Book Reviews
As originally published in The Physiologist
Volume 45, Number 2, April 2002, page 122
Attitudes on Altitude: Pioneers of Medical Research in Colorado’s High Mountains
Intestinal Lipid Metabolism
Attitudes on Altitude: Pioneers of Medical Research in Colorado’s High Mountains
John T. Reeves and Robert F. Grover
Boulder, CO: Univ. Press of Colorado, 2001, 218 pp., illus., index, $21.95.
ISBN: 0-87081-645-4
The quality of books on the history of physiology has improved dramatically in the last 10 years. Evolved from the impenetrable tomes of a few decades ago, current history books, especially those written contemporaneously and incorporating autobio-graphical chapters, have provided more enjoyable insight into the personalities of the scientists and the problems that confronted them. Reeves and Grover have filled an important historical gap in their book Attitudes on Altitude, which focuses on the pioneers of medical research conducted in the high mountains of Colorado prior to 1960. The editors were able to contact students and family, themselves now elderly, of the famous scientists who worked in the high country during the first half of the last century. Through extensive interviews and correspondence, they have preserved valuable information that would otherwise soon be irretrievably lost.
The editors did much more than the usual modern editing job (“type your manuscript, camera ready, within the blue borders and have it in my office in less than two weeks”). Throughout Attitudes on Altitude, the editors have either written the material themselves, or there is evidence of their literary touch. The result is a brilliant, insightful, entertaining book, so readable that it is a page turner. Glover and Newsom’s early investigations of the mysterious development of pulmonary hypertension in cattle make for excellent reading. J.S. Haldane, who laid the complete foundations for our understanding of the control of breathing, is a fascinating and impressive figure. One of my favorite characters is Mabel FitzGerald. How a proper Victorian lady could travel to the rough and raucous high-altitude mining towns of Colorado packing delicate glass instruments on mule back to investigate the effect of carbon dioxide on the drive to breathe, leaves one’s head spinning.
There are other wonderful chapters: on the Grollmans who measured cardiac output during acclimatization in detail that has never been matched, on the superb lifetime work of Bruce Dill, and on Jack Lichty’s ground breaking work on small babies being born in Leadville. Lichty made a discovery—maternal hypoxia results in full term small babies who get sick a lot—and for a time nobody grasped the significance, not just for high altitude, but also for any other circumstance that can cause maternal and fetal hypoxia such as carbon monoxide from cigarette smoking. In the final chapter, Bob Grover describes the work of Charlie Houston who pondered the case of Alex Drummond, a climber who got pneumonia when he went to altitude, a “pneumonia” that promptly cleared when he descended. Houston, a general practitioner in Aspen, showed the characteristics of all the pioneers featured in this book: perseverance, curiosity, and determination, in this case eventually leading to the description of high altitude pulmonary edema. Those same determined characteristics apply to the editors of Attitudes on Altitude, for this book had a ten-year-long gestation period. The result is a happy one that is readable not only by physiologists, but by the lay public as well. This slim volume belongs on the bookshelf of all who are intrigued by the process of science, who are curious about the kinds of people who become scientists, and who are interested by what happens to each of us when we ascend to high altitude.
Wiltz W. Wagner, Jr., Ph.D.
Indiana University School of Medicine
Intestinal Lipid Metabolism
Charles M. Mansbach II, Patrick Tso, Arnis Kuksis (Editors)
New York: Kluwer Academic/Plenum, 2001, 434 pp., index, $135
ISBN: 0-306-46241-9
Since 1990, the Federation of American Societies for Experimental Biology (FASEB) has sponsored regular meetings in Saxon River, VT, on the intestinal processing of lipids. These meetings have attracted the leading scientists in lipid biology and their students, and have served as both stimulus for research and recruiting tool for encouraging younger investigators to enter the field. The current book is drawn from the same underlying inspiration: to draw together definitive information on how the intestine processes lipids, and to reach investigators with an interest in this area and their pre- and postdoctoral trainees. Considering that intestinal absorption of lipids is central to the pathophysiologic processes of athero-sclerosis and obesity, there is much need for rigorous understanding of intestinal lipid physiology. The current book serves this purpose well.
The book is organized into chapters of 15 to 20 text pages in length, written by leading experts in intestinal lipid biology. The first chapter introduces the biophysics of intestinal luminal lipids, with discussion of lipid emulsification in the stomach and duodenum, the physicochemistry of lipolysis at the oil-water interface of emulsion droplets, and the physicochemistry of end-lipolysis in the aqueous phase and unstirred water layer of the mucosa. The next six chapters are definitive discussions of the following enzymes: preduodenal lipases; pancreatic lipase and colipase; pancreatic phospholipase A2, enterostatin/procolipase; and cholesterol esterase. These enzymes are discussed in the context of their gene and amino acid sequences and place in enzyme familes; purification and characterization of the enzymes; biophysical properties; crystallographic structure and catalytic mechanisms. Attention also is given to the biophysics of the catalytic event, since interface physics is important for many of these enzymes. Chapter 8 addresses the intestinal unstirred water layer specifically, and Chapter 17 analyses the surfactantlike particles involved in absorption of triacylglycerols. Chapters 9 through 16 are devoted to the physiology of intestinal enterocyte lipid processing, organized along the following themes: fatty acid binding proteins; microsomal triglyceride transfer protein and its role in the assembly of intestinal lipoproteins; intestinal enterocyte synthesis and trafficking of triacylglycerols; intestinal cholesterol absorption and metabolism; intestinal apoprotein biosynthesis and lipoprotein assembly. In the last instance, specific attention is given to apolipoprotein B and apolipoprotein A-IV. Chapters 18 to 21 address broader issues of intestinal enterocyte lipid processing, including: inhibitors of chylomicron formation and secretion; absorption and metabolism of peroxidized lipids; absorption of fat-soluble vitamins; and metabolism of interesterified fats. The final chapter, 22, addresses clinical nutrition with special attention to structured triacylglycerols. The book is well-indexed, and chapters contain valuable introductory comments and concluding sections. There is a uniformity of presentation and editorial style which is very pleasing.
The field of lipid biology has a rich history, and the authors of each chapter do an excellent job of citing important scientific contributions of the last half-century as well as providing recent citations through the late 1990’s. Lipid physiology cannot be understood without understanding the biophysics of the substrate molecules, and their assembly into the macroarchitecture of membranes, micelles, and lipid droplets. Both with the chapters specifically addressing lipid biophysics and the frequent reference to biophysics in other chapters, the reader is given an excellent sense of this elegant field. The physiological significance of lipid transformations, both metabolic and architectural, are detailed. Each chapter imparts important insights into the physiology of intestinal lipid breakdown, absorption, metabolism, and reassembly into circulating lipoproteins, something which is exceedingly difficult to understand without a definitive text of this nature. The elegance of each metabolic enzyme is detailed, with extensive discussions of crystal structure, catalytic sites, and substrate catalysis.
Importantly, regulation of enzyme and apolipoprotein gene expression is discussed extensively, with references extending up until 1998. As regulation of gene expression is a very rapidly moving field, this is the one area where this book may not serve as a definitive reference source. Neverthe-less, the principles established at the time of its writing remain, and these chapters will stand as a valuable reference point for work conducted 1998 and prior.
Taken collectively, this is an outstanding compendium of current knowledge on the biophysics, biochemistry, and physiology of lipid processing within the gut lumen and by intestinal enterocytes. The final chapter on the use of structured triacylglycerols points towards an area which is not emphasized in this book, which is intestinal pathophysiology in the clinical management of lipid disorders. There is also limited discussion of how the principles presented in this book translate into understanding of atherosclerotic vascular disease, a principal disorder related to intestinal lipid pathophysiology. This is not a deficiency of the book, simply an acknowledgement that these two vast fields of scientific endeavor must each have focussed textbooks. Rather, this current book provides a substantially up-to-date, and outstandingly thorough presentation of the physiologic interface between the lipids of our dietary world, and our inner corpus.
James M. Crawford
University of Florida