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Wakabayashi T, Takahashi M, Okazaki H, Okazaki S, Yokote K, Tada H, Ogura M, Ishigaki Y, Yamashita S, Harada-Shiba M. Current Diagnosis and Management of Familial Hypobetalipoproteinemia 1. J Atheroscler Thromb 2024; 31:1005-1023. [PMID: 38710625 PMCID: PMC11224688 DOI: 10.5551/jat.rv22018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 05/08/2024] Open
Abstract
Familial hypobetalipoproteinemia (FHBL) 1 is a rare genetic disorder with an autosomal codominant mode of inheritance and is caused by defects in the apolipoprotein (apo) B (APOB) gene that disable lipoprotein formation. ApoB proteins are required for the formation of very low-density lipoproteins (VLDLs), chylomicrons, and their metabolites. VLDLs transport cholesterol and triglycerides from the liver to the peripheral tissues, whereas chylomicrons transport absorbed lipids and fat-soluble vitamins from the intestine. Homozygous or compound heterozygotes of FHBL1 (HoFHBL1) are extremely rare, and defects in APOB impair VLDL and chylomicron secretion, which result in marked hypolipidemia with malabsorption of fat and fat-soluble vitamins, leading to various complications such as growth disorders, acanthocytosis, retinitis pigmentosa, and neuropathy. Heterozygotes of FHBL1 are relatively common and are generally asymptomatic, except for moderate hypolipidemia and possible hepatic steatosis. If left untreated, HoFHBL1 can cause severe complications and disabilities that are pathologically and phenotypically similar to abetalipoproteinemia (ABL) (an autosomal recessive disorder) caused by mutations in the microsomal triglyceride transfer protein (MTTP) gene. Although HoFHBL1 and ABL cannot be distinguished from the clinical manifestations and laboratory findings of the proband, moderate hypolipidemia in first-degree relatives may help diagnose HoFHBL1. There is currently no specific treatment for HoFHBL1. Palliative therapy including high-dose fat-soluble vitamin supplementation may prevent or delay complications. Registry research on HoFHBL1 is currently ongoing to better understand the disease burden and unmet needs of this life-threatening disease with few therapeutic options.
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Affiliation(s)
- Tetsuji Wakabayashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Manabu Takahashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiroaki Okazaki
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Sachiko Okazaki
- Division for Health Service Promotion, The University of Tokyo, Tokyo, Japan
| | | | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Masatsune Ogura
- Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Tokyo, Japan
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Shizuya Yamashita
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - on behalf of the Committee on Primary Dyslipidemia under the Research Program on Rare and Intractable Disease of the Ministry of Health, Labour and Welfare of Japan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
- Division for Health Service Promotion, The University of Tokyo, Tokyo, Japan
- Chiba University, Chiba, Japan
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
- Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Tokyo, Japan
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
- Cardiovascular Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Pisciotta L, Ossoli A, Ronca A, Garuti A, Fresa R, Favari E, Calabresi L, Calandra S, Bertolini S. Plasma HDL pattern, cholesterol efflux and cholesterol loading capacity of serum in carriers of a novel missense variant (Gly176Trp) of endothelial lipase. J Clin Lipidol 2022; 16:694-703. [PMID: 36002365 DOI: 10.1016/j.jacl.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Loss of function variants of LIPG gene encoding endothelial lipase (EL) are associated with primary hyperalphalipoproteinemia (HALP), a lipid disorder characterized by elevated plasma levels of high density lipoprotein cholesterol (HDL-C). OBJECTIVE Aim of the study was the phenotypic and genotypic characterization of a family with primary HALP. METHODS HDL subclasses distribution was determined by polyacrylamide gradient gel electrophoresis. Serum content of preβ-HDL was assessed by (2D)-electrophoresis. Cholesterol efflux capacity (CEC) of serum mediated by ABCA1, ABCG1 or SR-BI was assessed using cells expressing these proteins. Cholesterol loading capacity (CLC) of serum was assayed using cultured human macrophages. Next generation sequencing was used for DNA analysis. Plasma EL mass was determined by ELISA. RESULTS Three family members had elevated plasma HDL-C, apoA-I and total phospholipids, as well as a reduced content of preβ-HDL. These subjects were heterozygous carriers of a novel variant of LIPG gene [c.526 G>T, p.(Gly176Trp)] found to be deleterious in silico. Plasma EL mass in carriers was lower than in controls. CEC of sera mediated by ABCA1 and ABCG1 transporters was substantially reduced in the carriers. This effect was maintained after correction for serum HDL concentration. The sera of carriers were found to have a higher CLC in cultured human macrophages than control sera. CONCLUSION The novel p.(Gly176Trp) variant of endothelial lipase is associated with changes in HDL composition and subclass distribution as well as with functional changes affecting cholesterol efflux capacity of serum which suggest a defect in the early steps of revere cholesterol transport.
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Affiliation(s)
- Livia Pisciotta
- Department of Internal Medicine, University of Genoa, Genoa, Italy (Drs Pisciotta, Garuti, and Bertolini); Dietetics and Clinical Nutrition Unit, IRCCS-Polyclinic Hospital San Martino, Genoa, Italy (Dr Pisciotta).
| | - Alice Ossoli
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy (Dr Ossoli)
| | - Annalisa Ronca
- Department of Food and Drug, University of Parma, Parma, Italy (Drs Ronca and Favari)
| | - Anna Garuti
- Department of Internal Medicine, University of Genoa, Genoa, Italy (Drs Pisciotta, Garuti, and Bertolini)
| | - Raffaele Fresa
- Department of Internal Medicine, University of Genoa, Genoa, Italy (Drs Pisciotta, Garuti, and Bertolini)
| | - Elda Favari
- Department of Food and Drug, University of Parma, Parma, Italy (Drs Ronca and Favari)
| | - Laura Calabresi
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy (Dr Ossoli)
| | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy (Dr Calandra)
| | - Stefano Bertolini
- Department of Internal Medicine, University of Genoa, Genoa, Italy (Drs Pisciotta, Garuti, and Bertolini)
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Alves AC, Miranda B, Moldovan O, Santo RE, Gouveia Silva R, Soares Cardoso S, Diogo L, Seidi M, Sequeira S, Bourbon M. Rare primary dyslipidaemias associated with low LDL and HDL cholesterol values in Portugal. Front Genet 2022; 13:1088040. [PMID: 37138899 PMCID: PMC10150381 DOI: 10.3389/fgene.2022.1088040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 05/05/2023] Open
Abstract
Background: Dyslipidaemia represents a group of disorders of lipid metabolism, characterized by either an increase or decrease in lipid particles, usually associated with triglycerides, LDL cholesterol (LDL-C) and/or HDL cholesterol (HDL-C). Most hyperlipidaemias and HDL deficiencies confer an increased cardiovascular risk, while hypolipidaemia, such as abeta or hypobetalipoproteinemia, may present different manifestations ranging from poor weight progression to neurological manifestations. The aim of this study is to present 7 cases with rare dyslipidaemias associated with low LDL or low HDL cholesterol values, referred to our laboratory for the genetic identification of the cause of the dyslipidaemia. Methods: Lipid profile was determined for each individual in an automated equipment Integra Cobas (Roche). Molecular analysis was performed by NGS with a target panel of 57 genes involved in lipid metabolism (Sure select QXT, Agilent) and samples were run in a NextSEQ Sequencer (Illumina). Only genes associated to rare forms of low HDL-c or LDL-c were analysed for this work, namely: ABCA1, APOA1, LCAT, SCARB1, APOB, PCSK9, MTTP, SAR1B, and ANGPTL3. All rare variants (MAF<5%) found in these genes were confirmed by Sanger sequencing. Results and discussion: This study includes 7 index cases (IC), with the following clinical diagnoses: Fish Eye Disease (1), Hypoalphalipoproteinemia (1) and Abetalipoproteinemia (ABL) / Familial Hypobetalipoproteinemia (FHBL) (5). We have identified one IC with a compound heterozygosity in LCAT causing Fish Eye Disease and one IC with a variant in ABCA1 in homozygosity causing Tangier disease. We found variants causing homozygous FHBL in 2 IC, one of whom has an undescribed pathogenic variant in homozygosity in APOB (c.12087+1G>A) and the other is a possible compound heterozygous for APOB variants c.2604+1G>A and c.4651C>T/p.(Gln1551*). In two patients only a variant in heterozygosity (c.3365delG/p.(Gly1122Vfs*62) and c.11095A>T/p.(Arg3699*)). In the remaining patient, no variants were identified. NGS proved to be a fundamental key for genetic testing of rare lipid disorders, allowing us to find the genetic cause of disease in 6/7 patients with low HDL-c and LDL-c. Patients with these rare conditions should be identified as early as possible in order to minimize or prevent clinical manifestations. The unsolved case is still under investigation.
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Affiliation(s)
- Ana Catarina Alves
- Grupo de Investigação Cardiovascular, Unidade de Investigação e Desenvolvimento, Departamento de Promoção da saúde e doenças não transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
- *Correspondence: Ana Catarina Alves,
| | - Beatriz Miranda
- Grupo de Investigação Cardiovascular, Unidade de Investigação e Desenvolvimento, Departamento de Promoção da saúde e doenças não transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
| | - Oana Moldovan
- Serviço de Genética Médica, Departamento de Pediatria, Hospital de Santa Maria, CHULN E P E, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | | | - Raquel Gouveia Silva
- Serviço de Genética Médica, Departamento de Pediatria, Hospital de Santa Maria, CHULN E P E, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | | | - Luísa Diogo
- Centro de Referência de Doenças Hereditárias Do Metabolismo, Hospital Pediátrico—Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Mónica Seidi
- Serviço de Endocrinologia, Hospital de Loulé, Loulé, Portugal
- Serviço de Medicina Interna, Hospital de Santo Espírito de Angra Do Heroísmo, Angra Do Heroísmo, Portugal
| | - Silvia Sequeira
- Centro de Referência de Doenças Hereditárias Do Metabolismo, Hospital de Dona Estefânia—Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Mafalda Bourbon
- Grupo de Investigação Cardiovascular, Unidade de Investigação e Desenvolvimento, Departamento de Promoção da saúde e doenças não transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Lisboa, Portugal
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