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To the Editor: Dr Nissen and colleagues¹ reported that 5 weeks of treatment with intravenous recombinant ApoA-I Milano–phospholipid complexes (ETC-216) resulted in an average of 4.2% reduction in the volume of coronary atheroma. We disagree, however, with their speculation that this benefit is related to dimerization of high-density lipoprotein (HDL) and improved reverse cholesterol transport. In fact, the HDL pattern of individuals with the ApoA-I Milano variant has been shown to consist primarily of the smaller HDL-3 particles with a nearly total absence of the larger HDL-2 particles.² Consequently, the infusion of ApoA-I Milano is likely to generate HDL-3 rather than HDL-2 particles. The misconception regarding the term dimerization may originate from the finding that ApoA-I Milano is indeed capable of giving rise to ApoA-I dimers while the size of the resultant HDL particles on lipidation remains small.¹

It is also of interest that individuals with another cardioprotective isoform, ApoA-I . . . [Full Text of this Article]

Hyuntae Kim, PhD
hkim@pharmacy.arizona.edu

Elaine L. Jacobson, PhD; Myron K. Jacobson, PhD
College of Pharmacy
University of Arizona
Tucson

Andras G. Lacko, PhD
University of North Texas Heath Science Center at Fort Worth

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