Submitted to: Clinical Chemistry
Publication Type: Review Article
Publication Acceptance Date: 4/2/2009
Publication Date: 11/20/2009
Citation: Schaefer, E. 2009. Limitations of automated remnant lipoprotein cholesterol assay for diagnostic use. Clinical Chemistry. 55(11):2061-2062. Interpretive Summary:
Technical Abstract: I wish to comment on the limitations of automated remnant lipoprotein cholesterol (RemL-C) assay reported in Clinical Chemistry. Remnants are lipoprotein particles produced after newly formed triglyceride-rich lipoproteins (TRLs) of either hepatic or intestinal origin enter the plasma space and undergo lipolysis via the action of lipoprotein lipase in the capillary bed. During this process, these lipoproteins lose triglyceride and pick up cholesteryl ester and apolipoprotein E (apoE) from other lipoproteins through the action of cholesteryl ester transfer protein. The development of a clinical diagnostic method for measuring remnant lipoprotein cholesterol has been hampered by difficulties with isolation. Moreover, the characteristics of remnant lipoproteins have not been clearly defined. The most consistent definition of remnant lipoproteins has been proposed as an apoE-rich lipoprotein fraction within TRLs, which increases in the postprandial state. The original immunoseparation method for the measurement of remnant-like lipoprotein particle cholesterol (RLP- C) was developed by Nakajima and colleagues in Japan and satisfied these criteria. Normal ranges in the US for this analyte were developed using samples from the Framingham Offspring Study. The separation of newly formed TRLs from remnant lipoproteins is crucial because the later lipoproteins are atherogenic and are important for the assessment of coronary heart disease (CHD) risk, especially in women.