Subfractions and Subpopulations of HDL: An Update
M. Rizzo, J. Otvos, D. Nikolic, G. Montalto, P.P. Toth and M. Banach
Affiliation: Biomedical Department of Internal Medicine and Medical Specialties (DiBiMIS), University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
Keywords: Cardiovascular risk, electrophoresis, high-density lipoprotein, nuclear magnetic resonance, proteome, subclasses,
High-density lipoproteins (HDL) are classified as atheroprotective because they are involved in transport of
cholesterol to the liver, known as “reverse cholesterol transport (RCT)” exerting antioxidant and anti-inflammatory activities.
There is also evidence for cytoprotective, vasodilatory, antithrombotic, and anti-infectious activities for these lipoproteins.
HDLs are known by structural, metabolic and biologic heterogeneity. Thus, different methods are able to distinguish
several subclasses of HDL. Different separation techniques appear to support different HDL fractions as being atheroprotective
or related with lower cardiovascular (CV) risk. However, HDL particles are not always protective. Modification of
constituents of HDL particles (primarily in proteins and lipids) can lead to the decrease in their activity and induce proatherogenic
properties, especially when isolated from patients with augmented systemic inflammation. According to
available studies, it seems that HDL functionality may be a better therapeutic target than HDL cholesterol quantity; however,
it is still disputable which subfractions are most beneficial. There is mounting evidence supporting HDL subclasses
as an important biomarker to predict and/or reduce CV risk. In this review we discuss recent notices on atheroprotective
and functional characteristic of different HDL subfractions. Also, we provide a brief overview of the different methods
used by clinicians and researchers to separate HDL subfractions. Ongoing and future investigations will yield important
new information if any given separation method might represent a ‘gold standard’, and which subfractions are reliable
markers of CV risk and/or potential targets of novel, more focused, and effective therapies.
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