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Updated: May 2, 2026

High-Density Lipoprotein-Specific Phospholipid Efflux Assay
Published on: September 30, 2025
Impaired cholesterol efflux capacity and vasculoprotective function of high-density lipoprotein in heart transplant
Neha Singh1, Frank Jacobs1, Daniel J Rader2
1Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Catholic University of Leuven, Leuven, Belgium.
Insights
High-density lipoprotein (HDL) function is impaired in heart transplant recipients, despite similar HDL cholesterol levels. This reduced HDL function is not linked to cardiac allograft vasculopathy (CAV).
Area of Science:
- Cardiology
- Immunology
- Transplantation Science
Background:
- High-density lipoprotein (HDL) metabolism is altered in heart transplant recipients.
- HDL function may be impaired in these patients, impacting cardiovascular health post-transplant.
Purpose of the Study:
- To investigate HDL function in heart transplant recipients.
- To assess cholesterol efflux capacity and vasculoprotective function of HDL.
- To determine the relationship between HDL function and cardiac allograft vasculopathy (CAV).
Main Methods:
- Cross-sectional study of 52 heart transplant recipients 5-15 years post-transplantation.
- Analysis of cholesterol efflux capacity using apolipoprotein B-depleted plasma.
- Evaluation of HDL vasculoprotective function via endothelial progenitor cell migration assay.
Main Results:
- Heart transplant recipients showed reduced normalized cholesterol efflux (24.1%) and vasculoprotective function (27.0%) compared to controls.
- HDL function was similar in patients with and without CAV and not related to C-reactive protein (CRP) levels.
- Higher CRP levels (≥6 mg/liter) were observed in patients with CAV.
Conclusions:
- HDL function is impaired in heart transplant recipients.
- Impaired HDL function is unrelated to CAV status in these patients.
- CAV-positive patients have a higher proportion of elevated CRP levels.
Background:
High-density lipoprotein (HDL) metabolism is significantly altered in heart transplant recipients. We hypothesized that HDL function may be impaired in these patients.
Methods:
Fifty-two patients undergoing coronary angiography between 5 and 15 years after heart transplantation were recruited in this cross-sectional study. Cholesterol efflux capacity of apolipoprotein B-depleted plasma was analyzed using a validated assay. The vasculoprotective function of HDL was studied by means of an endothelial progenitor cell migration assay.
Results:
HDL cholesterol levels were similar in heart transplant patients compared with healthy controls. However, normalized cholesterol efflux and vasculoprotective function were reduced by 24.1% (p < 0.001) and 27.0% (p < 0.01), respectively, in heart transplant recipients compared with healthy controls. HDL function was similar in patients with and without cardiac allograft vasculopathy (CAV) and was not related to C-reactive protein (CRP) levels. An interaction effect (p = 0.0584) was observed between etiology of heart failure before transplantation and steroid use as factors of HDL cholesterol levels. Lower HDL cholesterol levels occurred in patients with prior ischemic cardiomyopathy who were not taking steroids. However, HDL function was independent of the etiology of heart failure before transplantation and steroid use. The percentage of patients with a CRP level ≥6 mg/liter was 3.92-fold (p < 0.01) higher in patients with CAV than in patients without CAV.
Conclusions:
HDL function is impaired in heart transplant recipients, but it is unrelated to CAV status. The proportion of patients with a CRP level ≥6 mg/liter is prominently higher in CAV-positive patients.
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