The effect of plant sterols and different low doses of omega-3 fatty acids from fish oil on lipoprotein subclasses

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1 The effect of plant sterols and different low doses of omega-3 fatty acids from fish oil on lipoprotein subclasses 18 June 2015 Doris Jacobs Unilever R&D Vlaardingen

2 Background Elevated low-density lipoprotein-cholesterol in blood is an important risk factor for coronary heart disease (CHD). The intake of phytosterols (PS) is known to lower LDL-Chol. An intake of ~2 g/d phytosterols reduces LDL-Chol by 8-10%. Elevated fasting triglycerides (TG) are considered as an emerging risk factor for CHD. The intake of long chain n-3 fatty acids (eicosapentaenoic acid (EPA: 20:5-n3) and docosahexaenoic acid (DHA: 22:6-n3) such as present in fish oil has been shown to reduce fasting TG concentrations. An intake of 2-4 g/d of EPA+DHA reduces TG concentrations by 25-35%.

Study Design Objective: to assess the combined effects plant sterols (PS) and low doses of EPA/DHA from fish oil on TG and lipoproteins. 2.25 g/d PS + 1.8 g/d EPA/DHA 2.25 g/d PS + 1.3 g/d EPA/DHA 332 subjects 2.

3 Study Design Objective: to assess the combined effects plant sterols (PS) and low doses of EPA/DHA from fish oil on TG and lipoproteins g/d PS g/d EPA/DHA 2.25 g/d PS g/d EPA/DHA 332 subjects 2.25 g/d PS g/d EPA/DHA 2.25 g/d PS Control fasting serum 4 weeks fasting serum Randomized, double-blind, placebo-controlled, parallel efficacy study; Subjects: apparently healthy, yet hypercholesterolemic (TC: 5-8 mm); 85 men, 247 women; years; kg/m 2 ; Test products: fixed amount of plant sterols (PS) and varying amounts of EPA/DHA from fish oil incorporated in a low-fat spread; Control (PLA): low-fat spreads without PS and EPA/DHA The spreads (30 g) were consumed daily with the main meals.

4 Effect on exogenous metabolites EPA/DHA concentrations in the red blood cell membranes are expected to reflect differences in EPA/DHA intakes between intervention groups the concentrations of EPA and DHA in red blood cell membranes were measured together with other 32 fatty acids using GC- FID

5 Principal component analysi of fatty acids

6 Effect on EPA and DHA Concentrations of EPA and DHA in erythrocytes after treatment relative to before treatment. EPA concentrations are higher following PS+EPA/DHA treatments when compared to DHA concentrations.

7 Primary objective Does the combined effects of PS and EPA+DHA reduce both LDL-Chol and TG concentrations and thus simultaneously reduce two relevant CHD risk factors? What is the minimum dose of EPA+DHA to achieve a significant reduction in TG concentrations, while still obtaining a meaningful LDL-C lowering effect ( 8%)?

8 Ras, R.T. et al. J. Nutr. 2014, 144(10), Effect on TG and LDL-Chol p<0.05; p<0.01 wrt PLA b=-0.07 p= The combination of EPA/DHA from fish oil and PS lowers TG concentrations in a dose-dependent manner (9-16%) while also reducing LDL-cholesterol concentrations (~13%) in a population with borderline-high to high cholesterol concentrations.

9 Secondary Objective Specific lipoprotein subclasses may be more accurate estimates for CHD. The effect of PS on LDL particle size is inconsistent. PUFA s have been shown to increase large HDL particles and to reduce large VLDL particles. What is the combined effect on TG and Chol in lipoprotein subclasses?

10 Lipoprotein metabolism

11 Lipoprotein composition

12 Lipoprotein particle size and density

13 NMR-based lipoprotein profiles 564 diffusion-edited spectra TG model: ppm = 1746 data points Chol model: ppm = 961 data points

14 Calibration set: Liposearch HPLC 290 samples cholesterol triglycerides

15 Lipoprotein model Liposearch Diffusion edited 1 H-NMR spectra PLS model (-CH 2 -)n -CH 3 Xb=Y -C(18)H 3

16 PLS Model building/validation - cookbook ET BL 190 samples 100 samples Modeling set nlv =1..n PLS models 10 times External test set Validation set PLS model Y, RMSECV,Q2CV Beta, optimal # LV Y, RMSEP,Q2 Permutation tests, selectivity ratio

17 Example: LP sublass HDL17

18 Selectivity ratio SR i = var exp,i /var res,i Black curve: NMR spectrum Colored curves: regions that are selected by the model

19 Significant models of lipoprotein subclasses Chol Q 2 >0.6 VLDL03 VLDL < Q 2 <0.6 VLDL05 VLDL06 Q 2 <0.45 VLDL07 LDL08 LDL09 LDL10 LDL11 LDL12 LDL13 HDL14 HDL15 HDL16 HDL17 HDL18 HDL19 HDL20 TG Mihaleva VV et al. Anal Chem (1):

20 PLS-DA PS vs PLA PS + low EPA/DHA vs PLA Q 2 =0.21 Q 2 =0.15 PS + medium EPA/DHA vs PLA Q 2 =0.32 PS + high EPA/DHA vs PLA Q 2 =0.45

21 c(ei)/c(bl) Effects of PS and EPA/DHA on VLDL subclasses c(ei)/c(bl) c(ei)/c(bl) c(ei)/c(bl) c(ei)/c(bl) PS lowered Chol in large-medium VLDL particles. PS + medium / high EPA/DHA induced stronger reductions in Chol in larger VLDL particles. VLDL03-TG VLDL04-TG VLDL05-TG VLDL06-TG VLDL07-TG PLA PS PS+L PS+M PS+H PLA PS PS+L PS+M PS+H PLA PS PS+L PS+M PS+H PLA PS PS+L PS+M PS+H PLA PS PS+L PS+MPS+H p<0.05; p< wrt PLA PS did not change TG in VLDL particles. PS + medium / high EPA/DHA reduced TG in large-medium VLDL particles.

22 Effects of PS and EPA/DHA on LDL subclasses PS lowered Chol in all LDL particles. PS + EPA/DHA did not enhance or attenuate these reductions induced by PS. PS did not change TG in LDL particles. PS + medium EPA/DHA slightly reduced TG in large-medium LDL particles. p<0.05; p< wrt PLA

23 Effects of PS and EPA/DHA on HDL subclasses PS and PS+EPA/DHA did not change Chol and TG in total HDL. PS did not change Chol and TG in HDL subclasses. PS + EPA/DHA increased in a dose-dependent manner Chol in large HDL subclasses. PS + medium / high EPA/DHA reduced Chol in the smallest HDL subclass. PS + medium / high EPA/DHA increased TG in the largest HDL subclass. PS + medium /high EPA/DHA reduced TG in the smaller HDL particles. p<0.05; p< wrt PLA

Effects of PS and EPA/DHA on TG and Chol in lipoprotein subclasses PS most likely reduces Chol transport to the liver and as a consequence thereof reduces hepatic VLDL production and less conversion

24 Effects of PS and EPA/DHA on TG and Chol in lipoprotein subclasses PS most likely reduces Chol transport to the liver and as a consequence thereof reduces hepatic VLDL production and less conversion from VLDL and LDL particles. EPA and DHA is known to reduce the fatty acid delivery to the liver. This may lead to reduced hepatic VLDL production and increased VLDL clearance through neutral lipid exchange with HDL. The larger HDL particles are more stable and less susceptible to catabolism.

25 PCA loading plot based on PS+ low, medium, high EPA,DHA end-of-treatment

26 Correlation Matrix: Fatty acids vs TG and Chol in Lipoprotein subclasses C 8:0 C10:0 C12:0 C14:0 C14:1 C15:0 C15:1 C16:0 C16:1 C17:0 C17:1 C18:0 C18:1 (n-9) C18:2 (n-6,9) C18:3 (n-6,9,12) C18:3 + C19:0 ALA; C18:3 (n-3) C18:4 C20:0 C20:1 C20:2 (n-6) C20:3 (n-6) C20:4 (n-6) C20:3 (n-3) EPA; C20:5 (n-3) C22:0 C22:1 C22:2 (n-6,9) C23:0 C22:4 C22:5 (n-6) C24:0 DHA; C22:6 (n-3) C24:1 Unknowns Based on End of Treatment data for PS + low/medium/high EPA/DHA treatment groups VLDL03-CHOL VLDL04-CHOL VLDL05-CHOL VLDL06-CHOL VLDL07-CHOL LDL08-CHOL LDL09-CHOL LDL10-CHOL LDL11-CHOL HDL15-CHOL HDL16-CHOL HDL17-CHOL HDL18-CHOL VLDLtotal-CHOL LDLtotal-CHOL HDLtotal-CHOL VLDL03-TG VLDL04-TG VLDL05-TG VLDL06-TG VLDL07-TG LDL08-TG LDL09-TG LDL10-TG LDL11-TG HDL15-TG HDL16-TG HDL17-TG HDL18-TG VLDLtotal-TG LDLtotal-TG HDLtotal-TG TG HDL-CHOL CHOL LDL/HDL LDL-CHOL R <R< <R<-0.5 R -0.5

27 Correlation Matrix Based on End of Treatment data for PS + low/medium/high EPA/DHA treatment groups R=0.18 R=0.2 R=0.16 R=0.17 No significant correlations between EPA and DHA concentrations and TG and Chol concentrations in lipoprotein subclasses

28 Conclusion The concentrations of EPA and DHA were increased following the PS+EPA/DHA treatment. The combination of EPA/DHA from fish oil and PS lowered TG concentrations in a dose-dependent manner (9-16%) while also reducing LDL-cholesterol concentrations (~13%). The shift in lipoprotein distribution induced by PS indicates reduced hepatic VLDL production and less conversion from VLDL and LDL particles as a possible consequence of reduced Chol transport to the liver. The shift in lipoprotein distribution induced by EPA and DHA suggests reduced hepatic VLDL production and increased VLDL clearance through neutral lipid exchange with HDL as a possible consequence of reduced the fatty acid delivery to the liver. No correlations between the concentrations of EPA /DHA and the TG and Chol concentrations in lipoprotein subclasses were found.

29 Thank you! Daniël van Schalkwijk Albert de Graaf Rouyanne T. Ras Isabelle Demonty Elke A. Trautwein Ferdi van Dorsten John van Duynhoven Velitchka Mihaleva Jacques Vervoort Johan Westerhuis Age Smilde

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