الفهرس 
Composition, Metabolism and Physiological Functions of LipoproteinsOnly 14 pages are availabe for public view
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Abstract
Lipoproteins in Critically Ill Patients
A lipoprotein is a biochemical assembly that contains
both proteins and lipids. Lipoprotein particles arise from the
intestine and the liver, and transport lipids and cholesterol
around the body. Also, they have a role in inhibition of
inflammation, oxidation, and activation of endothelium,
coagulation or platelet aggregation.
The systemic inflammatory response syndrome
(SIRS) represents the body’s response to a variety of
clinical insults. Both the innate and adaptive immune
systems play a critical role in pathophysiology of SIRS.
During the course of infection, total cholesterol and
lipoprotein content are reduced in serum of patients with
sepsis and this reduction is associated with higher mortality
and infectious complications.
Lipoproteins are thought to be important regulators of
the host immune response during endotoxemia. They
neutralize lipopolysaccharides (LPS) and exert direct antiinflammatory
actions.
There are clinical aspects relevant to the role of
lipoproteins in critically ill patients which can be seen as a
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diagnostic role, protective role, predictive role and
therapeutic potential.
Despite the remarkable diagnostic accuracy of highdensity
lipoprotein cholesterol concentration (HDL-C), it
would be premature to seek its immediate establishment as
a new diagnostic marker for routine clinical use.
HDL-C participates in the innate immune response
and apparently modulates favorable binding and
neutralizing bacterial toxins. The presence of enough HDL
in plasma before the infectious insult can be protective,
stemming from its function as a scavenger of bacterial
toxins.
It was found that total and HDL cholesterol may
reflect disease severity and be a manifestation of the
negative acute phase response. The low cholesterol levels
may predispose critically ill patients to endotoxemia,
sepsis, and multiple organ dysfunction syndromes
(MODS).
HDL may prove to be a safe and effective treatment
to prevent or reverse the consequences of sepsis, shock, and
tissue injury. HDL can be normalized by therapeutic
approaches targeted to raise HDL either by direct method
e.g reconstituted HDL, or indirect method, e.g. tight
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glycemic control and pharmacological modulation which
have been demonstrated to increase HDL, and thus improve
outcomes in critically ill patients.
Limitations of statins as a treatment for sepsis are
related to their side effects and mode of delivery. Two
common side effects are, particularly relevant in sepsis:
liver dysfunction and myositis. The most serious adverse
effect associated with statins therapy is myopathy, which
can lead to rhabdomyolysis, and acute renal necrosis. The
‘statins’ class are only available as an oral preparation and
lack of an intravenous formulation for statins in patients
with sepsis also limits its use.