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Konaklieva MI, Plotkin BJ. Targeting host-specific metabolic pathways-opportunities and challenges for anti-infective therapy. Front Mol Biosci 2024; 11:1338567. [PMID: 38455763 PMCID: PMC10918472 DOI: 10.3389/fmolb.2024.1338567] [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: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
Microorganisms can takeover critical metabolic pathways in host cells to fuel their replication. This interaction provides an opportunity to target host metabolic pathways, in addition to the pathogen-specific ones, in the development of antimicrobials. Host-directed therapy (HDT) is an emerging strategy of anti-infective therapy, which targets host cell metabolism utilized by facultative and obligate intracellular pathogens for entry, replication, egress or persistence of infected host cells. This review provides an overview of the host lipid metabolism and links it to the challenges in the development of HDTs for viral and bacterial infections, where pathogens are using important for the host lipid enzymes, or producing their own analogous of lecithin-cholesterol acyltransferase (LCAT) and lipoprotein lipase (LPL) thus interfering with the human host's lipid metabolism.
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Affiliation(s)
| | - Balbina J. Plotkin
- Department of Microbiology and Immunology, Midwestern University, Downers Grove, IL, United States
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Ciro Acosta S, Díaz-Ordóñez L, Gutierrez-Medina JD, Silva-Cuero YK, Arango-Vélez LG, García-Trujillo AO, Pachajoa H. Familial LCAT Deficiency and Low HDL-C Levels: In silico Characterization of Two Rare LCAT Missense Mutations. Appl Clin Genet 2024; 17:23-32. [PMID: 38404612 PMCID: PMC10893891 DOI: 10.2147/tacg.s438135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/16/2023] [Indexed: 02/27/2024] Open
Abstract
Mutations in the lecithin-cholesterol acyltransferase (LCAT) gene, which catalyzes the esterification of cholesterol, result in two types of autosomal recessive disorders: Familial LCAT deficiency (FLD) and Fish Eye Disease (FED). While both phenotypes are characterized by corneal opacities and different forms of dyslipidemia, such as low levels of high-density lipoprotein-cholesterol (HDL-C), FLD exhibits more severe clinical manifestations like splenomegaly, anemia, and renal failure. We describe the first clinically and genetically confirmed case of FLD in Colombia which corresponds to a 46-year-old woman with corneal opacity, hypothyroidism, and dyslipidemia, who does not have any manifestations of renal failure, with two pathogenic heterozygous missense variants in the LCAT gene: LCAT (NM_000229.2):c.803G>A (p.Arg268His) and LCAT (NM_000229.2):c.368G>C (p.Arg123Pro). In silico analysis of the mutations predicted the physicochemical properties of the mutated protein, causing instability and potentially decreased LCAT function. These compound mutations highlight the clinical heterogeneity of the phenotypes associated with LCAT gene mutations.
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Affiliation(s)
- Sebastian Ciro Acosta
- Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
| | - Lorena Díaz-Ordóñez
- Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
- Departamento de Ciencias Basicas Medicas, Facultad de Salud, Universidad Icesi, Cali, Colombia
| | - Juan David Gutierrez-Medina
- Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clinicas, Fundacion Valle del Lili, Cali, Colombia
| | - Yisther Katherine Silva-Cuero
- Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
- Departamento de Ciencias Basicas Medicas, Facultad de Salud, Universidad Icesi, Cali, Colombia
| | - Luis Guillermo Arango-Vélez
- Servicio de Endocrinologia, Fundacion Valle del Lili, Cali, Colombia
- Departamento de Medicina interna, Seccion de Endocrinologia, Universidad Icesi, Cali, Colombia
| | - Andrés Octavio García-Trujillo
- Servicio de Endocrinologia, Fundacion Valle del Lili, Cali, Colombia
- Departamento de Medicina interna, Seccion de Endocrinologia, Universidad Icesi, Cali, Colombia
| | - Harry Pachajoa
- Centro de Investigaciones en Anomalias Congenitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
- Departamento de Ciencias Basicas Medicas, Facultad de Salud, Universidad Icesi, Cali, Colombia
- Genetic Division, Fundacion Valle del Lili, Cali, Colombia
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Bonilha I, Luchiari B, Nadruz W, Sposito AC. Very low HDL levels: clinical assessment and management. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:3-18. [PMID: 36651718 PMCID: PMC9983789 DOI: 10.20945/2359-3997000000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In individuals with very low high-density lipoprotein (HDL-C) cholesterol, such as Tangier disease, LCAT deficiency, and familial hypoalphalipoproteinemia, there is an increased risk of premature atherosclerosis. However, analyzes based on comparisons of populations with small variations in HDL-C mediated by polygenic alterations do not confirm these findings, suggesting that there is an indirect association or heterogeneity in the pathophysiological mechanisms related to the reduction of HDL-C. Trials that evaluated some of the HDL functions demonstrate a more robust degree of association between the HDL system and atherosclerotic risk, but as they were not designed to modify lipoprotein functionality, there is insufficient data to establish a causal relationship. We currently have randomized clinical trials of therapies that increase HDL-C concentration by various mechanisms, and this HDL-C elevation has not independently demonstrated a reduction in the risk of cardiovascular events. Therefore, this evidence shows that (a) measuring HDL-C as a way of estimating HDL-related atheroprotective system function is insufficient and (b) we still do not know how to increase cardiovascular protection with therapies aimed at modifying HDL metabolism. This leads us to a greater effort to understand the mechanisms of molecular action and cellular interaction of HDL, completely abandoning the traditional view focused on the plasma concentration of HDL-C. In this review, we will detail this new understanding and the new horizon for using the HDL system to mitigate residual atherosclerotic risk.
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Affiliation(s)
- Isabella Bonilha
- Universidade de Campinas (Unicamp), Laboratório de Biologia Vascular e Aterosclerose (AtheroLab), Divisão de Cardiologia, Campinas, SP, Brasil
| | - Beatriz Luchiari
- Universidade de Campinas (Unicamp), Laboratório de Biologia Vascular e Aterosclerose (AtheroLab), Divisão de Cardiologia, Campinas, SP, Brasil
| | - Wilson Nadruz
- Universidade de Campinas (Unicamp), Divisão de Cardiologia, Campinas, SP, Brasil
| | - Andrei C Sposito
- Universidade de Campinas (Unicamp), Laboratório de Biologia Vascular e Aterosclerose (AtheroLab), Divisão de Cardiologia, Campinas, SP, Brasil,
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Fistrek Prlic M, Coric M, Calabresi L, Pavanello C, Mosca L, Cavallari U, Vukovic Brinar I, Karanovic S, Laganovic M, Jelakovic B. Two novel variants in the lecithin:cholesterol acyltransferase gene resulted in classic LCAT deficiency. ATHEROSCLEROSIS PLUS 2022; 49:28-31. [PMID: 36644204 PMCID: PMC9833264 DOI: 10.1016/j.athplu.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 01/18/2023]
Abstract
Background and aims We report the first two cases of familial lecithin:cholesterol acyltransferase (LCAT) deficiency in Croatia with classical clinical and biochemical features. Patients and methods A 30-year-old man with nephrotic syndrome, corneal opacities, hepatosplenomegaly, anemia, low high-density lipoprotein (HDL)-cholesterol levels and arterial hypertension (blood pressure >200/100 mmHg) was admitted to our department. At admission, he had an elevated creatinine serum level (233 μmol/L), proteinuria of 12 g in 24-h urine (g/24 h), 3-7 erythrocytes in urine sediment and notable anemia (hemoglobin level 90 g/l). His HDL-cholesterol was significantly low (0.42 mmol/L). Besides chronic kidney disease (CKD), other secondary causes of hypertension were ruled out. The patient was previously diagnosed with membranous nephropathy and treated unsuccessfully with immunosuppressive agents (steroids, cyclosporine, cyclophosphamide). Re-evaluation of histopathological findings of kidney biopsy revealed massive deposition of lipid material in the glomerular basal membrane and in the mesangial region. His 4-year younger brother was also evaluated due to corneal opacities and new-onset arterial hypertension. Nephrotic range proteinuria with preserved global renal function was determined. He also had very low HDL-cholesterol levels. Results Kidney biopsies from both patients were consistent with LCAT deficiency. The disease was confirmed by measurement of LCAT enzyme activity, plasma cholesterol esterification rate, and genetic testing. Two novel missense variants in the LCAT gene (c.496G > A and c.1138T > C) were found. Conclusions To our knowledge, the presented cases are the first reported cases of genetic LCAT deficiency in Croatia. Given the clinical presentation, the complete lack of LCAT activity and cholesterol esterification rate, diagnosis of familial LCAT deficiency was made.
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Affiliation(s)
- Margareta Fistrek Prlic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia,Corresponding author. Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, UHC Zagreb, Kispaticeva ulica 12, 10000, Zagreb, Croatia.
| | - Marijana Coric
- Department of Pathology, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Laura Calabresi
- Center E. Grossi Paoletti, Department of Pharmacology, University of Milan, Via Balzaretti 9, 20133, Milan, Italy
| | - Chiara Pavanello
- Center E. Grossi Paoletti, Department of Pharmacology, University of Milan, Via Balzaretti 9, 20133, Milan, Italy
| | - Lorena Mosca
- Medical Genetics Unit, Department of Services, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Ugo Cavallari
- Medical Genetics Unit, Department of Services, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Ivana Vukovic Brinar
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Sandra Karanovic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Mario Laganovic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia,Department of Nephrology, University Hospital Merkur, University of Zagreb, School of Medicine, Zajceva 19, 10000, Zagreb, Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
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de Serpa Brandão RMS, Britto FB, do Monte Neto JT, Lima MC, do Monte SJH, de Sousa Lima AV, Pereira EM, da Silva HJN, Oliveira DMTE, Coelho AGB, da Silva AS. Familial lecithin-cholesterol acyltransferase deficiency: If so rare, why so frequent in the state of Piauí, northeastern Brazil? Mol Genet Metab Rep 2022; 30:100840. [PMID: 35242572 PMCID: PMC8856911 DOI: 10.1016/j.ymgmr.2021.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/16/2022] Open
Abstract
Lecithin-cholesterol acyltransferase (LCAT), an enzyme that participates in lipoprotein metabolism, plays an important role in cholesterol homeostasis. Mutations in the LCAT gene can cause two rare genetic disorders: familial LCAT deficiency (FLD), which is characterized by corneal opacities, normocytic anemia, dyslipidemia, and proteinuria progressing to chronic renal failure, and fish-eye disease (FED), which causes dyslipidemia and progressive corneal opacities. Herein, we report six suspected cases of FLD in the backlands of Piauí, located in northeast Brazil. A genetic diagnosis was performed in index cases. Among these, a further investigation was performed to identify new cases in the families. In addition, molecular analyses were performed to verify the levels of consanguinity within families and the existence of a genetic relationship between them. All six index cases were confirmed as FLD with an identical mutation (c.803G > A, p.R268H). The genetic investigation confirmed another 7 new cases of FLD, 52 heterozygous and 6 individuals without mutations. The rate of consanguinity revealed that marriages within the family did not contribute to the high number of FLD cases within the restricted region. The elders of each family (patriarchs and matriarchs) were subjected to a kinship analysis and were more genetically related to each other than the control group. Bayesian analysis was implemented to confirm the hypothesis of connectivity among patriarchs and matriarchs and indicated that they were genetically more related to each other than would be randomly expected, thus suggesting the occurrence of a possible founder effect in these families.
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Affiliation(s)
- Rafael Melo Santos de Serpa Brandão
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 16. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
- Corresponding author.
| | - Fábio Barros Britto
- Department of Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 01. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - José Tiburcio do Monte Neto
- Department of General Practice – Nephrology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Marcelo Cunha Lima
- Universitary Hospital (HU-UFPI/EBSERH), Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Semiramis Jamil Hadad do Monte
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 16. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Antonio Vanildo de Sousa Lima
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 16. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Ester Miranda Pereira
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 16. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Higo José Neri da Silva
- Master's Program in Science and Health, Federal University of Piauí, Teresina, Brazil, Centro de Ciências da Saúde, Avenida Frei Serafim n° 2280. Bairro Centro, Teresina, Piauí 64001-020, Brazil
| | - Deylane Menezes Teles e Oliveira
- Graduate Program in Biotechnology - RENORBIO, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Antonio Gilberto Borges Coelho
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 16. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
| | - Adalberto Socorro da Silva
- Laboratory of Immunogenetics and Molecular Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 16. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
- Department of Biology, Federal University of Piauí, Teresina, Brazil, Campus Ministro Petrônio Portella - SG 01. Bairro Ininga, Teresina, Piauí 64049-550, Brazil
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Vitali C, Bajaj A, Nguyen C, Schnall J, Chen J, Stylianou K, Rader DJ, Cuchel M. A systematic review of the natural history and biomarkers of primary Lecithin:Cholesterol Acyltransferase (LCAT) deficiency. J Lipid Res 2022; 63:100169. [PMID: 35065092 PMCID: PMC8953693 DOI: 10.1016/j.jlr.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/16/2021] [Accepted: 12/28/2021] [Indexed: 10/31/2022] Open
Abstract
Syndromes associated with LCAT deficiency, a rare autosomal recessive condition, include fish-eye disease (FED) and familial LCAT deficiency (FLD). FLD is more severe and characterized by early and progressive chronic kidney disease (CKD). No treatment is currently available for FLD, but novel therapeutics are under development. Furthermore, although biomarkers of LCAT deficiency have been identified, their suitability to monitor disease progression and therapeutic efficacy is unclear, as little data exist on the rate of progression of renal disease. Here, we systematically review observational studies of FLD, FED, and heterozygous subjects, which summarize available evidence on the natural history and biomarkers of LCAT deficiency, in order to guide the development of novel therapeutics. We identified 146 FLD and 53 FED patients from 219 publications, showing that both syndromes are characterized by early corneal opacity and markedly reduced HDL-C levels. Proteinuria/hematuria were the first signs of renal impairment in FLD, followed by rapid decline of renal function. Furthermore, LCAT activity toward endogenous substrates and the percentage of circulating esterified cholesterol (EC%) were the best discriminators between these two syndromes. In FLD, higher levels of total, non-HDL, and unesterified cholesterol were associated with severe CKD. We reveal a nonlinear association between LCAT activity and EC% levels, in which subnormal levels of LCAT activity were associated with normal EC%. This review provides the first step toward the identification of disease biomarkers to be used in clinical trials and suggests that restoring LCAT activity to subnormal levels may be sufficient to prevent renal disease progression.
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Mehta R, Elías-López D, Martagón AJ, Pérez-Méndez OA, Sánchez MLO, Segura Y, Tusié MT, Aguilar-Salinas CA. LCAT deficiency: a systematic review with the clinical and genetic description of Mexican kindred. Lipids Health Dis 2021; 20:70. [PMID: 34256778 PMCID: PMC8276382 DOI: 10.1186/s12944-021-01498-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND LCAT (lecithin-cholesterol acyltransferase) deficiency is characterized by two distinct phenotypes, familial LCAT deficiency (FLD) and Fish Eye disease (FED). This is the first systematic review evaluating the ethnic distribution of LCAT deficiency, with particular emphasis on Latin America and the discussion of three Mexican-Mestizo probands. METHODS A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) Statement in Pubmed and SciELO. Articles which described subjects with LCAT deficiency syndromes and an assessment of the ethnic group to which the subject pertained, were included. RESULTS The systematic review revealed 215 cases (154 FLD, 41 FED and 20 unclassified) pertaining to 33 ethnic/racial groups. There was no association between genetic alteration and ethnicity. The mean age of diagnosis was 42 ± 16.5 years, with fish eye disease identified later than familial LCAT deficiency (55 ± 13.8 vs. 41 ± 14.7 years respectively). The prevalence of premature coronary heart disease was significantly greater in FED vs. FLD. In Latin America, 48 cases of LCAT deficiency have been published from six countries (Argentina (1 unclassified), Brazil (38 FLD), Chile (1 FLD), Columbia (1 FLD), Ecuador (1 FLD) and Mexico (4 FLD, 1 FED and 1 unclassified). Of the Mexican probands, one showed a novel LCAT mutation. CONCLUSIONS The systematic review shows that LCAT deficiency syndromes are clinically and genetically heterogeneous. No association was confirmed between ethnicity and LCAT mutation. There was a significantly greater risk of premature coronary artery disease in fish eye disease compared to familial LCAT deficiency. In FLD, the emphasis should be in preventing both cardiovascular disease and the progression of renal disease, while in FED, cardiovascular risk management should be the priority. The LCAT mutations discussed in this article are the only ones reported in the Mexican- Amerindian population.
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Affiliation(s)
- Roopa Mehta
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Av. Vasco de Quiroga 15, Belisario Domínguez Secc. 16, , Tlalpan, 14080, México City, México
| | - Daniel Elías-López
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Av. Vasco de Quiroga 15, Belisario Domínguez Secc. 16, , Tlalpan, 14080, México City, México
| | - Alexandro J Martagón
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Av. Vasco de Quiroga 15, Belisario Domínguez Secc. 16, , Tlalpan, 14080, México City, México.,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L, México
| | - Oscar A Pérez-Méndez
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, México City, México
| | - Maria Luisa Ordóñez Sánchez
- Department of Molecular Biology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - Yayoi Segura
- Department of Molecular Biology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - Maria Teresa Tusié
- Department of Molecular Biology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Av. Vasco de Quiroga 15, Belisario Domínguez Secc. 16, , Tlalpan, 14080, México City, México. .,Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L, México.
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Pavanello C, Ossoli A, Arca M, D'Erasmo L, Boscutti G, Gesualdo L, Lucchi T, Sampietro T, Veglia F, Calabresi L. Progression of chronic kidney disease in familial LCAT deficiency: a follow-up of the Italian cohort. J Lipid Res 2020; 61:1784-1788. [PMID: 32998975 PMCID: PMC7707181 DOI: 10.1194/jlr.p120000976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Familial LCAT deficiency (FLD) is a rare genetic disorder of HDL metabolism, caused by loss-of-function mutations in the LCAT gene and characterized by a variety of symptoms including corneal opacities and kidney failure. Renal disease represents the leading cause of morbidity and mortality in FLD cases. However, the prognosis is not known and the rate of deterioration of kidney function is variable and unpredictable from patient to patient. In this article, we present data from a follow-up of the large Italian cohort of FLD patients, who have been followed for an average of 12 years. We show that renal failure occurs at the median age of 46 years, with a median time to a second recurrence of 10 years. Additionally, we identify high plasma unesterified cholesterol level as a predicting factor for rapid deterioration of kidney function. In conclusion, this study highlights the severe consequences of FLD, underlines the need of correct early diagnosis and referral of patients to specialized centers, and highlights the urgency for effective treatments to prevent or slow renal disease in patients with LCAT deficiency.
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Affiliation(s)
- Chiara Pavanello
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Alice Ossoli
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura D'Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuliano Boscutti
- Nephrology, Dialysis and Transplantation Unit, S. Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis, and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Tiziano Lucchi
- Metabolic Disease Clinic, Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Sampietro
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Laura Calabresi
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
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Knotek M, Novak R, Jaklin-Kekez A, Mrzljak A. Combined liver-kidney transplantation for rare diseases. World J Hepatol 2020; 12:722-737. [PMID: 33200012 PMCID: PMC7643210 DOI: 10.4254/wjh.v12.i10.722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Combined liver and kidney transplantation (CLKT) is indicated in patients with failure of both organs, or for the treatment of end-stage chronic kidney disease (ESKD) caused by a genetic defect in the liver. The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT. They are major indications for CLKT in children. However, in some of them (e.g., atypical hemolytic uremic syndrome or primary hyperoxaluria), CLKT may be required in adults as well. Primary hyperoxaluria is divided into three types, of which type 1 and 2 lead to ESKD. CLKT has been proven effective in renal function replacement, at the same time preventing recurrence of the disease. Nephronophthisis is associated with liver fibrosis in 5% of cases and these patients are candidates for CLKT. In alpha 1-antitrypsin deficiency, hereditary C3 deficiency, lecithin cholesterol acyltransferase deficiency and glycogen storage diseases, glomerular or tubulointerstitial disease can lead to chronic kidney disease. Liver transplantation as a part of CLKT corrects underlying genetic and consequent metabolic abnormality. In atypical hemolytic uremic syndrome caused by mutations in the genes for factor H, successful CLKT has been reported in a small number of patients. However, for this indication, CLKT has been largely replaced by eculizumab, an anti-C5 antibody. CLKT has been well established to provide immune protection of the transplanted kidney against donor-specific antibodies against class I HLA, facilitating transplantation in a highly sensitized recipient.
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Affiliation(s)
- Mladen Knotek
- Department of Medicine, Tree Top Hospital, Hulhumale 23000, Maldives
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Rafaela Novak
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | | | - Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia.
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10
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Pavanello C, Ossoli A, Turri M, Strazzella A, Simonelli S, Laurenzi T, Kono K, Yamada K, Kiyosawa N, Eberini I, Calabresi L. Activation of Naturally Occurring Lecithin:Cholesterol Acyltransferase Mutants by a Novel Activator Compound. J Pharmacol Exp Ther 2020; 375:463-468. [PMID: 32980814 DOI: 10.1124/jpet.120.000159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
Lecithin:cholesterol acyltransferase (LCAT) is a unique plasma enzyme able to esterify cholesterol, and it plays an important role in HDL maturation and promotion of reverse cholesterol transport. Familial LCAT deficiency (FLD; OMIM number 245900) is a rare recessive disease that results from loss-of-function mutations in the LCAT gene and has no cure. In this study, we assessed the in vitro efficacy of a novel small-molecule LCAT activator. Cholesterol esterification rate (CER) and LCAT activity were tested in plasma from six controls and five FLD homozygous carriers of various LCAT mutations at different doses of the compound (0.1, 1, and 10 µg/ml). In control plasma, the compound significantly increased both CER (P < 0.001) and LCAT activity (P = 0.007) in a dose-dependent manner. Both CER and LCAT activity increased by 4- to 5-fold, reaching maximum activation at the dose of 1 µg/ml. Interestingly, Daiichi Sankyo compound produced an increase in CER in two of the five tested LCAT mutants (Leu372--Arg and Val309--Met), while LCAT activity increased in three LCAT mutants (Arg147--Trp, Thr274--Ile and Leu372--Arg); mutant Pro254--Ser was not activated at any of the tested doses. The present findings form the basis for personalized therapeutic interventions in FLD carriers and support the potential LCAT activation in secondary LCAT defects. SIGNIFICANCE STATEMENT: We characterized the pharmacology of a novel small-molecule LCAT activator in vitro on a subset of naturally occurring LCAT mutants. Our findings form the basis for personalized therapeutic interventions for familial LCAT deficiency carriers, who can face severe complications and for whom no cure exists.
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Affiliation(s)
- Chiara Pavanello
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Alice Ossoli
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Marta Turri
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Arianna Strazzella
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Sara Simonelli
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Tommaso Laurenzi
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Keita Kono
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Keisuke Yamada
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Naoki Kiyosawa
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Ivano Eberini
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
| | - Laura Calabresi
- Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari (C.P., A.O., M.T., A.S., S.S., L.C.) and Dipartimento di Scienze Farmacologiche e Biomolecolari (T.L., I.E.), Università degli Studi di Milano, Milan, Italy; Specialty Medicine Research Laboratories I, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.K., N.K.); and Medical Affairs Planning Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan (K.Y.)
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Abstract
PURPOSE OF REVIEW Genetic LCAT deficiency is a rare metabolic disorder characterized by low-plasma HDL cholesterol levels. Clinical manifestations of the disease include corneal opacification, anemia, and renal disease, which represents the major cause of morbidity and mortality in carriers. RECENT FINDINGS Biochemical and clinical manifestations of the disease are very heterogeneous among carriers. The collection of large series of affected individuals is needed to answer various open questions on this rare disorder of lipid metabolism, such as the cause of renal damage in patients with complete LCAT deficiency and the cardiovascular risk in carriers of different LCAT gene mutations. SUMMARY Familial LCAT deficiency is a rare disease, with serious clinical manifestations, which can occur in the first decades of life, and presently with no cure. The timely diagnosis in carriers, together with the identification of disease biomarkers able to predict the evolution of clinical manifestations, would be of great help in the identification of carriers to address to future available therapies.
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Affiliation(s)
- Chiara Pavanello
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
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12
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Norum KR, Remaley AT, Miettinen HE, Strøm EH, Balbo BEP, Sampaio CATL, Wiig I, Kuivenhoven JA, Calabresi L, Tesmer JJ, Zhou M, Ng DS, Skeie B, Karathanasis SK, Manthei KA, Retterstøl K. Lecithin:cholesterol acyltransferase: symposium on 50 years of biomedical research from its discovery to latest findings. J Lipid Res 2020; 61:1142-1149. [PMID: 32482717 PMCID: PMC7397740 DOI: 10.1194/jlr.s120000720] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/21/2020] [Indexed: 01/04/2023] Open
Abstract
LCAT converts free cholesterol to cholesteryl esters in the process of reverse cholesterol transport. Familial LCAT deficiency (FLD) is a genetic disease that was first described by Kaare R. Norum and Egil Gjone in 1967. This report is a summary from a 2017 symposium where Dr. Norum recounted the history of FLD and leading experts on LCAT shared their results. The Tesmer laboratory shared structural findings on LCAT and the close homolog, lysosomal phospholipase A2. Results from studies of FLD patients in Finland, Brazil, Norway, and Italy were presented, as well as the status of a patient registry. Drs. Kuivenhoven and Calabresi presented data from carriers of genetic mutations suggesting that FLD does not necessarily accelerate atherosclerosis. Dr. Ng shared that LCAT-null mice were protected from diet-induced obesity, insulin resistance, and nonalcoholic fatty liver disease. Dr. Zhou presented multiple innovations for increasing LCAT activity for therapeutic purposes, whereas Dr. Remaley showed results from treatment of an FLD patient with recombinant human LCAT (rhLCAT). Dr. Karathanasis showed that rhLCAT infusion in mice stimulates cholesterol efflux and suggested that it could also enhance cholesterol efflux from macrophages. While the role of LCAT in atherosclerosis remains elusive, the consensus is that a continued study of both the enzyme and disease will lead toward better treatments for patients with heart disease and FLD.
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Affiliation(s)
- Kaare R Norum
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Helena E Miettinen
- Department of Medicine, University of Helsinki and University Central Hospital, Helsinki, Finland
| | - Erik H Strøm
- Departments of Pathology Oslo University Hospital, Oslo, Norway
| | - Bruno E P Balbo
- Division of Nephrology and Molecular Medicine Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Carlos A T L Sampaio
- Division of Nephrology and Molecular Medicine Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ingrid Wiig
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Jan Albert Kuivenhoven
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura Calabresi
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - John J Tesmer
- Department of Biological Sciences, Purdue University, West Lafayette, IN
| | - Mingyue Zhou
- Cardiometabolic Disorder Research, AMGEN, San Francisco, CA
| | - Dominic S Ng
- Department of Medicine, University of Toronto and Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Bjørn Skeie
- Anesthesiology, Oslo University Hospital, Oslo, Norway
| | | | - Kelly A Manthei
- Life Sciences Institute, University of Michigan, Ann Arbor, MI
| | - Kjetil Retterstøl
- Department of Nutrition, University of Oslo, Oslo, Norway .,Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Lipid Clinic, Oslo University Hospital, Oslo, Norway
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13
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Hegele RA, Borén J, Ginsberg HN, Arca M, Averna M, Binder CJ, Calabresi L, Chapman MJ, Cuchel M, von Eckardstein A, Frikke-Schmidt R, Gaudet D, Hovingh GK, Kronenberg F, Lütjohann D, Parhofer KG, Raal FJ, Ray KK, Remaley AT, Stock JK, Stroes ES, Tokgözoğlu L, Catapano AL. Rare dyslipidaemias, from phenotype to genotype to management: a European Atherosclerosis Society task force consensus statement. Lancet Diabetes Endocrinol 2020; 8:50-67. [PMID: 31582260 DOI: 10.1016/s2213-8587(19)30264-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 12/18/2022]
Abstract
Genome sequencing and gene-based therapies appear poised to advance the management of rare lipoprotein disorders and associated dyslipidaemias. However, in practice, underdiagnosis and undertreatment of these disorders are common, in large part due to interindividual variability in the genetic causes and phenotypic presentation of these conditions. To address these challenges, the European Atherosclerosis Society formed a task force to provide practical clinical guidance focusing on patients with extreme concentrations (either low or high) of plasma low-density lipoprotein cholesterol, triglycerides, or high-density lipoprotein cholesterol. The task force also recognises the scarcity of quality information regarding the prevalence and outcomes of these conditions. Collaborative registries are needed to improve health policy for the care of patients with rare dyslipidaemias.
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Affiliation(s)
- Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Jan Borén
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henry N Ginsberg
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Marcello Arca
- Department of Internal Medicine and Allied Sciences, Center for Rare Disorders of Lipid Metabolism, Sapienza University of Rome, Rome, Italy
| | - Maurizio Averna
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Laura Calabresi
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - M John Chapman
- National Institute for Health and Medical Research (INSERM), Sorbonne University and Pitié-Salpétrière University Hospital, Paris, France
| | - Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Center, Department of Medicine, Université de Montréal, Montreal, QC, Canada; ECOGENE, Clinical and Translational Research Center, Chicoutimi, QC, Canada; Lipid Clinic, Chicoutimi Hospital, Chicoutimi, QC, Canada
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dieter Lütjohann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Klaus G Parhofer
- Medizinische Klinik IV-Grosshadern, University of Munich, Munich, Germany
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jane K Stock
- European Atherosclerosis Society, Gothenburg, Sweden
| | - Erik S Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS MultiMedica, Milan, Italy
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14
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Fountoulakis N, Lioudaki E, Lygerou D, Dermitzaki EK, Papakitsou I, Kounali V, Holleboom AG, Stratigis S, Belogianni C, Syngelaki P, Stratakis S, Evangeliou A, Gakiopoulou H, Kuivenhoven JA, Wevers R, Dafnis E, Stylianou K. The P274S Mutation of Lecithin-Cholesterol Acyltransferase (LCAT) and Its Clinical Manifestations in a Large Kindred. Am J Kidney Dis 2019; 74:510-522. [PMID: 31103331 DOI: 10.1053/j.ajkd.2019.03.422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/02/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE & OBJECTIVE Lecithin-cholesterol acyltransferase (LCAT) catalyzes the maturation of high-density lipoprotein. Homozygosity for loss-of-function mutations causes familial LCAT deficiency (FLD), characterized by corneal opacities, anemia, and renal involvement. This study sought to characterize kidney biopsy findings and clinical outcomes in a family with FLD. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS 2 (related) index patients with clinically apparent FLD were initially identified. 110 of 122 family members who consented to genetic analysis were also studied. PREDICTORS Demographic and laboratory parameters (including lipid profiles and LCAT activity) and full sequence analysis of the LCAT gene. Kidney histologic examination was performed with samples from 6 participants. OUTCOMES Cardiovascular and renal events during a median follow-up of 12 years. Estimation of annual rate of decline in glomerular filtration rate. ANALYTICAL APPROACH Analysis of variance, linear regression analysis, and Fine-Gray competing-risk survival analysis. RESULTS 9 homozygous, 57 heterozygous, and 44 unaffected family members were identified. In all affected individuals, full sequence analysis of the LCAT gene revealed a mutation (c.820C>T) predicted to cause a proline to serine substitution at amino acid 274 (P274S). Homozygosity caused a complete loss of LCAT activity. Kidney biopsy findings demonstrated lipid deposition causing glomerular basement membrane thickening, mesangial expansion, and "foam-cell" infiltration of kidney tissue. Tubular atrophy, glomerular sclerosis, and complement fixation were associated with worse kidney outcomes. Estimated glomerular filtration rate deteriorated among homozygous family members at an average annual rate of 3.56 mL/min/1.73 m2. The incidence of cardiovascular and renal complications was higher among homozygous family members compared with heterozygous and unaffected members. Mild thrombocytopenia was a common finding among homozygous participants. LIMITATIONS The presence of cardiovascular disease was mainly based on medical history. CONCLUSIONS The P274S LCAT mutation was found to cause FLD with renal involvement. Tubular atrophy, glomerular sclerosis, and complement fixation were associated with a worse renal prognosis.
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Affiliation(s)
| | - Eirini Lioudaki
- Nephrology Department, Heraklion University Hospital, Crete, Greece
| | - Dimitra Lygerou
- Nephrology Department, Heraklion University Hospital, Crete, Greece
| | | | | | - Vasiliki Kounali
- Nephrology Department, Heraklion University Hospital, Crete, Greece
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Spyros Stratigis
- Nephrology Department, Heraklion University Hospital, Crete, Greece
| | | | | | | | - Athanasios Evangeliou
- Papageorgiou General Hospital, Department of Pediatrics IV, Aristotle University of Thessaloniki, Thessalonika
| | - Hariklia Gakiopoulou
- Pathology Department, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ron Wevers
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eugene Dafnis
- Nephrology Department, Heraklion University Hospital, Crete, Greece
| | - Kostas Stylianou
- Nephrology Department, Heraklion University Hospital, Crete, Greece.
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15
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A proteomic approach to identify novel disease biomarkers in LCAT deficiency. J Proteomics 2018; 198:113-118. [PMID: 30529744 DOI: 10.1016/j.jprot.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/22/2022]
Abstract
Genetic LCAT deficiency is a rare recessive autosomal disease due to loss-of-function mutations in the gene coding for the enzyme lecithin:cholesterol acyltransferase (LCAT). Homozygous carriers are characterized by corneal opacity, haemolytic anaemia and renal disease, which represent the first cause of morbidity and mortality in these subjects. Diagnostic and prognostic markers capable of early detecting declining kidney function in these subjects are not available, and the specific serum or urine proteomic signature of LCAT deficient carriers has never been assessed. Taking advantage of a proteomic approach, we performed 2-DE analysis of carriers' plasma and identified proteins present at different concentration in samples from homozygous carriers. Our data confirm the well-known alterations in the concentration of circulating apolipoproteins, with a statistically significant decrease of both apoA-I and apoA-II and a statistically significant increase of apoC-III. Furthermore, we observed increased level of alpha-1-antitrypsin, zinc-alpha-2-glycoprotein and retinol-binding protein 4, and reduced level of clusterin and haptoglobin. Interestingly, only beta but not alpha subunit of haptoglobin is significant reduced in homozygous subjects. Despite the limited sample size, our findings set the basis for assessing the identified protein in a larger population and for correlating their levels with clinical markers of renal function and anaemia. SIGNIFICANCE: This investigation defines the effects of LCAT deficiency on the level of the major plasma proteins in homozygous and heterozygous carriers. Increase for some proteins, with different function, together with a drop for haptoglobin, and specifically for haptoglobin beta chains, are reported for the first time as part of a coherent signature. We are glad to have the opportunity to report our findings on this subject, which is one of the main interests for our research group, when Journal of Proteomics celebrates its 10th anniversary. With its various sections devoted to different areas of research, this journal is a privileged forum for publishing proteomic investigations without restrictions either in sample type or in technical approach. It is as well a privileged forum for reviewing literature data on various topics related to proteomics investigation, as colleagues in our research group have done over the years; by the way, a good share of the reviewed papers were as well reports published in Journal of Proteomics itself. The journal also offers opportunities for focused surveys through thematic issues devoted to a variety of subjects, timely selected for their current relevance in research; it was an honour for colleagues in our group to recently act as editors of one of those. Out of this diverse experience, we express our appreciation for the endeavour of Journal of Proteomics in its first 10 years of life - and wish identical and possibly greater success for the time to come.
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16
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Manthei KA, Yang SM, Baljinnyam B, Chang L, Glukhova A, Yuan W, Freeman LA, Maloney DJ, Schwendeman A, Remaley AT, Jadhav A, Tesmer JJ. Molecular basis for activation of lecithin:cholesterol acyltransferase by a compound that increases HDL cholesterol. eLife 2018; 7:41604. [PMID: 30479275 PMCID: PMC6277198 DOI: 10.7554/elife.41604] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/06/2018] [Indexed: 01/29/2023] Open
Abstract
Lecithin:cholesterol acyltransferase (LCAT) and LCAT-activating compounds are being investigated as treatments for coronary heart disease (CHD) and familial LCAT deficiency (FLD). Herein we report the crystal structure of human LCAT in complex with a potent piperidinylpyrazolopyridine activator and an acyl intermediate-like inhibitor, revealing LCAT in an active conformation. Unlike other LCAT activators, the piperidinylpyrazolopyridine activator binds exclusively to the membrane-binding domain (MBD). Functional studies indicate that the compound does not modulate the affinity of LCAT for HDL, but instead stabilizes residues in the MBD and facilitates channeling of substrates into the active site. By demonstrating that these activators increase the activity of an FLD variant, we show that compounds targeting the MBD have therapeutic potential. Our data better define the substrate binding site of LCAT and pave the way for rational design of LCAT agonists and improved biotherapeutics for augmenting or restoring reverse cholesterol transport in CHD and FLD patients. Cholesterol is a fatty substance found throughout the body that is essential to our health. However, if too much cholesterol builds up in our blood vessels, it can cause blockages that lead to heart and kidney problems. The body removes excess cholesterol by sending out high-density lipoproteins (HDL) that capture the fatty molecules and carry them to the liver where they are eliminated. The first step in this process requires an enzyme called LCAT, which converts cholesterol into a form that HDL particles can efficiently pack and transport. The enzyme acts by interacting with HDL particles, and chemically joining cholesterol with another compound. Finding ways to make LCAT perform better and produce more HDL could improve treatments for heart disease. This could be particularly helpful to people with genetic changes that make LCAT defective. Several small molecules that ‘dial up’ the activity of LCAT have been identified, but how they act on the enzyme is not always well understood. Manthei et al. therefore set out to determine precisely how one such small activator promotes LCAT function. The experiments involved using a method known as crystallography to look at the structure of LCAT when it is attached to the small molecule. They also evaluated the activity of the enzyme and other aspects of the protein in the presence of the small molecule and HDL particles. Taken together, the results led Manthei et al. to suggest that the small molecule works by more efficiently bringing into LCAT the materials that this enzyme needs to create the transport-ready form of cholesterol. The small molecule also partially restored the activity of mutant LCAT found in human disease. This knowledge may help to design more drug-like chemicals to ‘boost’ the activity of LCAT and prevent heart and kidney disease, especially in people who carry a defective version of the enzyme.
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Affiliation(s)
- Kelly A Manthei
- Life Sciences Institute, University of Michigan, Ann Arbor, United States
| | - Shyh-Ming Yang
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, United States
| | - Bolormaa Baljinnyam
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, United States
| | - Louise Chang
- Life Sciences Institute, University of Michigan, Ann Arbor, United States
| | - Alisa Glukhova
- Life Sciences Institute, University of Michigan, Ann Arbor, United States
| | - Wenmin Yuan
- Department of Pharmaceutical Sciences and Biointerfaces Institute, University of Michigan, Ann Arbor, United States
| | - Lita A Freeman
- Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - David J Maloney
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, United States
| | - Anna Schwendeman
- Department of Pharmaceutical Sciences and Biointerfaces Institute, University of Michigan, Ann Arbor, United States
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Ajit Jadhav
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, United States
| | - John Jg Tesmer
- Department of Biological Sciences, Purdue University, Indiana, United States
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Castro-Ferreira I, Carmo R, Silva SE, Corrêa O, Fernandes S, Sampaio S, Pedro RP, Praça A, Oliveira JP. Novel Missense LCAT Gene Mutation Associated with an Atypical Phenotype of Familial LCAT Deficiency in Two Portuguese Brothers. JIMD Rep 2017; 40:55-62. [PMID: 28983876 DOI: 10.1007/8904_2017_57] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022] Open
Abstract
Familial lecithin-cholesterol acyltransferase deficiency (FLD) is a rare recessive disorder of cholesterol metabolism, caused by loss-of-function mutations in the human LCAT gene, leading to alterations in the lipid/lipoprotein profile, with extremely low HDL levels.The classical FLD phenotype is characterized by diffuse corneal opacification, haemolytic anaemia and proteinuric chronic kidney disease (CKD); an incomplete form, only affecting the corneas, has been reported in a few families worldwide.We describe an intermediate phenotype of LCAT deficiency, with CKD preceding the development of corneal clouding, in two Portuguese brothers apparently homozygous for a novel missense LCAT gene mutation. The atypical phenotype, the diagnosis of membranous nephropathy in the proband's native kidney biopsy, the late-onset and delayed recognition of the corneal opacification, the co-segregation with Gilbert syndrome and the late recurrence of the primary disease in kidney allograft all contributed to obscure the diagnosis of an LCAT deficiency syndrome for many years.A major teaching point is that on standard light microscopy examination the kidney biopsies of patients with LCAT deficiency with residual enzyme activity may not show significant vacuolization and may be misdiagnosed as membranous nephropathy. The cases of these two patients also illustrate the importance of performing detailed physical examination in young adults presenting with proteinuric CKD, as the most important clue to the diagnosis of FLD is in the eyes.
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Affiliation(s)
- I Castro-Ferreira
- Service of Nephrology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal.
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Oporto, Portugal.
| | - Rute Carmo
- Service of Nephrology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
| | - Sérgio Estrela Silva
- Service of Ophthalmology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
- Department of Organs of the Senses, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
| | - Otília Corrêa
- Labco Clinical Laboratory Dr. Joāo Ribeiro, Rua Augusto Simões, 1430 - 1°, salas 1-3, 4470-147, Maia, Portugal
| | - Susana Fernandes
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Oporto, Portugal
- Unit of Genetics, Department of Pathology, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
| | - Susana Sampaio
- Service of Nephrology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Oporto, Portugal
| | - Rodrigues-Pereira Pedro
- Service of Pathology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
- Department of Pathology, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
| | - Augusta Praça
- Service of Nephrology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
- NephroCare Haemodialysis Clinic, Rua João Mendes Cardoso, 24-C, 4520-233, Santa Maria da Feira, Portugal
| | - João Paulo Oliveira
- I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Oporto, Portugal
- NephroCare Haemodialysis Clinic, Rua João Mendes Cardoso, 24-C, 4520-233, Santa Maria da Feira, Portugal
- Service of Medical Genetics and Reference Centre for Inherited Metabolic Diseases, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Oporto, Portugal
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Ahmad SB, Miller M, Hanish S, Bartlett ST, Hutson W, Barth RN, LaMattina JC. Sequential kidney-liver transplantation from the same living donor for lecithin cholesterol acyl transferase deficiency. Clin Transplant 2016; 30:1370-1374. [PMID: 27490864 DOI: 10.1111/ctr.12826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lecithin cholesterol acyl transferase (LCAT) deficiency is a rare autosomal recessive disorder of lipoprotein metabolism that results in end-stage renal disease (ESRD) necessitating transplantation. As LCAT is produced in the liver, combined kidney and liver transplantation was proposed to cure the clinical syndrome of LCAT deficiency. METHODS A 29-year-old male with ESRD secondary to LCAT deficiency underwent a sequential kidney-liver transplantation from the same living donor (LD). One year following the kidney transplant, auxiliary partial orthotopic liver transplant (APOLT) of a left lateral segment from the same donor was performed. RESULTS At 5 years follow-up, there have been no major complications, readmissions, or rejection episodes. Serum lipid abnormalities recurred within the first year, but liver and kidney allograft function remains intact. CONCLUSION Few cases of sequential transplantation from the same LD have been performed in adults. This is the first APOLT and multi-organ transplant performed for LCAT deficiency. Sequential organ transplant from the same LD for ESRD secondary to a metabolic disorder of the liver is feasible in adults and should be further investigated.
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Affiliation(s)
- Sarwat B Ahmad
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Michael Miller
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven Hanish
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen T Bartlett
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Hutson
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rolf N Barth
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John C LaMattina
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Ossoli A, Neufeld EB, Thacker SG, Vaisman B, Pryor M, Freeman LA, Brantner CA, Baranova I, Francone NO, Demosky SJ, Vitali C, Locatelli M, Abbate M, Zoja C, Franceschini G, Calabresi L, Remaley AT. Lipoprotein X Causes Renal Disease in LCAT Deficiency. PLoS One 2016; 11:e0150083. [PMID: 26919698 PMCID: PMC4769176 DOI: 10.1371/journal.pone.0150083] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/09/2016] [Indexed: 12/31/2022] Open
Abstract
Human familial lecithin:cholesterol acyltransferase (LCAT) deficiency (FLD) is characterized by low HDL, accumulation of an abnormal cholesterol-rich multilamellar particle called lipoprotein-X (LpX) in plasma, and renal disease. The aim of our study was to determine if LpX is nephrotoxic and to gain insight into the pathogenesis of FLD renal disease. We administered a synthetic LpX, nearly identical to endogenous LpX in its physical, chemical and biologic characteristics, to wild-type and Lcat-/- mice. Our in vitro and in vivo studies demonstrated an apoA-I and LCAT-dependent pathway for LpX conversion to HDL-like particles, which likely mediates normal plasma clearance of LpX. Plasma clearance of exogenous LpX was markedly delayed in Lcat-/- mice, which have low HDL, but only minimal amounts of endogenous LpX and do not spontaneously develop renal disease. Chronically administered exogenous LpX deposited in all renal glomerular cellular and matrical compartments of Lcat-/- mice, and induced proteinuria and nephrotoxic gene changes, as well as all of the hallmarks of FLD renal disease as assessed by histological, TEM, and SEM analyses. Extensive in vivo EM studies revealed LpX uptake by macropinocytosis into mouse glomerular endothelial cells, podocytes, and mesangial cells and delivery to lysosomes where it was degraded. Endocytosed LpX appeared to be degraded by both human podocyte and mesangial cell lysosomal PLA2 and induced podocyte secretion of pro-inflammatory IL-6 in vitro and renal Cxl10 expression in Lcat-/- mice. In conclusion, LpX is a nephrotoxic particle that in the absence of Lcat induces all of the histological and functional hallmarks of FLD and hence may serve as a biomarker for monitoring recombinant LCAT therapy. In addition, our studies suggest that LpX-induced loss of endothelial barrier function and release of cytokines by renal glomerular cells likely plays a role in the initiation and progression of FLD nephrosis.
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Affiliation(s)
- Alice Ossoli
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Edward B. Neufeld
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Seth G. Thacker
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Boris Vaisman
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Milton Pryor
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Lita A. Freeman
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Christine A. Brantner
- NHLBI Electron Microscopy Core Facility, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Irina Baranova
- Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nicolás O. Francone
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Stephen J. Demosky
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Cecilia Vitali
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Monica Locatelli
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Mauro Abbate
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Carlamaria Zoja
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Guido Franceschini
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Laura Calabresi
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Alan T. Remaley
- Lipoprotein Metabolism Section, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
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Kasiske B, Saito T. The kidney and lipids: preface. Clin Exp Nephrol 2014; 18:180-4. [DOI: 10.1007/s10157-014-0954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Patients with extremely low high-density lipoprotein-cholesterol (HDL-C) pose distinct challenges to clinical diagnosis and management. Confirmation of HDL-C levels below 20 mg/dl in the absence of severe hypertriglyceridemia should be followed by evaluation for secondary causes, such as androgen use, malignancy, and primary monogenic disorders, namely, apolipoprotein A-I mutations, Tangier disease, and lecithin-cholesterol acyltransferase deficiency. Global cardiovascular risk assessment is a critical component of comprehensive evaluation, although the association between extremely low HDL-C levels and atherosclerosis remains unclear. Therapeutic interventions address reversible causes of low HDL-C, multiorgan abnormalities that may accompany primary disorders and cardiovascular risk modification when appropriate. Uncommon encounters with patients exhibiting extremely low HDL-C provide an opportunity to directly observe the role of HDL metabolism in atherosclerosis and beyond the vascular system.
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Affiliation(s)
- Daniel J Rader
- Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, 11-125 Translational Research Center, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
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