fed Proc. 1982 Dec;41(14):3015-21. Yechiel E, Barenholz Y. Relationships between membrane lipid composition and biological properties of rat myocytes. Effect of aging and manipulation of lipid composition. J Biol Chem 1985 Aug 5;260(16):9123-31 Yehuda S, Rabinovitz S, Mostofsky DI. Modulation of learning and neuronal membrane composition in the rat by essential fatty acid preparation: time course analysis. Neurochem Res. 1998 May;23(5):627-34 | |