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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:2086.)
© 2002 American Heart Association, Inc.

Lipoproteins

Mast Cell Tryptase Degrades HDL and Blocks Its Function as an Acceptor of Cellular Cholesterol

Miriam Lee; Christian P. Sommerhoff; Arnold von Eckardstein; Frank Zettl; Hans Fritz; Petri T. Kovanen

From the Wihuri Research Institute (M.L., P.T.K.), Helsinki, Finland; Abteilung Klinische Chemie und Klinische Biochemie (C.P.S., F.Z., H.F.), Chirurgische Klinik und Poliklinik Innenstadt der LMU, München, Germany; Institut für Klinische Chemie und Laboratoriumsmedizin (A.v.E.), Zentrallaboratorium, Westfälische Wilhelms-Universität Münster, Münster, Germany; and Faculty of Biology (M.L.), University of Havana, Cuba.

Correspondence to Petri T. Kovanen, MD, Wihuri Research Institute, Kalliolinnatie 4, Helsinki 00140, Finland. E-mail petri.kovanen{at}wri.fi

Abstract

Objective— In human atherosclerotic lesions, degranulated mast cells are found in the vicinity of macrophage foam cells. Mast cell granules contain tryptase, a tetrameric serine protease requiring glycosaminoglycans for stabilization. No endogenous inhibitors have been described for tryptase, and the physiological functions of the enzyme are poorly understood. Here, we investigated the effects of human tryptase on the integrity of high density lipoprotein (HDL)₃ and on its ability to release cholesterol from cultured mouse macrophage foam cells.

Methods and Results— Incubation of HDL₃ with tryptase led to degradation of its apolipoproteins. Tryptase predominantly degraded a quantitatively minor subfraction of HDL₃ that is lipid poor, exhibits electrophoretic pre-ß mobility, and contains either apolipoprotein A-I or apolipoprotein A-IV as its sole apolipoprotein. Moreover, tryptase caused functional changes in HDL₃ by destroying its ability to promote high-affinity efflux of cholesterol from macrophage foam cells, ie, the pre-ß-HDL-dependent component of the process. Human aortic proteoglycans increased the ability of tryptase to proteolyze HDL₃, suggesting that the proteoglycan-rich extracellular matrix of the arterial intima provides an appropriate environment for the extracellular actions of tryptase.

Conclusions— By depleting pre-ß-HDL, mast cell tryptase may impair the initial step of reverse cholesterol transport and will then favor cellular accumulation of cholesterol during atherogenesis.

Key Words: tryptase • human mast cells • arterial proteoglycans • cholesterol efflux • HDL₃

A key feature of atherosclerosis is the accumulation of cholesterol in the macrophages of the arterial intima.¹ According to current concepts, cholesterol is taken up by the intimal macrophages when they ingest modified LDL, whereas HDL can remove cholesterol from the macrophages and carry it back into the circulation.² Thus, for cholesterol to accumulate in the intimal macrophages, uptake must exceed release of cholesterol by these cells.³ One reason for such an imbalance is the inability of the HDL particles to remove cholesterol efficiently from intimal macrophages.

HDL removes cellular cholesterol by unspecific and specific mechanisms, ie, by aqueous diffusion and by interaction with cell-surface proteins, respectively.^4,5 The former process, ie, in the nonspecific diffusion-mediated pathway, does not essentially require apolipoproteins. If there is any role of apolipoproteins in this pathway, it would be enhancement of the plasma enzyme lecithin-cholesterol acyltransferase (LCAT), which operates as a driving force in the net efflux of cholesterol from cells to -HDL. By promoting esterification of the cholesterol in plasma HDL, it channels cholesterol into the core of the spherical -migrating HDL and so expands the size of the core and improves the cholesterol acceptor properties of -HDL. The latter process, ie, the apolipoprotein-mediated removal of cellular cholesterol, is mediated by lipid-free apolipoproteins and small discoidal lipid-poor HDL subfractions, which, in contrast to the major -migrating and lipid-rich component of HDL, exhibit pre-ß mobility when analyzed by agarose gel electrophoresis. In this pathway, the lipid acceptors interact with cell membrane proteins, notably with the ATP-binding cassette transporter A1, which leads to efficient net removal of phospholipids and cholesterol from the cells.⁶

After the initial observation that apoA-I in pre-ß-HDL is very sensitive to proteolytic degradation,⁷ we have shown that several proteases known to be present in the human arterial intima can degrade the apoA-I of HDL₃ in vitro, thereby impairing cellular cholesterol efflux. These proteases include certain matrix metalloproteases,⁸ plasmin and kallikrein,⁹ and chymase, a mast cell protease.¹⁰ In human atherosclerotic lesions, mast cells are often present in the vicinity of foam cells.¹¹ The mast cells are filled with cytoplasmic secretory granules that contain an abundance of 2 species of neutral serine proteases, tryptase and chymase. Indeed, as in other tissues, all the mast cells in the human arterial intima contain tryptase, and in addition, a variable fraction of them also contains chymase.¹¹ On mast cell activation, these proteases are secreted in their active forms. Accordingly, mast cells are potentially a significant source of neutral proteases in the extracellular fluid of the arterial intima. We have previously demonstrated that mast cell chymase efficiently proteolyzes the minor pre-ß-HDL subpopulations containing only apoA-I or only apoA-IV, thereby destroying the high-affinity component of cholesterol efflux induced by HDL₃ and plasma.^10,12 However, the ability of the other major mast cell protease, tryptase, to degrade plasma lipoproteins has not been investigated so far.

Tryptase is a unique serine protease that is enzymatically active only in its tetrameric form and requires glycosaminoglycans, notably the heparin proteoglycans of mast cells, for preservation of its tetrameric structure and its enzymatic activity.^13–15 Tryptase and heparin proteoglycans are colocalized within mast cells and are cosecreted on degranulation. Importantly, the mast cell heparin proteoglycans tend to prevent monomerization of the enzyme after secretion, thereby preserving its activity in the extracellular fluid.¹⁶ However, nothing is known about the potential of the proteoglycans present in the human arterial intima to regulate the activity of tryptase.

In the present study, we investigated whether human tryptase can degrade HDL. In addition, we studied the effect of tryptase on the ability of HDL₃ to promote high-affinity efflux of cholesterol from macrophage foam cells and the influence of the proteoglycans isolated from the human aorta on these effects.

Methods

Please refer to the expanded Methods section in the online supplement (which can be accessed at http://atvb.ahajournals.org).

ß-Tryptase was purified from human lung tissue and was also produced as a recombinant protein. Proteoglycans were isolated from the intima and media of human aortas. HDL₃ (1.125 to 1.210 g/mL) was isolated from freshly isolated normolipidemic human plasma by sequential ultracentrifugation. ³H-labeled HDL₃ was treated with tryptase as described in the figure legends. For measurement of cholesterol efflux, ³H-cholesterol-loaded mouse peritoneal macrophages were incubated with the indicated concentrations of HDL₃, after which the radioactivity in the cell-free medium was determined.

Results

Proteolysis of HDL₃ by Tryptase
Because purified tryptase is an unstable tetrameric enzyme that requires aminoglycans for its stabilization, initial incubations of tryptase with HDL₃ were performed in the presence of heparin. HDL₃ (1 mg/mL), in which the apolipoproteins had been radiolabeled, was incubated with tryptase in the presence of heparin (mass ratio of heparin to tryptase 5:1) for up to 20 hours, and the formation of small peptides was measured (trichloroacetic acid-soluble radioactivity). As shown in Figure 1A, 10 µg/mL of tryptase in the assay produced a modest degree of degradation of HDL₃ (slightly <1%) during the 20-hour incubation. However, increasing the concentration of tryptase to 30 µg/mL resulted in progressive degradation of HDL₃ (up to 8%) during the incubation period. This concentration of the enzyme was selected for further experiments. As shown in Figure 1B, increasing the mass ratio of heparin to tryptase from 5:1 to 10:1 did not increase the rate at which tryptase degraded HDL₃. However, in the presence of a lower heparin concentration (mass ratio 1:1), HDL₃ degradation was slower, particularly during the latter part of the incubation, an effect comparable to that found when incubations were carried out in the absence of heparin (mass ratio 0:1). In general, in the presence of heparin, the rate of HDL₃ degradation was most rapid during the first hour of incubation and then leveled off to reach a maximal value of 10% at 20 hours of incubation. When proteoglycans isolated from the human aortic wall were added instead of heparin, the rate of HDL₃ degradation was even higher than that in the presence of heparin, reaching maximally 20% in the presence of a proteoglycan-to-tryptase mass ratio of 10:1 (Figure 1C). Finally, recombinant tryptase also degraded HDL₃ (data not shown), thus excluding the possibility that the tryptase preparations from lung tissues were contaminated with other lung-derived proteases, particularly chymase.

View larger version (31K): [in this window] [in a new window]   Figure 1. Degradation of HDL3 by human mast cell tryptase. 3H-HDL3 (1 mg, 2 dpm/ng) was incubated with tryptase (10 or 30 µg, specific activity 0.82 n-tosyl l-arginine methyl ester units/µg) for various periods of time at 37°C in 1 mL of buffer containing 150 mmol/L NaCl, 1 mmol/L EDTA, and 5 mmol/L Tris-HCl, pH 7.4. A, The incubations were carried out in the presence of commercial heparin (5:1 heparin-to-tryptase mass ratio). B and C, Incubations of 3H-HDL3 were carried out as described above but in the presence of increasing concentrations of commercial heparin (B) or proteoglycans extracted from the human aorta (C). The aminoglycan-to-tryptase mass ratios are given in parentheses. At the indicated time points, trichloroacetic acid (TCA)-soluble radioactivity was measured and expressed as a percentage of the total radioactivity present in the 3H-HDL3 at the start of the incubation. Values are mean±SD of triplicate incubations.

Effect of Tryptase on HDL₃-Induced Cholesterol Efflux
We next determined the effect of tryptase on the ability of HDL₃ to promote the efflux of cellular cholesterol from macrophage foam cells. For this purpose, HDL₃ was preincubated with or without tryptase for 20 hours at 37°C, after which the enzymatic activity of tryptase was blocked by the addition of leupeptin, and the mixtures were added to macrophage foam cells. As expected, intact control HDL₃ led to a dose-dependent and saturable increase in ³H-cholesterol efflux (Figures 2A and 2B). Preincubation of HDL₃ with tryptase reduced its ability to remove cholesterol from the cells. At HDL₃ concentrations <50 µg/mL, the inhibitory effect of tryptase on the high-affinity component of the cholesterol efflux process became evident. This effect of tryptase on cholesterol efflux was observed with heparin (Figure 2A) and arterial proteoglycans (Figure 2B) as stabilizers of tryptase. The concentration of HDL₃ necessary to achieve half of the maximal efficiency of the efflux process increased by 4-fold after tryptase treatment in both cases.

View larger version (28K): [in this window] [in a new window]   Figure 2. Effect of tryptase on HDL3-mediated efflux of cholesterol from macrophage foam cells. HDL3 (1 mg/mL) was incubated at 37°C in 150 mmol/L NaCl, 1 mmol/L EDTA, and 5 mmol/L Tris-HCl, pH 7.4, in the presence of tryptase (30 µg/mL, specific activity 0.82 TAME units/µg). The incubations were performed in the presence of either commercial heparin (A) or arterial proteoglycans extracted from the human aorta (B). The heparin-to-tryptase and proteoglycan-to-tryptase mass ratios were 10:1. After 20 hours, the incubations were stopped by adding leupeptin, and aliquots of the incubation mixtures were added in the indicated final concentrations of HDL3 to 3H-cholesterol-loaded macrophage foam cells cultured in a leupeptin-containing medium. The 3H radioactivity in the medium was determined after incubation for 6 hours at 37°C. Values are mean±SD of triplicate wells. From the values for each plate, blank values (efflux measured in the absence of HDL3) were subtracted.

Proteolysis of ApoA-I by Tryptase
Next, we studied whether the effect of tryptase treatment on the ability of the HDL₃ particles to act as cellular cholesterol acceptor was related to the degradation of the main HDL apolipoprotein, apoA-I. Aliquots of HDL₃ that had been incubated with tryptase (30 µg/mL) at 37°C for 20 hours were analyzed by 15% SDS-PAGE under nonreducing conditions. As shown in Figure 3A, a minor polypeptide band with a molecular mass of 26 kDa appeared below the apoA-I band, and moreover, the intensity of the peptides in the size range of 10 to 15 kDa became much stronger (proteolytic products are marked with arrows). Densitometric analysis of the gel demonstrated that 25% of apoA-I had been degraded by tryptase treatment. We also studied the effect of tryptase treatment on lipid-free apoA-I by incubating apoA-I (1 mg/mL) with tryptase (30 µg/mL) for 30 minutes (Figure 3B). SDS-PAGE revealed that the tryptase-treated apoA-I contained, in addition to intact apoA-I, a proteolytic fragment with an estimated molecular mass of 26 kDa.

View larger version (56K): [in this window] [in a new window]   Figure 3. Degradation of apoA-I by tryptase. HDL3 (1 mg/mL, A) or lipid-free apoA-I (1 mg/mL, B) was incubated with tryptase as described in the Figure 2 legend, except that the incubations were performed in the absence of heparin. The incubation mixtures were analyzed by SDS-PAGE (15% gel polyacrylamide [wt/vol]), and the protein bands were visualized with Coomassie brilliant blue. Lanes in panel A are as follows: 1, untreated HDL3; 2, tryptase-treated HDL3. Lanes in panel B are as follows: 1, untreated apoA-I; 2, tryptase-treated apoA-I. Note the appearance of apoA-I degradation products in both incubations (arrows).

Effect of Tryptase on HDL₃ Subpopulations
Using Superose 12 gel filtration chromatography, we next studied the size distribution of HDL₃ particles before and after incubation with tryptase (Figure 4A). Incubation of HDL₃ with or without tryptase was performed in the presence of heparin (10:1); the presence of the added glycosaminoglycan did not influence the elution profile of HDL₃ when the eluants were monitored for protein (not shown). After incubation for 20 hours in the absence of tryptase, HDL₃ (control HDL₃) consisted of a predominant population of larger particles and a minor population of smaller-sized particles. Analysis of the fractions by agarose gel electrophoresis showed that particles in the main peak were -migrating and those in the minor peak were pre-ß-migrating (not shown). Incubation of HDL₃ with tryptase did not change the size of the -HDL peak but fully depleted the pre-ß-HDL peak (Figure 4A). Moreover, tryptase treatment generated small peptides that had apparent molecular masses <7 kDa and that were found to be devoid of phospholipids; ie, they were essentially lipid-free apolipoprotein fragments. In addition, we found that proteolysis of HDL₃ with tryptase decreased the protein-to-phospholipid mass ratio of the -HDL from 0.55 to 0.42, reflecting partial loss of apolipoproteins.

View larger version (49K): [in this window] [in a new window]   Figure 4. Analysis of HDL3 subpopulations after tryptase treatment. A, HDL3 (1 mg/mL) was incubated with tryptase in the presence of heparin, as described in the Figure 2 legend (tryptase-treated HDL3). A control incubation was performed in the absence of tryptase and heparin (control HDL3). The incubations were stopped by adding leupeptin, after which the incubation mixtures were applied onto a Superose 12HR 10/30 gel filtration column at room temperature at a flow rate of 0.4 mL/min with use of a solution containing 5 mmol/L Tris-HCl, 150 mmol/L NaCl, and 1 mmol/L EDTA, pH 7.4, as eluant. Elution was monitored at 280 nm. The main peak areas were labeled as -HDL, pre-ß-HDL, and small-sized degradation products. B and C, Parallel incubations of HDL3 with tryptase were carried out as described above but in the absence of heparin, aliquots of the untreated and treated HDL3 were analyzed by either agarose electrophoresis, and bands were detected by apoA-I immunoblotting (B) or by 2D electrophoresis in the sequence agarose gel electrophoresisnondenaturing polyacrylamide gel electrophoresis (C). After electroblotting to a nitrocellulose membrane, apoA-I- and apoA-IV-containing particles were detected by using a polyclonal antiserum against human apoA-I (upper gels) or apoA-IV (lower gels) and horseradish peroxidase-conjugated second antibodies.

Because the major effect of tryptase was observed in the minor pre-ß-migrating component of HDL₃, we directed our attention to the specific effect of tryptase on the small subpopulations of lipid-poor pre-ß-HDL. To prevent undesirable shifts in the charge produced by the glycosaminoglycans during the electrophoretic analysis and given the fact that tryptase degraded HDL₃ even in the absence of added aminoglycans (see Figure 1B), incubations were carried out in the absence of heparin. We observed that the anti-apoA-I gave a strong signal with the pre-ß-HDL band, reflecting a higher avidity of the antibody against apoA-I in the pre-ß-HDL particles than in the -HDL particles. Moreover, the development time of the spots was adjusted to optimize visualization of the pre-ß band. This may also have led to an underestimation of the -HDL present in the samples. As shown in Figure 4B, on agarose gel electrophoresis and apoA-I immunoblotting of the tryptase-treated HDL₃, specific depletion of pre-ß-HDL from the HDL₃ preparation was observed. Because tryptase depleted the pre-ß-migrating HDL₃, we further studied its effect on the minor subspecies of lipid-poor HDL, which contain either apoA-I or apoA-IV as the only proteins. This analysis was performed by using nondenaturing 2D gradient gel electrophoresis (Figure 4C). In accordance with the above results demonstrating the effect of tryptase on the pre-ß-migrating fraction of HDL, we found that tryptase selectively degraded those apoA-I-containing particles (upper gels) and apoA-IV-containing particles (lower gels) that exhibited pre-ß mobility.

Discussion

In the present study, we demonstrate that human mast cell tryptase depletes HDL₃ of the minor subpopulation of pre-ß-HDL that contains only apoA-I or only apoA-IV and thereby prevents the high-affinity component of HDL₃ from promoting cholesterol efflux from macrophage foam cells.

In the enzymatically active tryptase tetramer, the active sites of the 4 monomers are directed toward a central pore whose narrow pore openings considerably restrict the interaction with macromolecular inhibitors and substrates.^13–15 In particular, the plasma anti-proteases and most other proteinase inhibitors are too bulky to fit into the narrow central pore, thus leaving the tryptase secreted by the degranulating mast cells in an enzymatically active state in the extracellular space. On the other hand, the position of the 4 active sites within the central pore of the tetramer allows access of only the substrates that are small and flexible or that present protruding regions to be cleaved from their surfaces.

ApoA-I of HDL₃, albeit a polypeptide with 245-amino acid residues, was significantly degraded by tryptase. ApoA-I is a protein that has been predicted to contain a series of amphipathic -helices, which adopt different conformations according to the degree of apoA-I lipidation.¹⁷ Monomeric apoA-I in solution is considered to be loosely folded and ellipsoidal in shape,¹⁸ whereas 2 discoidal models have been proposed for apoA-I in nascent HDL particles and are characterized as small unilamellar bilayers surrounded by apoA-I monomers.^19,20 It has been suggested that apoA-I in the small and lipid-poor pre-ß-HDL exposes surface domains that are more susceptible to protease attack than apoA-I in large spherical -HDL.⁷ Such exposure would also explain the susceptibility of apoA-I in the pre-ß-HDL to tryptase-mediated degradation. Finally, our findings (ie, those demonstrating that tryptase-dependent proteolysis of HDL₃ leads to simultaneous losses of the pre-ß-HDL particles and of the high-affinity component of cholesterol efflux) strongly support the notion that the protease-sensitive domains of apoA-I in the pre-ß-HDL particles are essential for mediating the unidirectional and high-affinity efflux of cellular cholesterol promoted by HDL₃.^10,12,21

In contrast to the pre-ß-HDL particles, the fully lipidated (spherical) species of HDL in the HDL₃ fraction, ie, the -HDL particles, essentially promote a bidirectional and nonspecific aqueous diffusion mechanism, in which no specific apolipoprotein domains are required, although the presence of the scavenger receptor BI facilitates this process by tethering HDL particles on the surface of macrophages. Thus, limited proteolysis of apoA-I in the -migrating particles does not modify their size or integrity (Figure 3A) and does not significantly reduce net cholesterol efflux from macrophage foam cells in vitro. Interestingly, we have found that limited proteolysis of HDL₃ does not modify the ability of apoA-I as an activator of LCAT.²¹ However, in our culture system, the HDL₃-dependent efflux of cellular cholesterol does not depend on LCAT activity (data not shown), a finding that suggested a minor role for -HDL in the net cholesterol efflux at low HDL₃ concentrations (in the high-affinity range). The fact that there is no LCAT activity in the extracellular fluid of the human arterial intima suggests that the net efflux of cellular cholesterol may largely depend on the maintenance of physiologically active lipid-poor species of HDL, primarily their pre-ß-migrating subpopulations.

Tryptase is stored in and released from mast cells together with heparin proteoglycans that stabilize the tetrameric structure of the enzyme and hence the enzymatic activity for a prolonged period of time.¹⁵ In the present study, we used commercial heparin glycosaminoglycan to stabilize the isolated tryptase tetramer during incubation periods of up to 24 hours. In accordance with a previous report,²² the glycosaminoglycan-to-tryptase mass ratios ranging from 10:1 to 5:1 produced maximal stabilization, which was reflected in degradation rates that were higher than those with mass ratios of 1:1. Interestingly, tryptase degraded HDL₃ more efficiently in the presence of human aortic proteoglycans than in the presence of commercial heparin. This result shows that (like the mast cell-derived heparin proteoglycans) the arterial proteoglycans can also stabilize the tryptase tetramer or may modulate the activity of tryptase, as has previously been reported for mast cell chymase.²³ Unexpectedly, even in the absence of exogenous arterial proteoglycans, tryptase caused progressive degradation of HDL₃ during a 20-hour incubation, suggesting that the high HDL₃ concentrations (1 mg/mL) sustained the enzymatic activity of tryptase against the apolipoproteins of HDL₃.

The regulation of tryptase in vivo is not known in detail. A recent study¹⁶ that used a physiological system in which tryptase was secreted from stimulated lung mast cells as a tryptase-proteoglycan complex revealed that this complex was stable only if another proteoglycan fraction, secreted by the mast cells but not complexed with tryptase, was also present. Removal of this fraction led to rapid inactivation of tryptase. The results suggest that in vivo after lung mast cell stimulation, the secreted proteoglycans that are not complexed with tryptase become separated from the secreted tryptase-proteoglycan complexes as they diffuse into the large volume of extracellular fluid. Thus, in human tissues, such as the lungs, after mast cell stimulation and exocytosis, the extracellular activity of tryptase is likely to be limited spatially to the microenvironment of each stimulated parent mast cell and limited temporally to a definite and short period of time. Our present observation suggests that in contrast to other tissues, in the subendothelially located proteoglycan-rich layer of the arterial intima, exocytosed tryptase may remain active for prolonged periods of time in a tissue volume that extends beyond the immediate microenvironment of the stimulated mast cell. In plasma, however, other proteins such as antithrombin III compete with tryptase for the binding of heparin, resulting in a rapid dissociation of the tryptase tetramer into enzymatically inactive monomers (that are detected by the ELISAs clinically used). Thus, the arterial intima but not the plasma compartment provides an appropriate environment for the degradation of apolipoproteins by tryptase that may result in a decrease of pre-ß₁-HDL in the intima rather than in the plasma.

We observed that tryptase is capable, although less so than HDL₃, of degrading other plasma lipoproteins, such as the apoB-100-containing lipoproteins VLDL, IDL, and LDL (data not shown). This observation further supports the view that plasma apolipoproteins may be the physiological substrates for human tryptase. However, the apoA-I and apoA-IV present in the small lipid-poor pre-ß-migrating HDL appear to be the most susceptible apolipoproteins, thus leading to specific and full depletion of these subpopulations of particles by tryptase under conditions in which the apolipoproteins of other lipoproteins are degraded only to a small degree.

In summary, the present results reveal that mast cell tryptase can degrade HDL₃, particularly lipid-free or poorly lipidated apoA-I and apoA-IV present in the minor subpopulation of pre-ß-migrating particles, and thereby may alter the functional properties of HDL₃ as an efficient acceptor of cellular cholesterol. Because (1) degranulated mast cells present in atherosclerotic lesions release tryptase, (2) the released tryptase is resistant to physiological protease inhibitors, and (3) tryptase is stabilized by arterial proteoglycans, it appears conceivable that in vivo, tryptase-secreting intimal mast cells may reduce the efflux of cholesterol from macrophages and thus contribute to the formation and maintenance of foam cells in atherosclerotic lesions. This novel finding further emphasizes our notion that stimulated mast cells found in human arterial intima¹¹ may play a role in retarding the efflux of cellular cholesterol from macrophage foam cells in vivo.

Acknowledgments

Financial support was obtained from the European Commission to the consortium (MAFAPS) by grant QLG1-1999-01007 to A.v.E. and P.T.K., from the Sonderforschungsbereich 469 of the University of Munich to C.P.S., and from the Aarne Koskelo and Sigrid Juselius Foundations (Helsinki, Finland) to M.L. We thank Dr Armin Steinmetz (University of Marburg, Marburg, Germany) for providing anti-apoA-IV antibodies and Päivi Ihamuotila and Isa Schaukal for excellent technical assistance.

Received May 27, 2002; accepted September 26, 2002.

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