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Lipoprotein Z, an abnormal LDL-like lipoprotein, independently predicts mortality in cirrhosis

Published:April 01, 2022DOI:https://doi.org/10.1016/j.ejim.2022.03.030
      Decreased plasma concentrations of high-density lipoproteins (HDL) make part of the lipoprotein abnormalities encountered in end-stage liver disease [
      • McIntyre N.
      Plasma lipids and lipoproteins in liver disease.
      ,
      • Privitera G.
      • Spadaro L.
      • Marchisello S.
      • Fede G.
      • Purrello F.
      Abnormalities of lipoprotein levels in liver cirrhosis: clinical relevance.
      ]. The liver plays a central role in both the production and metabolism of various lipoprotein classes, and produces enzymes such as lecithin:cholesterol acyltransferase (LCAT) and hepatic lipase which are critically involved in HDL metabolism [
      • McIntyre N.
      Plasma lipids and lipoproteins in liver disease.
      ,
      • Privitera G.
      • Spadaro L.
      • Marchisello S.
      • Fede G.
      • Purrello F.
      Abnormalities of lipoprotein levels in liver cirrhosis: clinical relevance.
      ]. LCAT is required for the esterification of free cholesterol to cholesteryl esters, thereby enabling HDL maturation, whereas hepatic lipase hydrolyses triglycerides in various lipoproteins including HDL [
      • Privitera G.
      • Spadaro L.
      • Marchisello S.
      • Fede G.
      • Purrello F.
      Abnormalities of lipoprotein levels in liver cirrhosis: clinical relevance.
      ,
      • Pavanello C.
      • Calabresi L.
      Genetic, biochemical, and clinical features of LCAT deficiency: update for 2020.
      ]. Yet, decreased plasma levels of HDL cholesterol or of its major apolipoprotein, apoAI, do not make part of prognostic tools for liver disease severity categorization such as the Child Pugh Turcotte (CPT) classification or the model for end-stage liver disease (MELD) score.

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