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Von Ruden S, Slusarenko N, Webster D. A Case Report of Hypertriglyceridemia-Associated Acute Pancreatitis Following Use of Brazil Nut Weight-Loss Supplement. J Pharm Pract 2022; 35:1049-1053. [DOI: 10.1177/08971900211015040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose: Brazil nuts ( Bertholletia excelsa) are consumed world-wide and have become a new trend in weight loss supplementation. We present a unique case of severe hypertriglyceridemia-associated acute pancreatitis following daily usage of a Brazil nut supplement product. Summary: A Hispanic female presented with severe hypertriglyceridemia and acute pancreatitis several months after starting a Brazil nut weight loss supplement in the setting of poorly controlled Type 2 Diabetes Mellitus. Her initial triglyceride level was undetectably high >10,000 mg/dL but improved rapidly following euglycemic insulin infusion and supplement cessation. The patient was managed with supportive care, started on oral fibrate therapy after abdominal symptoms improved, and was discharged to home in stable condition. Conclusion: It is essential for pharmacists to maintain a high index of suspicion for patients taking complementary and alternative medications and supplements who present with acutely altered laboratory parameters or onset of acute disease. In this instance, a patient was found to have profound hypertriglyceridemia with onset of acute pancreatitis following usage of a Brazil nut weight loss supplement.
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Feng L, Sun Y, Liu F, Wang C, Zhang C, Liu J, Jiang L. Clinical features and functions of a novel Lpl mutation C.986A>C (p.Y329S) in patient with hypertriglyceridemia. Curr Res Transl Med 2022; 70:103337. [PMID: 35679768 DOI: 10.1016/j.retram.2022.103337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate and assess the clinical features and functions of a new lipoprotein lipase (Lpl) gene mutation c.986A>C (p.Y329S) found in hypertriglyceridemia(HTG) patients from a Chinese family. METHODS Five members of a family with the proband were diagnosed with HTG were investigated, and fasting peripheral blood was collected . The plasma was then used to measure triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein cholesterol (HDL-C), free fatty acids (FFA), and glucose tolerance. Following that, genomic deoxyribonucleic acid (DNA) was extracted from whole-blood samples using the QIAamp whole-blood DNA kit, and the coding exon regions and flanking regions of 95 dyslipidemia-related genes were captured using GenCap liquid-phase target gene capture technology. The activity of LPL and its mutation were then determined using cell assays, and the newly discovered LPL mutant was functionally analyzed. The binding site of fenofibrate and LPL, as well as the mutation, were subjected to predictive analysis. RESULTS The LPL gene's c.986A>C (p.Y329S) heterozygous mutation was discovered, and patients with the mutation had the typical phenotype of LPL deficiency and weakened LPL activity. Furthermore, this mutant has been treated with fenofibrate, and its triglyceride level is perfectly controlled and stable. The prediction analysis of the fenofibrate and LPL binding sites reveals that the wild-type system, Phe378 contributes most to the binding energy of fenofibrate. In the mutant system, Tyr394, which contributes the most to the binding energy of fenofibrate, the contribution of S329 is greater than that of Y329 (0.9∼0.7 kal/mol) . After Y329 is mutated, the hydrogen bond data of fenofibrate and LPL will also increase to quote H-bond diagrams. CONCLUSIONS A heterozygous mutation c.986A>C (p.Y329S) in exon 6 of Lpl gene occurs in the proband with familial HTG. Lpl c.986A>C (p.Y329S) mutation weakens the activity of the LPL, which may be the pathogenic mutation of HTG. In addition, The proband has been treated with fenofibrate and the triglyceride level is ideally controlled and stable. The prediction analysis of the fenofibrate and LPL binding site shows that the wild-type system, Phe378 contributes most to the binding energy of fenofibrate. In the mutant system, Tyr394, which contributes the most to the binding energy of fenofibrate, the contribution of S329 is greater than that of Y329 (0.9∼0.7 kal/mol). After Y329 is mutated, the hydrogen bond data of fenofibrate and LPL will also increase, which may be one of the reasons why the mutation has no effect on the therapeutic effect of fenofibrate.
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Affiliation(s)
- Lingling Feng
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Department of Endocrinology, Laoling People's Hospital, Laoling 253600, Shandong Province, China
| | - Yujing Sun
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Fuqiang Liu
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Chuan Wang
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Chao Zhang
- Department of Biochemistry and Molecular Biology, Shandong University School of Medicine, Jinan, Shandong, 250012, China
| | - Jidong Liu
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China
| | - Ling Jiang
- Department of Endocrinology, Qilu Hospital, Cheeloo college of medicine, Shandong University, Jinan, 250012, China; Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, Shandong Province, China; Jinan Clinical Research Center for Endocrine and Metabolic Diseases, Jinan, 250012, Shandong Province, China.
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Khan SA, Khan A, Malik MI. Primary hypertriglyceridemia induced pancreatitis in a cohort of Pakistani children. J Pediatr Endocrinol Metab 2022; 35:669-672. [PMID: 35405772 DOI: 10.1515/jpem-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Primary hypertriglyceridemia is a rare condition in children. Hypertriglyceridemia induced pancreatitis is most commonly reported in adults, accounting for third most common cause after gallstones and alcohol consumption. The study aims to highlight the frequency of hypertriglyceridemia induced pancreatitis in a cohort of children presenting in a tertiary care hospital. METHODS A retrospective review of paediatric patients with pancreatitis was conducted in Shifa International hospital, Islamabad, from 2013 to 2020. All patients under 18 years of age who fulfilled the inclusion criteria were included. Medical records of patients were checked for symptoms, signs, age, growth parameters and laboratory investigations. Patients who had HTG were reviewed in detail for family history of pancreatitis or dyslipidemias. RESULTS We found a cohort of 6 patients with primary hypertriglyceridemia after excluding secondary causes. Out of these 6 patients, 4 (66.6%) were male and 2 (33.3%) were female. Minimum age of our patient was 2 months and maximum was 17 years with a mean age of 6.5 years. Two patients presented less than one year of age. Mean triglyceride levels was 1,599 + 523 mg/dL. Four patients (66.6%) had acute pancreatitis, one each (16.6%) had recurrent and chronic pancreatitis. Family history was positive for hyperlipidaemia in two patients who had positive consanguinity. Patients with positive family history were symptomatic at earlier age. CONCLUSIONS This is the first study to highlight primary hypertriglyceridemia presenting as pancreatitis in paediatric population from Pakistan. All patients had triglycerides level of greater than 1000 mg/dL.
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Affiliation(s)
- Sabeen Abid Khan
- Paediatrics Gastroenterologist, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Anusha Khan
- Paediatrics Gastroenterologist, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Munir Iqbal Malik
- Paediatrics Gastroenterologist, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Zhang X, Chen Y, Tong N, Shao Q, Zhou Y, Mu T, Yang X, Zhang Y. Maternally inherited diabetes and deafness coexists with lipoprotein lipase gene mutation-associated severe hyperlipidemia that was resistant to fenofibrate and atorvastatin, but sensitive to bezafibrate: A case report. J Diabetes Investig 2021; 13:397-401. [PMID: 34460997 PMCID: PMC8847153 DOI: 10.1111/jdi.13651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 02/05/2023] Open
Abstract
Maternally inherited diabetes and deafness is a rare genetic disease mainly caused by a point mutation in mitochondrial deoxyribonucleic acid. Lipoprotein lipase gene mutations are associated with familial dyslipidemias, which are difficult to manage. We reported for the first time a case that had both maternally inherited diabetes and severe hyperlipidemia caused by lipoprotein lipase gene mutation (C.347(exon3)G>C) that was resistant to fenofibrate and atorvastatin. We were able to manage the patient’s hyperlipidemia with bezafibrate, and her diabetes was well controlled with insulin. In conclusion, genetic testing is helpful in identifying rare and interesting cases when clinicians suspect inheritable diseases. Additionally, when one fibrate drug is ineffective in treating hyperlipidemia, it might be worthwhile trying another fibrate.
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Affiliation(s)
- Xiaojuan Zhang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Yongyong Chen
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China.,Department of Endocrinology and Metabolism, The Fifth People's Hospital of Chongqing, Chongqing, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Shao
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Yueyang Zhou
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Tong Mu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoling Yang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Yuwei Zhang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
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Abstract
PURPOSE OF REVIEW Hypertriglyceridemia is a common dyslipidemia associated with an increased risk of cardiovascular disease and pancreatitis. Severe hypertriglyceridemia may sometimes be a monogenic condition. However, in the vast majority of patients, hypertriglyceridemia is due to the cumulative effect of multiple genetic risk variants along with lifestyle factors, medications, and disease conditions that elevate triglyceride levels. In this review, we will summarize recent progress in the understanding of the genetic basis of hypertriglyceridemia. RECENT FINDINGS More than 300 genetic loci have been identified for association with triglyceride levels in large genome-wide association studies. Studies combining the loci into polygenic scores have demonstrated that some hypertriglyceridemia phenotypes previously attributed to monogenic inheritance have a polygenic basis. The new genetic discoveries have opened avenues for the development of more effective triglyceride-lowering treatments and raised interest towards genetic screening and tailored treatments against hypertriglyceridemia. The discovery of multiple genetic loci associated with elevated triglyceride levels has led to improved understanding of the genetic basis of hypertriglyceridemia and opened new translational opportunities.
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Affiliation(s)
- Germán D. Carrasquilla
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Mærsk Building, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Malene Revsbech Christiansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Mærsk Building, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Tuomas O. Kilpeläinen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Mærsk Building, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Lahoz C, Mostaza JM. Familial hypertriglyceridemia/polygenic hypertrigliceridemia. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2021; 33 Suppl 2:37-42. [PMID: 34006352 DOI: 10.1016/j.arteri.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022]
Abstract
For decades, familial hypertriglyceridemia (HTG) has been considered a specific entity characterized by an increase in VLDL particles and an autosomal dominant inheritance pattern. In the genomics era, it has been proven that familial HTG, although it could be grouped in families, had a polygenic inheritance in which the phenotype would be determined by concomitant environmental factors. Hence its inclusion in the group of polygenic HTGs. Clinically, they are characterized by moderate HTG, with the consequent increase in cardiovascular risk, and in rare cases, by severe HTG with risk of acute pancreatitis. Treatment will be based on controlling environmental factors, implementing hygienic-dietetic measures and sometimes drugs, to reduce cardiovascular risk in moderate HTGs and acute pancreatitis risk in severe HTGs.
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Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Hospital Carlos III, Madrid, España.
| | - José María Mostaza
- Unidad de Lípidos y Riesgo Vascular, Hospital Carlos III, Madrid, España
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Ahmadpoor P, Aglae C, Cariou S, Pambrun E, Renaud S, Garo F, Darmon R, Schultz C, Prelipcean C, Reboul P, Moranne O. Physiological role of plasma and its components and the clinical implications of different methods of apheresis: A narrative review. Ther Apher Dial 2020; 25:262-272. [PMID: 32710797 DOI: 10.1111/1744-9987.13567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/17/2020] [Accepted: 07/22/2020] [Indexed: 12/23/2022]
Abstract
Nowadays, therapeutic plasmapheresis (TP) is accepted as part of the treatment for specific groups of diseases. The availability of different methods, including double filtration and adsorption, increases selectivity for the removal of substances. However, the use of these techniques requires a thorough understanding of the characteristics and components of plasma. By considering pivotal papers from several databases, the aim of this narrative review is to describe the characteristics of plasma related to apheresis techniques. We have tried to cover the clinical implications including physiology, estimation of plasma volume, viscosity, and a description of its components including the size, volume of distribution, and half-lives of the different substances to be removed or maintained depending on the clinical situation and applied apheresis technique. Applying this knowledge will help us to choose the right method and dosage and improve the efficacy of the procedure by preventing or addressing any complications.
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Affiliation(s)
- Pedram Ahmadpoor
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Cedric Aglae
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Sylvain Cariou
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Emilie Pambrun
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Sophie Renaud
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Florian Garo
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Ruben Darmon
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Celine Schultz
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Camelia Prelipcean
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Pascal Reboul
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France
| | - Olivier Moranne
- Service Nephrologie-Dialyse-Aphérèse, CHU Carémeau, Université de Montpellier-Nîmes, Nîmes, France.,EA2415, Université de Montpellier, Montpellier, France
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Hubacek JA, Dlouha D, Adamkova V, Schwarzova L, Lanska V, Ceska R, Satny M, Vrablik M. The Gene Score for Predicting Hypertriglyceridemia: New Insights from a Czech Case-Control Study. Mol Diagn Ther 2020; 23:555-562. [PMID: 31222479 DOI: 10.1007/s40291-019-00412-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Plasma triglyceride (TG) values are significant predictors of cardiovascular and total mortality. The plasma levels of TGs have an important genetic background. We analyzed whether 32 single nucleotide polymorphisms (SNPs) identified in genome-wide association studies are discriminators of hypertriglyceridemia (HTG) in the Czech population. OBJECTIVES The objective of this study was to replicate and test the original findings in an independent study and to re-analyze the gene score leading to HTG. METHODS In total, we analyzed 32 SNPs in 209 patients with plasma TG levels over 10 mmol/L (HTG group) and compared them in a case-control design with 524 treatment-naïve controls (normotriglyceridemic [NTG] group) with plasma TG values below 1.8 mmol/L. RESULTS Sixteen SNPs were significantly associated with an increased risk of HTG development, with odds ratios (ORs) (95% confidence interval [CI]) varying from 1.40 (1.01-1.95) to 4.69 (3.29-6.68) (rs964184 within the APOA5 gene). Both unweighted (sum of the risk alleles) and weighted gene scores (WGS) (log of the achieved ORs per individual genotype) were calculated, and both gene scores were significantly different between groups. The mean score of the risk alleles was significantly increased in the HTG group compared to the NTG group (18.5 ± 2.5 vs. 15.7 ± 2.3, respectively; P < 0.00001). Subjects with a WGS over 9 were significantly more common in the HTG group (44.5%) than in the NTG group, in which such a high score was observed in only 4.7% of subjects (OR 16.3, 95% CI 10.0-36.7; P < 0.0000001). CONCLUSIONS An increased number of risk genetic variants, calculated both in a weighted or unweighted manner, significantly discriminates between the subjects with HTG and controls. Population-specific sets of SNPs included into the gene score seem to yield better discrimination power.
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Affiliation(s)
- Jaroslav A Hubacek
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine (IKEM-DEM-LAR), Videnska 1958/9, 140 21, Prague 4, Czech Republic.
| | - Dana Dlouha
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine (IKEM-DEM-LAR), Videnska 1958/9, 140 21, Prague 4, Czech Republic
| | - Vera Adamkova
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lucie Schwarzova
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vera Lanska
- Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Richard Ceska
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Satny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Vrablik
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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