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Abumrad NA, Cabodevilla AG, Samovski D, Pietka T, Basu D, Goldberg IJ. Endothelial Cell Receptors in Tissue Lipid Uptake and Metabolism. Circ Res 2021; 128:433-450. [PMID: 33539224 DOI: 10.1161/circresaha.120.318003] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lipid uptake and metabolism are central to the function of organs such as heart, skeletal muscle, and adipose tissue. Although most heart energy derives from fatty acids (FAs), excess lipid accumulation can cause cardiomyopathy. Similarly, high delivery of cholesterol can initiate coronary artery atherosclerosis. Hearts and arteries-unlike liver and adrenals-have nonfenestrated capillaries and lipid accumulation in both health and disease requires lipid movement from the circulation across the endothelial barrier. This review summarizes recent in vitro and in vivo findings on the importance of endothelial cell receptors and uptake pathways in regulating FAs and cholesterol uptake in normal physiology and cardiovascular disease. We highlight clinical and experimental data on the roles of ECs in lipid supply to tissues, heart, and arterial wall in particular, and how this affects organ metabolism and function. Models of FA uptake into ECs suggest that receptor-mediated uptake predominates at low FA concentrations, such as during fasting, whereas FA uptake during lipolysis of chylomicrons may involve paracellular movement. Similarly, in the setting of an intact arterial endothelial layer, recent and historic data support a role for receptor-mediated processes in the movement of lipoproteins into the subarterial space. We conclude with thoughts on the need to better understand endothelial lipid transfer for fuller comprehension of the pathophysiology of hyperlipidemia, and lipotoxic diseases such as some forms of cardiomyopathy and atherosclerosis.
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Affiliation(s)
- Nada A Abumrad
- Division of Nutritional Sciences, Department of Medicine, Washington University School of Medicine, Saint Louis, MO (N.A.A., D.S., T.P.)
| | - Ainara G Cabodevilla
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University Grossman School of Medicine (A.G.C., D.B., I.J.G.)
| | - Dmitri Samovski
- Division of Nutritional Sciences, Department of Medicine, Washington University School of Medicine, Saint Louis, MO (N.A.A., D.S., T.P.)
| | - Terri Pietka
- Division of Nutritional Sciences, Department of Medicine, Washington University School of Medicine, Saint Louis, MO (N.A.A., D.S., T.P.)
| | - Debapriya Basu
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University Grossman School of Medicine (A.G.C., D.B., I.J.G.)
| | - Ira J Goldberg
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University Grossman School of Medicine (A.G.C., D.B., I.J.G.)
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Cefalù AB, Giammanco A, Noto D, Spina R, Cabibi D, Barbagallo CM, Averna M. Effectiveness and safety of lomitapide in a patient with familial chylomicronemia syndrome. Endocrine 2021; 71:344-350. [PMID: 33006726 DOI: 10.1007/s12020-020-02506-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/23/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Familial chylomicronemia syndrome (FCS) is characterized by severe fasting hypertriglyceridemia, abdominal pain, and recurrent acute pancreatitis. Available triglyceride-lowering drugs are insufficient to avoid pancreatitis. Therefore, there is a significant unmet medical need for effective triglyceride-lowering drugs for patients with FCS. CASE REPORT We report the second case of a patient with FCS and recurrent pancreatitis treated with lomitapide. Lomitapide treatment resulted in a reduction of fasting TG levels from 2897 mg/dL (32.71 mmol/L) to an average of 954 mg/dL (10.77 mmol/L) on the 30 mg lomitapide equating to a 67% reduction from baseline. After 26 months of lomitapide treatment, histological activity score for hepatic fibrosis was stable although liver biopsy showed a marked increase of liver steatosis and mild perivenular and perisinusoidal fibrosis. CONCLUSIONS Lomitapide is effective in reducing triglycerides in FCS and preventing the recurrence of acute pancreatitis. A longer follow-up is necessary to evaluate long-term risk of progression toward severe stages of liver fibrosis. A prospective clinical trial may identify which subgroup of FCS patients would benefit from lomitapide treatment in the absence of significant liver adverse effects.
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Affiliation(s)
- Angelo B Cefalù
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Antonina Giammanco
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Davide Noto
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Rossella Spina
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Daniela Cabibi
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Carlo M Barbagallo
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Maurizio Averna
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica Di Eccellenza "G. D'Alessandro" (PROMISE), Università degli Studi di Palermo, Via del Vespro 129, 90127, Palermo, Italy.
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Dai J, Jiang M, Hu Y, Xiao J, Hu B, Xu J, Han X, Shen S, Li B, Wu Z, He Y, Ren Y, Wen L, Wang X, Hu G. Dysregulated SREBP1c/miR-153 signaling induced by hypertriglyceridemia worsens acute pancreatitis and delays tissue repair. JCI Insight 2021; 6:138584. [PMID: 33491670 PMCID: PMC7934861 DOI: 10.1172/jci.insight.138584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023] Open
Abstract
Severe acute pancreatitis (AP) is a life-threatening disease with up to 30% mortality. Therefore, prevention of AP aggravation and promotion of pancreatic regeneration are critical during the course and treatment of AP. Hypertriglyceridemia (HTG) is an established aggravating factor for AP that hinders pancreatic regeneration; however, its exact mechanism remains unclear. Using miRNA sequencing and further verification, we found that miRNA-153 (miR-153) was upregulated in the pancreas of HTG animal models and in the plasma of patients with HTG-AP. Increased miR-153 aggravated HTG-AP and delayed pancreatic repair via targeting TRAF3. Furthermore, miR-153 was transcriptionally suppressed by sterol regulatory element-binding transcription factor 1c (SREBP1c), which was suppressed by lipoprotein lipase malfunction-induced HTG. Overexpressing SREBP1c suppressed miR-153 expression, alleviated the severity of AP, and facilitated tissue regeneration in vivo. Finally, therapeutic administration of insulin also protected against HTG-AP via upregulating SREBP1c. Collectively, our results not only provide evidence that HTG leads to the development of more severe AP and hinders pancreatic regeneration via inducing persistent dysregulation of SREBP1c/miR-153 signaling, but also demonstrate that SREBP1c activators, including insulin, might be used to treat HTG-AP in patients.
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Affiliation(s)
- Juanjuan Dai
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingjie Jiang
- Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yangyang Hu
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jingbo Xiao
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Hu
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiyao Xu
- Department of Emergency, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao Han
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuangjun Shen
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Li
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zengkai Wu
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan He
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingchun Ren
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Wen
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xingpeng Wang
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guoyong Hu
- Department of Gastroenterology and.,Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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54
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Gill PK, Dron JS, Dilliott AA, McIntyre AD, Cao H, Wang J, Movsesyan IG, Malloy MJ, Pullinger CR, Kane JP, Hegele RA. Ancestry-specific profiles of genetic determinants of severe hypertriglyceridemia. J Clin Lipidol 2021; 15:88-96. [PMID: 33303403 DOI: 10.1016/j.jacl.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/31/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Susceptibility to severe hypertriglyceridemia (HTG), defined as plasma triglyceride (TG) levels ≥10 mmol/L (880 mg/dL), is conferred by both heterozygous rare variants in five genes involved in TG metabolism and numerous common single-nucleotide polymorphisms (SNPs) associated with TG levels. OBJECTIVE To date, these genetic susceptibility factors have been comprehensively assessed primarily in severe HTG patients of European ancestry. Here, we expand our analysis to HTG patients of East Asian and Hispanic ancestry. METHODS The genomic DNA of 336, 63 and 199 severe HTG patients of European, East Asian and Hispanic ancestry, respectively, was evaluated using a targeted next-generation sequencing panel to screen for: 1) rare variants in LPL, APOA5, APOC2, GPIHBP1 and LMF1; 2) common, small-to-moderate effect SNPs, quantified using a polygenic score; and 3) common, large-effect polymorphisms, APOA5 p.G185C and p.S19W. RESULTS While the proportion of individuals with high polygenic scores was similar, frequency of rare variant carriers varied across ancestries. Compared with ancestry-matched controls, Hispanic patients were the most likely to have a rare variant (OR = 5.02; 95% CI 3.07-8.21; p < 0.001), while European patients were the least likely (OR = 2.56; 95% CI 1.58-4.13; p < 0.001). The APOA5 p.G185C polymorphism, exclusive to East Asians, was significantly enriched in patients compared with controls (OR = 10.1; 95% CI 5.6-18.3; p < 0.001), showing the highest enrichment among the measured genetic factors. CONCLUSION While TG-associated rare variants and common SNPs are both found in statistical excess in severe HTG patients of different ancestral backgrounds, the overall genetic profiles of each ancestry group were distinct.
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Affiliation(s)
- Praneet K Gill
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jacqueline S Dron
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Allison A Dilliott
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adam D McIntyre
- Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Henian Cao
- Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jian Wang
- Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Irina G Movsesyan
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Mary J Malloy
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Clive R Pullinger
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - John P Kane
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Robert A Hegele
- Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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55
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Yamamoto T, Gotoda T. Polygenic Architecture of Common Severe Hypertriglyceridemia. J Atheroscler Thromb 2020; 27:1255-1256. [PMID: 32493883 PMCID: PMC7840165 DOI: 10.5551/jat.ed133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Takashi Yamamoto
- Department of Metabolic Biochemistry, Faculty of Medicine, Kyorin University
| | - Takanari Gotoda
- Department of Metabolic Biochemistry, Faculty of Medicine, Kyorin University
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56
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Serveaux Dancer M, Marmontel O, Wozny AS, Marcais C, Mahl M, Dumont S, Simonet T, Moulin P, Di Filippo M, Charrière S. Involvement of a homozygous exon 6 deletion of LMF1 gene in intermittent severe hypertriglyceridemia. J Clin Lipidol 2020; 14:756-761. [PMID: 33039347 DOI: 10.1016/j.jacl.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022]
Abstract
Severe hypertriglyceridemia (HTG), characterized by triglycerides (TG) permanently over 10 mmol/L, may correspond to familial chylomicronemia syndrome (FCS), a rare disorder. However, hypertriglyceridemic patients more often present multifactorial chylomicronemia syndrome (MCS), characterized by highly variable TG. A few nonsense variants of LMF1 gene were reported in literature in FCS patients. In this study, we described a woman with an intermittent severe HTG. NGS analysis and the sequencing of a long range PCR product revealed a homozygous deletion of 6507 base pairs in LMF1 gene, c.730-1528_898-3417del, removing exon 6, predicted to create an in-frame deletion of 56 amino acids, p.(Thr244_Gln299del). Despite an exon 6 homozygous deletion of LMF1, the patient's highly variable lipid phenotype was suggestive of MCS diagnosis.
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Affiliation(s)
- Marine Serveaux Dancer
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie Moléculaire et Métabolique, Pierre-Bénite Cedex, France
| | - Oriane Marmontel
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Oullins Cedex, France; Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Biochimie et Biologie Moléculaire Grand Est, Bron Cedex, France
| | - Anne-Sophie Wozny
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie Moléculaire et Métabolique, Pierre-Bénite Cedex, France
| | - Christophe Marcais
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie Moléculaire et Métabolique, Pierre-Bénite Cedex, France; INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Oullins Cedex, France
| | - Muriel Mahl
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie Moléculaire et Métabolique, Pierre-Bénite Cedex, France
| | - Sabrina Dumont
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Biochimie et Biologie Moléculaire Grand Est, Bron Cedex, France
| | - Thomas Simonet
- Hospices Civils de Lyon, Cellule BioInformatique, Bron Cedex, France
| | - Philippe Moulin
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Oullins Cedex, France; Hospices Civils de Lyon, Hôpital Louis Pradel, Fédération d'endocrinologie, Maladies Métaboliques, Diabète et Nutrition, Bron Cedex, France
| | - Mathilde Di Filippo
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Oullins Cedex, France; Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Biochimie et Biologie Moléculaire Grand Est, Bron Cedex, France
| | - Sybil Charrière
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Oullins Cedex, France; Hospices Civils de Lyon, Hôpital Louis Pradel, Fédération d'endocrinologie, Maladies Métaboliques, Diabète et Nutrition, Bron Cedex, France.
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Abstract
Hypertriglyceridemia is one of the most common lipid abnormalities encountered in clinical practice. Many monogenic disorders causing severe hypertriglyceridemia have been identified, but in most patients triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors. Common secondary causes include obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs. Correcting these factors and optimizing lifestyle choices, including dietary modification, is important before starting drug treatment. The goal of drug treatment is to reduce the risk of pancreatitis in patients with severe hypertriglyceridemia and cardiovascular disease in those with moderate hypertriglyceridemia. This review discusses the various genetic and acquired causes of hypertriglyceridemia, as well as current management strategies. Evidence supporting the different drug and non-drug approaches to treating hypertriglyceridemia is examined, and an easy to adopt step-by-step management strategy is presented.
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Affiliation(s)
- Vinaya Simha
- Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Dyslipidemias include both rare single gene disorders and common conditions that have a complex underlying basis. In London, ON, there is fortuitous close physical proximity between the Lipid Genetics Clinic and the London Regional Genomics Centre. For >30 years, we have applied DNA sequencing of clinical samples to help answer scientific questions. More than 2000 patients referred with dyslipidemias have participated in an ongoing translational research program. In 2013, we transitioned to next-generation sequencing; our targeted panel is designed to concurrently assess both monogenic and polygenic contributions to dyslipidemias. Patient DNA is screened for rare variants underlying 25 mendelian dyslipidemias, including familial hypercholesterolemia, hepatic lipase deficiency, abetalipoproteinemia, and familial chylomicronemia syndrome. Furthermore, polygenic scores for LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol, and triglycerides are calculated for each patient. We thus simultaneously document both rare and common genetic variants, allowing for a broad view of genetic predisposition for both individual patients and cohorts. For instance, among patients referred with severe hypertriglyceridemia, defined as ≥10 mmol/L (≥885 mg/dL), <1% have a mendelian disorder (ie, autosomal recessive familial chylomicronemia syndrome), ≈15% have heterozygous rare variants (a >3-fold increase over normolipidemic individuals), and ≈35% have an extreme polygenic score (a >3-fold increase over normolipidemic individuals). Other dyslipidemias show a different mix of genetic determinants. Genetic results are discussed with patients and can support clinical decision-making. Integrating DNA testing into clinical care allows for a bidirectional flow of information, which facilitates scientific discoveries and clinical translation.
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Affiliation(s)
- Robert A. Hegele
- From the Department of Medicine (R.A.H.), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Biochemistry (R.A.H., J.S.D.), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Robarts Research Institute (R.A.H., J.S.D.), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jacqueline S. Dron
- Department of Biochemistry (R.A.H., J.S.D.), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Robarts Research Institute (R.A.H., J.S.D.), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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He LH, Gao JH, Yu XH, Wen FJ, Luo JJ, Qin YS, Chen MX, Zhang DW, Wang ZB, Tang CK. Artesunate inhibits atherosclerosis by upregulating vascular smooth muscle cells-derived LPL expression via the KLF2/NRF2/TCF7L2 pathway. Eur J Pharmacol 2020; 884:173408. [PMID: 32739175 DOI: 10.1016/j.ejphar.2020.173408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 01/01/2023]
Abstract
Lipoprotein lipase (LPL) plays a central role in hydrolyzing triglyceride and its deficiency leads to atherosclerosis. Artesunate (ART), a derivative of artemisinin, has been demonstrated that ART reduces the formation of atherosclerotic plaques. However, it remains unclear whether ART-alleviated atherosclerotic lesion is involved in regulating lipid metabolism. ApoE-/- mice were fed a high-fat diet to form atherosclerotic plaques and then injected with artesunate or not. Oil Red O, HE and Masson staining were performed to assess atherosclerotic plaques. Both Western blot and qRT-PCR were applied to detect protein expression. The Luciferase reporter gene and Chromatin immunoprecipitation assays were used to assess the interaction between proteins. Immunofluorescence assay was performed to show the localization of target proteins. In vitro, our data shown that ART increased LPL expression and inhibition of NRF2 blocked the binding of TCF7L2 to LPL promoter region in VSMCs. Downregulated Klf2 could decrease the nuclear enrichment of NRF2, TCF7L2 and LPL expression. In vivo, ART decreased atherosclerotic plaque formation and increased VSMC counts and LPL expression within atherosclerotic plaques. We observed the reduced tendency of serum lipids, and increased in serum LPL activity in mice. In support of vitro data, the markedly increased KLF2, TCF7L2 and LPL expression have been detected in aorta. Our study suggests that ART may be a novel therapeutic drug for inhibition of atherosclerotic plaque formation. The molecular mechanism may involve in upregulation of LPL expression via the KLF2/NRF2/TCF7L2 pathway in VSMCs.
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Affiliation(s)
- Lin-Hao He
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China; School of Pharmaceutical Science, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Jia-Hui Gao
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China
| | - Xiao-Hua Yu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China
| | - Feng-Jiao Wen
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China
| | - Jing-Jing Luo
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China; School of Pharmaceutical Science, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Yu-Sheng Qin
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China
| | - Ming-Xin Chen
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China; School of Pharmaceutical Science, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Da-Wei Zhang
- Department of Pediatrics and Group on the Molecular and Cell Biology of Lipids, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
| | - Zong-Bao Wang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China; School of Pharmaceutical Science, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China.
| | - Chao-Ke Tang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan International Scientific and Technological Cooperation Base of Arteriosclerotic Disease, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang Medical College, University of South China, Hengyang, Hunan, 421001, China.
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Wang CY, Chen YQ, Jin JY, Du R, Fan LL, Xiang R. A Novel Nonsense Mutation of ABCA8 in a Han-Chinese Family With ASCVD Leads to the Reduction of HDL-c Levels. Front Genet 2020; 11:755. [PMID: 32760429 PMCID: PMC7373792 DOI: 10.3389/fgene.2020.00755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023] Open
Abstract
Arteriosclerotic cardiovascular disease (ASCVD) is one of the major causes of death worldwide and most commonly develops as a result of atherosclerosis (AS). As we all know, dyslipidemia is a leading pathogenic risk factor for ASCVD, which leads to cardiac ischemic injury and myocardial infarction. Dyslipidemias include hypercholesterolemia, hypertriglyceridemia, increased low-density lipoprotein cholesterol (LDL-c) and decreased high density lipoproteins cholesterol (HDL-c). Mutations of dyslipidemia related genes have been proved to be the crucial contributor to the development of AS and ASCVD. In this study, a Han-Chinese family with ASCVD was enrolled and the lipid testing discovered an obvious reduced levels of HDL-c in the affected members. We then performed whole exome sequencing to detect the candidate genes of the family. After data filtering, a novel heterozygous nonsense mutation (NM_007168: c.3460C>T; p.R1154X) of ABCA8 was detected and validated to be co-separated in the family members by Sanger sequencing. Previous studies have proved that deleterious heterozygous ABCA8 variants may disrupt cholesterol efflux and reduce HDL-c levels in humans and mice. This study may be the second report related to ABCA8 mutations in patients with reduced levels of HDL-c. Our study not only contributed to the genetic counseling and prenatal genetic diagnosis of patients with ASCVD caused by reduced HDL-c levels, but also provided a new sight among ABCA8, cholesterol efflux and HDL-c levels.
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Affiliation(s)
- Chen-Yu Wang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China
| | - Ya-Qin Chen
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jie-Yuan Jin
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China
| | - Ran Du
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China
| | - Liang-Liang Fan
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal for Human Disease, School of Life Sciences, Central South University, Changsha, China
| | - Rong Xiang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cell Biology, School of Life Sciences, Central South University, Changsha, China.,Hunan Key Laboratory of Animal for Human Disease, School of Life Sciences, Central South University, Changsha, China
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61
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Fang LJ, Abuduxikuer K, Yan XM, Zhu H, Huang KY. An infant presenting with extreme hypertriglyceridemia diagnosed as glycogen storage disease type Ia. J Pediatr Endocrinol Metab 2020; 33:803-808. [PMID: 32436859 DOI: 10.1515/jpem-2019-0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022]
Abstract
Background Marked hypertriglyceridemia in infancy is extremely rare. Patients with severe hypertriglyceridemia in early life may be unmasked by a primary or secondary cause. Case presentation A female infant was born in a good condition with normal Apgar scores. No special clinical symptoms and signs had been found within the first two months of life. Poor oral intake and failure to thrive were two main clinical manifestations when she was referred to our hospital at the age of 3.5 months. The milky serum was the only one characteristic presentation. Laboratory testing showed extremely high level of triglycerides, cholesterol and lactate. Many other laboratory indexes cannot be detected because of severe hyperlipemic samples. Multi-gene panel testing for 249 genes about genetic and metabolic liver disease were performed. Gene analysis revealed a G6PC gene deficiency. The patient was a homozygote for c.248G > A, p.R83H and her parents were both the heterozygotes. The infant had been diagnosed as glycogen storage disease type Ia. Conclusions We report an infant presenting with extreme hypertriglyceridemia diagnosed as glycogen storage disease type Ia by genetic testing. The gene panel can be used to confirm the diagnosis and delineate the exact type of glycogen storage disease, which could ultimately really help to reduce unnecessary tests and invasive examinations. Serum lipid should be close monitoring in order to prevent the complications and improve the prognosis.
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Affiliation(s)
- Ling-Juan Fang
- Department of Pediatric Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, China
| | - Kuerbanjiang Abuduxikuer
- The Center for Pediatric Liver Disease, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, China
| | - Xiu-Mei Yan
- Department of Pediatric Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, China
| | - Huan Zhu
- Department of Pediatric Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, China
| | - Kai-Yu Huang
- Department of Pediatric Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, China
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62
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Pu N, Yang Q, Shi XL, Chen WW, Li XY, Zhang GF, Li G, Li BQ, Ke L, Tong ZH, Cooper DN, Chen JM, Li WQ, Li JS. Gene-environment interaction between APOA5 c.553G>T and pregnancy in hypertriglyceridemia-induced acute pancreatitis. J Clin Lipidol 2020; 14:498-506. [PMID: 32561169 DOI: 10.1016/j.jacl.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/15/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The etiology of hypertriglyceridemia (HTG) and, consequently, HTG-induced acute pancreatitis (HTG-AP), is complex. OBJECTIVE Herein, we explore a possible gene-environment interaction between APOA5 c.553G>T (p.185Gly>Cys, rs2075291), a common variant associated with altered triglyceride levels, and pregnancy in HTG-AP. METHODS We enrolled 318 Chinese HTG-AP patients and divided them into 3 distinct groups: Group 1, male patients (n = 183); Group 2, female patients whose disease was unrelated to pregnancy (n = 105); and Group 3, female patients whose disease was related to pregnancy (n = 30). APOA5 rs2075291 genotype status was determined by Sanger sequencing. A total of 362 healthy Han Chinese subjects were used as controls. Data on body mass index, peak triglyceride level, age of disease onset, episode number, and clinical severity of HTG-AP were collected from each patient. Multiple comparisons, between patient groups, between patient groups and controls, or within each patient group, were performed. RESULTS A robust association of APOA5 rs2075291 with HTG-AP in general, and HTG-AP during pregnancy in particular, was demonstrated. The minor T allele showed a stronger association with Group 3 patients than with either Group 1 or Group 2 patients. This stronger association was due mainly to the much higher frequency of TT genotype in Group 3 patients (20%) than that (<6%) in Group 1 and Group 2 patients. Moreover, the TT genotype was associated with a significantly higher peak triglyceride level in Group 3 patients compared with the GG genotype. CONCLUSION Our findings provide evidence for an interaction between APOA5 rs2075291 and pregnancy in HTG-AP.
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Affiliation(s)
- Na Pu
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qi Yang
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Xiao-Lei Shi
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei-Wei Chen
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiao-Yao Li
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Intensive Care Unit, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guo-Fu Zhang
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gang Li
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bai-Qiang Li
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lu Ke
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhi-Hui Tong
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jian-Min Chen
- EFS, Univ Brest, Inserm, UMR 1078, GGB, Brest, France
| | - Wei-Qin Li
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Jie-Shou Li
- Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Pinilla-Monsalve GD, Lores J, Pachajoa H, López-Ponce de León JD, López A, Rodríguez-Rojas LX, Nastasi-Catanese JA. A Novel APOC2 Mutation in a Colombian Patient with Recurrent Hypertriglyceridemic Pancreatitis. Appl Clin Genet 2020; 13:63-69. [PMID: 32280258 PMCID: PMC7125404 DOI: 10.2147/tacg.s243148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/20/2020] [Indexed: 11/26/2022] Open
Abstract
Hypertriglyceridemia is a common disease with only 2% of cases exhibiting monogenic mutations. Familial chylomicronemia syndrome (FCS) is a rare genetic condition associated with recurrent and severe episodes of pancreatitis and is mainly caused by mutations in the LPL gene, with few cases related to abnormal function of apolipoprotein C-II. This is a 50-year-old female with a past medical history of arterial hypertension, miscarriage and recurrent pancreatitis. In the last four years, her triglycerides and lipase concentration reached >3000 mg/dL and >700 U/L, respectively. The patient was not responsive to statins, fibrates, or tetrahydrolipstatin. A novel homozygous frameshift mutation on exon 3 of the APOC2 gene was detected, c.133_134delTC. Subsequent Sanger sequencing confirmed that three first-degree relatives were carriers of the same mutation. To the best of our knowledge, we are reporting the first Colombian patient with FCS due to an APOC2 mutation. We propose that this mutation caused recurrent hypertriglyceridemic pancreatitis.
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Affiliation(s)
| | - Juliana Lores
- Faculty of Health Sciences, Universidad Icesi, Cali 760032, Colombia.,Department of Genetics, Fundación Valle del Lili, Cali 760032, Colombia
| | - Harry Pachajoa
- Faculty of Health Sciences, Universidad Icesi, Cali 760032, Colombia.,Department of Genetics, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juan D López-Ponce de León
- Faculty of Health Sciences, Universidad Icesi, Cali 760032, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali 760032, Colombia
| | - Alejandro López
- Faculty of Health Sciences, Universidad Icesi, Cali 760032, Colombia.,Department of Endocrinology, Fundación Valle del Lili, Cali 760032, Colombia
| | - Lisa X Rodríguez-Rojas
- Faculty of Health Sciences, Universidad Icesi, Cali 760032, Colombia.,Department of Genetics, Fundación Valle del Lili, Cali 760032, Colombia
| | - José A Nastasi-Catanese
- Faculty of Health Sciences, Universidad Icesi, Cali 760032, Colombia.,Department of Genetics, Fundación Valle del Lili, Cali 760032, Colombia
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64
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Plengpanich W, Muanpetch S, Charoen S, Kiateprungvej A, Khovidhunkit W. Genetic and functional studies of the LMF1 gene in Thai patients with severe hypertriglyceridemia. Mol Genet Metab Rep 2020; 23:100576. [PMID: 32190547 PMCID: PMC7068683 DOI: 10.1016/j.ymgmr.2020.100576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/23/2022] Open
Abstract
Severe hypertriglyceridemia (HTG) due to chylomicronemia is associated with acute pancreatitis and is related to genetic disturbances in several proteins involved in triglyceride (TG) metabolism. Lipase maturation factor 1 (LMF1) is a protein essential for the maturation of lipoprotein lipase (LPL). In this study, we examined the genetic spectrum of the LMF1 gene among subjects with severe HTG and investigated the functional significance of 6 genetic variants in vitro. All 11 exons of the LMF1 gene were sequenced in 101 Thai subjects with severe HTG. For an in vitro study, we performed site-directed mutagenesis, transient expression in cld cells, and measured LPL protein and LPL activity. We identified 2 common variants [p.(Gly36Asp) and p.(Pro562Arg)] and 12 rare variants [p.(Thr143Met), p.(Asn249Ser), p.(Ala287Val), p.(Met346Val), p.(Thr395Ile), p.(Gly410Arg), p.(Asp433Asn), p.(Asp491Asn), p.(Asn501Tyr), p.(Ala504Val), p.(Arg523His), and p.(Leu563Arg)] in 29 patients. In vitro study of the p.(Gly36Asp), p.(Asn249Ser), p.(Ala287Val), p.(Asn501Tyr), p.(Pro562Arg) and p.(Leu563Arg) variants, however, revealed that both LPL mass and LPL activity in each of the transfected cells were not significantly different from those in the wild type LMF1 transfected cells, suggesting that these variants might not play a significant role in severe HTG phenotype in our subjects. Among 101 subjects with severe hypertriglyceridemia (HTG), 2 common and 12 rare variants in the LMF1 gene were identified None of the 6 missense variants studied were associated with a reduction in lipoprotein mass or activity These rare variants in the LMF1 gene may not play an important role in severe HTG phenotypes in the Thai population
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Affiliation(s)
- Wanee Plengpanich
- Endocrinology and Metabolism Unit, Department of Medicine and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University, Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Patumwan, Bangkok 10330, Thailand
| | - Suwanna Muanpetch
- Endocrinology and Metabolism Unit, Department of Medicine and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University, Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Patumwan, Bangkok 10330, Thailand
| | - Supannika Charoen
- Endocrinology and Metabolism Unit, Department of Medicine and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University, Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Patumwan, Bangkok 10330, Thailand
| | - Arunrat Kiateprungvej
- Endocrinology and Metabolism Unit, Department of Medicine and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University, Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Patumwan, Bangkok 10330, Thailand
| | - Weerapan Khovidhunkit
- Endocrinology and Metabolism Unit, Department of Medicine and Hormonal and Metabolic Disorders Research Unit, Faculty of Medicine, Chulalongkorn University, Excellence Center in Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Patumwan, Bangkok 10330, Thailand
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65
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Matsunaga A, Nagashima M, Yamagishi H, Saku K. Variants of Lipid-Related Genes in Adult Japanese Patients with Severe Hypertriglyceridemia. J Atheroscler Thromb 2020; 27:1264-1277. [PMID: 32115487 PMCID: PMC7840158 DOI: 10.5551/jat.51540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Aim: Hypertriglyceridemia is a type of dyslipidemia that contributes to atherosclerosis and coronary heart disease. Variants in lipoprotein lipase (LPL), apolipoprotein CII (APOC2), apolipoprotein AV (APOA5), glycosylphosphatidylinositol- anchored high-density lipoprotein-binding protein 1 (GPIHBP1), lipase maturation factor 1 (LMF1), and glucokinase regulator (GCKR) are responsible for hypertriglyceridemia. We investigated the molecular basis of severe hypertriglyceridemia in adult patients referred to the Clinical Laboratory at Fukuoka University Hospital. Methods: Twenty-three adult patients with severe hypertriglyceridemia (> 1,000 mg/dL, 11.29 mmol/L) were selected. The coding regions of candidate genes were sequenced by next-generation sequencing. Forty-nine genes reportedly associated with hypertriglyceridemia were analyzed. Results: In the 23 patients, we detected 70 variants: 28 rare and 42 common ones. Among the 28 rare variants with < 1% allele frequency, p.I4533L in APOB, p.M490I in MLXIPL, p.L152M in NCAN, and p.S264T in TIMD4 were novel. We did not observe single gene homozygous or compound heterozygous disease-causing rare variants in any of the 23 hypertriglyceridemia cases. However, in silico algorithms and previous reports indicated that five rare variants, APOA5 (p.T184S), GCKR (c.354 + 1G>A), LMF1 (p.G410R), and LRP1 (p.G813R; p.R2173Q), and seven common variants, APOA5 (pG185C), APOE (p.C130R; p.E262K/p.E263K), GCKR (p.V103M), GPIHBP1 (p.C14F), LRP1 (p.Y4054F), and MLXIPL (p.Q241H), can cause hypertriglyceridemia. However, all five disease-causing rare variants detected in this study were heterozygous. Conclusions: The prevalence of disease-causing rare variants in candidate genes in severe hypertriglyceridemia patients was low. The major causes of severe hypertriglyceridemia were not single gene abnormalities, but involved multiple gene variations and environmental factors.
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Affiliation(s)
- Akira Matsunaga
- Department of Laboratory Medicine, Fukuoka University School of Medicine
| | - Mariko Nagashima
- Department of Laboratory Medicine, Fukuoka University School of Medicine
| | - Hideko Yamagishi
- Department of Laboratory Medicine, Fukuoka University School of Medicine
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
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66
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Dron JS, Wang J, McIntyre AD, Cao H, Hegele RA. The polygenic nature of mild-to-moderate hypertriglyceridemia. J Clin Lipidol 2020; 14:28-34.e2. [PMID: 32033914 DOI: 10.1016/j.jacl.2020.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with mild-to-moderate hypertriglyceridemia (HTG) are thought to share specific genetic susceptibility factors that are also present in patients with severe HTG, but no data have been reported on this issue. OBJECTIVE The objective of this study was to characterize genetic profiles of patients with mild-to-moderate HTG and compare them to patients with severe HTG. METHODS DNA from patients with mild-to-moderate HTG was sequenced using our targeted sequencing panel, "LipidSeq". For each patient, we assessed 1) rare variants disrupting five TG metabolism genes and 2) the accumulation of 16 common single-nucleotide polymorphisms (SNPs) using a polygenic risk score. The genetic profiles for these patients were then compared with normolipidemic controls from the 1000 Genomes Project and with patients with severe HTG. RESULTS Across 134 patients with mild-to-moderate HTG, 9.0% carried heterozygous rare variants and 26.9% had an excess accumulation of common SNPs. Patients with mild-to-moderate HTG were 2.38 times (95% CI [1.13-4.99]; P = .021) more likely to carry a rare variant and 3.26 times (95% CI [2.02-5.26]; P < .0001) more likely to have an extreme polygenic risk score compared with the 1000 Genomes Project. In addition, patients with severe HTG were 1.86 times (95% CI [0.98-3.51]; P = .032) more likely to carry a rare variant and 1.63 times (95% CI [1.07-2.48]; P = .013) more likely to have an extreme polygenic risk score than patients with mild-to-moderate HTG. CONCLUSIONS We report an increased prevalence of genetic determinants in patients with an increased severity of the HTG phenotype when considering either rare variants disrupting TG metabolism genes or an excess accumulation of common SNPs. As well, the findings confirm that the most prevalent genetic contributor to HTG, regardless of severity, is polygenic SNP accumulation.
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Affiliation(s)
- Jacqueline S Dron
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jian Wang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Adam D McIntyre
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Henian Cao
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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67
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Setia N, Movva S, Balakrishnan P, Biji IK, Sawhney JPS, Puri R, Arora A, Puri RD, Saxena R, Mishra S, Apte S, Kulshrestha S, Ramprasad VL, Verma IC. Genetic analysis of familial hypercholesterolemia in Asian Indians: A single-center study. J Clin Lipidol 2020; 14:35-45. [PMID: 32044282 DOI: 10.1016/j.jacl.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH), an autosomal codominant disorder characterized by very high low-density lipoprotein cholesterol, is strongly associated with premature coronary artery disease. OBJECTIVES Molecular landscape of FH in Asian Indians is not well studied, although this ethnic group comprises a large proportion of the world population. Knowledge of mutations in these groups is useful for identifying persons affected with FH, saving their lives, and cascade screening in their relatives. METHODS Potential cases of FH (n = 100) were identified by criteria adapted for the Indian population from Dutch Lipid Clinic Network criteria. Pathogenic variants were analyzed in LDLR, APOB 100 (exons 26 and 29), PCSK9, and APOE genes using Sanger sequencing and multiplex ligation-dependent probe amplification technique. Cases in whom there were no pathogenic variants were tested by next-generation sequencing using a targeted panel of genes. RESULTS Thirty-eight pathogenic variants were identified in 47 of 100 unrelated probands. Of these variants, 33 were identified in LDLR, 3 in APOB, and 2 in PCSK9 genes. Ten pathogenic variants were novel. Mutations were detected in 91.4% of those subjects classified as definite, 40% as probable, and in 18.8% as possible FH cases based on modified Dutch Lipid Clinic Network criteria. A likely founder mutation in intron 10 (c.1587-1G>A) of LDLR gene was observed in 6 North Indian families. The conventional pathogenic variants in APOB and PCSK9 genes and those previously reported in LDLR gene among Asian Indians were not detected in this cohort. CONCLUSION This study demonstrates genetic heterogeneity of FH in India. The variants observed were different from those described in Western populations. Next-generation sequencing technology helped identify new mutations in APOB gene, suggesting that in less-studied populations, it is better to sequence the whole gene rather than test for specific mutations.
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Affiliation(s)
- Nitika Setia
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.
| | - Sireesha Movva
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Prahlad Balakrishnan
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ishpreet K Biji
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Raman Puri
- Department of Cardiology, Indrapratha Apollo Hospital, New Delhi, India
| | - Anjali Arora
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ratna D Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Renu Saxena
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Samarth Kulshrestha
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Ishwar C Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.
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Abstract
Hypertriglyceridemia, a commonly encountered phenotype in cardiovascular and metabolic clinics, is surprisingly complex. A range of genetic variants, from single-nucleotide variants to large-scale copy number variants, can lead to either the severe or mild-to-moderate forms of the disease. At the genetic level, severely elevated triglyceride levels resulting from familial chylomicronemia syndrome (FCS) are caused by homozygous or biallelic loss-of-function variants in LPL, APOC2, APOA5, LMF1, and GPIHBP1 genes. In contrast, susceptibility to multifactorial chylomicronemia (MCM), which has an estimated prevalence of ~1 in 600 and is at least 50-100-times more common than FCS, results from two different types of genetic variants: (1) rare heterozygous variants (minor allele frequency <1%) with variable penetrance in the five causal genes for FCS; and (2) common variants (minor allele frequency >5%) whose individually small phenotypic effects are quantified using a polygenic score. There is indirect evidence of similar complex genetic predisposition in other clinical phenotypes that have a component of hypertriglyceridemia, such as combined hyperlipidemia and dysbetalipoproteinemia. Future considerations include: (1) evaluation of whether the specific type of genetic predisposition to hypertriglyceridemia affects medical decisions or long-term outcomes; and (2) searching for other genetic contributors, including the role of genome-wide polygenic scores, novel genes, non-linear gene-gene or gene-environment interactions, and non-genomic mechanisms including epigenetics and mitochondrial DNA.
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69
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Balashanmugam MV, Shivanandappa TB, Nagarethinam S, Vastrad B, Vastrad C. Analysis of Differentially Expressed Genes in Coronary Artery Disease by Integrated Microarray Analysis. Biomolecules 2019; 10:biom10010035. [PMID: 31881747 PMCID: PMC7022900 DOI: 10.3390/biom10010035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Coronary artery disease (CAD) is a major cause of end-stage cardiac disease. Although profound efforts have been made to illuminate the pathogenesis, the molecular mechanisms of CAD remain to be analyzed. To identify the candidate genes in the advancement of CAD, microarray dataset GSE23766 was downloaded from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) were identified, and pathway and gene ontology (GO) enrichment analyses were performed. The protein-protein interaction network was constructed and the module analysis was performed using the Biological General Repository for Interaction Datasets (BioGRID) and Cytoscape. Additionally, target genes-miRNA regulatory network and target genes-TF regulatory network were constructed and analyzed. There were 894 DEGs between male human CAD samples and female human CAD samples, including 456 up regulated genes and 438 down regulated genes. Pathway enrichment analyses revealed that DEGs (up and down regulated) were mostly enriched in the superpathway of steroid hormone biosynthesis, ABC transporters, oxidative ethanol degradation III and Complement and coagulation cascades. Similarly, geneontology enrichment analyses revealed that DEGs (up and down regulated) were mostly enriched in the forebrain neuron differentiation, filopodium membrane, platelet degranulation and blood microparticle. In the PPI network and modules (up and down regulated), MYC, NPM1, TRPC7, UBC, FN1, HEMK1, IFT74 and VHL were hub genes. In the target genes-miRNA regulatory network and target genes—TF regulatory network (up and down regulated), TAOK1, KHSRP, HSD17B11 and PAH were target genes. In conclusion, the pathway and GO ontology enriched by DEGs may reveal the molecular mechanism of CAD. Its hub and target genes, MYC, NPM1, TRPC7, UBC, FN1, HEMK1, IFT74, VHL, TAOK1, KHSRP, HSD17B11 and PAH were expected to be new targets for CAD. Our finding provided clues for exploring molecular mechanism and developing new prognostics, diagnostic and therapeutic strategies for CAD.
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Affiliation(s)
- Meenashi Vanathi Balashanmugam
- Department of Biomedical Sciences, College of Pharmacy, Shaqra University, Al Dawadmi 11911, Saudi Arabia; (M.V.B.); (T.B.S.); (S.N.)
| | - Thippeswamy Boreddy Shivanandappa
- Department of Biomedical Sciences, College of Pharmacy, Shaqra University, Al Dawadmi 11911, Saudi Arabia; (M.V.B.); (T.B.S.); (S.N.)
| | - Sivagurunathan Nagarethinam
- Department of Biomedical Sciences, College of Pharmacy, Shaqra University, Al Dawadmi 11911, Saudi Arabia; (M.V.B.); (T.B.S.); (S.N.)
| | - Basavaraj Vastrad
- Department of Pharmaceutics, SET’S College of Pharmacy, Dharwad, Karnataka 580002, India;
| | - Chanabasayya Vastrad
- Biostatistics and Bioinformatics, Chanabasava Nilaya, Bharthinagar, Dharwad 580001, Karanataka
- Correspondence: ; Tel.: +91-9480-073398
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70
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Garg A, Garg V, Hegele RA, Lewis GF. Practical definitions of severe versus familial hypercholesterolaemia and hypertriglyceridaemia for adult clinical practice. Lancet Diabetes Endocrinol 2019; 7:880-886. [PMID: 31445954 DOI: 10.1016/s2213-8587(19)30156-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022]
Abstract
Diagnostic scoring systems for familial hypercholesterolaemia and familial chylomicronaemia syndrome often cannot differentiate between adults who have extreme dyslipidaemia based on a simple monogenic cause versus people with a more complex cause involving polygenic factors and an environmental component. This more complex group of patients carries a substantial risk of atherosclerotic cardiovascular disease in the case of marked hypercholesterolaemia and pancreatitis in the case of marked hypertriglyceridaemia. Complications are mainly a function of the degree of disturbance in lipid metabolism resulting in elevated lipid levels, so the added value of knowing the precise genetic cause in clinical decision making is unclear and does not lead to clinically meaningful benefit. We propose that for severe elevations of plasma low density lipoprotein cholesterol or triglyceride, the primary factor driving intervention should be the biochemical perturbation rather than the clinical risk score. This underscores the importance of expanding the definition of severe dyslipidaemias and to not rely solely on clinical scoring systems to identify individuals who would benefit from appropriate treatment approaches. We advocate for the use of simple, practical, clinical, and largely biochemically based definitions for severe hypercholesterolaemia (eg, LDL cholesterol >5 mmol/L) and severe hypertriglyceridaemia (triglyceride >10 mmol/L), which complement current definitions of familial hypercholesterolaemia and familial chylomicronaemia syndrome. Irrespective of the precise genetic cause, individuals diagnosed with severe hypercholesterolaemia and severe hypertriglyceridaemia require intensive therapy, including special consideration for new effective but more expensive therapies.
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Affiliation(s)
- Ankit Garg
- Departments of Medicine and Physiology, Division of Endocrinology and Metabolism, Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Vinay Garg
- Departments of Medicine and Physiology, Division of Endocrinology and Metabolism, Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gary F Lewis
- Departments of Medicine and Physiology, Division of Endocrinology and Metabolism, Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada.
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71
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Ariza MJ, Pérez-López C, Almagro F, Sánchez-Tévar AM, Muñiz-Grijalvo O, Álvarez-Sala Walter LA, Rioja J, Sánchez-Chaparro MÁ, Valdivielso P. Genetic variants in the LPL and GPIHBP1 genes, in patients with severe hypertriglyceridaemia, detected with high resolution melting analysis. Clin Chim Acta 2019; 500:163-171. [PMID: 31669931 DOI: 10.1016/j.cca.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Pathogenic variants in lipoprotein lipase (LPL) and glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) have been described in patients with severe hypertriglyceridaemia. We aimed to optimise high resolution melting (HRM) assays to detect the presence of functional variants in these genes. METHODS One hundred and sixteen patients with severe hypertriglyceridaemia were studied. HRM assays were optimised to scan exons and splice junctions in LPL and GPIHBP1. Sanger sequencing was the reference method. Next-generation-sequencing (NGS) was performed in five patients, including one with Familial Chylomicronemia syndrome (FCS). RESULTS We identified 15 different variants in LPL and 6 in GPIHBP1. The variants revealed with NGS were also detected with HRM, including a rare premature stop codon in LPL (p.Trp421*) and two LPL pathogenic variants in the patient with FCS (p.His80Arg + p.Gly215Glu). Having multiple functional variant alleles was associated with pancreatitis onset at younger ages and higher baseline triglycerides. CONCLUSIONS Our HRM assays detected the presence of functional gene variants that were confirmed with Sanger and NGS sequencing. The presence of multiple functional variant alleles was associated with differences in the clinical profile. Therefore, these assays represent a reliable, cost-effective tool that can be used to complement the NGS approach for gene scanning.
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Affiliation(s)
- María José Ariza
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain.
| | - Carmen Pérez-López
- Internal Medicine Unit, University Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - Fátima Almagro
- Lipids Unit, Internal Medicine, University Hospital Donostia, San Sebastian, Begiristain Doktorea Pasealekua, 107-115, 20014 Donostia, Gipuzkoa, Spain
| | - Ana María Sánchez-Tévar
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain
| | - Ovidio Muñiz-Grijalvo
- UCERV-UCAMI, Internal Medicine Department, University Hospital Virgen del Rocío, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
| | - Luis Antonio Álvarez-Sala Walter
- Lipids Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, IiSGM, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Av. Séneca, 2, 28040 Madrid, Spain
| | - José Rioja
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain
| | - Miguel Ángel Sánchez-Chaparro
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain; Internal Medicine Unit, University Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - Pedro Valdivielso
- Department of Medicine and Dermatology, Lipids and Atherosclerosis Laboratory, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, C/Marqués de Beccaria n° 3, 29010 Málaga, Spain; Internal Medicine Unit, University Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
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72
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D'Erasmo L, Di Costanzo A, Cassandra F, Minicocci I, Polito L, Montali A, Ceci F, Arca M. Spectrum of Mutations and Long-Term Clinical Outcomes in Genetic Chylomicronemia Syndromes. Arterioscler Thromb Vasc Biol 2019; 39:2531-2541. [PMID: 31619059 DOI: 10.1161/atvbaha.119.313401] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Familial chylomicronemia syndrome (FCS) and multifactorial chylomicronemia syndrome (MCS) are the prototypes of monogenic and polygenic conditions underlying genetically based severe hypertriglyceridemia. These conditions have been only partially investigated so that a systematic comparison of their characteristics remains incomplete. We aim to compare genetic profiles and clinical outcomes in FCS and MCS. Approach and Results: Thirty-two patients with severe hypertriglyceridemia (triglyceride >1000 mg/dL despite lipid-lowering treatments with or without history of acute pancreatitis) were enrolled. Rare and common variants were screened using a panel of 18 triglyceride-raising genes, including the canonical LPL, APOC2, APOA5, GP1HBP1, and LMF1. Clinical information was collected retrospectively for a median period of 44 months. Across the study population, 37.5% were classified as FCS due to the presence of biallelic, rare mutations and 59.4% as MCS due to homozygosity for nonpathogenic or heterozygosity for pathogenic variants in canonical genes, as well as for rare and low frequency variants in noncanonical genes. As compared with MCS, FCS patients showed a lower age of hypertriglyceridemia onset, higher levels of on-treatment triglycerides, and 3-fold higher incidence rate of acute pancreatitis. CONCLUSIONS Our data indicate that the genetic architecture and natural history of FCS and MCS are different. FCS expressed the most severe clinical phenotype as determined by resistance to triglyceride-lowering medications and higher incidence of acute pancreatitis episodes. The most common genetic abnormality underlying FCS was represented by biallelic mutations in LPL while APOA5 variants, in combination with high rare polygenic burden, were the most frequent genotype of MCS.
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Affiliation(s)
- Laura D'Erasmo
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
| | - Alessia Di Costanzo
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
| | - Francesca Cassandra
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
| | - Ilenia Minicocci
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
| | - Luca Polito
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
| | - Anna Montali
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
| | - Fabrizio Ceci
- Department of Experimental Medicine (F. Ceci), Sapienza University of Rome, Italy
| | - Marcello Arca
- From the Department of Internal Medicine and Medical Specialties (L.D., A.D.C., F. Cassandra, I.M., L.P., A.M., M.A.), Sapienza University of Rome, Italy
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O'Dea LSL, MacDougall J, Alexander VJ, Digenio A, Hubbard B, Arca M, Moriarty PM, Kastelein JJP, Bruckert E, Soran H, Witztum JL, Hegele RA, Gaudet D. Differentiating Familial Chylomicronemia Syndrome From Multifactorial Severe Hypertriglyceridemia by Clinical Profiles. J Endocr Soc 2019; 3:2397-2410. [PMID: 31777768 PMCID: PMC6864364 DOI: 10.1210/js.2019-00214] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
Context Differentiation between familial chylomicronemia syndrome (FCS, type 1 hyperlipoproteinemia), a rare metabolic disorder, and the more common multifactorial severe hypertriglyceridemia (sHTG, type 5 hyperlipoproteinemia) is challenging because of their overlapping symptoms but important in patient management. Objective To assess whether readily obtainable clinical information beyond triglycerides can effectively diagnose and differentiate patients with FCS from those with sHTG, based on well-curated data from two intervention studies of these conditions. Methods The analysis included 154 patients from two phase 3 clinical trials of patients with sHTG, one cohort with genetically confirmed FCS (n = 49) and one with multifactorial sHTG (n = 105). Logistic regression analyses were performed to determine the ability of variables (patient demographics, medical history, and baseline lipids, individually or in sets) to differentiate the patient populations. Receiver operating characteristics were used to determine the variable sets with the highest accuracy (percentage of times actual values matched predicted) and optimal sensitivity and specificity. Results The primary model diagnosed 45 of 49 patients with FCS and 99 of 105 patients with sHTG correctly. Optimal sensitivity for all available parameters (n = 17) was 91.8%, optimal specificity was 94.3%, and accuracy was 93.5%. Fasting low-density lipoprotein cholesterol (LDL-C) provided the highest individual predictability. However, a three-variable set of ultracentrifugally measured LDL-C, body mass index, and pancreatitis history differentiated the diseases with a near similar accuracy of 91.0%, and adding high-density lipoprotein cholesterol and very low-density lipoprotein cholesterol for a five-variable set provided a small incremental increase in accuracy (92.2%). Conclusions In the absence of genetic testing, hypertriglyceridemic patients with FCS and sHTG can be differentiated with a high degree of accuracy by analyzing readily obtainable clinical information.
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Affiliation(s)
| | | | | | | | | | - Marcello Arca
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Patrick M Moriarty
- Department of Medicine, Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, Kansas
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, AZ Amsterdam, Netherlands
| | - Eric Bruckert
- Institut E3M et IHU Cardiométabolique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Handrean Soran
- Manchester University Hospital NHS Trust, Manchester, England
| | | | - Robert A Hegele
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Daniel Gaudet
- Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, Quebec, Canada
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Abstract
Our understanding of the role of the vascular endothelium has evolved over the past 2 decades, with the recognition that it is a dynamically regulated organ and that it plays a nodal role in a variety of physiological and pathological processes. Endothelial cells (ECs) are not only a barrier between the circulation and peripheral tissues, but also actively regulate vascular tone, blood flow, and platelet function. Dysregulation of ECs contributes to pathological conditions such as vascular inflammation, atherosclerosis, hypertension, cardiomyopathy, retinopathy, neuropathy, and cancer. The close anatomic relationship between vascular endothelium and highly vascularized metabolic organs/tissues suggests that the crosstalk between ECs and these organs is vital for both vascular and metabolic homeostasis. Numerous reports support that hyperlipidemia, hyperglycemia, and other metabolic stresses result in endothelial dysfunction and vascular complications. However, how ECs may regulate metabolic homeostasis remains poorly understood. Emerging data suggest that the vascular endothelium plays an unexpected role in the regulation of metabolic homeostasis and that endothelial dysregulation directly contributes to the development of metabolic disorders. Here, we review recent studies about the pivotal role of ECs in glucose and lipid homeostasis. In particular, we introduce the concept that the endothelium adjusts its barrier function to control the transendothelial transport of fatty acids, lipoproteins, LPLs (lipoprotein lipases), glucose, and insulin. In addition, we summarize reports that ECs communicate with metabolic cells through EC-secreted factors and we discuss how endothelial dysregulation contributes directly to the development of obesity, insulin resistance, dyslipidemia, diabetes mellitus, cognitive defects, and fatty liver disease.
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Affiliation(s)
- Xinchun Pi
- From the Section of Athero & Lipo, Department of Medicine, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (X.P., L.X.)
| | - Liang Xie
- From the Section of Athero & Lipo, Department of Medicine, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX (X.P., L.X.)
| | - Cam Patterson
- University of Arkansas for Medical Sciences, Little Rock (C.P.)
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75
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Dron JS, Wang J, McIntyre AD, Cao H, Robinson JF, Duell PB, Manjoo P, Feng J, Movsesyan I, Malloy MJ, Pullinger CR, Kane JP, Hegele RA. Partial LPL deletions: rare copy-number variants contributing towards severe hypertriglyceridemia. J Lipid Res 2019; 60:1953-1958. [PMID: 31519763 DOI: 10.1194/jlr.p119000335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/09/2019] [Indexed: 01/31/2023] Open
Abstract
Severe hypertriglyceridemia (HTG) is a relatively common form of dyslipidemia with a complex pathophysiology and serious health complications. HTG can develop in the presence of rare genetic factors disrupting genes involved in the triglyceride (TG) metabolic pathway, including large-scale copy-number variants (CNVs). Improvements in next-generation sequencing technologies and bioinformatic analyses have better allowed assessment of CNVs as possible causes of or contributors to severe HTG. We screened targeted sequencing data of 632 patients with severe HTG and identified partial deletions of the LPL gene, encoding the central enzyme involved in the metabolism of TG-rich lipoproteins, in four individuals (0.63%). We confirmed the genomic breakpoints in each patient with Sanger sequencing. Three patients carried an identical heterozygous deletion spanning the 5' untranslated region (UTR) to LPL exon 2, and one patient carried a heterozygous deletion spanning the 5'UTR to LPL exon 1. All four heterozygous CNV carriers were determined to have multifactorial severe HTG. The predicted null nature of our identified LPL deletions may contribute to relatively higher TG levels and a more severe clinical phenotype than other forms of genetic variation associated with the disease, particularly in the polygenic state. The identification of novel CNVs in patients with severe HTG suggests that methods for CNV detection should be included in the diagnostic workup and molecular genetic evaluation of patients with high TG levels.
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Affiliation(s)
- Jacqueline S Dron
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada.,Departments of Biochemistry Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - Jian Wang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - Adam D McIntyre
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - Henian Cao
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - John F Robinson
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - P Barton Duell
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR 97239
| | - Priya Manjoo
- Department of Medicine, Gordon and Leslie Diamond Centre, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - James Feng
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94158
| | - Irina Movsesyan
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94158
| | - Mary J Malloy
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94158
| | - Clive R Pullinger
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94158
| | - John P Kane
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94158
| | - Robert A Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada .,Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada.,Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
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76
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Witztum JL, Gaudet D, Freedman SD, Alexander VJ, Digenio A, Williams KR, Yang Q, Hughes SG, Geary RS, Arca M, Stroes ESG, Bergeron J, Soran H, Civeira F, Hemphill L, Tsimikas S, Blom DJ, O'Dea L, Bruckert E. Volanesorsen and Triglyceride Levels in Familial Chylomicronemia Syndrome. N Engl J Med 2019; 381:531-542. [PMID: 31390500 DOI: 10.1056/nejmoa1715944] [Citation(s) in RCA: 322] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Familial chylomicronemia syndrome is a rare genetic disorder that is caused by loss of lipoprotein lipase activity and characterized by chylomicronemia and recurrent episodes of pancreatitis. There are no effective therapies. In an open-label study of three patients with this syndrome, antisense-mediated inhibition of hepatic APOC3 mRNA with volanesorsen led to decreased plasma apolipoprotein C-III and triglyceride levels. METHODS We conducted a phase 3, double-blind, randomized 52-week trial to evaluate the safety and effectiveness of volanesorsen in 66 patients with familial chylomicronemia syndrome. Patients were randomly assigned, in a 1:1 ratio, to receive volanesorsen or placebo. The primary end point was the percentage change in fasting triglyceride levels from baseline to 3 months. RESULTS Patients receiving volanesorsen had a decrease in mean plasma apolipoprotein C-III levels from baseline of 25.7 mg per deciliter, corresponding to an 84% decrease at 3 months, whereas patients receiving placebo had an increase in mean plasma apolipoprotein C-III levels from baseline of 1.9 mg per deciliter, corresponding to a 6.1% increase (P<0.001). Patients receiving volanesorsen had a 77% decrease in mean triglyceride levels, corresponding to a mean decrease of 1712 mg per deciliter (19.3 mmol per liter) (95% confidence interval [CI], 1330 to 2094 mg per deciliter [15.0 to 23.6 mmol per liter]), whereas patients receiving placebo had an 18% increase in mean triglyceride levels, corresponding to an increase of 92.0 mg per deciliter (1.0 mmol per liter) (95% CI, -301.0 to 486 mg per deciliter [-3.4 to 5.5 mmol per liter]) (P<0.001). At 3 months, 77% of the patients in the volanesorsen group, as compared with 10% of patients in the placebo group, had triglyceride levels of less than 750 mg per deciliter (8.5 mmol per liter). A total of 20 of 33 patients who received volanesorsen had injection-site reactions, whereas none of the patients who received placebo had such reactions. No patients in the placebo group had platelet counts below 100,000 per microliter, whereas 15 of 33 patients in the volanesorsen group had such levels, including 2 who had levels below 25,000 per microliter. No patient had platelet counts below 50,000 per microliter after enhanced platelet-monitoring began. CONCLUSIONS Volanesorsen lowered triglyceride levels to less than 750 mg per deciliter in 77% of patients with familial chylomicronemia syndrome. Thrombocytopenia and injection-site reactions were common adverse events. (Funded by Ionis Pharmaceuticals and Akcea Therapeutics; APPROACH Clinical Trials.gov number, NCT02211209.).
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Affiliation(s)
- Joseph L Witztum
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Daniel Gaudet
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Steven D Freedman
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Veronica J Alexander
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Andres Digenio
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Karren R Williams
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Qingqing Yang
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Steven G Hughes
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Richard S Geary
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Marcello Arca
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Erik S G Stroes
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Jean Bergeron
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Handrean Soran
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Fernando Civeira
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Linda Hemphill
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Sotirios Tsimikas
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Dirk J Blom
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Louis O'Dea
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Eric Bruckert
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
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The Role of Genetics in Cardiovascular Risk Reduction: Findings From a Single Lipid Clinic and Review of the Literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:200-204. [PMID: 31153847 DOI: 10.1016/j.carrev.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Genetic information is not routinely obtained in the management of most lipid disorders or in primary or secondary prevention of cardiovascular disease (CVD). We sought to determine the prevalence of pathogenic variants associated with lipoprotein metabolism or coronary artery disease (CAD) in a single lipid clinic and discuss the future use of genetic information in CVD prevention. METHODS Genetic testing was offered to patients with hypertriglyceridemia (defined as pre-treatment fasting triglycerides ≥150 mg/dL), elevated LDL-C (defined as pre-treatment ≥190 mg/dL), low HDL-C (defined as ≤40 mg/dL), elevated lipoprotein (a) (defined as ≥50 mg/dL or 100 nmol/L) or premature CAD (defined as an acute coronary syndrome or revascularization before age 40 years in men and 50 years in women) using next-generation DNA sequencing of 327 exons and selected variants in 129 genes known or suspected to be associated with lipoprotein metabolism or CAD. RESULTS 82 of 84 patients (97.6%) were found to have a variant associated with abnormal lipid metabolism or CAD. The most common pathogenic or likely pathogenic variants included those of the LDL receptor (15 patients) and lipoprotein lipase (9 patients). Other common variants included those of apolipoprotein A5 (14 patients) and variants associated with elevated lipoprotein (a) (25 patients). CONCLUSIONS The majority of patients presenting to a single lipid clinic were found to have at least one variant associated with abnormal lipoprotein metabolism or CAD. Incorporating genetic information, including the use of genetic risk scores, is anticipated in the future care of lipid disorders and CVD prevention.
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Chait A, Eckel RH. The Chylomicronemia Syndrome Is Most Often Multifactorial: A Narrative Review of Causes and Treatment. Ann Intern Med 2019; 170:626-634. [PMID: 31035285 DOI: 10.7326/m19-0203] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The chylomicronemia syndrome occurs when triglyceride levels are severely elevated (usually >16.95 mmol/L [1500 mg/dL]) and is characterized by such clinical features as abdominal pain, acute pancreatitis, eruptive xanthomas, and lipemia retinalis. It may result from 1 of 3 conditions: the presence of secondary forms of hypertriglyceridemia concurrent with genetic causes of hypertriglyceridemia, termed multifactorial chylomicronemia syndrome (MFCS); a deficiency in the enzyme lipoprotein lipase and some associated proteins, termed familial chylomicronemia syndrome (FCS); or familial partial lipodystrophy. Most chylomicronemia syndrome cases are the result of MFCS; FCS is very rare. In all these conditions, triglyceride-rich lipoproteins accumulate because of impaired plasma clearance. This review describes the 3 major causes of the chylomicronemia syndrome; their consequences; and the approaches to treatment, which differ considerably by group.
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Affiliation(s)
- Alan Chait
- University of Washington, Seattle, Washington (A.C.)
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, Colorado (R.H.E.)
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Verbeek R, Oldoni F, Surendran RP, Zwinderman AH, Khaw KT, Stroes ESG, Wareham NJ, Boekholdt SM, Dallinga-Thie GM. A 3-SNP gene risk score and a metabolic risk score both predict hypertriglyceridemia and cardiovascular disease risk. J Clin Lipidol 2019; 13:492-501. [PMID: 30910668 DOI: 10.1016/j.jacl.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/24/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evidence on the causal link between plasma triglyceride (TG) levels and risk for cardiovascular disease (CVD) has recently emerged. Individuals with the metabolic syndrome have an increased risk for acquiring elevated TG levels later in life. Moreover, common DNA sequence variations in genes affecting TG levels identify individuals at risk for elevated plasma TG levels. OBJECTIVE We evaluated whether a 3-single nucleotide polymorphism (SNP) TG gene risk score (GRS) and a metabolic risk score (MetRS) both improved CVD risk prediction. METHODS A 3-SNP GRS and MetRS were generated in the EPIC-Norfolk cohort (n = 20,074) based on 3 SNPs in LPL and APOA5 or the number of Metabolic Syndrome criteria present (maximum 5), respectively. The associations between the 3-SNP GRS, MetRS, TG levels, and CVD risk were evaluated. RESULTS The 3-SNP GRS and MetRS were both linearly associated with plasma TG levels, that is, +0.25 mmol/L [95% CI 0.22-0.27] per allele change (P < .001) and +0.72 mmol/L [95% CI 0.70-0.73] per increase of number of metabolic syndrome risk score points (P < .001), respectively. We observed a positive association between the 3-SNP GRS and the risk of CVD with an adjusted hazard ratio (HR) of 1.35 [95% CI 1.04-1.74] for the highest versus the lowest GRS, which was independent of the MetRS. For the MetRS, the adjusted HR was 2.03 [95% CI 1.73-2.40] for the highest versus the lowest MetRS. CONCLUSION Both the 3-SNP GRS and the MetRS are associated with increased plasma TG levels and increased risk for CVD.
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Affiliation(s)
- Rutger Verbeek
- Departments of Vascular Medicine and Experimental Vascular Medicine, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Federico Oldoni
- Department of Pediatrics, Section of Molecular Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - R Preethi Surendran
- Departments of Vascular Medicine and Experimental Vascular Medicine, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Ailko H Zwinderman
- Department of Biostatistics, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Kay T Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Erik S G Stroes
- Departments of Vascular Medicine and Experimental Vascular Medicine, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Nick J Wareham
- Medical Research Council Epidemiology Unit, Cambridge, United Kingdom
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Geesje M Dallinga-Thie
- Departments of Vascular Medicine and Experimental Vascular Medicine, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, the Netherlands.
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80
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Diabetic Ketoacidosis Revealing a Severe Hypertriglyceridemia and Acute Pancreatitis in Type 1 Diabetes Mellitus. Case Rep Endocrinol 2019; 2019:8974619. [PMID: 30723557 PMCID: PMC6339756 DOI: 10.1155/2019/8974619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/01/2018] [Accepted: 12/26/2018] [Indexed: 11/17/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Investigations revealed hypertriglyceridemia at 64g/L, lipasemia at 1000 U/L, and stage E pancreatitis on abdominal CT. The patient was treated with intravenous insulin, rehydration, and fenofibrate with good clinical and biological evolution. Severe hypertriglyceridemia causing pancreatitis in type 1 diabetes mellitus is a rare but very serious complication of DKA in children.
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81
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Chyzhyk V, Kozmic S, Brown AS, Hudgins LC, Starc TJ, Davila AD, Blevins TC, Diffenderfer MR, He L, Geller AS, Rush C, Hegele RA, Schaefer EJ. Extreme hypertriglyceridemia: Genetic diversity, pancreatitis, pregnancy, and prevalence. J Clin Lipidol 2019; 13:89-99. [DOI: 10.1016/j.jacl.2018.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/06/2018] [Accepted: 09/11/2018] [Indexed: 12/22/2022]
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82
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Severe hypertriglyceridemia is primarily polygenic. J Clin Lipidol 2019; 13:80-88. [DOI: 10.1016/j.jacl.2018.10.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/22/2022]
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83
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Surendran RP, Udayyapan SD, Clemente-Postigo M, Havik SR, Schimmel AWM, Tinahones F, Nieuwdorp M, Dallinga-Thie GM. Decreased GPIHBP1 protein levels in visceral adipose tissue partly underlie the hypertriglyceridemic phenotype in insulin resistance. PLoS One 2018; 13:e0205858. [PMID: 30408040 PMCID: PMC6224034 DOI: 10.1371/journal.pone.0205858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/02/2018] [Indexed: 01/29/2023] Open
Abstract
GPIHBP1 is a protein localized at the endothelial cell surface that facilitates triglyceride (TG) lipolysis by binding lipoprotein lipase (LPL). Whether Glycosyl Phosphatidyl Inositol high density lipoprotein binding protein 1 (GPIHBP1) function is impaired and may underlie the hyperTG phenotype observed in type 2 diabetes is not yet established. To elucidate the mechanism underlying impaired TG homeostasis in insulin resistance state we studied the effect of insulin on GPIHBP1 protein expression in human microvascular endothelial cells (HMVEC) under flow conditions. Next, we assessed visceral adipose tissue GPIHBP1 protein expression in type 2 diabetes Leprdb/db mouse model as well as in subjects with ranging levels of insulin resistance. We report that insulin reduces the expression of GPIHBP1 protein in HMVECs. Furthermore, GPIHBP1 protein expression in visceral adipose tissue in Leprdb/db mice is significantly reduced as is the active monomeric form of GPIHBP1 as compared to Leprdb/m mice. A similar decrease in GPIHBP1 protein was observed in subjects with increased body weight. GPIHBP1 protein expression was negatively associated with insulin and HOMA-IR. In conclusion, our data suggest that decreased GPIHBP1 availability in insulin resistant state may hamper peripheral lipolysis capacity.
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Affiliation(s)
- R. Preethi Surendran
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Shanti D. Udayyapan
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Malaga, Malaga, Spain
- CIBER Fisiopatologia de la Obesidad y Nutrición (CB06/03), Barcelona, Spain
| | - Stefan R. Havik
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Alinda W. M. Schimmel
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Fransisco Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Malaga, Malaga, Spain
- CIBER Fisiopatologia de la Obesidad y Nutrición (CB06/03), Barcelona, Spain
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Geesje M. Dallinga-Thie
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga (Virgen de la Victoria)/Universidad de Malaga, Malaga, Spain
- * E-mail:
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84
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Intensive genetic analysis for Chinese patients with very high triglyceride levels: Relations of mutations to triglyceride levels and acute pancreatitis. EBioMedicine 2018; 38:171-177. [PMID: 30420299 PMCID: PMC6306308 DOI: 10.1016/j.ebiom.2018.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/27/2018] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Abstract
Background Severe hypertriglyceridemia (SHTG, TG ≥5·65 mmol/L), a disease, usually resulting from a combination of genetic and environmental factors, may increase the risk of acute pancreatitis (AP). However, previous genetic analysis has been limited by lacking of related observation of gene to AP. Methods The expanding genetic sequencing including 15 TG-related genes (LPL, LMF1, APOC2, GPIHBP1, GCKR, ANGPTL3, APOB, APOA1-A4-C3-A5, TRIB1, CETP, APOE, and LIPI) was performed within 103 patients who were diagnosed with primary SHTG and 46 age- and sex-matched normal controls. Findings Rare variants were found in 46 patients and 12 controls. The detection rate of rare variants in SHTG group increased by 19·5% via intensive genetic analysis. Presence of rare variants in LPL, APOA5, five LPL molecular regulating genes and all the sequenced genes were found to be associated with SHTG (p < 0·05). Of noted, patients with history of AP presented higher frequency of rare variants in LPL gene and all the LPL molecular regulating genes (27·8% vs.4·7% and 50·0% vs. 20·0%). The risk scores for SHTG determined by common TG-associated variants were increased in subgroups according to the extent of SHTG when they were compared with that of controls. Finally, patients without rare variants within SHTG group also presented higher risk scores than control group (p < 0·05). Interpretation Expanding genetic analysis had a higher detection rate of rare variants in patients with SHTG. Rare variants in LPL and its molecular regulating genes could increase the risk of AP among Chinese patients with SHTG. Fund This work was partially supported by the Capital Health Development Fund (201614035) and CAMS. Major Collaborative Innovation Project (2016-I2M-1-011) awarded to Dr. Jian-Jun Li, MD, PhD.
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85
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Ariza MJ, Rioja J, Ibarretxe D, Camacho A, Díaz-Díaz JL, Mangas A, Carbayo-Herencia JA, Ruiz-Ocaña P, Lamíquiz-Moneo I, Mosquera D, Sáenz P, Masana L, Muñiz-Grijalvo O, Pérez-Calahorra S, Valdivielso P, Suárez Tembra M, Iglesias GP, Carbayo Herencia J, Guerrero Buitrago C, Vila L, Morales Coca C, Llargués Rocabruna E, Perea Castillo V, Pedro-Botet J, Climent E, Mauri Pont M, Pinto X, Ortega Martínez de la Victoria E, Amor J, Zambón Rados D, Blanco Vaca F, Ramiro Lozano J, Fuentes Jiménez F, Soler I, Ferrer C, Zamora Cervantes A, Vila Belmonte A, Novoa Mogollón F, Sanchez-Hernández R, Expósito Montesdeoca A, Romero Jiménez M, González García M, Bueno Díez M, Brea Hernando A, Lahoz C, Mostaza Prieto J, Millán Núñez-Cortés J, Reinares García L, Blanco Echevarría A, Ariza Corbo MJ, Rioja Villodres J, Sánchez-Chaparro M, Jansen Chaparro S, Sáenz Aranzubía P, Martorell Mateu E, Almagro Múgica F, Muñiz Grijalvo O, Masana Martín L, Plana Gil N, Ibarretxe Gerediaga D, Rodríguez Borjabad C, Zabala López S, Hernández Mijares A, Ascaso Gimilio J, Pérez García L, Civeira Murillo F, Pérez-Calahorra S, Lamiquiz-Moneo I, Mateo Gallego R, Marco Benedí V, Ferrando Vela J. Molecular basis of the familial chylomicronemia syndrome in patients from the National Dyslipidemia Registry of the Spanish Atherosclerosis Society. J Clin Lipidol 2018; 12:1482-1492.e3. [DOI: 10.1016/j.jacl.2018.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/09/2018] [Accepted: 07/24/2018] [Indexed: 01/16/2023]
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86
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Clinical whole exome sequencing in severe hypertriglyceridemia. Clin Chim Acta 2018; 488:31-39. [PMID: 30389453 DOI: 10.1016/j.cca.2018.10.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little data exist regarding the clinical application of whole exome sequencing (WES) for the molecular diagnosis of severe hypertriglyceridemia (HTG). METHODS WES was performed for 28 probands exhibiting severe HTG (≥1000 mg/dl) without any transient causes. We evaluated recessive and dominant inheritance models in known monogenic HTG genes, followed by disease-network gene prioritization and copy number variation (CNV) analyses to identify causative variants and a novel genetic mechanism for severe HTG. RESULTS We identified possible causative variants for severe HTG, including three novel variants, in nine probands (32%). In the recessive inheritance model, we identified two homozygous subjects with lipoprotein lipase (LPL) deficiency and one subject harboring compound heterozygous variants in both LPL and APOA5 genes (hyperchylomicronemia). In the dominant inheritance model, we identified probands harboring deleterious heterozygous variants in LPL, glucokinase regulatory protein, and solute carrier family 25 member 40 genes, possibly associated with this extreme HTG phenotype. However, gene prioritization and CNV analyses did not validate the novel genes associated with severe HTG. CONCLUSIONS In 28 probands with severe HTG, we identified potential causative variants within nine genes associated with rare Mendelian dyslipidemias. Clinical WES may be feasible for such extreme cases, potentially leading to appropriate therapies.
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87
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GPIHBP1 autoantibody syndrome during interferon β1a treatment. J Clin Lipidol 2018; 13:62-69. [PMID: 30514621 DOI: 10.1016/j.jacl.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/21/2018] [Accepted: 10/12/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Autoantibodies against glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) cause chylomicronemia by blocking the ability of GPIHBP1 to bind lipoprotein lipase (LPL) and transport the enzyme to its site of action in the capillary lumen. OBJECTIVE A patient with multiple sclerosis developed chylomicronemia during interferon (IFN) β1a therapy. The chylomicronemia resolved when the IFN β1a therapy was discontinued. Here, we sought to determine whether the drug-induced chylomicronemia was caused by GPIHBP1 autoantibodies. METHODS We tested plasma samples collected during and after IFN β1a therapy for GPIHBP1 autoantibodies (by western blotting and with enzyme-linked immunosorbent assays). We also tested whether the patient's plasma blocked the binding of LPL to GPIHBP1 on GPIHBP1-expressing cells. RESULTS During IFN β1a therapy, the plasma contained GPIHBP1 autoantibodies, and those autoantibodies blocked GPIHBP1's ability to bind LPL. Thus, the chylomicronemia was because of the GPIHBP1 autoantibody syndrome. Consistent with that diagnosis, the plasma levels of GPIHBP1 and LPL were very low. After IFN β1a therapy was stopped, the plasma triglyceride levels returned to normal, and GPIHBP1 autoantibodies were undetectable. CONCLUSION The appearance of GPIHBP1 autoantibodies during IFN β1a therapy caused chylomicronemia. The GPIHBP1 autoantibodies disappeared when the IFN β1a therapy was stopped, and the plasma triglyceride levels fell within the normal range.
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88
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Liu C, Li L, Guo D, Lv Y, Zheng X, Mo Z, Xie W. Lipoprotein lipase transporter GPIHBP1 and triglyceride-rich lipoprotein metabolism. Clin Chim Acta 2018; 487:33-40. [PMID: 30218660 DOI: 10.1016/j.cca.2018.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 02/05/2023]
Abstract
Increased plasma triglyceride serves as an independent risk factor for cardiovascular disease (CVD). Lipoprotein lipase (LPL), which hydrolyzes circulating triglyceride, plays a crucial role in normal lipid metabolism and energy balance. Hypertriglyceridemia is possibly caused by gene mutations resulting in LPL dysfunction. There are many factors that both positively and negatively interact with LPL thereby impacting TG lipolysis. Glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1), a newly identified factor, appears essential for transporting LPL to the luminal side of the blood vessel and offering a platform for TG hydrolysis. Numerous lines of evidence indicate that GPIHBP1 exerts distinct functions and plays diverse roles in human triglyceride-rich lipoprotein (TRL) metabolism. In this review, we discuss the GPIHBP1 gene, protein, its expression and function and subsequently focus on its regulation and provide critical evidence supporting its role in TRL metabolism. Underlying mechanisms of action are highlighted, additional studies discussed and potential therapeutic targets reviewed.
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Affiliation(s)
- Chuhao Liu
- Clinical Anatomy & Reproductive Medicine Application Institute, University of South China, Hengyang 421001, Hunan, China; 2016 Class of Excellent Doctor, University of South China, Hengyang 421001, Hunan, China
| | - Liang Li
- Department of Pathophysiology, University of South China, Hengyang 421001, Hunan, China
| | - Dongming Guo
- Clinical Anatomy & Reproductive Medicine Application Institute, University of South China, Hengyang 421001, Hunan, China
| | - Yuncheng Lv
- Clinical Anatomy & Reproductive Medicine Application Institute, University of South China, Hengyang 421001, Hunan, China
| | - XiLong Zheng
- Department of Biochemistry and Molecular Biology, The Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, The University of Calgary, Health Sciences Center, 3330 Hospital Dr NW, Calgary T2N 4N1, Alberta, Canada; Key Laboratory of Molecular Targets & Clinical Pharmacology, School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, Guangdong, China
| | - Zhongcheng Mo
- Clinical Anatomy & Reproductive Medicine Application Institute, University of South China, Hengyang 421001, Hunan, China.
| | - Wei Xie
- Clinical Anatomy & Reproductive Medicine Application Institute, University of South China, Hengyang 421001, Hunan, China.
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89
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Clinical and functional studies of two novel variants in the LPL gene in subjects with severe hypertriglyceridemia. Clin Chim Acta 2018; 487:22-27. [PMID: 30179614 DOI: 10.1016/j.cca.2018.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/10/2018] [Accepted: 08/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Two novel variants (p.Arg270Gly and p.Asp308Glyfs*3) in the LPL gene have recently been identified in subjects with hypertriglyceridemia (HTG). In this study, we investigated clinical and genetic features of their families and examined the functional significance of these two variants in vitro. METHODS Clinical and genetic data were collected. Site-directed mutagenesis and transient expression in cld cells were performed. Lipoprotein lipase (LPL) mass and activity were measured. RESULTS In vitro studies showed that LPL mass and activity in the media of cells transfected with the p.Arg270Gly variant were significantly reduced. In the cell lysates, however, LPL mass was preserved but LPL activity was reduced, suggesting that the LPL defect was in the secretion and activity. For the p.Asp308Glyfs*3 variant, LPL mass in the cell lysate was relatively preserved compared to that of the wild-type, while LPL mass in the media was decreased albeit not significantly. LPL activities in the cell lysate and in the media of cells transfected with this variant were significantly reduced, suggesting that the p.Asp308Glyfs*3 variant might affect the activity, and possibly, secretion of LPL. CONCLUSIONS These novel variants in the LPL gene were likely pathogenic with the defect in secretion and/or activity.
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90
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Péterfy M, Bedoya C, Giacobbe C, Pagano C, Gentile M, Rubba P, Fortunato G, Di Taranto MD. Characterization of two novel pathogenic variants at compound heterozygous status in lipase maturation factor 1 gene causing severe hypertriglyceridemia. J Clin Lipidol 2018; 12:1253-1259. [PMID: 30172716 DOI: 10.1016/j.jacl.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/07/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Severe hypertriglyceridemia is a rare disease characterized by triglyceride levels higher than 1000 mg/dL (11.3 mmol/L) and acute pancreatitis. The disease is caused by pathogenic variants in genes encoding lipoprotein lipase (LPL), apolipoprotein A5, apolipoprotein C2, glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1, and lipase maturation factor 1 (LMF1). OBJECTIVE We aim to identify the genetic cause of severe hypertriglyceridemia and characterize the new variants in a patient with severe hypertriglyceridemia. METHODS The proband was a male showing severe hypertriglyceridemia (triglycerides 1416 mg/dL, 16.0 mmol/L); proband's relatives were also screened. Genetic screening included direct sequencing of the above genes and identification of large rearrangements in the LPL gene. Functional characterization of mutant LMF1 variants was performed by complementing LPL maturation in transfected LMF1-deficient mouse fibroblasts. RESULTS The proband and his affected brother were compound heterozygotes for variants in the LMF1 gene never identified as causative of severe hypertriglyceridemia c.[157delC;1351C>T];[410C>T], p.[(Arg53Glyfs*5)];[(Ser137Leu)]. Functional analysis demonstrated that the p.(Arg53Glyfs*5) truncation completely abolished and the p.(Ser137Leu) missense variant dramatically diminished the lipase maturation activity of LMF1. CONCLUSIONS In addition to a novel truncating variant, we describe for the first time a missense variant functionally demonstrated affecting the lipase maturation function of LMF1. This is the first case in which compound heterozygous variants in LMF1 were functionally demonstrated as causative of severe hypertriglyceridemia.
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Affiliation(s)
- Miklós Péterfy
- Department of Basic Medical Sciences, Western University of Health Sciences, Pomona, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Candy Bedoya
- Department of Basic Medical Sciences, Western University of Health Sciences, Pomona, CA, USA
| | - Carola Giacobbe
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy; CEINGE S.C.a r.l. Biotecnologie Avanzate, Napoli, Italy
| | - Carmen Pagano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Marco Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Paolo Rubba
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Giuliana Fortunato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy; CEINGE S.C.a r.l. Biotecnologie Avanzate, Napoli, Italy
| | - Maria Donata Di Taranto
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy; CEINGE S.C.a r.l. Biotecnologie Avanzate, Napoli, Italy.
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Moulin P, Dufour R, Averna M, Arca M, Cefalù AB, Noto D, D'Erasmo L, Di Costanzo A, Marçais C, Alvarez-Sala Walther LA, Banach M, Borén J, Cramb R, Gouni-Berthold I, Hughes E, Johnson C, Pintó X, Reiner Ž, van Lennep JR, Soran H, Stefanutti C, Stroes E, Bruckert E. Identification and diagnosis of patients with familial chylomicronaemia syndrome (FCS): Expert panel recommendations and proposal of an “FCS score”. Atherosclerosis 2018; 275:265-272. [DOI: 10.1016/j.atherosclerosis.2018.06.814] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/23/2018] [Accepted: 06/13/2018] [Indexed: 12/31/2022]
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92
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Brown WV. Clinical Lipidology and the Prevention of Vascular Disease: Time for Personalized Therapy. Clin Pharmacol Ther 2018; 104:269-281. [DOI: 10.1002/cpt.1127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
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93
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Serveaux Dancer M, Di Filippo M, Marmontel O, Valéro R, Piombo Rivarola MDC, Peretti N, Caussy C, Krempf M, Vergès B, Mahl M, Marçais C, Moulin P, Charrière S. New rare genetic variants of LMF1 gene identified in severe hypertriglyceridemia. J Clin Lipidol 2018; 12:1244-1252. [PMID: 30037590 DOI: 10.1016/j.jacl.2018.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The LMF1 (lipase maturation factor 1) gene encodes a protein involved in lipoprotein lipase and hepatic lipase maturation. Homozygous mutations in LMF1 leading to severe hypertriglyceridemia (SHTG) are rare in the literature. A few additional rare LMF1 variants have been described with poor functional studies. OBJECTIVE The aim of this study was to assess the frequency of LMF1 variants in a cohort of 385 patients with SHTG, without homozygous or compound heterozygous deleterious mutations identified in lipoprotein lipase (LPL), apolipoprotein A5 (APOA5), apolipoprotein C2 (APOC2), glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 (GPIHBP1) genes, and to determine their functionality. METHODS LMF1 coding variants were screened using denaturing high-performance liquid chromatography followed by direct sequencing. In silico studies of LMF1 variants were performed, followed by in vitro functional studies using human embryonic kidney 293T (HEK-293T) cells cotransfected with vectors encoding human LPL and LMF1 cDNA. LPL activity was measured in cell culture medium after heparin addition using human VLDL-TG as substrate. RESULTS Nineteen nonsynonymous coding LMF1 variants were identified in 65 patients; 10 variants were newly described in SHTG. In vitro, p.Gly172Arg, p.Arg354Trp, p.Arg364Gln, and p.Arg537Trp LMF1 variants decreased LPL activity, and the p.Trp464Ter variant completely abolished LPL activity. We identified a young girl heterozygote for the p.Trp464Ter variant and a homozygote carrier of the p.Gly172Arg variant with a near 50% decreased LPL activity in vitro and in vivo. CONCLUSION The study confirms the rarity of LMF1 variants in a large cohort of patients with SHTG. LMF1 variants are likely to be involved in multifactorial hyperchylomicronemia. Partial LMF1 defects could be associated with intermittent phenotype as described for p.Gly172Arg homozygous and p.Trp464Ter heterozygous carriers.
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Affiliation(s)
- Marine Serveaux Dancer
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie moléculaire et métabolique, Pierre-Bénite, France
| | - Mathilde Di Filippo
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Service de Biochimie et Biologie moléculaire Grand Est, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Oriane Marmontel
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Service de Biochimie et Biologie moléculaire Grand Est, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - René Valéro
- Université d'Aix-Marseille, C2VN, INSERM UMR1062, INRA UMR1260, APHM, service de nutrition, maladies métaboliques, endocrinologie Hôpital La Conception, Marseille, France
| | | | - Noël Peretti
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service d'Hépato-Gastroentérologie Nutrition pédiatrique, Bron, France
| | - Cyrielle Caussy
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'endocrinologie, diabète, nutrition, Centre Intégré de l'Obésité Rhône-Alpes, Fédération Hospitalo-Universitaire DO-iT, Lyon, Pierre-Bénite, France
| | - Michel Krempf
- CHU de Nantes, Hôpital de l'Hôtel Dieu, Service d'endocrinologie, maladies métaboliques et nutrition, Institut du thorax, Centre de Recherche en Nutrition Humaine, INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - Bruno Vergès
- CHU de Dijon, Service d'endocrinologie-diabétologie, INSERM LNC-UMR 1231, Dijon, France
| | - Murielle Mahl
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie moléculaire et métabolique, Pierre-Bénite, France
| | - Christophe Marçais
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Centre de Biologie Sud, Laboratoire de Biochimie moléculaire et métabolique, Pierre-Bénite, France
| | - Philippe Moulin
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Hôpital Louis Pradel, Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, Bron, France
| | - Sybil Charrière
- INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, Villeurbanne, Oullins, France; Hospices Civils de Lyon, Hôpital Louis Pradel, Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, Bron, France.
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Clinical and biochemical features of different molecular etiologies of familial chylomicronemia. J Clin Lipidol 2018; 12:920-927.e4. [DOI: 10.1016/j.jacl.2018.03.093] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 12/21/2022]
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Characterizing familial chylomicronemia syndrome: Baseline data of the APPROACH study. J Clin Lipidol 2018; 12:1234-1243.e5. [PMID: 30318066 DOI: 10.1016/j.jacl.2018.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Familial chylomicronemia syndrome (FCS) is a rare metabolic disorder caused by mutations in lipoprotein lipase (LPL) or genes required for LPL functionality and is characterized by hyperchylomicronemia that results in recurrent episodes of acute pancreatitis. Owing to the rarity of FCS, there are few case series describing the phenotypic variability in FCS patients in detail. OBJECTIVE To provide baseline characteristics in the largest study population to date of patients with FCS. METHODS We analyzed baseline demographic and clinical characteristics of adult FCS patients in the phase 3 APPROACH study of volanesorsen sodium (antisense inhibitor of apolipoprotein C-III). RESULTS Sixty-six patients were included in the analysis. Mean (SD) age was 46 (13) years; and mean body mass index was 24.9 (5.7) kg/m2. We identified causal mutations in 79% (52) of patients, with LPL mutations accounting for 62% (41) of cases. Median age at diagnosis was 24 years, 54% were females, and 81% were Caucasian. All patients followed a low-fat diet, 43% received fibrates, 27% fish oils, and 21% statins. Median fasting triglyceride levels (P25, P75) were 1985 (1179, 3047 mg/dL). Overall, 76% of patients reported ≥1 lifetime episode of acute pancreatitis; 23 patients reported a total of 53 pancreatitis events in the 5 years before enrollment. CONCLUSIONS Our data emphasize the severe hypertriglyceridemia characteristic of FCS patients despite restrictive low-fat diets and frequent use of existing hypolipemic therapies. Acute pancreatitis and recurrent acute pancreatitis are frequent complications of FCS. Diagnosis at an older age suggests likely underdiagnosis and underappreciation of this rare disorder.
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Marmontel O, Charrière S, Simonet T, Bonnet V, Dumont S, Mahl M, Jacobs C, Nony S, Chabane K, Bozon D, Janin A, Peretti N, Lachaux A, Bardel C, Millat G, Moulin P, Marçais C, Di Filippo M. Single, short in-del, and copy number variations detection in monogenic dyslipidemia using a next-generation sequencing strategy. Clin Genet 2018; 94:132-140. [DOI: 10.1111/cge.13250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 01/08/2023]
Affiliation(s)
- O. Marmontel
- Service de Biochimie et Biologie moléculaire Grand Est, GHE; Hospices Civils de Lyon; Bron France
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397; Université Claude Bernard Lyon 1, INSA Lyon; Villeurbanne France
| | - S. Charrière
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397; Université Claude Bernard Lyon 1, INSA Lyon; Villeurbanne France
- Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, GHE; Hospices Civils de Lyon; Bron France
| | - T. Simonet
- Service de Biostatistique-Bioinformatique; Hospices Civils de Lyon; Lyon France
- Univ Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Villeurbanne France
| | - V. Bonnet
- Service de Biochimie et Biologie moléculaire Grand Est, GHE; Hospices Civils de Lyon; Bron France
| | - S. Dumont
- Service de Biochimie et Biologie moléculaire Grand Est, GHE; Hospices Civils de Lyon; Bron France
| | - M. Mahl
- Centre de Biologie Sud, Laboratoire de Biochimie moléculaire et métabolique, GHS; Hospices Civils de Lyon; Pierre-Benite France
| | - C. Jacobs
- Service de Biochimie et Biologie moléculaire Grand Est, GHE; Hospices Civils de Lyon; Bron France
| | - S. Nony
- Service de Biochimie et Biologie moléculaire Grand Est, GHE; Hospices Civils de Lyon; Bron France
| | - K. Chabane
- Laboratoire d'hématologie, Biologie Moléculaire; Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon; Pierre-Benite France
| | - D. Bozon
- Plateforme NGS CHU Lyon, GHE; Hospices Civils de Lyon; Bron France
| | - A. Janin
- Plateforme NGS CHU Lyon, GHE; Hospices Civils de Lyon; Bron France
| | - N. Peretti
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397; Université Claude Bernard Lyon 1, INSA Lyon; Villeurbanne France
- Service de Gastroentérologie Hépatologie et Nutrition Pédiatrique, GHE; Hospices Civils de Lyon; Bron France
| | - A. Lachaux
- Service de Gastroentérologie Hépatologie et Nutrition Pédiatrique, GHE; Hospices Civils de Lyon; Bron France
- INSERM U 1111, Faculté de médecine Lyon Est; Université Lyon 1; Lyon France
| | - C. Bardel
- Service de Biostatistique-Bioinformatique; Hospices Civils de Lyon; Lyon France
- Univ Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Villeurbanne France
| | - G. Millat
- Plateforme NGS CHU Lyon, GHE; Hospices Civils de Lyon; Bron France
| | - P. Moulin
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397; Université Claude Bernard Lyon 1, INSA Lyon; Villeurbanne France
- Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, GHE; Hospices Civils de Lyon; Bron France
| | - C. Marçais
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397; Université Claude Bernard Lyon 1, INSA Lyon; Villeurbanne France
- Centre de Biologie Sud, Laboratoire de Biochimie moléculaire et métabolique, GHS; Hospices Civils de Lyon; Pierre-Benite France
- CENS, Centre de Recherche en Nutrition Humaine Rhône-Alpes; Oullins France
| | - M. Di Filippo
- Service de Biochimie et Biologie moléculaire Grand Est, GHE; Hospices Civils de Lyon; Bron France
- Univ-Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397; Université Claude Bernard Lyon 1, INSA Lyon; Villeurbanne France
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Wilson LM, Cross RR, Duell PB. Reduced psychological distress in familial chylomicronemia syndrome after patient support group intervention. J Clin Lipidol 2018; 12:240-242. [DOI: 10.1016/j.jacl.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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99
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Brown WV, Gaudet D, Goldberg I, Hegele R. Roundtable on etiology of familial chylomicronemia syndrome. J Clin Lipidol 2018; 12:5-11. [DOI: 10.1016/j.jacl.2017.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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100
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Reiner Ž. Triglyceride-Rich Lipoproteins and Novel Targets for Anti-atherosclerotic Therapy. Korean Circ J 2018; 48:1097-1119. [PMID: 30403015 PMCID: PMC6221868 DOI: 10.4070/kcj.2018.0343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022] Open
Abstract
Although elevated serum low-density lipoprotein-cholesterol (LDL-C) is without any doubts accepted as an important risk factor for cardiovascular disease (CVD), the role of elevated triglycerides (TGs)-rich lipoproteins as an independent risk factor has until recently been quite controversial. Recent data strongly suggest that elevated TG-rich lipoproteins are an independent risk factor for CVD and that therapeutic targeting of them could possibly provide further benefit in reducing CVD morbidity, events and mortality, apart from LDL-C lowering. Today elevated TGs are treated with lifestyle interventions, and with fibrates which could be combined with omega-3 fatty acids. There are also some new drugs. Volanesorsen, is an antisense oligonucleotid that inhibits the production of the Apo C-III which is crucial in regulating TGs metabolism because it inhibits lipoprotein lipase (LPL) and hepatic lipase activity but also hepatic uptake of TGs-rich particles. Evinacumab is a monoclonal antibody against angiopoietin-like protein 3 (ANGPTL3) and it seems that it can substantially lower elevated TGs levels because ANGPTL3 also regulates TGs metabolism. Pemafibrate is a selective peroxisome proliferator-activated receptor alpha modulator which also decreases TGs, and improves other lipid parameters. It seems that it also has some other possible antiatherogenic effects. Alipogene tiparvovec is a nonreplicating adeno-associated viral vector that delivers copies of the LPL gene to muscle tissue which accelerates the clearance of TG-rich lipoproteins thus decreasing extremely high TGs levels. Pradigastat is a novel diacylglycerol acyltransferase 1 inhibitor which substantially reduces extremely high TGs levels and appears to be promising in treatment of the rare familial chylomicronemia syndrome.
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Affiliation(s)
- Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
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