APOA5-1131T>C genotype effects on apolipoprotein A5 and triglyceride levels in response to dietary intervention and regular exercise (DIRE) in hypertriglyceridemic subjects

Association of the APOA-5 Genetic Variant rs662799 with Metabolic Changes after an Intervention for 9 Months with a Low-Calorie Diet with a Mediterranean Profile

In cross-sectional studies, the genetic variant rs662799 of the APOA5 gene is associated with high serum triglyceride concentrations, and in some studies, the effect of short-term dietary interventions has been evaluated. The aim of the present investigation was to evaluate the role of this genetic variant in metabolic changes after the consumption of a low-calorie diet with a Mediterranean pattern for 9 months. A population of 269 Caucasian obese patients was recruited. Adiposity and biochemical parameters were measured at the beginning (basal level) and after 3 and 9 months of the dietary intervention. The rs662799 genotype was assessed with a dominant analysis (TT vs. CT + CC). The APOA5 variant distribution was: 88.1% (n = 237) (TT), 11.5% (n = 31) (TC) and 0.4% (n = 1) (CC). There were significant differences only in triglyceride levels at all times of the study between the genotype groups. After 3 and 9 months of dietary intervention, the following parameters improved in both genotype groups: adiposity parameters, systolic pressure, total cholesterol, LDL cholesterol, leptin, adiponectin and the leptin/adiponectin ratio. The intervention significantly decreased insulin levels, HOMA-IR and triglyceride levels in non-C allele carriers (Delta 9 months TT vs. TC + CC). i.e., insulin levels (delta: −3.8 + 0.3 UI/L vs. −1.2 + 0.2 UI/L; p = 0.02), HOMA-IR levels (delta: −1.2 + 0.2 units vs. −0.3 + 0.1 units; p = 0.02), triglyceride levels (delta: −19.3 + 4.2 mg/dL vs. −4.2 + 3.0 mg/dL; p = 0.02). In conclusion, non-C allele carriers of rs662799 of the APOA5 gene showed a decrease of triglyceride, insulin and HOMA-IR levels after consuming a low-calorie diet with a Mediterranean pattern; we did not observe this effect in C allele carriers, despite a significant weight loss.

Personalized Dietary Recommendations Based on Lipid-Related Genetic Variants: A Systematic Review

Background

Obesity and dyslipidemias are risk factors for developing cardiovascular diseases, the leading causes of morbidity and mortality worldwide. The pathogenesis of these diseases involves environmental factors, such as nutrition, but other aspects like genetic polymorphisms confer susceptibility to developing obesity and dyslipidemias. In this sense, nutrigenetics is being used to study the influence of genetic variations on the circulating lipid responses promoted by certain nutrients or foods to provide specific dietary strategies considering the genetic factors in personalized nutrition interventions.

Objective

To identify throughout a systematic review the potential nutrigenetic recommendations that demonstrate a strong interaction between gene-diet and circulating lipid variations.

Methods

This systematic review used the PRISMA-Protocol for manuscript research and preparation using PubMed and ScienceDirect databases. Human studies published in English from January 2010 to December 2020 were included. The main results were outcomes related to gene-diet interactions and plasmatic lipids variation.

Results

About 1,110 articles were identified, but only 38 were considered to fulfill the inclusion criteria established based on the reported data. The acquired information was organized based on gene-diet interaction with nutrients and components of the diet and dietary recommendation generated by each interaction: gene-diet interaction with dietary fats, carbohydrates or dietary fiber, gene-diet interaction with nutraceutical or dietary supplementation, and gene-diet interaction with proteins.

Conclusion

Findings included in this systematic review indicated that a certain percentage of dietary macronutrients, the consumption of specific amounts of polyunsaturated or monounsaturated fatty acids, as well as the ingestion of nutraceuticals or dietary supplements could be considered as potential strategies for the development of a wide range of nutrigenetic interventions since they have a direct impact on the blood levels of lipids. In this way, specific recommendations were identified as potential tools in developing precision diets and highlighted the importance of personalized nutrition. These recommendations may serve as a possible strategy to implement as dietary tools for the preventive treatment and control alterations in lipid metabolism.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021248816, identifier [CRD42021248816].

Efficacy and Safety of Fenofibrate-Statin Combination Therapy in Patients With Inadequately Controlled Triglyceride Levels Despite Previous Statin Monotherapy: A Multicenter, Randomized, Double-blind, Phase IV Study

PURPOSE

Residual cardiovascular risk reduction by fenofibrate in patients with high serum triglyceride (TG) levels despite previous statin monotherapy is not well characterized. The purpose of this study was to evaluate the efficacy and safety of a combination of choline fenofibrate and statin in patients with inadequately controlled TG levels despite previous statin monotherapy.

METHODS

This prospective, multicenter, randomized, double-blind study was conducted in Korea. A total of 133 patients with controlled LDL-C but elevated TG levels, already receiving statin monotherapy, were enrolled in the study, which was conducted from July 2018 to December 2019. Patients were randomly assigned to receive combination therapy with choline fenofibrate and statin or statin monotherapy in a 1:1 ratio. After 8 weeks of treatment, the lipid profiles and safety parameters of the patients in the 2 groups were compared.

FINDINGS

The study included 127 patients (64 in the combination group and 63 in the control group) older than 19 years. After 8 weeks of therapy, mean serum TG levels significantly decreased from 269.8 to 145.5 mg/dL (P < 0.0001) in the combination therapy group, whereas no significant changes occurred in the statin monotherapy group (from 271.1 to 280.5 mg/dL). Contrarily, the mean serum HDLC levels significantly increased from 45.0 to 50.4 mg/dL (P = 0.0004) in the combination therapy group, whereas there were no significant changes in the monotherapy group (from 44.3 to 44.7 mg/dL). There were no additional serious adverse events in the combination therapy group compared with the statin monotherapy group.

IMPLICATIONS

The combination therapy using choline fenofibrate and statin was found to be effective in serum TG control and likely tolerable in patients with high TG levels despite statin monotherapy. A larger study, conducted for a longer duration, is needed to evaluate the effectiveness of this combination in reducing cardiovascular risk. ClinicalTrials.gov identifier: NCT03874260.

APOA-5 Genetic Variant rs662799: Role in Lipid Changes and Insulin Resistance after a Mediterranean Diet in Caucasian Obese Subjects

Background and Aims

This APOA5-1131C allele is related with a higher serum triglyceride levels and perhaps a different metabolic response to a dietary intervention. The aim of the present investigation was to evaluate SNP rs662799 in the APOA5 gene and its associations with metabolic effects after a hypocaloric diet with Mediterranean pattern.

Methods

A population of 363 Caucasian obese patients was enrolled. Anthropometric parameters and serum parameters (lipid profile, insulin, homeostasis model assessment (HOMA-IR), glucose, C reactive protein, adiponectin, resistin, and leptin levels) were measured, at basal time and after 3 months. All patients were genotyped in the rs662799 polymorphism.

Results

The APOA5 variant distribution was as follows: 89.3% (n = 324) (TT) were homozygous for the T allele, 10.5% (n = 38) (TC) were heterozygous, and 0.2% (n = 1) (CC) were homozygous for the C allele. Triglyceride levels were higher in patients with the C allele. After dietary intervention, BMI, weight, fat mass, waist circumference, systolic blood pressure, adiponectin, leptin, and adiponectin/leptin ratio improved significantly in both genotype groups TT and TC+CC. After dietary intervention, insulin levels (delta: −3.6 ± 0.8 UI/L vs. −1.5 ± 0.6 UI/L; P = 0.03), HOMA-IR (delta: −1.5 ± 0.4 units vs. −0.3 ± 0.2 units; P = 0.02), and triglyceride levels (delta: −19.3 ± 4.2 mg/dL vs. −3.2 ± 3.1 mg/dL; P = 0.02) decreased in non-C allele carriers.

Conclusions

C allele carriers of rs662799 of the APOA5 gene did not show an improvement in triglyceride, insulin, and HOMA-IR levels after a significant weight loss due to a hypocaloric diet with a Mediterranean pattern.

Legumes as Functional Food for Cardiovascular Disease

Legumes are an essential food source worldwide. Their high-quality proteins, complex carbohydrates, dietary fiber, and relatively low-fat content make these an important functional food. Known to possess a multitude of health benefits, legume consumption is associated with the prevention and treatment of cardiovascular diseases (CVD). Legume crude protein isolates and purified peptides possess many cardiopreventive properties. Here, we review selected economically valued legumes, their taxonomy and distribution, biochemical composition, and their protein components and the mechanism(s) of action associated with cardiovascular health. Most of the legume protein studies had shown upregulation of low-density lipoprotein (LDL) receptor leading to increased binding and uptake, in effect significantly reducing total lipid levels in the blood serum and liver. This is followed by decreased biosynthesis of cholesterol and fatty acids. To understand the relationship of identified genes from legume studies, we performed gene network analysis, pathway, and gene ontology (GO) enrichment. Results showed that the genes were functionally interrelated while enrichment and pathway analysis revealed involvement in lipid transport, fatty acid and triglyceride metabolic processes, and regulatory processes. This review is the first attempt to collate all known mechanisms of action of legume proteins associated with cardiovascular health. This also provides a snapshot of possible targets leading to systems-level approaches to further investigate the cardiometabolic potentials of legumes.

Interaction of polymorphisms in APOA4-APOA5-ZPR1-BUD13 gene cluster and sleep duration on 5-year lipid changes in middle aged and older Chinese

STUDY OBJECTIVES

Lipid profiles are influenced by both genetic and environmental factors. Genetic variants in the APOA4-APOA5-ZPR1-BUD13 gene cluster and aberrant sleep duration were independently identified to be associated with lipids in previous studies. We aimed to investigate whether sleep duration modified the genetic associations with longitudinal lipids changes.

METHODS

Four single nucleotide polymorphisms (SNPs), rs17119975, rs651821, rs7396835, and rs964184 in the APOA4-APOA5-ZPR1-BUD13 gene cluster were genotyped among 8648 apparently healthy subjects from the Dongfeng-Tongji (DFTJ) cohort. Information on sleep duration was obtained by questionnaires. Changes in total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), were evaluated from baseline to 5-year follow-up.

RESULTS

After multivariate adjustments, we found that rs651821 and weighted genetic risk score (GRS) were significantly associated with increased triglyceride, and the genetic association with triglyceride change consistently strengthened across sleep duration categories. The differences in triglyceride changes per increment of risk allele for rs651821 were 0.028 (SE = 0.017, p = 0.112), 0.051 (SE = 0.009, p < 0.001), and 0.064 (SE = 0.016, p < 0.001) in individuals with sleep duration ≤7, >7-<9, and ≥9 h, respectively (p interaction = 0.031). The GRS also showed a significant interaction with sleep duration categories for triglyceride change (p interaction = 0.010). In addition, all of the four SNPs and GRS were inversely related to HDL-c changes.

CONCLUSIONS

Longer sleep duration might exacerbate the adverse effects of SNPs in APOA4-APOA5-ZPR1-BUD13 gene cluster on 5-year triglyceride changes.

Associations of Anthropometric Characteristics, Dietary Habits, and Aerobic Capacity With Cardiovascular Risk Factors of Health-Science Students

The aim of this cross-sectional study was to study the relative importance of dietary habits and aerobic capacity in parameters related to cardiovascular risk in 271 female and 95 male health-science students (mean age = 19.1 ± 1.4 years). In females, fatty-meat consumption predicted triglycerides (β = .649, p < .001) and high-density lipoprotein (HDL; β = -.242, p = .001) and low-density lipoprotein (LDL; β = .373, p < .001) cholesterol levels. Consumption of nuts, legumes, and complex carbohydrates predicted triglyceride (β = -.099, p = .074), HDL (β = .231, p = .001), and LDL (β = -.155, p = .025) levels, respectively. Aerobic capacity (β = -.245, p < .001) and fatty-meat intake (β = .230, p < .001) predicted diastolic blood pressure (BP); body mass index (BMI) predicted systolic BP (β = .340, p < .001). In males, body fat percentage was the strongest predictor of triglycerides (β = .348, p = .004), cholesterol (β = .366, p = .006), HDL (β = -.378, p = .004), and LDL (β = .271, p = .043) levels. Aerobic capacity (β = -.263, p = .013) and fatty-meat consumption (β = .334, p = .005) independently predicted triglyceride levels. Nut (β = -.286, p = .013) and fatty-meat intake (β = .361, p = .002) predicted systolic BP, while BMI predicted diastolic BP (β = .209, p = .045). As health sciences students, these participants are future health professionals; targeting such populations is important for chronic disease prevention.

Lifestyle genomics and the metabolic syndrome: A review of genetic variants that influence response to diet and exercise interventions

Metabolic syndrome (MetS) comprises a cluster of risk factors that includes central obesity, dyslipidemia, impaired glucose homeostasis and hypertension. Individuals with MetS have elevated risk of type 2 diabetes and cardiovascular disease; thus placing significant burdens on social and healthcare systems. Lifestyle interventions (comprised of diet, exercise or a combination of both) are routinely recommended as the first line of treatment for MetS. Only a proportion of people respond, and it has been assumed that psychological and social aspects primarily account for these differences. However, the etiology of MetS is multifactorial and stems, in part, on a person's genetic make-up. Numerous single nucleotide polymorphisms (SNPs) are associated with the various components of MetS, and several of these SNPs have been shown to modify a person's response to lifestyle interventions. Consequently, genetic variants can influence the extent to which a person responds to changes in diet and/or exercise. The goal of this review is to highlight SNPs reported to influence the magnitude of change in body weight, dyslipidemia, glucose homeostasis and blood pressure during lifestyle interventions aimed at improving MetS components. Knowledge regarding these genetic variants and their ability to modulate a person's response will provide additional context for improving the effectiveness of personalized lifestyle interventions that aim to reduce the risks associated with MetS.

Study on the correlation between KCNJ11 gene polymorphism and metabolic syndrome in the elderly

The aim of the study was to examine the correlation between KCNJ11 gene polymorphism and metabolic syndrome in elderly patients. From January 2014 to January 2015, 54 elderly patients with metabolic syndrome were enrolled in this study as the observation group. During the same period, 46 healthy elderly individuals were enrolled in this study as the control group. KCNJ11 gene polymorphism (rs28502) was analyzed using polymerase chain reaction-restriction fragment length polymorphism. The expression levels of mRNA in different genotypes were detected using FQ-PCR. ELISA was used to evaluate the KCNJ11 protein expression in different genotypes. KCNJ11 gene polymorphism and metabolic syndrome was studied by measuring the blood pressure levels in patients with different genotypes. Three genotypes of KCNJ11 gene in rs28502 were CC, CT and TT. The CC, CT and TT genotype frequencies in healthy population were 8.5, 9.2 and 82.2%, respectively, while the genotype frequencies in patients with metabolic syndrome were 42.4, 49.8 and 7.8%, respectively. There were significant differences between groups (P≤0.05). However, the genotype frequencies of C/T in healthy individuals and metabolic syndrome patients were 35.3 and 38.3%, respectively. There were no significant differences between groups (P>0.05). FQ-PCR results showed that the KCNJ11 mRNA expression levels in the control and observation groups had no significant differences (P>0.05). However, the results obtained from ELISA analysis revealed that KCNJ11 protein expression level in the observation group was significantly higher than that in the control group (P<0.05). In conclusion, KCNJ11 gene polymorphism is associated with metabolic syndrome in the elderly. Elderly patients with the CC and TT genotypes are more likely to develop metabolic syndrome.

Inverse association of legume consumption and dyslipidemia: Isfahan Healthy Heart Program

BACKGROUND

Dietary intervention for improving serum lipids emphasizes on dietary fiber, plant protein, and flavonoids. This study was performed to examine whether regular legume consumption could alter serum lipids level and prevalence of dyslipidemia.

MATERIALS AND METHODS

This cross-sectional study was performed among 9660 randomly selected Iranian adults in 3 districts in the central part of Iran, using data collected in the Isfahan Healthy Heart Program in 2007. Dietary behavior including frequency of legume consumption was assessed by 48-item food frequency questionnaire. Fasting serum lipids were measured by standard enzymatic methods. We applied analysis covariance test to compare adjusted mean of serum lipids across legume consumption quartile and logistic regression test was used to determine odds ratio 95% confidence interval of dyslipidemia based on legume consumption in unadjusted and 4-adjusted models.

RESULTS

Adjusted mean triglyceride significantly reduced and high-density lipoprotein cholesterol (HDL-C) enhanced by increasing legume consumption (P = .04). The frequency of legume consumption associated with occurrence of all kinds of dyslipidemia except for hypercholesterolemia, especially for those who had consumed legume more than 1 time per day in adjusted models (hypertriglyceridemia: 0.82 [0.68-0.98]; high low-density lipoprotein [LDL-C]: 0.76 [0.60-0.97], and low HDL-C: 0.81 [0.71-0.92]).

CONCLUSION

We found an inverse dose-response association between the frequency of legume consumption and the risk of hypertriglyceridemia, high LDL-C, and low HDL-C. Therefore it is suggested that increasing legume intake may be an important part of a dietary approach for primary prevention of cardiovascular disease.

Consumption of whole grains and legumes modulates the genetic effect of the APOA5 -1131C variant on changes in triglyceride and apolipoprotein A-V concentrations in patients with impaired fasting glucose or newly diagnosed type 2 diabetes

Background

The apolipoprotein A5 gene (APOA5) -1131 T > C polymorphism is associated with mild hypertriglyceridemia in type 2 diabetic subjects, and interacts with dietary fat in the determination of triglyceride concentrations. We examined whether a substitution of whole grains and legumes for refined rice in a high carbohydrate diet (about 65% of energy derived from carbohydrate) may modify the effect of this variant on changes in apolipoprotein A-V (apoA-V) and triglyceride concentrations.

Methods

We genotyped the APOA5 -1131 T > C in individuals with impaired fasting glucose (IFG) or newly diagnosed type 2 diabetes, who were randomly assigned to either a group ingesting whole grain and legume meals daily or a control group for 12 weeks.

Results

After dietary intervention, we observed significant interactions between the APOA5 -1131 T > C polymorphism and carbohydrate sources (whole grains and legumes versus refined rice) in the determination of mean percent changes in triglyceride and apoA-V (P interactions <0.001 and =0.038, respectively). In the refined rice group (n = 93), the carriers of the risk C allele (n = 50) showed a greater increase in the mean percent changes of triglyceride and apoA-V than noncarriers after adjusting for HOMA-IR (P = 0.004 and 0.021, respectively). The whole grain and legume group (n = 92), however, showed a decrease in fasting glucose, HOMA-IR, and triglyceride, and an increase in apoA-V, irrespective of genotype.

Conclusions

The data showed that the magnitude of the genetic effect of the APOA5 -1131C variant on triglyceride and apoA-V levels was modulated when substituting consumption of whole grains and legumes for refined rice as a carbohydrate source in IFG or diabetic subjects.

Trial registration

ClinicalTrials.gov: NCT01784952.

The association between APOA5 haplotypes and plasma lipids is not modified by energy or fat intake: the Czech HAPIEE study

BACKGROUND AND AIMS

Several smaller studies reported interactions between dietary factors and apolipoprotein A5 (APOA5) gene polymorphisms in determination of plasma lipids. We tested interactions between APOA5 haplotypes and dietary intake in determination of plasma triglycerides (TG) and other lipids.

METHODS AND RESULTS

Participants (5487 males and females aged 45-69) were classified according to the number (0, 1, 2+) of minor APOA5 alleles (using T-1131 > C; rs662799 and Ser19 > Trp; rs3135506 polymorphisms) and into three groups of low (bottom 25%), medium (26th-75th percentile) and high (top 25%) of intake of total energy and total, saturated and polyunsaturated fats, assessed by food frequency questionnaire. The age-sex adjusted geometric means of plasma TG increased with the number of minor alleles, from 1.57 (standard error 0.01), to 1.79 (0.02) to 2.29 (0.10) mmol/L (p < 0.00001) but TG did not differ between groups with low, medium and high total energy intake (p = 0.251). TG concentrations were highest in subjects with the combination of 2+ minor alleles and the highest energy intake (mean 2.59 [0.19], compared with 1.62 [0.03] in subjects with lowest energy intake and no minor allele) but the interaction between energy intake and APOA5 haplotypes was not statistically significant (p = 0.186). Analogous analyses with total, saturated and polyunsaturated fat intake yielded similar nonsignificant results. Effects of APOA5 and dietary intakes on total and HDL cholesterol were weaker and no interactions were significant.

CONCLUSION

In this Slavic Caucasian population sample, we did not detect the hypothesized interaction between common SNPs within the APOA5 gene and diet in determination of blood lipids.

Relationship between the distribution of plasma HDL subclasses and the polymorphisms of APOA5 in hypertriglyceridemia

AIMS

This study aims to examine the possible associations between high density lipoprotein (HDL) subclass distribution and APOA5-1131T>C polymorphism in hypertriglyceridemia.

METHODS

The distribution of HDL subclasses was quantified by 2-dimensional electrophoresis in conjunction with immunodetection method. The APOA5-1131T>C polymorphism was identified in 95 hypertriglyceridemic (HTG) patients and 102 healthy subjects by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).

RESULTS

The APOA5-1131C (C) allele frequency was higher in the HTG group than in the control group. Plasma triglycerides (TG) were significantly higher and apoA5 was significantly lower in patients with the C allele when compared to patients with the APOA5-1131T (T) allele, even more dramatically so in the APOA5-1131CC homozygote. In both the HTG group and the control group, the frequency of the C allele was positively correlated with levels of TG, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and apolipoprotein B100 (apoB100), and negatively correlated with levels of high density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (apoA1) and apolipoprotein A5 (apoA5) (P<0.001). In all subjects, the frequency of the C allele was positively correlated with the level of small-sized HDL (preβ(1)-HDL and HDL(3a)), and negatively correlated with levels of HDL(2a) and HDL(2b).

CONCLUSION

Changes in HDL subclass distributions in HTG may be related to the APOA5-1131T>C polymorphism. This polymorphism leads to a general shift towards smaller-sized HDL.

Effects of APOA5 -1131T>C (rs662799) on fasting plasma lipids and risk of metabolic syndrome: evidence from a case-control study in China and a meta-analysis

The apolipoprotein A5 (APOA5) gene −1131T>C (rs662799) has been suggested to be involved in the pathway of lipid homeostasis and the development of metabolic syndrome (MetS). However, the findings are not consistent. To systematically evaluate the associations between −1131T>C polymorphism and fasting lipid parameters and the risk of MetS, we conducted a case-control study in a Chinese population and a meta-analysis. The findings from 1840 Chinese participants indicated that the C allele carriers had significantly higher fasting total cholesterol (TC), triglycerides (TG) and lower HDL-cholesterol (HDL-C) than the TT homozygotes carriers. The −1131C allele was also found to be significantly associated with increased risk of MetS (OR  =  1.40, 95% confidence interval (CI)  =  1.15, 1.69) compared to the TT homozygotes. In the meta-analysis of 51,868 participants from 46 East Asian studies, 26 European studies and 19 studies of other ethnic groups, the −1131C allele was associated with higher fasting TC (weighted mean difference (WMD)  =  0.08 mmol/L, 95% CI  =  0.05, 0.10, P = 1.74×10⁻⁹), TG (WMD  =  0.30 mmol/L, 95% CI  =  0.26, 0.33, P =  1.87×10⁻⁵⁵), LDL-cholesterol (LDL-C) (WMD  =  0.04 mmol/L, 95% CI  =  0.02, 0.07, P = 0.002), and lower HDL-C (WMD  =  −0.05 mmol/L, 95% CI  =  −0.06,−0.04, P = 1.88×10⁻²¹), respectively. Based on 12 studies with 5,573 MetS cases and 8,290 controls from 5 East Asian studies, 5 European studies and 2 studies of other ethnic groups, the −1131C allele was associated with increased risk of MetS with an OR (95% CI)  =  1.33 (1.16, 1.53) in the overall population, 1.43 (1.29, 1.58) in East Asian and 1.30 (0.94, 1.78) in European populations. In conclusion, the −1131C allele may be associated with elevated levels of fasting TG, TC, LDL-C and decreased HDL-C, and increased risk of MetS, especially in East Asians.

The paradox of ApoA5 modulation of triglycerides: evidence from clinical and basic research

Apolipoprotein A5 (ApoA5) is a key regulator of plasma triglycerides (TG), even though its plasma concentration is very low compared to other known apoproteins. Over the years, researchers have attempted to elucidate the molecular mechanisms by which ApoA5 regulates plasma TG in vivo. Though still under debate, two theories broadly describe how ApoA5 modulates TG levels: (i) ApoA5 enhances the catabolism of TG-rich lipoproteins and (ii) it inhibits the rate of production of very low-density lipoprotein (VLDL), the major carrier of TGs. This review will summarize the basic and clinical studies that describe the importance of ApoA5 in TG metabolism. Population studies conducted in various countries have demonstrated an association between single nucleotide polymorphisms (SNPs) in ApoA5 and the increased risk to cardiovascular disease and metabolic syndrome (including diabetes and obesity). ApoA5 is also highly expressed during liver regeneration and is an acute phase protein associated with HDL, which is independent of its effects on TG metabolism.

CONCLUSION

Despite considerable evidences available from clinical and basic research studies on the role of ApoA5 in TG metabolism and its indirect link to metabolic diseases, additional investigations are needed to understand the paradoxical role of this important apoprotein is modulated by both diet and its polymorphism variants.