ADRENOCORTICOTROPIC HORMONE LOWERS SERUM LP(A) AND LDL CHOLESTEROL CONCENTRATIONS IN HEMODIALYSIS-PATIENTS

Previously, we have shown that short-term administration of adrenocort icotrophic hormone (ACTH) results in reduced concentrations of apolipo protein B-containing lipoproteins, including lipoprotein(a), and reduc ed activities of hepatic lipase. These effects were observed in steroi d-treated patients suffering from iatrogenic ACTH deficiency and in he althy individuals. The direct nature of the influence of ACTH on hepat ic lipoprotein metabolism was confirmed by in vitro experiments. The a im of the present investigation was to study the effects of ACTH treat ment on uremic patients, who exhibit disturbed lipoprotein pattern due to the slow removal of triglyceride-rich lipoproteins and who probabl y are ACTH resistant. Eight patients on chronic hemodialysis were stud ied. After one intramuscular injection of Synacthen Depot (a synthetic ACTH(1-24) preparation from Ciba Geigy AG, Basel, Switzerland) 1 mg, the only change noted was a significant reduction of 26% in median lip oprotein(a) concentration. After five injections, a further decrease ( 65%) was found in the lipoprotein(a) concentration. Also, reductions i n median concentrations of total cholesterol, low density lipoprotein cholesterol and apolipoprotein B were observed. The magnitude of these changes was 15 to 30%. In contrast to previously studied groups, no c hanges were observed regarding triglyceride metabolism. Significantly increased median concentration of apolipoprotein CIII was found. Howev er, the excess apolipoprotein CIII was confined to the fraction that w as not associated with apolipoprotein B. Thus, administration of ACTH to uremic patients improved their atherogenic lipoprotein profile, a f act that may have future therapeutic implications. In comparison to pr eviously studied groups, the uremic patients responded rather slowly a nd not at all regarding triglyceride metabolism.