Abstract
Hyperinsulinemia secondary to insulin resistance in type-II diabetes or in the metabolic syndrome is associated with the “atherogenetic lipoprotein phenotype”: high triglycerides, small, dense low-density lipoprotein (LDL) cholesterol, and low high-density lipoprotein (HDL) cholesterol. In contrast, hyperinsulinemia in pancreas–kidney transplant recipients (PKT-R), secondary to systemic venous drainage of the heteropically implanted pancreas graft, leads to high lipoprotein lipase (LPL) activity and a presumably antiatherogenic lipoprotein profile with very attenuated postprandial lipemia, high HDL cholesterol, and a preponderance of large-sized HDL (HDL2) and large buoyant LDL particles. We interpret these findings to suggest that in PKT-R, peripheral hyperinsulinemia upregulates LPL activity in peripheral tissues, which induces rapid clearance of chylomicron triglycerides from plasma and, thus, attenuates postprandial lipemia. Low postprandial lipemia allows little net cholesteryl ester transfer from HDL to triglyceride-rich lipoproteins, keeping the levels of the antiatherogenic lipoprotein HDL high and potentially increasing, thereby reverse cholesterol transport. The type of lipoprotein metabolism and pattern present in PKT-R is associated with a low cardiovascular risk in the general population; it cannot be excluded, however, that hyperinsulinemia as found in PKT-R may contribute to atherosclerosis by effects unrelated to lipoprotein metabolism.
Similar content being viewed by others
Author information
Authors and Affiliations
Additional information
Received: 25 September 1998 Received after revision: 14 June 1999 Accepted: 12 July 1999
About this article
Cite this article
Föger, B., Königsrainer, A., Ritsch, A. et al. Pancreas transplantation modulates reverse cholesterol transport. Transpl Int 12, 360–364 (1999). https://doi.org/10.1007/s001470050240
Issue Date:
DOI: https://doi.org/10.1007/s001470050240