Clinical and biochemical features of different molecular etiologies of familial chylomicronemia.

Hegele, Robert A and Berberich, Amanda J and Ban, Matthew R and Wang, Jian and Digenio, Andres and Alexander, Veronica J and D'Erasmo, Laura and Arca, Marcello and Jones, Alan and Bruckert, Eric and Stroes, Erik S and Bergeron, Jean and Civeira, Fernando and Witztum, Joseph L and Gaudet, Daniel (2018) Clinical and biochemical features of different molecular etiologies of familial chylomicronemia. Journal of clinical lipidology. ISSN 1933-2874. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://linkinghub.elsevier.com/retrieve/pii/S1933...

Abstract

BACKGROUND

Familial chylomicronemia syndrome (FCS) is an ultra-rare phenotype that is usually caused by biallelic mutations in the LPL gene encoding lipoprotein lipase, or less often in APOC2, APOA5, LMF1, or GPIHBP1 genes encoding cofactors or interacting proteins.

OBJECTIVES

We evaluated baseline phenotypes among FCS participants in a phase 3 randomized placebo-controlled trial of volanesorsen (NCT02211209).

METHODS

Baseline clinical, fasting, and postfat load metabolic markers were assessed. Targeted next-generation DNA sequencing plus custom bioinformatics was used to genotype subjects.

RESULTS

Among 52 FCS individuals, 41 had biallelic LPL gene mutations (LPL-FCS patients): 82%, 7%, and 11% were missense, nonsense, and splicing variants, respectively. Eleven individuals had non-LPL-FCS; 2 had mutations in APOA5, 5 in GPIHBP1, and 1 each in LMF1 and APOC2 genes, respectively. Two other individuals were double heterozygotes, each with 1 normal LPL allele. All subjects had extremely high triglycerides (TGs) and chylomicrons, but very low levels of other lipoproteins. Compared with LPL-FCS individuals, non-LPL-FCS individuals were very similar for most traits, but had significantly higher postheparin LPL activity, higher 4-hour postprandial insulin and C-peptide levels; and higher low-density lipoprotein cholesterol levels. In non-LPL-FCS individuals compared to those with LPL-FCS, there were also nonsignificant trends toward lower levels of total and chylomicron TGs, lower 4-hour postprandial chylomicron TG levels, and higher very-low-density lipoprotein TG levels.

CONCLUSION

Thus, LPL FCS and non-LPL FCS are largely phenotypically similar. However, LPL FCS patients have lower postheparin LPL activity and a trend toward higher TGs, whereas low-density lipoprotein cholesterol was higher in non-LPL-FCS patients.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: QW Microbiology. Immunology
Divisions: Planned IP Care > Respiratory Medicine
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Depositing User: Mr Philip O'Reilly
Date Deposited: 04 Jun 2018 13:51
Last Modified: 04 Jun 2018 13:51
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1663

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