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Genetic Heterogeneity of Familial Hypercholesterolemia: Repercussions for Molecular Diagnosis. Int J Mol Sci 2023; 24:ijms24043224. [PMID: 36834635 PMCID: PMC9961636 DOI: 10.3390/ijms24043224] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Genetics of Familial Hypercholesterolemia (FH) is ascribable to pathogenic variants in genes encoding proteins leading to an impaired LDL uptake by the LDL receptor (LDLR). Two forms of the disease are possible, heterozygous (HeFH) and homozygous (HoFH), caused by one or two pathogenic variants, respectively, in the three main genes that are responsible for the autosomal dominant disease: LDLR, APOB and PCSK9 genes. The HeFH is the most common genetic disease in humans, being the prevalence about 1:300. Variants in the LDLRAP1 gene causes FH with a recessive inheritance and a specific APOE variant was described as causative of FH, contributing to increase FH genetic heterogeneity. In addition, variants in genes causing other dyslipidemias showing phenotypes overlapping with FH may mimic FH in patients without causative variants (FH-phenocopies; ABCG5, ABCG8, CYP27A1 and LIPA genes) or act as phenotype modifiers in patients with a pathogenic variant in a causative gene. The presence of several common variants was also considered a genetic basis of FH and several polygenic risk scores (PRS) have been described. The presence of a variant in modifier genes or high PRS in HeFH further exacerbates the phenotype, partially justifying its variability among patients. This review aims to report the updates on the genetic and molecular bases of FH with their implication for molecular diagnosis.
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Abstract
Atherosclerotic cardiovascular disease is the leading cause of death globally. Despite its important risk of premature atherosclerosis and cardiovascular disease, familial hypercholesterolemia (FH) is still largely underdiagnosed worldwide. It is one of the most frequently inherited diseases due to mutations, for autosomal dominant forms, in either of the LDLR, APOB, and PCSK9 genes or possibly a few mutations in the APOE gene and, for the rare autosomal forms, in the LDLRAP1 gene. The discovery of the genes implicated in the disease has largely helped to improve the diagnosis and treatment of FH from the LDLR by Brown and Goldstein, as well as the introduction of statins, to PCSK9 discovery in FH by Abifadel et al., and the very rapid availability of PCSK9 inhibitors. In the last two decades, major progress has been made in clinical and genetic diagnostic tools and the therapeutic arsenal against FH. Improving prevention, diagnosis, and treatment and making them more accessible to all patients will help reduce the lifelong burden of the disease.
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Affiliation(s)
- Marianne Abifadel
- UMR1148, Inserm, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, F-75018 Paris, France.,Laboratory of Biochemistry and Molecular Therapeutics (LBTM), Faculty of Pharmacy, Pôle Technologie-Santé, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Catherine Boileau
- UMR1148, Inserm, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, F-75018 Paris, France.,Département de Génétique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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3
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Role of B Lymphocytes in the Pathogenesis of NAFLD: A 2022 Update. Int J Mol Sci 2022; 23:ijms232012376. [PMID: 36293233 PMCID: PMC9603875 DOI: 10.3390/ijms232012376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Non-alcoholic fatty liver disease and its related complications are becoming one of the most important health problems globally. The liver functions as both a metabolic and an immune organ. The crosstalk between hepatocytes and intrahepatic immune cells plays a key role in coordinating a dual function of the liver in terms of the protection of the host from antigenic overload as a result of receiving nutrients and gut microbiota antigenic stimulation via facilitating immunologic tolerance. B cells are the most abundant lymphocytes in the liver. The crucial role of intrahepatic B cells in energy metabolism under different immune conditions is now emerging in the literature. The accumulating evidence has demonstrated that the antibodies and cytokines produced by B cells in the microenvironment play key and distinct roles in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Herein, we have aimed to consolidate and update the current knowledge about the pathophysiological roles of B cells as well as the underlying mechanisms in energy metabolism. Understanding how B cells can exacerbate and suppress liver damage by exploiting the antibodies and cytokines they produce will be of great importance for designing B-cell targeting therapies to treat various liver diseases.
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Richard MA, Yang W, Sok P, Li M, Carmichael SL, von Behren J, Reynolds P, Fisher PG, Collins RT, Hobbs CA, Luke B, Shaw GM, Lupo PJ. Differential newborn DNA methylation among individuals with complex congenital heart defects and childhood lymphoma. Birth Defects Res 2022; 114:1434-1439. [PMID: 36226634 DOI: 10.1002/bdr2.2105] [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: 07/07/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is emerging evidence that children with complex congenital heart defects (CHDs) are at increased risk for childhood lymphoma, but the mechanisms underlying this association are unclear. Thus, we sought to evaluate the role of DNA methylation patterns on "CHD-lymphoma" associations. METHODS From >3 million live births (1988-2004) in California registry linkages, we obtained newborn dried bloodspots from eight children with CHD-lymphoma through the California BioBank. We performed case-control epigenome-wide association analyses (EWAS) using two comparison groups with reciprocal discovery and validation to identify differential methylation associated with CHD-lymphoma. RESULTS After correction for multiple testing at the discovery and validation stages, individuals with CHD-lymphoma had differential newborn methylation at six sites relative to two comparison groups. Our top finding was significant in both EWAS and indicates PPFIA1 cg25574765 was hypomethylated among individuals with CHD-lymphoma (mean beta = 0.04) relative to both unaffected individuals (mean beta = 0.93, p = 1.5 × 10-12 ) and individuals with complex CHD (mean beta = 0.95, p = 3.8 × 10-8 ). PPFIA1 encodes a ubiquitously expressed liprin protein in one of the most commonly amplified regions in many cancers (11q13). Further, cg25574765 is a proposed marker of pre-eclampsia, a maternal CHD risk factor that has not been fully evaluated for lymphoma risk in offspring, and the tumor microenvironment that may drive immune cell malignancies. CONCLUSIONS We identified associations between molecular changes present in the genome at birth and risk of childhood lymphoma among those with CHD. Our findings also highlight novel perinatal exposures that may underlie methylation changes in CHD predisposing to lymphoma.
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Affiliation(s)
- Melissa A Richard
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Wei Yang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Pagna Sok
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ming Li
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Julie von Behren
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Paul G Fisher
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Neurology, Stanford University School of Medicine, Palo Alto, California, USA
| | - R Thomas Collins
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Charlotte A Hobbs
- Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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5
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Rutkowska L, Sałacińska K, Salachna D, Matusik P, Pinkier I, Kępczyński Ł, Piotrowicz M, Starostecka E, Lewiński A, Gach A. Identification of New Genetic Determinants in Pediatric Patients with Familial Hypercholesterolemia Using a Custom NGS Panel. Genes (Basel) 2022; 13:genes13060999. [PMID: 35741760 PMCID: PMC9223034 DOI: 10.3390/genes13060999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
The most common form of inherited lipid disorders is familial hypercholesterolemia (FH). It is characterized primarily by high concentrations of the clinical triad of low-density lipoprotein cholesterol, tendon xanthomas and premature CVD. The well-known genetic background are mutations in LDLR, APOB and PCSK9 gene. Causative mutations can be found in 60−80% of definite FH patients and 20−30% of those with possible FH. Their occurrence could be attributed to the activity of minor candidate genes, whose causal mechanism has not been fully discovered. The aim of the conducted study was to identify disease-causing mutations in FH-related and candidate genes in pediatric patients from Poland using next generation sequencing (NGS). An NGS custom panel was designed to cover 21 causative and candidate genes linked to primary dyslipidemia. Recruitment was performed using Simon Broome diagnostic criteria. Targeted next generation sequencing was performed on a MiniSeq sequencer (Illumina, San Diego, CA, USA) using a 2 × 150 bp paired-end read module. Sequencing data analysis revealed pathogenic and possibly pathogenic variants in 33 out of 57 studied children. The affected genes were LDLR, APOB, ABCG5 and LPL. A novel pathogenic 7bp frameshift deletion c.373_379delCAGTTCG in the exon 4 of the LDLR gene was found. Our findings are the first to identify the c.373_379delCAGTTCG mutation in the LDLR gene. Furthermore, the double heterozygous carrier of frameshift insertion c.2416dupG in the LDLR gene and missense variant c.10708C>T in the APOB gene was identified. The c.2416dupG variant was defined as pathogenic, as confirmed by its cosegregation with hypercholesterolemia in the proband’s family. Although the APOB c.10708C>T variant was previously detected in hypercholesterolemic patients, our data seem to demonstrate no clinical impact. Two missense variants in the LPL gene associated with elevated triglyceride plasma level (c.106G>A and c.953A>G) were also identified. The custom NGS panel proved to be an effective research tool for identifying new causative aberrations in a genetically heterogeneous disease as familial hypercholesterolemia (FH). Our findings expand the spectrum of variants associated with the FH loci and will be of value in genetic counseling among patients with the disease.
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Affiliation(s)
- Lena Rutkowska
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
- Correspondence: (L.R.); (A.L.); (A.G.)
| | - Kinga Sałacińska
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Dominik Salachna
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Iwona Pinkier
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Łukasz Kępczyński
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Małgorzata Piotrowicz
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
| | - Ewa Starostecka
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Disease, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland;
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 90-419 Lodz, Poland
- Correspondence: (L.R.); (A.L.); (A.G.)
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz, Poland; (K.S.); (D.S.); (I.P.); (Ł.K.); (M.P.)
- Correspondence: (L.R.); (A.L.); (A.G.)
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Kovács B, Cseprekál O, Diószegi Á, Lengyel S, Maroda L, Paragh G, Harangi M, Páll D. The Importance of Arterial Stiffness Assessment in Patients with Familial Hypercholesterolemia. J Clin Med 2022; 11:jcm11102872. [PMID: 35628997 PMCID: PMC9144855 DOI: 10.3390/jcm11102872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are still the leading cause of mortality due to increased atherosclerosis worldwide. In the background of accelerated atherosclerosis, the most important risk factors include hypertension, age, male gender, hereditary predisposition, diabetes, obesity, smoking and lipid metabolism disorder. Arterial stiffness is a firmly established, independent predictor of cardiovascular risk. Patients with familial hypercholesterolemia are at very high cardiovascular risk. Non-invasive measurement of arterial stiffness is suitable for screening vascular dysfunction at subclinical stage in this severe inherited disorder. Some former studies found stiffer arteries in patients with familial hypercholesterolemia compared to healthy controls, while statin treatment has a beneficial effect on it. If conventional drug therapy fails in patients with severe familial hypercholesterolemia, PCSK9 inhibitor therapy should be administered; if these agents are not available, performing selective LDL apheresis could be considered. The impact of recent therapeutic approaches on vascular stiffness is not widely studied yet, even though the degree of accelerated athero and arteriosclerosis correlates with cardiovascular risk. The authors provide an overview of the diagnosis of familial hypercholesterolemia and the findings of studies on arterial dysfunction in patients with familial hypercholesterolemia, in addition to presenting the latest therapeutic options and their effects on arterial elasticity parameters.
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Affiliation(s)
- Beáta Kovács
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Orsolya Cseprekál
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary;
| | - Ágnes Diószegi
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Szabolcs Lengyel
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - László Maroda
- Department of Medical Clinical Pharmacology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - György Paragh
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
| | - Mariann Harangi
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
- Correspondence: ; Tel.: +36-52-255-525
| | - Dénes Páll
- Division of Metabolism, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.K.); (Á.D.); (S.L.); (G.P.); (D.P.)
- Department of Medical Clinical Pharmacology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
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Jarauta E, Bea-Sanz AM, Marco-Benedi V, Lamiquiz-Moneo I. Genetics of Hypercholesterolemia: Comparison Between Familial Hypercholesterolemia and Hypercholesterolemia Nonrelated to LDL Receptor. Front Genet 2020; 11:554931. [PMID: 33343620 PMCID: PMC7744656 DOI: 10.3389/fgene.2020.554931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/28/2020] [Indexed: 01/04/2023] Open
Abstract
Severe hypercholesterolemia (HC) is defined as an elevation of total cholesterol (TC) due to the increase in LDL cholesterol (LDL-C) >95th percentile or 190 mg/dl. The high values of LDL-C, especially when it is maintained over time, is considered a risk factor for the development of atherosclerotic cardiovascular disease (ASCVD), mostly expressed as ischemic heart disease (IHD). One of the best characterized forms of severe HC, familial hypercholesterolemia (FH), is caused by the presence of a major variant in one gene (LDLR, APOB, PCSK9, or ApoE), with an autosomal codominant pattern of inheritance, causing an extreme elevation of LDL-C and early IHD. Nevertheless, an important proportion of serious HC cases, denominated polygenic hypercholesterolemia (PH), may be attributed to the small additive effect of a number of single nucleotide variants (SNVs), located along the whole genome. The diagnosis, prevalence, and cardiovascular risk associated with PH has not been fully established at the moment. Cascade screening to detect a specific genetic defect is advised in all first- and second-degree relatives of subjects with FH. Conversely, in the rest of cases of HC, it is only advised to screen high values of LDL-C in first-degree relatives since there is not a consensus for the genetic diagnosis of PH. FH is associated with the highest cardiovascular risk, followed by PH and other forms of HC. Early detection and initiation of high-intensity lipid-lowering treatment is proposed in all subjects with severe HC for the primary prevention of ASCVD, with an objective of LDL-C <100 mg/dl or a decrease of at least 50%. A more aggressive reduction in LDL-C is necessary in HC subjects who associate personal history of ASCVD or other cardiovascular risk factors.
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Affiliation(s)
- Estíbaliz Jarauta
- Hospital Universitario Miguel Servet, Instituto de Investigacion Sanitaria Aragon (IIS Aragn), Zaragoza, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Psychiatry a Dermatology, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana Ma Bea-Sanz
- Hospital Universitario Miguel Servet, Instituto de Investigacion Sanitaria Aragon (IIS Aragn), Zaragoza, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria Marco-Benedi
- Hospital Universitario Miguel Servet, Instituto de Investigacion Sanitaria Aragon (IIS Aragn), Zaragoza, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Itziar Lamiquiz-Moneo
- Hospital Universitario Miguel Servet, Instituto de Investigacion Sanitaria Aragon (IIS Aragn), Zaragoza, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Psychiatry a Dermatology, Universidad de Zaragoza, Zaragoza, Spain
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8
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Mohebi R, Chen Q, Hegele RA, Rosenson RS. Failure of cosegregation between a rare STAP1 missense variant and hypercholesterolemia. J Clin Lipidol 2020; 14:636-638. [PMID: 32828708 DOI: 10.1016/j.jacl.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
Autosomal dominant familial hypercholesterolemia (FH) is characterized by elevated low-density lipoprotein cholesterol levels and an increased risk for atherosclerotic cardiovascular disease. Although rare pathogenic variants in genes encoding the low-density lipoprotein receptor, apolipoprotein B, proprotein convertase subtilisin/kexin 9 are found in more than 80% of molecularly defined patients with FH, a few rare minor causative genes have been proposed, including the gene encoding signal-transducing adaptor family member 1 (STAP1). Here, we describe a patient with hypercholesterolemia and the rare heterozygous missense variant p.D207N in STAP1. However, extending the pedigree showed failure of the variant to cosegregate with hypercholesterolemia, as both his sons were carriers of the variant and both were also normolipidemic. The findings add to the evidence against STAP1 as a genetic locus for FH.
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Affiliation(s)
- Reza Mohebi
- Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qinzhong Chen
- Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert S Rosenson
- Cardiometabolics Unit, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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9
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Reeskamp LF, Tromp TR, Defesche JC, Grefhorst A, Stroes ESG, Hovingh GK, Zuurbier L. Next-generation sequencing to confirm clinical familial hypercholesterolemia. Eur J Prev Cardiol 2020; 28:875-883. [PMID: 34298557 DOI: 10.1093/eurjpc/zwaa451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Familial hypercholesterolemia is characterised by high low-density lipoprotein-cholesterol levels and is caused by a pathogenic variant in LDLR, APOB or PCSK9. We investigated which proportion of suspected familial hypercholesterolemia patients was genetically confirmed, and whether this has changed over the past 20 years in The Netherlands. METHODS Targeted next-generation sequencing of 27 genes involved in lipid metabolism was performed in patients with low-density lipoprotein-cholesterol levels greater than 5 mmol/L who were referred to our centre between May 2016 and July 2018. The proportion of patients carrying likely pathogenic or pathogenic variants in LDLR, APOB or PCSK9, or the minor familial hypercholesterolemia genes LDLRAP1, ABCG5, ABCG8, LIPA and APOE were investigated. This was compared with the yield of Sanger sequencing between 1999 and 2016. RESULTS A total of 227 out of the 1528 referred patients (14.9%) were heterozygous carriers of a pathogenic variant in LDLR (80.2%), APOB (14.5%) or PCSK9 (5.3%). More than 50% of patients with a Dutch Lipid Clinic Network score of 'probable' or 'definite' familial hypercholesterolemia were familial hypercholesterolemia mutation-positive; 4.8% of the familial hypercholesterolemia mutation-negative patients carried a variant in one of the minor familial hypercholesterolemia genes. The mutation detection rate has decreased over the past two decades, especially in younger patients in which it dropped from 45% in 1999 to 30% in 2018. CONCLUSIONS A rare pathogenic variant in LDLR, APOB or PCSK9 was identified in 14.9% of suspected familial hypercholesterolemia patients and this rate has decreased in the past two decades. Stringent use of clinical criteria algorithms is warranted to increase this yield. Variants in the minor familial hypercholesterolemia genes provide a possible explanation for the familial hypercholesterolemia phenotype in a minority of patients.
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Affiliation(s)
- Laurens F Reeskamp
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - Tycho R Tromp
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - Joep C Defesche
- Department of Clinical Genetics, University of Amsterdam, The Netherlands
| | - Aldo Grefhorst
- Department of Experimental Vascular Medicine, University of Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - Linda Zuurbier
- Department of Clinical Genetics, University of Amsterdam, The Netherlands
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10
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Reeskamp LF, Tromp TR, Defesche JC, Grefhorst A, Stroes ES, Hovingh GK, Zuurbier L. Next-generation sequencing to confirm clinical familial hypercholesterolemia. Eur J Prev Cardiol 2020:2047487320942996. [PMID: 32718233 DOI: 10.1177/2047487320942996] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Familial hypercholesterolemia is characterised by high low-density lipoprotein-cholesterol levels and is caused by a pathogenic variant in LDLR, APOB or PCSK9. We investigated which proportion of suspected familial hypercholesterolemia patients was genetically confirmed, and whether this has changed over the past 20 years in The Netherlands. METHODS Targeted next-generation sequencing of 27 genes involved in lipid metabolism was performed in patients with low-density lipoprotein-cholesterol levels greater than 5 mmol/L who were referred to our centre between May 2016 and July 2018. The proportion of patients carrying likely pathogenic or pathogenic variants in LDLR, APOB or PCSK9, or the minor familial hypercholesterolemia genes LDLRAP1, ABCG5, ABCG8, LIPA and APOE were investigated. This was compared with the yield of Sanger sequencing between 1999 and 2016. RESULTS A total of 227 out of the 1528 referred patients (14.9%) were heterozygous carriers of a pathogenic variant in LDLR (80.2%), APOB (14.5%) or PCSK9 (5.3%). More than 50% of patients with a Dutch Lipid Clinic Network score of 'probable' or 'definite' familial hypercholesterolemia were familial hypercholesterolemia mutation-positive; 4.8% of the familial hypercholesterolemia mutation-negative patients carried a variant in one of the minor familial hypercholesterolemia genes. The mutation detection rate has decreased over the past two decades, especially in younger patients in which it dropped from 45% in 1999 to 30% in 2018. CONCLUSIONS A rare pathogenic variant in LDLR, APOB or PCSK9 was identified in 14.9% of suspected familial hypercholesterolemia patients and this rate has decreased in the past two decades. Stringent use of clinical criteria algorithms is warranted to increase this yield. Variants in the minor familial hypercholesterolemia genes provide a possible explanation for the familial hypercholesterolemia phenotype in a minority of patients.
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Affiliation(s)
- Laurens F Reeskamp
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - Tycho R Tromp
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - Joep C Defesche
- Department of Clinical Genetics, University of Amsterdam, The Netherlands
| | - Aldo Grefhorst
- Department of Experimental Vascular Medicine, University of Amsterdam, The Netherlands
| | - Erik Sg Stroes
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, University of Amsterdam, The Netherlands
| | - Linda Zuurbier
- Department of Clinical Genetics, University of Amsterdam, The Netherlands
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