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Clinical Chemistry (CC 1) > (M) Lec 4: Lipids and Lipoproteins (Part 1) > Flashcards

(M) Lec 4: Lipids and Lipoproteins (Part 1) Flashcards

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1
Q
  • referred to as “fats”
  • is composed of C and H (hydrocarbons)
  • is soluble to ORGANIC acids but insoluble in water
  • functions as metabolic fuel, membrane stabilizers, and has many uses in different metabolic pathways (precursor for steroid hormones)
A

Lipids

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2
Q

Familiarize with the 5 major lipids

A
  1. Phospholipids (most abundant)
  2. Cholesterol
  3. Triglycerides
  4. Fatty Acids
  5. Fat-Soluble Vitamins (A, D, E, K)
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3
Q

Lipids provide how many times more energy than carbohydrates and proteins?

A

Twice as much

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4
Q

Match the ff. functions to the right fat-sloluble vitamin:

  1. For the eyes to avoid blindness
  2. For coagulation factors
  3. Prevents bone disorders and rickettsia
  4. An antioxidant

A, D, E, or K (provide all 4)

Sorry I’m trying to compress the cards as much as possible so just answer it altogether

A
  1. A
  2. K
  3. D
  4. E
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5
Q

Classification of Lipids

What are the 2 glycerol esters?

A
  1. Triglycerides
  2. Phosphoglycerides
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6
Q

Classification of Lipids

What are the 2 sterol derivatives?

A
  1. Cholesterol
  2. Phytosterol

Note: Sterols have RINGS (thank you beyonce)

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7
Q

What is the 1 sphingosine derivative/sphingolipid?

A

Ceramide

Note: The derivatives have 2 fatty acids attached to sphingosine

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8
Q

Classification of Lipids

This accounts for the 4 fat-soluble vitamins (A, D, E, K)

A

Terpenes

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9
Q
  • a long chain of C-H bonds that terminate with a carboxyl group (RCOOH)
  • the building blocks of lipids
  • is mostly bound with albumin
  • product of TAG hydrolysis and adipose tissue
  • e.g. palmitic, stearic, oleic, linoleic, and arachidonic acid
A

Fatty Acids

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10
Q

Classification of Fatty Acids

As to length, choose among the ff.:
1. Short chain
2. Medium chain
3. Very long chain
4. Long chain

A. > 12 C atoms
B. 4-6 C atoms
C. 8-12 C atoms
D. > 20 C atoms

A
  1. B
  2. C
  3. D
  4. A
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11
Q

The no. of atoms of a fatty acid should be (odd/even)?

A

Even

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12
Q

Classification of Fatty Acids

As to no. of C=C bonds, choose among the ff.:
1. has one double bond
2. w/o double bonds
3. has 2 or more double bonds
4. w/ double bonds

A. Saturated
B. Unsaturated
C. Monounsaturated
D. Polyunsaturated

A
  1. C
  2. A
  3. D
  4. B
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13
Q

Classification of Fatty Acids

As to no. of C=C bonds and their structures, choose among the ff.:
1. is bent, liquid at RT, and not stable
2. is liquid at RT because the Cs are on the same side producing a kink
3. is solid at RT as it behaves like a saturated fatty acid
4. is linear, compact, solid at RT and harder to break

A. Saturated
B. Unsaturated
C. Cis configuration
D. Trans configuration

A
  1. B
  2. C
  3. D
  4. A
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14
Q

Fatty Acids (additional)

  1. This is the major dietary fatty acid
  2. These are not synthesized from carbohydrate precursors unlike most fatty acids but are instead supplied by the diet as they are essential fatty acids (2)
  3. These are precursors for the synthesis of eicosanoids (prostaglandins, thromboxanes, prostacyclins, and leukotrienes)

A. Elaidic Acid
B. Linolenic Acid
C. Polyunsaturated Fatty Acids
D. Linoleic Acid

A
  1. A
  2. B & D
  3. C
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15
Q

These 2 eicosanoids are for inflammation and clotting factor development, respectively

A
  1. Inflammation - Prostaglandins
  2. Clotting Factors - Thromboxanes
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16
Q
  • are aka phosphoglycerides
  • most abundant lipid derived from phosphatidic acid
  • has 2 fatty acids + phosphorylated glycerol (structure is similar to TAGs but instead of 3, they have 2 fatty acids)
  • is amphipathic (has hydrophillic and hydrophobic parts)
  • forms include lecithin/phosphatidyl choline, sphingomyelin, and cephalin
A

Phospholipids

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17
Q

Phospholipids

Match them according to prevalence in the cell structure:
1. Lecithin
2. Cephalin
3. Sphingomyelin

A. 20%
B. 10%
C. 70%

A
  1. C
  2. B
  3. A
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18
Q

Phospholipids

  • This is essential for the membrane and for diagnosing neonatal distress syndrome
  • Acts as a reference material for the 3rd trimester of pregnancy which correlates to lung maturity of the baby
  • Acts as a surfactant for effective gas exchange
A

Sphingomyelin

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19
Q
  • this contains 3 molecules of fatty acid + 1 molecule of glycerol by ester bonds
  • is very HYDROPHOBIC and water insoluble (it has no charge)
  • forms adipose tissue
  • when metabolized, it releases the fatty acids as its energy source (used when in a fasting state)
  • additional info: lipoprotein lipase (LPL), epinephrine, and cortisol
A

Triglycerides (TAGs)

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20
Q
  • this enzyme breaks the TAG and releases fatty acid and glycerol (lipemia clearing factor)
  • removes entities that cause turbidity (TAG-rich lipoproteins) to plasma and serum
  • a deficiency of this enzyme reduces clearance therefore there will be accumulation of TAGs
A

Lipoprotein Lipase (LPL)

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21
Q
  • this evaluates suspected atherosclerosis and measures the body’s ability to metabolize fat
  • requires a 12-14 hour fasting period to clear the chylomicrons
  • serum or plasma can be used
  • postural changes can decrease this analyte by 50% when laying down
A

Triglycerides (TAGs)

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22
Q

Triglycerides

If the sample is lipemic or will be delayed in processing, how do you preserve it?

A

Freeze at -20ºC

Make sure to warm and mix it before testing

Note: Frozen samples produce a different reading so it’s better to analyze immediately

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23
Q

Triglycerides

Bilirubin is considered an interference because as we age (around 45-65 years old), it (increases/decreases) by 2ml/dL every year

A

Increases

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24
Q
  • nucleus is made out of cyclopentanoperhydrophenanthrene
  • an unsaturated steroid alcohol with 4 rings and a single C-H side chain
  • is synthesized in the liver and found on the surface of lipoproteins
A

Cholesterol

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25
Q
  • its A ring and OH group are amphipathic
  • not catabolized by most cells (not an energy source) but synthesized by animals
  • a source of primary and secondary bile acids, steroid hormones, and vitamin D
  • e.g. progestins, glucocorticoids, mineralocorticoids, androgens, and estrogens

Note: Bile acids are emulsifying agents

A

Cholesterol

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26
Q

Forms of Cholesterol

  • makes up 70% of the cholesterol
  • can be found in plasma or serum (at the CORE)
  • is bound to fatty acid (hydrophobic form)
  • undergoes esterification by the Lecithin Cholesterol Acyl Transferase enzyme (LCAT); is activated by APO A1
A

Cholesterol Ester

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27
Q

Forms of Cholesterol

  • makes up 30% of the cholesterol
  • this can be found in plasma, serum, and RBCs (at the SURFACE)
  • the OH group attached to a ring is amphipathic
A

Free Cholesterol

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28
Q

This function of the LCAT enzyme transfers fatty acid from lecithin to a cholesterol ring

A

For esterification

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29
Q

Sources of Cholesterol

  1. This makes up 15% of the cholesterol in our body
  2. This makes up 85% of the cholesterol in our body and is the precursor for steroid hormones

Which is EXOGENOUS and which is ENDOGENOUS?

A
  1. Exogenous
  2. Endogenous
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30
Q
  • one 18-carbon or longer fatty acid is bound to an amino group of sphingosine
  • is important for cell membrane structure and the CNS
  • has the ff. forms: sphingomyelin, galactosylceramide, and glucosylceramide
A

Ceramide

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31
Q
  • has 5 branched chain units
  • are intermediates in the metabolic production of cholesterol
  • a precursor for the fat-soluble vitamins
A

Terpenes

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32
Q

What are the 3 major lipid components in plasma?

A
  1. Triglycerides (TAGs)
  2. Cholesterol
  3. Phospholipids
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33
Q
  • these are a complex of lipids with specialized proteins
  • transports TAG and cholesterol to sites of energy storage and utilization
A

Lipoproteins

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34
Q
  • known as the protein portion of lipoproteins
  • is an “amphipathic helix”
A

Apolipoproteins

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35
Q
  • this helps keep lipids in the solution during bloodstream circulation
  • it directs lipids to the correct target organs and tissues in the body
  • it maintains structural integrity of the complex
  • these serve as ligands for cell receptors
  • are activators/inhibitors of various enzymes that modify lipoprotein particles
A

Apolipoproteins

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36
Q

Alauporic Nomenclature (apolipoproteins)

  1. Helps activate the LCAT enzyme
  2. An arginine-rich apolipoprotein
  3. The thin-line lipoprotein which activates the LCAT reaction
  4. Is produced by the liver and intestine
  5. Causes high LDL levels; higher risk for developing CAD and Alzheimer’s

A. Apo A1
B. Apo E
C. Apo D
D. Apo E4

Yes, there are 4 choices for 5 questions, one answer will be doubled

A
  1. A
  2. B
  3. C
  4. A
  5. D
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37
Q

Alauporic Nomenclature (apolipoproteins)

What are Apo B-100 and Apo B-48 made out of? (2 separate answers)

A
  1. Apo B-100: VLDL and LDL
  2. Apo B-48: Chylomicrons
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38
Q

Alauporic Nomenclature (apolipoproteins)

What Apo C protein activates the LPL enzyme?

A

Apo C2

39
Q

Lipoproteins

  • the largest and least dense
  • density is < 0.95 kg/L
  • composed of 90% TAG and 1-2% CHON
  • contains apolipoproteins B48, C, E, and A4
A

Chylomicrons

Note: Apo B48 is EXCLUSIVE for chylomicrons

40
Q

Lipoproteins

  • is produced by the intestine (exogenous)
  • completely cleared within 6-9 hours post-prandial
  • transports exogenous/dietary TAGs to the liver, muscles, and fat deposits
A

Chylomicrons

41
Q

Lipoproteins

This appears milky in apperance at the top of the specimen sample when you let the sample stand for several hours OR the patient did not fast

A

Chylomicrons

42
Q

Lipoproteins

  • has a density of 0.95-1.006 kg/L
  • composed of 65% TAGs (fasting plasma), 16% CE, and 6-10% CHON
  • contains apolipoproteins B100, C, and E (C and E are minor apolipoproteins)
  • it has a uniform and homogenous turbidity after overnight standing
  • is secreted by the liver (endogenous)
  • it transports endogenous TAGs from the liver to muscles, fat deposits, and peripheral tissues
A

Very Low Density Lipoprotein (VLDL)

43
Q

Lipoproteins

  • the smallest but densest lipoprotein
  • aka “alpha lipoprotein”
  • has a density of 1.063-1.21 kg/L
  • composed of 30% PL, 25% CE, and 45-50% CHON
  • contains apolipoproteins A1 (main), A2, and C
  • produced by the liver and intestine (endogenous)
  • transports excess cholesterol (reverse cholesterol transport)
A

High Density Lipoproteins

44
Q

Lipoproteins

This kind of HDL transports cholesterol back to the liver (is more cardioprotective than the other HDL) more efficiently

A

HDL 2 (more effective than HDL 1)

45
Q

Lipoproteins

This process of HDL maintains equilibrium; refers to collecting excess cholesterol in the peripheral tissue to go back to the liver (reused or excreted as bile)

A

Reverse Transport

Note: HDL is anti-atherogenic (good cholesterol)

46
Q

Lipoproteins

High Density Lipoprotein Reference Values:

What are the low (cut-off level) and high values?

A

Low: < 40mg/dL
High: ≥ 60mg/dL

47
Q

Lipoproteins

  • a major end product resulting from VLDL catabolism
  • the most cholesterol rich and most atherogenic
  • density is 1.019-1.063 kg/L
  • composed of 50% CE and 18% of CHON and PL
  • contains apolipoproteins B100 (MAIN) and E
  • produced by the liver
  • this transports cholesterol to the peripheral tissues
A

Low Density Lipoproteins (LDL)

48
Q

Lipoproteins

Low Density Lipoprotein Reference Values:
1. < 100mg/dL
2. 100-129 mg/dL
3. 130-159 mg/dL
4. 160-189 mg/dL
5. ≥ 190 mg/dL

A. Optimal
B. Very High
C. High
D. Borderline
E. Near/Above Optimal

A
  1. A
  2. E
  3. D
  4. C
  5. B
49
Q

Minor Lipoproteins

  • the product of VLDL catabolism
  • is converted to LDL
  • density is 1.006-1.019 kg/L
  • migrates either in the pre-B or B region
  • major lipids include endogenous TAG and CE
  • major apolipoprotein is B100
A

Intermediate Density Lipoprotein (IDL)

50
Q

Minor Lipoproteins

If IDL is not cleared, it could result to what condition?

A

Type 3 Lipoproteinemia

51
Q

Minor Lipoproteins

  • known as the “sinking pre-B lipoprotein”
  • produced in the liver
  • these are LDL-like particles with Apo-A linked to Apo-B 100 by a disulfide bond
  • density is 1.045-1.080 kg/L
  • major lipids include CE and phospholipids
  • the secondary transporter of cholesterol to tissues
A

Lipoprotein (a)

52
Q

Minor Lipoproteins

Lipoprotein (a) is a/an (dependent/independent) risk factor for atherosclerosis

A

Independent

53
Q

Minor Lipoproteins

An increased Lipoprotein (a) level indicates what conditions?

A

Premature CHD and Stroke

Use ELISA and turbidimetric methods to detect it

54
Q

Minor Lipoproteins

What is the normal reference range for lipoprotein (a)?

A

< 20mg/dL to 1500mg/dL

55
Q

Minor Lipoproteins

Lipoprotein (a) is similar to LDL in what 2 parameters?

A
  1. Density
  2. Electrophoretic mobility
56
Q

Minor Lipoproteins

  • a specific and sensitive indicator of cholestasis
  • indicative of obstructive jaundice and LCAT deficiency
  • contains phospholipids and free cholesterol
  • has Apo-C and albumin
A

Lipoprotein (x)

57
Q

Minor Lipoproteins

This is considered as a dysfunctional HDL

A

Oxidized HDL

58
Q

Minor Lipoproteins

  • the “floating B lipoprotein” and “VLDL rich in cholesterol”
  • has the same density with VLDL (< 1.006 kg/L) but migrates with LDL in the B region
  • there’s an increase in Type 3 hyperlipoproteinemia or dysbetalipoproteinemia
A

B-VLDL

59
Q

Minor Lipoproteins

Failure to convert VLDL to LDL leads to the accumulation of what?

A

IDL

60
Q

Lipid Metabolism

This process:
- needs pancreatic lipase to clear fatty acids (converting them into dietary lipids)
- involves small lipids forming aggregates with bile acids to be absorbed
- it forms micelles which are absorbed by the intestines

A

Lipid Adsorption

61
Q

Lipid Metabolism

This process/pathway:
- causes LPL to catalyze a hydrolysis reaction which releases glycerol and fatty acids from chylomicrons

A

Exogenous Pathway

62
Q

Lipid Metabolism

Exogenous Pathway:
Which receptors found in specific organs can Apo-C and Apo-E bind to? (2 answers)

A
  • Apo-C: Receptors on adipose tissue
  • Apo-E: Receptors on hepatocytes
63
Q

Lipid Metabolism

This process/pathway:
- hydrolyzes VLDL which turns into IDL
- the IDL is returned to the liver and further hydrolyzed by hepatic lipase
- it releases glycerol and fatty acids which leave behind IDL remnants called LDLs

A

Endogenous Pathway

64
Q
  • this is produced in the liver and is a component of HDL
  • it transfers TAGs from Apo-B lipoproteins in exchange for cholesterol esters in HDL
  • it catalyzes the transfer of CEs to Apo-B100-containing particles in exchange for TAGs
  • it connects the forward and reverse cholesterol transport pathways
A

Cholesterol Ester Transfer Protein (CETP)

65
Q

This pathway is considered to be an alternative pathway for HDL metabolism

+ a deficiency of this analyte leads to the production of large cholesterol-laden (heavily loaded) HDL

A

Cholesterol Ester Transfer Protein (CETP)

66
Q

Enzymes in Lipoprotein Metabolism

This enzyme is for the efflux of cholesterol from peripheral cells into HDL

A

ATP-binding casette protein A1 (ABCA1)

67
Q

Enzymes in Lipoprotein Metabolism

This enzyme:
- hydrolyzes TAG in lipoproteins (CM and VLDL)
- has phospholipids and Apo-C2 as cofactors

A

Lipoprotein Lipase

68
Q

Enzymes in Lipoprotein Metabolism

This enzyme:
- hydrolyzes TAG and phospholipids from HDL
- hydrolyzes lipids in VLDL and IDL

A

Hepatic TAG Lipase

69
Q

Enzymes in Lipoprotein Metabolism

This enzyme:
- esterifies cholesterol from HDL
- has Apo-A1 as a co-factor
- the end product is lysolecithin and cholesterol ester

A

Lecithin Cholesterol Acyltransferase (LCAT)

70
Q

Enzymes in Lipoprotein Metabolism

This enzyme hydrolyzes phospholipids and TAGs in HDL

A

Endothelial Lipase

71
Q

Sample Considerations

Kindly choose the correct words to make the sentences true:

  1. Total cholesterol, TAGs, and HDL-C when frozen is (satisfactorily/unsatifactorily) analyzed
  2. Lipemic samples occur in (fasting/non-fasting) blood
  3. Lipemic samples may be (pre/post-treated) by ultracentrifugation and enzymatic cleavage
  4. Lipoproteins are differentiated based on (electrophoresis/flow cytometry) and ultracentrifugation
  5. (Plasma/Serum) is the best choice in measuring lipoproteins
A
  1. Satifactorily
  2. Non-fasting
  3. Pre-treated
  4. Electrophoresis
  5. Serum

Note: Ultracentrifugation helps for tests that use turbidity to measure concentration

72
Q

Sample Considerations

Non-HDL C is computed using what formula?

A

Total Cholesterol - HDL

Note: LDL is computed manually

73
Q

Sample Considerations

Samples can be stored at (given temperature) for how many days?
1. 4ºC
2. -20ºC
3. -70ºC

A. 1-3 months
B. 3 days
C. For longer

A
  1. B
  2. A
  3. C
74
Q

Sample Considerations

Although serum is the best choice in measuring lipoproteins, some labs like to use EDTA/heparinized plasma however there is a major disadvantage in relation to the machine, what is that disadvantage?

A

It can clog the machine

75
Q

Sample Considerations

When performing a lipid profile test, what parameters are included? (5)

A
  1. Cholesterol
  2. TAG
  3. HDL
  4. LDL
  5. VLDL
76
Q

Patient Preparation

Fasting specimens are used for what 2 analyes?

A

TAG and LDL

77
Q

Patient Preparation

Kindly choose the correct words to make the sentences true:

  1. Due to CETP, concentrations of LDL-C and HDL-C (rise/decline) temporarily after eating
  2. When a standing patient reclines, extravascular water transfer to the vascular system and (dilutes/concentrates) non-diffusable plasma constituents
  3. There is a/an (increase/decrease) of as much as 10% in the concentrations of TC, LDL-C, and HDL-C [based on question #2]
A
  1. Decline (this is due to chylomicrons)
  2. Dilutes
  3. Decrease
78
Q

Total Cholesterol

What specimen is used: plasma, serum, both, or non of these?

A

Both

79
Q

Total Cholesterol

How long is the fasting period for a serum sample of total cholesterol?

A

10-14 hours

80
Q

Total Cholesterol

TOF: Total cholesterol cannot be taken from a non-fasting sample

A

False (it is allowed, but some doctors prefer a fasting sample)

81
Q

Total Cholesterol (TESTING)

  • Principle of the test: The dehydration and oxidation of cholesterol to form a colored compound
  • There are double bonds and an OH-group in the sterol structure
A

Chemical (Colorimetric)

82
Q

Total Cholesterol (TESTING)

For Chemical (Colorimetric)
1. This method is considered the BEST method and has an end product of Cholestadienyl Monosulfonic Acid (GREEN)
2. This method has an end product of Cholestadienyl Disulfonic Acid (RED)
3. This method produces a GREEN-colored reaction
4. This method produces a RED-colored reaction and is sensitive

A. Liebermann-Burchardt Reaction
B. Para-Toluene Sulfonic Acid Reaction
C. Salkowski Reaction
D. Tsugaeff Reaction

A
  1. A
  2. C
  3. B
  4. D
83
Q

Total Cholesterol (TESTING)

For Chemical (Colorimetric)

Glacial acetic acid, Acetic anhydride, and Conc. H2SO4 are the components to what mixture?

A

Color Developer Mixture

84
Q

Total Cholesterol (TESTING)

For Chemical (Colorimetric)
1. Colorimetry (Pearson, Stern, and Mac Gavack)
2. C + E + S + Precipitation (Schoenheimer, Sperry, Parekh, and Jung)
3. C + E + Saponification (Abell-Kendal)
4. C + Extraction (Bloors)

A. One Step Method
B. Two Step Method
C. Three Step Method
D. Four Step Method

A
  1. A
  2. D
  3. C
  4. B
85
Q

Total Cholesterol (TESTING)

This method:
- is precise but not specific
- produces a pink-red reaction
- not used as a reference method due to interfering substances

A

Enzymatic Method (by Flegg)

86
Q

Total Cholesterol (TESTING)

What is the CDC’s reference method for Flegg’s Enzymatic Method?

A

ABELL, LEVY, and BRODIE Method

87
Q

Total Cholesterol (TESTING)

ABELL, LEVY, and BRODIE Reference Method:
1. Saponification
2. Extraction
3. Colorimetry

A. Leibermann-Burchardt Reaction
B. Alcoholic KOH
C. Hexane

A
  1. B
  2. C
  3. A
88
Q

Total Cholesterol (TESTING)

Interferences:
What levels of ascorbic acid and bilirubin are considered interferences in the enzymatic method? (2 answers)

A

Ascorbic Acid: >30 mg/dL (falsely increased)
Bilirubin: >5mg/dL

Note: Use Potassium Ferricyanide to counteract Bilirubin

89
Q

Total Cholesterol (TESTING)

Reference Values:
1. < 200 mg/dL
2. >240 mg/dL
3. 200-239 mg/dL

A. Normal
B. Borderline High
C. High Cholesterol

A
  1. A
  2. C
  3. B
90
Q

Total Cholesterol (TESTING)

What is the conversion factor?

A

0.026 mmol/L

91
Q

Total Cholesterol (TESTING)

This is the highest order method for serum cholesterol analysis (gold standard)

A

Isotope Dilution Mass Spectrometry (IDMS)

92
Q

Total Cholesterol (TESTING)

Increased or Decreased?
- Hyperlipoproteinemia TII, III, V
- Biliary cirrhosis
- Nephrotic syndrome
- Poorly controlled diabetes mellitus
- Alcoholism
- Primary hypothyroidism

A

Increased

93
Q

Total Cholesterol (TESTING)

Increased or Decreased?
- Severe hepatocellular disease
- Malnutrition
- Severe burns
- Hyperthyroidism
- Malabsorption syndrome

A

Decreased

Clinical Chemistry (CC 1) (22 decks)

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