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Hypertriglyceridemia: HELP
Articles from Justus-Liebig-Universitat Giessen
Based on 8 articles published since 2009

These are the 8 published articles about Hypertriglyceridemia that originated from Justus-Liebig-Universitat Giessen during 2009-2019.
+ Citations + Abstracts
1 Review Current knowledge of hypertriglyceridemic pancreatitis. 2014

Valdivielso, Pedro / Ramírez-Bueno, Alba / Ewald, Nils. ·Department of Medicine and Dermatology, University of Malaga, Spain; Servicio de Medicina Interna, Hospital Virgen de la Victoria, Malaga, Spain. · Servicio de Medicina Interna, Hospital Virgen de la Victoria, Malaga, Spain. · Justus-Liebig-University Giessen, 35392 Giessen, Germany; General Hospital Luebbecke-Rahden, Department of Internal Medicine, 32312 Luebbecke, Germany. Electronic address: nils.ewald@innere.med.uni-giessen.de. ·Eur J Intern Med · Pubmed #25269432.

ABSTRACT: Severe hypertriglyceridemia (HTG) is a well established and the most common cause of acute pancreatitis (AP) after alcohol and gall stone disease. It is alleged to account for up to 10% of all pancreatitis episodes. Studies suggest that in patients with triglyceride (TG) levels>1000 mg/dL (>11.3 mmol/L), hypertriglyceridemia-induced acute pancreatitis (HTGP-AP) occurs in approximately 15-20% of all subjects referred to Lipid Clinics. Until now, there is no clear evidence which patients with severe HTG will develop pancreatitis and which will not. Underlying pathophysiological concepts include hydrolysis of TG by pancreatic lipase and excessive formation of free fatty acids with inflammatory changes and capillary injury. Additionally hyperviscosity and ischemia may play a decisive role. The clinical features of HTG-AP patients are supposed to be no different from patients with AP of other etiologies. Yet, there are well-conducted studies suggesting that HTG-AP is associated with a higher severity and complication rate. Therapeutic measurements in HTG-AP include dietary modifications, different antihyperlipidemic agents, insulin and/or heparin treatment. The beneficial use of plasmapheresis is repeatedly reported and suggested in many studies. Yet, due to the lack of randomized and controlled trials, it is currently unknown if plasmapheresis may improve morbidity and mortality in the clinical setting of HTG-AP. Since there are no commonly accepted clinical guidelines in the management of HTG-AP, there is a definite need for an international, multicenter approach to this important subject.

2 Review Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis. 2012

Ewald, Nils / Kloer, Hans-Ulrich. ·Third Medical Department, University Hospital Giessen and Marburg, Giessen Site, Klinikstr. 33, 35392 Giessen, Germany. nils.ewald@innere.med.uni-giessen.de ·Clin Res Cardiol Suppl · Pubmed #22528130.

ABSTRACT: Hypertriglyceridemia is associated with a number of severe diseases such as acute pancreatitis and coronary artery disease. In severe hypertriglyceridemia (SHTG, triglycerides > 1,000 mg/dL), rapid lowering of plasma triglycerides (TG) has to be achieved. Treatment regimes include nutritional intervention, the use of antihyperlipidemic drugs, and therapeutic apheresis. Apheretic treatment is indicated in medical emergencies such as hypertriglyceridemic pancreatitis. Reviewing the current literature, plasmapheresis appears to be a safe and useful therapeutic tool in patients suffering from SHTG. Apheretic treatment is able to remove the causative agent for pancreatic inflammation. Data suggests that the use of apheresis should be performed as early as possible in order to achieve best results. The use of plasmapheresis, however, is limited due to the rather high costs and the limited availability of the procedure.

3 Review The impact of oral vitamin A derivatives on lipid metabolism - What recommendations can be derived for dealing with this issue in the daily dermatological practice? 2011

Klör, Hans-Ulrich / Weizel, Achim / Augustin, Matthias / Diepgen, Thomas L / Elsner, Peter / Homey, Bernhard / Kapp, Alexander / Ruzicka, Thomas / Luger, Thomas. ·Department of Endocrinology, Diabetology, Metabolism and Nutritional Medicine, University Clinic of Giessen and Marburg, Germany. ·J Dtsch Dermatol Ges · Pubmed #21392258.

ABSTRACT: Retinoids and vitamin A derivatives have been widely used topically and systemically in the treatment of hyper- and parakeratotic skin diseases, genodermatoses, severe acne, autoimmune diseases (i. e. lupus erythematosus) or cutaneous T-cell lymphoma for more than 30 years. In addition to the desired proliferation-inhibiting, differentiation-inducing and antiinflammatory or sebo-suppressive effects, vitamin A derivatives also affect lipid metabolism. This is shown primarily by an increase of transaminases, triglycerides or cholesterol levels which vary in intensity from patient to patient. The degree of impact on the different parameters of lipid metabolism depends on the nature of the vitamin A derivative on the one hand due to different receptor specific binding interactions (RAR/RXR), while on the other hand posttranslational processes also play a major role. This review paper gives a brief, concise overview of the vitamin A derivatives and possible effects on lipid metabolism that can be expected. Additionally it contains a recommendation for secure handling of abnormal laboratory values before, during and after oral therapy with vitamin A derivatives. The aim of this article is to provide practical help and confidence in dealing with vitamin A derivatives in daily clinical practice. The publication was created in cooperation with the Deutsche Dermatologische Gesellschaft (DDG) and Deutsche Gesellschaft zur Bekämpfung von Fettstoffwechselstörungen und ihren Folgeerkrankungen (DGFF [Lipid-Liga] e. V.).

4 Review Severe hypertriglyceridemia: an indication for apheresis? 2009

Ewald, Nils / Kloer, Hans-Ulrich. ·Third Medical Department, University Hospital Giessen and Marburg, Giessen Site, Rodthohl 6, 35392 Giessen, Germany. nils.ewald@innere.med.uni-giessen.de ·Atheroscler Suppl · Pubmed #20129374.

ABSTRACT: OBJECTIVE: Severe hypertriglyceridemia is associated with a number of severe complications such as acute pancreatitis. Rapid lowering of excessively elevated triglyceride (TG) levels is therefore a primary medical goal in these patients. According to previous reports, immediate apheretic treatment might be an interesting option in order to rapidly lower excessively elevated TG levels. METHODS: A review of the current available literature was therefore conducted in order to provide an overview of the present data on apheretic treatment for patients with severe hypertriglyceridemia. RESULTS: A single session of plasmapheresis proofs capable of lowering TG levels by up to 70%, producing clear clinical and laboratory improval. The best clinical benefit concerning reduction in morbitity and mortality can be achieved when apheresis is used as early as possible. Even repetitive use of apheresis is reported. There is controversy on technical details, such as different apheresis techniques (plasma exchange versus double-membrane filtration), slightly favoring plasma exchange. CONCLUSIONS: In patients with severe hypertriglyceridemia plasmapheresis seems to be a safe and useful tool in rapidly lowering excessively elevated TG levels. Apheresis can be used to rapidly decrease triglyceride levels, and thus remove the causative agent for continuing damage. The indications are medical emergencies such as hypertriglyceridemic pancreatitis with excessively elevated TG levels (TG > 1000 mg/dl). If indicated, it should be used as early as possible.

5 Review Severe hypertriglyceridemia and pancreatitis: presentation and management. 2009

Ewald, Nils / Hardt, Philip D / Kloer, Hans-Ulrich. ·Third Medical Department, University Hospital Giessen and Marburg, Giessen Site, Rodthohl 6, Giessen, Germany. nils.ewald@innere.med.uni-giessen.de ·Curr Opin Lipidol · Pubmed #19770656.

ABSTRACT: PURPOSE OF REVIEW: Hypertriglyceridemia (HTG) is a well recognized cause of acute pancreatitis accounting for approximately up to 10% of all cases and even up to 50% of all cases in pregnancy. Both primary and secondary disorders of lipoprotein metabolism may be associated with hypertriglyceridemic pancreatitis (HTGP). The purpose of this review is to provide an overview of the current studies on presentation and management of HTGP. RECENT FINDINGS/CONCLUSION: Hydrolysis of triglycerides by pancreatic lipase and formation of free fatty acids that induce inflammatory changes are postulated to account for the development of HTGP, yet the exact pathophysiology remains unclear. The clinical features of patients with HTGP are generally not different from patients with acute pancreatitis of other causes, and there is some evidence that HTGP is associated with a higher severity or a higher complication rate. There is no clear evidence as to which HTG patients will develop pancreatitis. Several studies have evaluated the effect of apheresis, the benefit of insulin and/or heparin treatment and the use of different antihyperlipidemic agents in HTGP. Dietary modifications resemble the key features in the long-term management of HTG. Whether HTG may cause chronic pancreatitis in the long-term follow-up remains controversial.

6 Article Pathogenic classification of LPL gene variants reported to be associated with LPL deficiency. 2016

Rodrigues, Rute / Artieda, Marta / Tejedor, Diego / Martínez, Antonio / Konstantinova, Pavlina / Petry, Harald / Meyer, Christian / Corzo, Deyanira / Sundgreen, Claus / Klor, Hans U / Gouni-Berthold, Ioanna / Westphal, Sabine / Steinhagen-Thiessen, Elisabeth / Julius, Ulrich / Winkler, Karl / Stroes, Erik / Vogt, Anja / Hardt, Phillip / Prophet, Heinrich / Otte, Britta / Nordestgaard, Borge G / Deeb, Samir S / Brunzell, John D. ·Progenika Biopharma, Bizkaia, Spain. Electronic address: rute.rodrigues@grifols.com. · Progenika Biopharma, Bizkaia, Spain. · uniQure NV, Amsterdam, The Netherlands. · Director of the German HITRIG, Third Medical Department and Policlinic, Giessen University Hospital, Justus-Liebig-University of Giessen, Giessen, Germany. · Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany. · Institute of Clinical Chemistry, Lipid Clinic, Magdeburg, Germany. · Charité-Universitätsmedizin Berlin, Berlin, Germany. · Universitätsklinikum Carl Gustav Carus an der Technischen Universität, Medizinische Klinik III, Dresden, Germany. · Institute of Clinical Chemistry and Laboratory Medicine and Lipid Outpatient Clinic, University Hospital Freiburg, Freiburg, Germany. · Department of Vascular Medicine, Amsterdam Medical Center/University of Amsterdam, Amsterdam, The Netherlands. · LMU Klinikum der Universität München, Medizinische Klinik und Poliklinik 4, München, Germany. · Gießen and Marburg University Hospital, Giessen, Germany. · Lipidambulanz, Rostock, Germany. · Universitätsklinikum Münster, Medizinische Klinik D, Med. Clinic, Münster, Münster, Germany. · Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · Department of Medicine (Division of Medical Genetics), University of Washington, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA. · Department of Medicine (Division of Metabolism, Endocrinology and Nutrition), University of Washington, Seattle, WA, USA. ·J Clin Lipidol · Pubmed #27055971.

ABSTRACT: BACKGROUND: Lipoprotein lipase (LPL) deficiency is a serious lipid disorder of severe hypertriglyceridemia (SHTG) with chylomicronemia. A large number of variants in the LPL gene have been reported but their influence on LPL activity and SHTG has not been completely analyzed. Gaining insight into the deleterious effect of the mutations is clinically essential. METHODS: We used gene sequencing followed by in-vivo/in-vitro and in-silico tools for classification. We classified 125 rare LPL mutations in 33 subjects thought to have LPL deficiency and in 314 subjects selected for very SHTG. RESULTS: Of the 33 patients thought to have LPL deficiency, only 13 were homozygous or compound heterozygous for deleterious mutations in the LPL gene. Among the 314 very SHTG patients, 3 were compound heterozygous for pathogenic mutants. In a third group of 51,467 subjects, from a general population, carriers of common variants, Asp9Asn and Asn291Ser, were associated with mild increase in triglyceride levels (11%-35%). CONCLUSION: In total, 39% of patients clinically diagnosed as LPL deficient had 2 deleterious variants. Three patients selected for very SHTG had LPL deficiency. The deleterious mutations associated with LPL deficiency will assist in the diagnosis and selection of patients as candidates for the presently approved LPL gene therapy.

7 Article Pro-inflammatory chemokines CCL2, chemerin, IP-10 and RANTES in human serum during an oral lipid tolerance test. 2016

Schmid, Andreas / Bala, Margarita / Leszczak, Stephanie / Ober, Irene / Buechler, Christa / Karrasch, Thomas. ·Department of Internal Medicine III, Giessen University Hospital, Germany. Electronic address: andreas.schmid@innere.med.uni-giessen.de. · Department of Internal Medicine I, Regensburg University Hospital, Germany. · Department of Internal Medicine III, Giessen University Hospital, Germany. ·Cytokine · Pubmed #26950614.

ABSTRACT: BACKGROUND: There is a strong coincidence of obesity and a chronic state of modest inflammation. Secretion of pro-inflammatory cytokines from adipocytes and immune cells represents a key mechanism in this process and is affected by fatty acids. MATERIAL AND METHODS: A study cohort of 100 overnight fasted healthy volunteers underwent an oral lipid tolerance test (OLTT) by ingestion of 160ml of a protein- and sugar-free lipid emulsion of defined composition. Venal blood was drawn at 0h (fasting) and at 2, 4, and 6h after lipid ingestion. Subjects were characterized by anthropometric and standard laboratory parameters. Serum concentrations of CCL2, IP-10, chemerin, and RANTES were measured by enzyme-linked immunosorbent assay (ELISA). Murine 3T3-L1 adipocytes were stimulated with free fatty acids (FA) and with sex steroids and concentrations of CCL2 and chemerin in cell culture supernatants were measured by ELISA. RESULTS: A significant reduction of circulating CCL2, IP-10, and chemerin concentrations was observed as a consequence of triglyceride ingestion whereas RANTES levels were increased. CCL2 serum concentrations were positively correlated with resistin and visfatin levels and with LDL/HDL ratio and negatively with adiponectin. There were significant differences in chemerin and RANTES serum concentrations in female and male subjects. CCL2 secretion from 3T3-L1 adipocytes was inhibited by treatment with linoleic (LA) and oleic acid (OA) whereas chemerin secretion was induced. Chemerin release from 3T3-L1 adipocytes was inhibited by testosterone. CONCLUSIONS: Oral lipid loading is linked to reduced circulating pro-inflammatory chemokines CCL2, IP-10, and chemerin and to increased RANTES levels, suggesting that dietary lipids affect immune function.

8 Article Successful treatment of severe hypertriglyceridemia with a formula diet rich in omega-3 fatty acids and medium-chain triglycerides. 2010

Hauenschild, Annette / Bretzel, Reinhard G / Schnell-Kretschmer, Henning / Kloer, Hans-Ulrich / Hardt, Philip D / Ewald, Nils. ·Third Medical Department and Policlinic, University Hospital of Giessen and Marburg, Giessen, Germany. ·Ann Nutr Metab · Pubmed #20150726.

ABSTRACT: BACKGROUND: Patients with highly increased plasma triglyceride levels are at risk of developing serious complications such as pancreatitis, coronary heart disease and stroke. Therefore it is important to rapidly decrease plasma triglyceride levels. A sufficient control of triglyceride levels with drugs like fibrates, statins or nicotinic acid can usually only be attained after a couple of weeks. Plasma exchange appears to be a fast but expensive method to reduce triglyceride levels. In this study we describe the use of a new omega-3 fatty acid and medium-chain triglyceride-rich formula diet as a therapeutic concept to reduce plasma triglyceride levels fast and effectively. METHODS: Thirty-two patients with severe hypertriglyceridemia were treated with the especially composed formula diet for a period of 7 days. RESULTS: Within this period of time, plasma triglycerides decreased from 1,601 (402-4,555) to 554 (142-2,382) mg/dl (p < 0.05). Total cholesterol levels were reduced from 417 (211-841) to 287 (165-457) mg/dl (p < 0.001). Fasting glucose and uric acid levels also slightly decreased (-8%; -12%). The formula diet as a 1-week treatment was well tolerated and accepted by the patients. CONCLUSION: This diet was successfully used as an acute treatment in severe hypertriglyceridemia and showed effectiveness in rapidly and safely lowering plasma triglyceride levels.