The evolution of a Department of Internal Medicine under an integrated clinical enterprise model: the University of Kentucky experience.

The impact on the Department of Internal Medicine of the emergence of the University of Kentucky Healthcare Enterprise as an integrated clinical model has been enormous. In fiscal year 2004, the department was financially insolvent and on the verge of implementing plans to decrease faculty from 127 to 65. Since that time, the department has changed dramatically with a corresponding improvement in its clinical, academic, and financial activity.

Serum amyloid A and lipoprotein retention in murine models of atherosclerosis.

Objective: Elevated serum amyloid A (SAA) levels are associated with increased cardiovascular risk in humans. Because SAA associates primarily with lipoproteins in plasma and has proteoglycan binding domains, we postulated that SAA might mediate lipoprotein retention on atherosclerotic extracellular matrix.

Methods And Results: Immunohistochemistry was performed for SAA, apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), and perlecan on proximal aortic lesions from chow-fed low-density lipoprotein receptor (LDLR)-/- and apoE-/- mice euthanized at 10, 50, and 70 weeks.

Human secretory phospholipase A2 mediates decreased plasma levels of HDL cholesterol and apoA-I in response to inflammation in human apoA-I transgenic mice.

Objective: Plasma levels of high density lipoprotein (HDL) cholesterol and apolipoprotein (apo)A-I are decreased in inflammatory states. Secretory phospholipase A2 (sPLA2), an acute-phase protein, may play a key role in the pathophysiology of this phenomenon.

Methods And Results: To investigate the effects of sPLA2 on human-like HDL particles in vivo, we generated transgenic mice overexpressing human apoA-I and human sPLA2 (apoA-I/sPLA2 mice).

Association between serum amyloid A proteins and coronary artery disease: evidence from two distinct arteriosclerotic processes.

Background: Serum amyloid A (SAA) proteins are a family of inflammatory apolipoproteins that may modify high-density lipoprotein structure and function. Elevations of SAA have been reported in unstable coronary syndromes, but the levels and types of SAA protein in humans with spontaneous or transplant-associated coronary artery disease are not known.

Methods And Results: SAA levels were analyzed using an ELISA in 76 sera from 36 patients after cardiac transplantation and in 346 other individuals, 85 patients with atherosclerotic coronary disease plus 261 of their relatives.

Genetic control of inflammatory gene induction and NF-kappa B-like transcription factor activation in response to an atherogenic diet in mice.

A high fat, high cholesterol "atherogenic" diet induced considerably greater hepatic levels of conjugated dienes and expression of several inflammatory and oxidative stress responsive genes (JE, the mouse homologue of monocyte chemotactic protein-1, colony-stimulating factors, heme oxygenase, and members of the serum amyloid A family) in fatty streak susceptible C57BL/6 mice compared to fatty streak resistant C3H/HeJ mice. Since serum amyloid A proteins bind exclusively to HDL and influence the properties of HDL, serum amyloid A expression may contribute to the decrease in HDL levels seen in the susceptible strains. Induction of a similar set of genes was observed upon injection of minimally oxidized low density lipoprotein.