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eLetters published in the past 90 days:

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5 eLetters published for 3 different topic sources.

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National Cholesterol Awareness Month:
Decision Analysis Supports the Paradigm That Indiscriminate Supplementation of Vitamin E Does More Harm than Good
Dotan et al. (1 September 2009) [Abstract] [Full text] [PDF]
Jump to eLetter Re: Vitamin E may increase and decrease mortality
Dov Lichtenberg, et al.   (2 November 2009)
Jump to eLetter Vitamin E may increase and decrease mortality
Harri Hemilä   (15 October 2009)
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Integrative Physiology/Experimental Medicine:
Expression of Human ApoAII in Transgenic Rabbits Leads to Dyslipidemia: A New Model for Combined Hyperlipidemia
Koike et al. (1 December 2009) [Abstract] [Full text] [PDF]
Jump to eLetter eLetter for Koike et al, ATVB published September 24, 2009, 10.1161/ATVBAHA.109.190264
Athina D Kalopissis, et al.   (19 November 2009)
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Cell Biology/Signaling:
Saturated Fatty Acids Do Not Directly Stimulate Toll-Like Receptor Signaling
Erridge and Samani (1 November 2009) [Abstract] [Full text] [PDF]
Jump to eLetter Response to Hwang, et al.
Clett Erridge, et al.   (7 October 2009)
Jump to eLetter Saturated fatty acid-induced activation of Toll-like receptors (TLRs) is fatty acid-specific effect
Daniel H Hwang, et al.   (7 October 2009)
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National Cholesterol Awareness Month:
Decision Analysis Supports the Paradigm That Indiscriminate Supplementation of Vitamin E Does More Harm than Good
Dotan et al. (1 September 2009) [Abstract] [Full text] [PDF]
Decision Analysis Supports the Paradigm That Indiscriminate Supplementation of Vitamin...
Re: Vitamin E may increase and decrease mortality
2 November 2009
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Dov Lichtenberg,
Professor
Tel Aviv University,
Yedidya Dotan, Ilya Pinchuk, and Moshe Leshno

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Re: Re: Vitamin E may increase and decrease mortality

physidov{at}yahoo.com.au Dov Lichtenberg, et al.

Dr Hemila’s comment relates to the weakest point of our study [1], which is that we had to base our analysis on published data rather than on “raw”, individual level data, which was unavailable to us. Moreover, if the raw data had been available to us, we too may have been able to identify groups of subjects that can be expected to gain from vitamin E supplementation.

In spite of this shortcoming, and its possible outcome of ‘ecological fallacy’, we trust the results of our analysis because no reasonable alteration of the assumptions on which it is based yield a positive change in the QALY value.

As stated by Dr Hemila, his published data are in line with our assumption that many people may benefit from vitamin E supplementation. The list of such groups is growing.

First it included dialysis patients [2], and then came Levy’s diabetes patients [3]. Now we know that middle age smokers who take vitamin C are also likely to benefit from vitamin E. We also know that a large number of AD patients are ‘vitamin E responders’ that benefit from vitamin E supplementation, but we also know that it is harmful to non-responders [4].

As noted by Dr. Hemila, he agrees on what we consider the most important conclusion of our study (“taking supplements of vitamin E should be discouraged until we have better understanding” of who is likely to benefit from it). We agree with Dr. Hemila that his group is working in the right direction, namely collecting individual level data in one reasonable direction of supplementing moderate doses of both vitamins C and E to older (smoking?) men.

The only disagreement between our views is that given the heterogeneity of the effect of vitamin E, he views our single estimate of 0.30 QALY decrease misleading. As is clear from his letter, it did not mislead us. What it did is to add support to the conclusion that indiscriminate supplementation of vitamin E “should be discouraged”, which is far from being a consensus. The real challenge is to gain sufficient data to be able to define criteria on which selective supplementation can be based. Our view on this issue is expressed in a communication in BioFactors [5].

References.

1. Dotan, Y., Pinchuk, I., Lichtenberg, D. and Leshno, M. (2009) Decision analysis supports the paradigm that indiscriminate supplementation of vitamin E does more harm than good. Arterioscler. Thromb. Vasc. Biol., 29, 1304-1309.

2. Boaz, M., Smetana, S., Weinstein, T., Matas, Z., Gafter, U., Iaina, A., Knecht, A., Weissgarten, Y., Brunner, D., Fainaru, M. and Green, M.S. (2000) Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial. The Lancet 356, 1213-1218.

3. Milman, U., Blum, S., Shapira, C., Aronson, D., Miller-Lotan, R., Anbinder, Y., Alshiek, J., Bennett, L., Kostenko, M., Landau, M., Keidar, S., Levy, Y., Khemlin, A., Radan, A. and Levy, A.P. (2008) Vitamin E supplementation reduces cardiovascular events in a subgroup of middle-aged individuals with both Type 2 Diabetes Mellitus and the haptoglobin 2-2 genotype: A prospective double-blinded clinical trial. Arterioscler. Thromb. Vasc. Biol. 28, 341-347.

4. Lloret, A., Badia, M.C., Mora, N.J., Pallardo, F.V., Alonso, M.D. and Vina, J. (2009) Vitamin E paradox in Alzheimer's Disease: It does not prevent loss of cognition and may even be detrimental. Journal of Alzheimers Disease, 17, 143-149.

5. Dotan, Y., Lichtenberg, D. and Pinchuk, I. No evidence supports vitamin E indiscriminate supplementation. BioFactors, in press.

Decision Analysis Supports the Paradigm That Indiscriminate Supplementation of Vitamin...
Vitamin E may increase and decrease mortality
15 October 2009
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Harri Hemilä,
Associate professor
Department of Public Health, University of Helsinki, Helsinki, Finland

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Re: Vitamin E may increase and decrease mortality

harri.hemila{at}helsinki.fi Harri Hemilä

Dotan et al. estimated that vitamin E supplementation might reduce the mean number of quality-adjusted life years (QALYs) by 0.30 units (1). Nevertheless, they noted that this does not mean that all individuals are harmed by vitamin E; in fact they believed that many individuals may even benefit from vitamin E supplements.

This assessment by Dotan et al. was based on study-level data of several controlled trials. However, study-level analyses can lead to different conclusions than do corresponding individual-level analysis, a difference called the “ecological fallacy” (2). For this reason, examination of individual-level data is recommended, whenever feasible, in order to avoid the potential for the ecological fallacy introduced by study-level analyses (2).

Recently, we analyzed the heterogeneity of the effect on total mortality of 50 mg/day vitamin E in the large-scale ATBC Study, restricted to male smokers (3). We found strong evidence that the combination of age and dietary vitamin C intake modified the vitamin E effect (P=0.0005). This evidence of heterogeneity refutes the notion that the vitamin E effect might be uniform throughout the study population. Vitamin E supplements had no effect on participants who had vitamin C intake below the median. On the other hand, among participants who had vitamin C intake above the median, vitamin E increased mortality by 19% in men between 50 and 62 years of age, but reduced mortality by 41% in men who were 66 and older. Since the vitamin E effect is heterogeneous, a single estimate such as a 0.30 QALY decrease by vitamin E supplementation is misleading.

Our focus on age and dietary vitamin C as potential modifying factors was based on studies in which we explored the heterogeneity of the vitamin E effect on respiratory infections (4-6). Thus, our analysis of mortality was not exploratory; instead, we were testing the hypothesis that the previously identified factors might also modify the effect of vitamin E on mortality (3).

Dotan et al. (1) commented that small groups of people for whom vitamin E may be beneficial could be invisible within large trials. Our findings support this notion. The complexity observed in the ATBC study cautions about drawing generalized conclusions and encourages us to have patience until further research results are available.

Given the mainly negative findings in the vitamin E trials, I agree with Dotan et al. that taking supplements of vitamin E should be discouraged until we have a better understanding of the population groups that might benefit from it. Yet, Dotan et al.’s analysis of the study- level data does not indicate which path should be explored or in what direction investigation should proceed, whereas our analysis of the individual-level data of the ATBC Study suggests that trials on vitamin E and C effects on older men are warranted.

Referencess

1. Dotan Y, Pinchuk I, Lichtenberg D, Leshno M. Decision analysis supports the paradigm that indiscriminate supplementation of vitamin E does more harm than good. Arterioscler Thromb Vasc Biol. 2009;29:1304- 1309.

2. Berlin JA, Santanna J, Schmid CH, Szczech LA, Feldman HI. Individual patient- versus group-level data meta-regressions for the investigation of treatment effect modifiers: ecological bias rears its ugly head. Stat Med. 2002;21:371-387.

3. Hemilä H, Kaprio J. Modification of the effect of vitamin E supplementation on the mortality of male smokers by age and dietary vitamin C. Am J Epidemiol. 2009;169:946-953. http://dx.doi.org/10.1093/aje/kwn413

4. Hemilä H, Virtamo J, Albanes D, Kaprio J. The effect of vitamin E on common cold incidence is modified by age, smoking and residential neighborhood. J Am Coll Nutr. 2006;25:332-339. http://www.jacn.org/cgi/content/abstract/25/4/332

5. Hemilä H, Kaprio J. Vitamin E supplementation and pneumonia risk in males who initiated smoking at an early age: effect modification by body weight and dietary vitamin C. Nutr J. 2008;7:33. http://dx.doi.org/10.1186/1475-2891-7-33

6. Hemilä H, Kaprio J. Vitamin E supplementation may transiently increase tuberculosis risk in males who smoke heavily and have high dietary vitamin C intake. Br J Nutr. 2008;100:896-902. http://dx.doi.org/10.1017/S0007114508923709

Integrative Physiology/Experimental Medicine:
Expression of Human ApoAII in Transgenic Rabbits Leads to Dyslipidemia: A New Model for Combined Hyperlipidemia
Koike et al. (1 December 2009) [Abstract] [Full text] [PDF]
Expression of Human ApoAII in Transgenic Rabbits Leads to Dyslipidemia: A New Model...
eLetter for Koike et al, ATVB published September 24, 2009, 10.1161/ATVBAHA.109.190264
19 November 2009
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Athina D Kalopissis,
Director of Research at INSERM
UMRS 872, Centre de Recherche des Cordeliers, Paris, FRANCE,
Michèle Chabert

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Re: eLetter for Koike et al, ATVB published September 24, 2009, 10.1161/ATVBAHA.109.190264

athina.kalopissis{at}crc.jussieu.fr Athina D Kalopissis, et al.

We read with great interest the study by Koike et al. (1) presenting the first transgenic rabbit model expressing human apo A-II, and which displayed elevated levels of VLDL and remnants and a marked reduction in HDL, similarly to our transgenic mouse model expressing human apo A-II (2,3). Interestingly, rabbits injected with human apo A-II, either in lipid-free form or in reconstituted HDL, also displayed hypertriglyceridemia (4). Obviously, CETP activity which is present in rabbits, but not in mice, doesn’t have an appreciable impact on the dyslipidemic phenotype induced by human apo A-II. During the past decade, a number of studies in transgenic mice and humans have progressively unraveled the physiological role of human apo A-II (2-7). An unsuspected role of human apo A-II was the inhibition of the activities of lipoprotein lipase (LPL), hepatic lipase (HL) and endothelial lipase (EL), by an as yet undefined mechanism (2,5). Apo A-II, the second major apolipoprotein of HDL after apo A-I, can also be transferred, in small amounts, to VLDL. These human apo A-II containing-VLDL are a bad substrate for LPL, although they contain adequate apo C-II amounts (as shown by IEF electrophoresis followed by immunoblotting) (2). Thus, human apo A-II probably inhibits LPL activity without displacing apo C-II, the obligate LPL cofactor. An additional argument is that apo A-II also inhibits HL and EL that don’t necessitate a cofactor.

Two points in this paper are puzzling and need clarification to our opinion.

The first point concerns an HDL fraction present in transgenic rabbits and described as beta-HDL by the authors (1). Are beta-HDL specific for rabbits? In humans and rodents, only pre-beta HDL have been described, and they were classified as "pre-beta" because they migrate, like VLDL, at the pre-beta position in agarose gels.

The second point concerns the apo A-I band in urine (10 times concentrated) of control and transgenic rabbits (Supplemental figure II). This is intriguing, because the cubilin-megalin receptor and co-receptor system allows very rapid reabsorption of apo A-I in kidney proximal tubules (8,9). Is cubilin absent in rabbits? If so, this would explain apo A-I excretion in urine of normal and transgenic rabbits. Apo A-I is not found in urine of normal humans, rats or mice.

Athina D. Kalopissis, Ph.D. (corresponding author) (athina.kalopissis@crc.jussieu.fr)

Michèle Chabert, Ph.D. (michele.chabert@crc.jussieu.fr)

UMRS 872, Centre de Recherche des Cordeliers Paris, France

References

1. Koike T, Kitajima S, Yu Y, Nishijima K, Liu E, Sun H, Waqar AB, Shibata N, Inoue T, Wang Y, Zhang B, Kobayashi J, Morimoto M, Saku K, Watanabe T, Fan J. Expression of human apo A-II in transgenic rabbits leads to dyslipidemia. A new model for combined hyperlipidemia. Arterioscler Thromb Vasc Biol 2009;in press.

2. Boisfer E, Lambert G, Atger V, Tran NQ, Pastier D, Benetollo C, Trottier JF, Beaucamps I, Antonucci M, Laplaud M, Griglio S, Chambaz J, Kalopissis AD. Overexpression of human apolipoprotein A-II in mice induces hypertriglyceridemia due to defective very low density lipoprotein hydrolysis. J Biol Chem 1999;274:11564-11572.

3. Dugué-Pujol S, Rousset X, Pastier D, Tran NQ, Pautre V, Chambaz J, Chabert M, Kalopissis AD. Human apolipoprotein A-II associates with triglyceride-rich lipoproteins in plasma and impairs their catabolism. J Lipid Res 2006;47:2631-2639.

4. Hime NJ, Drew KJ, Wee K, Barter PJ, Rye KA. Formation of high density lipoproteins containing both apolipoprotein A-I and A-II in the rabbit. J Lipid Res 2006;47:115-122.

5. Broedl UC, Jin W, Fuki IV, Millar JS, Rader DJ. Endothelial lipase is less effective at influencing HDL metabolism in vivo in mice expressing apo A-II. J Lipid Res 2006;47:2191-2197.

6. Van’t Hooft FM, Ruotolo G, Boquist S, de Faire U, Eggertsen G, Hamsten A. Human evidence that the apolipoprotein A-II gene is implicated in visceral fat accumulation and metabolism of triglyceride-rich lipoproteins. Circulation 2001;104:1223-1228.

7. Birjmohun RS, Dallinga-Thie GM, Kuivenhoven JA, Stroes ESG, Otvos JD, Wareham NJ, Luben R, Kastelein JJP, Khaw KT, Boekholdt SM. Apolipoprotein A-II is inversely associated with risk of future coronary artery disease. Circulation 2007;116:2029-35.

8. Kozyraki R, Fyfe J, Kristiansen M, Gerdes C, Jacobsen C, Cui S, Christensen EI, Aminoff M, de la Chapelle A, Krahe R, Verroust PJ, Moestrup SK. The intrinsic factor-vitamin B12 receptor, cubilin, is a high -affinity apolipoprotein A-I receptor facilitating endocytosis of high- density lipoprotein. Nature Med 1999;5:656-661.

9. Dugué-Pujol, S., Rousset, X., Château, D., Pastier, D., Klein, C., Demeurie, J., Cywiner-Golenzer, C., Chabert, M., Verroust, P., Chambaz, J., Châtelet, F.-P., and Kalopissis, A.D. Apolipoprotein A-II is Catabolized in the Kidney as a function of its plasma concentration. J Lipid Res 2007;48:2151-2161.

Cell Biology/Signaling:
Saturated Fatty Acids Do Not Directly Stimulate Toll-Like Receptor Signaling
Erridge and Samani (1 November 2009) [Abstract] [Full text] [PDF]
Saturated Fatty Acids Do Not Directly Stimulate Toll-Like Receptor Signaling
Response to Hwang, et al.
7 October 2009
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Clett Erridge
Glenfield General Hospital,
Nilesh J Samani

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Re: Response to Hwang, et al.

ce55{at}leicester.ac.uk Clett Erridge, et al.

We welcome the comments of Hwang et al, as the hypothesis that saturated fatty acids (SFAs) may stimulate Toll-like receptor (TLR)- signalling has become a central component of much current research in the fields of atherosclerosis and insulin resistance, and accordingly requires rigorous testing and debate. In particular, several concerns have been raised regarding the design of our study and our interpretation of the results of this and previous studies of SFA signalling.

To address these points in turn, Hwang et al first raise the concern that we may have been inappropriately selective in our choice to examine the properties of a contaminated BSA in our studies (ie BSA-2), suggesting that we should have also examined a non-contaminated BSA. However, extensive experimentation was in fact performed using such a BSA, which we established to be non-contaminated, and the results of these studies are presented in Figure 4 of our report [1]. We showed that when SFA-BSA complexes were made using this non-contaminated BSA, no TLR-dependent signalling could be detected using diverse readouts. In fact, we went further than previous studies to show that the SFA/BSA complexes contained complexed fatty acids at expected molar ratios (Fig 4 A).

Next, Hwang et al suggest that our conclusions are not valid as we did not include co-transfection of TLR1 or TLR6 in our TLR-transfection experiments, citing their hypothesis that SFA signalling via TLR2 may require co-operation with the co-receptors TLR1 or TLR6. However, it should be noted that the cell line we chose to use for these experiments (HEK-293) is established to express sufficient levels of endogenous TLR1 and TLR6 [2-10], such that transfection with TLR2 alone endows full responsiveness of these cells to ligands that require TLR1 and TLR6 co- operation with TLR2, such as the di-acyl and tri-acyl lipopeptides FSL-1 and Pam3CSK4, respectively [2-10]. There is therefore no need for additional TLR1 or TLR6 transfection over baseline in these experiments, as supported by many previous studies using this system [2-10].

Hwang and colleagues also point out that not all studies reporting SFA-induced TLR-signalling have employed BSA complexing, as some studies have examined the properties of sodiated SFAs without BSA complexing [11- 14]. We acknowledge that this is correct and to address this possiblity, we also examined the potential of sodiated SFAs to stimulate TLR- signalling in the absence of BSA complexing. We found no evidence of TLR- signalling induced by sodiated SFAs in these experiments, as clearly presented in Supplementary Figure III of our recent report [1]. The divergent findings between the present and previous studies of sodiated SFAs may perhaps be explained by variations in the extent of LPS or lipopeptide contamination between batches of commercially sourced reagents. With this possibility in mind, we note that only Hwang and colleagues have reported induction of TLR-signalling by sodiated SFAs [11- 14], while the other studies reviewed in our article examined SFAs complexed to BSA.

Next, Hwang et al suggest that we may have prematurely discounted SFA -induced TLR-signalling as appropriate controls for potential bacterial contaminants were performed in previous studies showing the induction of TLR-dependent mediators by SFA/BSA complexes. Specifically, Hwang et al point out that polymyxin-B was used to neutralise LPS contamination in 3 of the 13 studies reviewed in our report [14-16], and limulus assays indicated that levels of LPS contamination were too low to affect the results in 3 other studies [17-19]. However, as discussed in our report, we found that neither of these strategies are effective at detecting or neutralising lipopeptide or flagellin contaminants, which we and others have shown may be common contaminants of laboratory reagents, such as BSA (supplementary figures IV and X and [20]).

Thus, although Hwang et al are correct that some of the previous studies of SFA signalling may have employed commercially-sourced 'low endotoxin' BSA to prepare SFA/BSA complexes [21], lipopeptide or other contaminants could nevertheless be present in such reagents that may explain their pro-inflammatory signatures. Another point that should be borne in mind is that the limulus assay is readily confounded by LPS- binding proteins, such as albumin, which are established to lead to marked underestimation of endotoxin concentrations in preparations containing such proteins. Indeed, as little as 1 μg/ml LBP or BPI was shown to completely block the ability of the limulus assay to detect LPS, and albumin itself was also shown to possess this property [22,23]. The extent of endotoxin contamination of BSA preparations used in previous studies may therefore have been significantly underestimated on the occasions where the limulus assay was used for LPS quantification.

A further possibility suggested by Hwang et al is that we may have observed TLR-dependent signalling of SFAs if we had used low serum conditions in our experiments. In fact, consistent with our earlier studies [24-26], and the methods detailed in the supplement, cells were routinely challenged with reagents in medium supplemented with 1% serum, as we have found this to provide the optimum level of fold-induction in our previous studies [24-26]. Thus, differences in serum concentrations are unlikely to explain the divergent findings of the present and previous studies.

Finally, with respect to the previous in vivo studies of modulation of TLR-signalling in response to diets rich in saturated fat, we would suggest that although these studies do indicate a role for TLRs in diseases such as atherosclerosis and insulin resistance, it does not necessarily follow that SFAs must be the causative agents of TLR- stimulation in these studies. With this notion in mind, it may be helpful to consider the implications of the SFA/TLR hypothesis in a physiological context, as several previous studies of SFA signalling have reported maximal activation of TLR4 signalling at concentrations of 75 to 100 μM in vitro [11-13,21,27]. Moreover, Hwang et al showed that 75 μM SFA stimulated TLR4 signalling in cultured cells at a level comparable with 200 ng/ml LPS [12], a concentration that would result in symptoms of severe endotoxaemia in human subjects [28]. If SFAs truly did stimulate TLR-signalling in the manner proposed in previous reports, these results suggest that subjects should experience symptoms concordant with severe endotoxaemia (ie systemic TLR4 activation), including fever, shock and multiple organ failure, if circulating SFA concentrations reached or exceeded 75 μM in vivo [28]. Notably, circulating SFA concentrations routinely exceed 150 μM in healthy subjects [29,30], yet such symptoms are not generally experienced.

In conclusion, we have performed and reported the results of the control experiments suggested by Hwang and colleagues, and the results of these experiments support our original conclusion that SFAs do not stimulate TLR-signalling. Further work will be required to elucidate alternative mechanisms that may link dietary fat intake with TLR-dependent chronic inflammatory pathologies such as atherosclerosis and insulin resistance.

References: 1. Erridge C, Samani NJ. Saturated fatty acids do not directly stimulate Toll-Like Receptor Signaling. Arterioscler Thromb Vasc Biol, published online Aug 6 (2009)

2. Alexopoulou L, Thomas V, Schnare M, Lobet Y, Anguita J, Schoen RT, Medzhitov R, Fikrig E, Flavell RA. Hyporesponsiveness to vaccination with Borrelia burgdorferi OspA in humans and TLR1- and TLR2- deficient mice. Nat Med 2002;8:878-884.

3. Kirschning CJ, Wesche H, Ayres TM, Rothe M. Human Toll-like receptor 2 confers responsiveness to bacterial lipopolysaccharide. J Exp Med 1998;188:2091-2097.

4. Sandor F, Latz E, Re F, Mandell L, Repik G, Golenbock DT, Espevik T, Kurt-Jones EA, Finberg RW. Importance of extra- and intracellular domains of TLR1 and TLR2 in NFkappa B signaling. J Cell Biol 2003;162:1099 -110.

5. Kurt-Jones EA, Mandell L, Whitney C, Padgett A, Gosselin K, Newburger PE, Finberg RW. Role of toll-like receptor 2 (TLR2) in neutrophil activation: GM-CSF enhances TLR2 expression and TLR2-mediated interleukin 8 responses in neutrophils. Blood 2002;100:1860-8.

6. Gautam JK, Ashish, Comeau LD, Krueger JK, Smith MF, Jr. Structural and functional evidence for the role of the TLR2 DD loop in TLR1/TLR2 heterodimerization and signaling. J Biol Chem 2006;281:30132-30142.

7. Onishi S, Honma K, Liang S, Stathopoulou P, Kinane D, Hajishengallis G, Sharma A. Toll-like receptor 2-mediated interleukin-8 expression in gingival epithelial cells by the Tannerella forsythia leucine-rich repeat protein BspA. Infect Immun 2008;76:198-205.

8. Hawn TR, Misch EA, Dunstan SJ, Thwaites GE, Lan NTN, Quy HT, Chau TTH, Rodrigues S, Nachman A, Janer M, Hien TT, Farrar JJ, Aderem A. A common human TLR1 polymorphism regulates the innate immune response to lipopeptides. Eur J Immunol 2007;37:2280-9.

9. Okusawa T, Fujita M, Nakamura J, Into T, Yasuda M, Yoshimura A, Hara Y, Hasebe A, Golenbock DT, Morita M, Kuroki Y, Ogawa T, Shibata K. Relationship between structures and biological activities of mycoplasmal diacylated lipopeptides and their recognition by toll-like receptors 2 and 6. Infect Immun 2004;72:1657-65.

10. Buwitt-Beckmann U, Heine H, Wiesmuller KH, Jung G, Brock R, Akira S, Ulmer AJ. TLR1- and TLR6-independent recognition of bacterial lipopeptides. J Biol Chem. 2006;281:9049-57.

11. Lee JY, Plakidas A, Lee WH, Heikkinen A, Chanmugam P, Bray G, Hwang DH. Differential modulation of Toll-like receptors by fatty acids: preferential inhibition by n-3 polyunsaturated fatty acids. J Lipid Res 2003;44:479-86.

12. Lee JY, Ye J, Gao Z, Youn HS, Lee WH, Zhao L, Sizemore N, Hwang DH. Reciprocal modulation of Toll-like receptor-4 signaling pathways involving MyD88 and phosphatidylinositol 3-kinase/AKT by saturated and polyunsaturated fatty acids. J Biol Chem 2003;278:37041-51.

13. Lee JY, Zhao L, Youn HS, Weatherill AR, Tapping R, Feng L, Lee WH, Fitzgerald KA, Hwang DH. Saturated fatty acid activates but polyunsaturated fatty acid inhibits Toll-like receptor 2 dimerized with Toll-like receptor 6 or 1. J Biol Chem 2004;279:16971-9.

14. Weatherill AR, Lee JY, Zhao L, Lemay DG, Youn HS, Hwang DH. Saturated and polyunsaturated fatty acids reciprocally modulate dendritic cell functions mediated through TLR4. J Immunol 2005;174:5390-5397.

15. Suganami T, Tanimoto-Koyama K, Nishida J, Itoh M, Yuan X, Mizuarai S, Kotani H, Yamaoka S, Miyake K, Aoe S, Kamei Y, Ogawa Y. Role of the Toll-like receptor 4/NF-kappaB pathway in saturated fatty acid- induced inflammatory changes in the interaction between adipocytes and macrophages. Arterioscler Thromb Vasc Biol 2007;27:84-91.

16. Radin MS, Sinha S, Bhatt BA, Dedousis N, O’Doherty RM. Inhibition or deletion of the lipopolysaccharide receptor Toll-like receptor-4 confers partial protection against lipid-induced insulin resistance in rodent skeletal muscle. Diabetologia 2008;51:336-46.

17. Shi H, Kokoeva MV, Inouye K, Tzameli I, Yin H, Flier JS. TLR4 links innate immunity and fatty acid-induced insulin resistance. J Clin Invest 2006;116:3015-3025.

18. Staiger H, Staiger K, Stefan N, Wahl HG, Machicao F, Kellerer M, Haring HU. Palmitate-induced interleukin-6 expression in human coronary artery endothelial cells. Diabetes 2004;53:3209-16.

19. Nguyen MT, Favelyukis S, Nguyen AK, Reichart D, Scott PA, Jenn A, Liu-Bryan R, Glass CK, Neels JG, Olefsky JM. A subpopulation of macrophages infiltrates hypertrophic adipose tissue and is activated by free fatty acids via Toll-like receptors 2 and 4 and JNK-dependent pathways. J Biol Chem 2007;282:35279-92.

20. Ye Z, Gan YH. Flagellin contamination of recombinant heat shock protein 70 is responsible for its activity on T cells. J Biol Chem 2007;282:4479-84.

21. Lee JY, Sohn KH, Rhee SH, Hwang D. Saturated fatty acids, but not unsaturated fatty acids, induce the expression of cyclooxygenase-2 mediated through Toll-like receptor 4. J Biol Chem 2001;276:16683-9.

22. Dentener MA, Von Asmuth EJ, Francot GJ, Marra MN, Buurman WA. Antagonistic effects of lipopolysaccharide binding protein and bactericidal/permeability-increasing protein on lipopolysaccharide-induced cytokine release by mononuclear phagocytes. Competition for binding to lipopolysaccharide. J Immunol 1993;151:4258-65.

23. Jürgens G, Müller M, Garidel P, Koch MH, Nakakubo H, Blume A, Brandenburg K. Investigation into the interaction of recombinant human serum albumin with Re-lipopolysaccharide and lipid A. J Endotoxin Res 2002;8:115-26.

24. Erridge C, Webb DJ, Spickett CM. Toll-like receptor 4 signalling is neither sufficient nor required for oxidised phospholipid mediated induction of interleukin-8 expression. Atherosclerosis 2007;193:77-85.

25. Erridge C, Spickett CM, Webb DJ. Non-enterobacterial endotoxins stimulate human coronary artery but not venous endothelial cell activation via Toll-like receptor 2. Cardiovasc Res 2007;73:181-9.

26. Erridge C, Kennedy S, Spickett CM, Webb DJ. Oxidised phospholipid inhibition of toll-like receptor (TLR) signalling is restricted to TLR2 and TLR4 - roles for CD14, LPS-binding protein and MD2 as targets for specificity of inhibition. J Biol Chem 2008;283:24748-59.

27. Schaeffler A, Gross P, Buettner R, Bollheimer C, Buechler C, Neumeier M, Kopp A, Schoelmerich J, Falk W. Fatty acid-induced induction of Toll-like receptor-4/nuclear factor-kappaB pathway in adipocytes links nutritional signalling with innate immunity. Immunology 2008;126:233-245.

28. van Deventer SJ, Buller HR, ten Cate JW, Aarden LA, Hack CE, Sturk A. Experimental endotoxemia in humans: analysis of cytokine release and coagulation, fibrinolytic, and complement pathways. Blood 1990;76:2520 -2526.

29. Fernández-Real JM, Vendrell J, Ricart W. Circulating adiponectin and plasma fatty acid profile. Clin Chem 2005;51:603-9.

30. Roden M, Price TB, Perseghin G, Petersen KF, Rothman DL, Cline GW, Shulman GI. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Invest 1996;97:2859-65.

Clett Erridge *, Nilesh J Samani

* Corresponding author Department of Cardiovascular Sciences University of Leicester Clinical Sciences Wing Glenfield Hospital Groby Road Leicester LE3 9QP

Email: ce55@le.ac.uk

Saturated Fatty Acids Do Not Directly Stimulate Toll-Like Receptor Signaling
Saturated fatty acid-induced activation of Toll-like receptors (TLRs) is fatty acid-specific effect
7 October 2009
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Daniel H Hwang,
Research Molecular Biologist
USDA/ARS Western Human Nutrition Research Center,
Yoshihiro Ogawa, Andreas Schaeffler

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Re: Saturated fatty acid-induced activation of Toll-like receptors (TLRs) is fatty acid-specific effect

daniel.hwang{at}ars.usda.gov Daniel H Hwang, et al.

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Erridge and Samani (1) reported that the in vitro activation of TLR2 and TLR4 by saturated fatty acids (SFAs) is due to TLR agonists contaminated in BSA preparations.   Here, we wish to present our view that there are critical flaws in the experimental design and data interpretation which we believe led to the erroneous conclusion that SFAs do not directly stimulate TLR-dependent signaling. Fig.1 in their report showed that SFAs alone do not activate NFκB in 293 cells transfected with TLR2, TLR4 or TLR5 expression plasmids. However, SFAs conjugated with the fatty acid-free BSA (BSA-2) activated NFκB in the cells transfected with TLR2 or TLR4/MD2 (panels appear to be wrongly labeled in the legend). Thus, they concluded that NFκB activation by the SFA-BSA preparations reported by many investigators is attributable to other TLR agonists contaminated in BSA preparations instead of the fatty acid-specific effect. This conclusion is invalid because they have not included proper controls in their experiments. First, SFAs do not activate TLR2 alone, but they activate TLR2 and TLR6 (or TLR1) heterodimer (2). SFAs also do not activate TLR5 (2). Therefore, 293 cells transfected with TLR2 alone or TLR5 are not appropriate models to demonstrate the stimulatory effects of SFAs on TLR activation.  Second, they examined five different BSA preparations for TLR activation and found that two of them activated TLRs, while the other three preparations including low endotoxin and fatty acid free BSA preparation (BSA-5, Sigma A8806) did not activate TLR4. They deliberately chose the preparation (BSA-2) that alone can activate TLRs to conjugate SFAs for their studies, and drew the conclusion that all previously reported studies have used the same BSA preparation. Furthermore, they incorrectly stated (1st paragraph in the Results section) that in studies by other investigators (ref.# 18-22 in their report) the same fatty acid free BSA preparation  was used to conjugate fatty acids. It should be noted that in the first report demonstrating that SFAs activate TLR4, the low endotoxin and fatty acid free BSA (Sigma A8806) was used to conjugate fatty acids as indicated in "Reagents" section (ref.# 3 in this Letter or ref.# 21 in their report). This BSA preparation (10 uM) alone did not induce the expression of TLR4 target gene products in RAW264.7 cells (3).  Therefore, Erridge and Samani (1) should have included SFA-BSA-5 or 3 that alone does not activate TLRs as a proper control. In other studies (ref.#18-20, 22 in their report), sodium salts of fatty acids without BSA were used: thus, contamination of TLR agonists in BSA was not an issue.

The activation of TLR4 by saturated fatty acids has been demonstrated not only through biochemical approaches using 293 cells transfected with TLR plasmids (2-4,6), macrophages (2-6,7), bone marrow-derived dendritic cells (4,7), 3T3L1 cells (8), muscle cells (9), endothelial cells (10), and murine pro-B cell line (5), but also with genetic and dietary approaches using TLR4 or TLR2+4 knockout (6,7) or TLR4 mutant mice (8,11,12). In most of these reports, the issue of TLR agonist contamination in BSA were appropriately addressed by including proper vehicle controls containing BSA alone in the assays, or by measuring the levels of LPS in BSA preparations.  Stimulatory effects of saturated fatty acids on TLR4 activation were not attenuated by Polymyxin B indicating no significant contamination of LPS in the SFA-BSA preparation used in these studies (8). Shi et al (6) and Nguyen et al (7) detected 0.03 and 0.04ng/ml of endotoxin in their fatty acid-BSA preparations, respectively. These amounts of endotoxin did not cause the activation of inflammatory signals in the cell types used.  In addition, docosahexaenoic acid-BSA inhibited the expression of TLR4 target gene products induced by saturated fatty acid-BSA in these studies (3,6). Kopp et al. (13) found no significant amount of LPS in their BSA preparation as determined by a novel technique using TLR4/MD2 fusion protein as a LPS-trap. Lauric acid and eicosapentaenoic acid conjugated with this BSA preparation reciprocally modulated the expression of TLR4 target gene product COX-2 in RAW264.7 cells, or TNFα in THP-1 cells (3,13). Together, these results indicate that the stimulatory effects of saturated fatty acids and inhibitory effects of n-3 polyunsaturated fatty acids on TLR activation are fatty acid-specific effects rather than the effects of contaminants in BSA.

Therefore, what can be said with the results of Erridge and Samani (1) is that the particular BSA preparation (BSA-2, Sigma A0281) contains contaminants that can activate TLR2 and TLR4. Their results do not disprove that SFAs activate TLR4 or TLR2 dimerized with TLR6 or TLR1. In addition, Fig. 1B in Erridge and Samani (1) showed that SFAs (without BSA) do not activate NFκB in 293 cells transfected with TLR4/MD2.  These results contradict those reported by other investigators demonstrating that sodium salt of lauric acid (without BSA conjugation) activates TLR4 and TLR2+4 dimer (2,4,5). Since the SFA was used without BSA conjugation, contamination of TLR agonists in BSA is a non-issue in these studies (2,4,5). Polymyxin B did not attenuate the stimulatory effect of lauric acid on NFκB activation and the expression of COX-2 (TLR4 target gene product) indicating that SFA effects are not due to possible contamination of LPS in the SFA preparation (4, and Fig. 1). Since lauric acid preparation does not activate TLR2 alone (2), the presence of TLR2 agonist contaminants in lauric acid preparation is also unlikely. Thus, stimulatory effects of saturated fatty acids and inhibitory effects of PUFAs are likely to be fatty acid-specific effects. In many studies (2-5, 8,9,11,12) demonstrating that SFAs activate TLRs, cells were treated with fatty acids in low serum media. The stimulatory effects of SFAs on TLR activation (NFκB activation and COX-2 expression) are more pronounced if cells are serum-starved (in medium containing 0.25% FBS) prior to the treatment with fatty acids in the same serum-poor medium as compared to the treatment of cells in the medium containing 10% FBS (Fig. 2). The same condition with serum poor medium has been used in the studies for ref. 2-5.  It is not clear why SFA effects are potentiated in the low serum medium.
One possibility is that serum contains many types of lipids that can release free fatty acids including polyunsaturated fatty acids which inhibit TLR activation induced by SFA. Another possibility is that albumin in the serum binds SFA added into the medium making it less available to the cells. In general, effective doses of fatty acid-BSA conjugates are much higher than fatty acid alone (as sodium salt).
Taken all together, the report by Erridge and Samani suggests that caution is needed in selecting and testing BSA preparations for possible contamination of TLR agonists. However, their results neither support their conclusion nor refute the results reported by other investigators that SFAs activate TLR2 dimers and TLR4. The mechanism by which fatty acids modulate the activation of TLRs remains to be elucidated. Schaeffler et al. (14) reported that 14 C-labeled fatty acids do not directly bind TLR4/MD2 complex. However, it is possible that direct binding of fatty acids to TLRs is not required to modulate TLR activation. Wong et al. (5) showed that fatty acids modulate the activation of TLR4 through regulation of dimerization and recruitment of TLR4 into lipid rafts in a reactive oxygen species-dependent manner.

 

Daniel H. Hwang, Ph.D. (corresponding author)
USDA/ARS Western Human Nutrition Research Center and University of California-Davis, U.S.A. (Daniel.hwang@ars.usda.gov)

Yoshihiro Ogawa, M.D., Ph.D.
Department of Molecular Medicine and Metabolism, Medical Research Institute, Tokyo Medical and Dental University, Japan (ogawa.mmm@mri.tmd.ac.jp)

Andreas Schaeffler, M.D., Ph.D.
Regensburg University Hospital, Department of Internal Medicine I, Germany (andreas.schaeffler@klinik.uni-regensburg.de)

 

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