Elsevier

Atherosclerosis

Volume 80, Issue 3, January 1990, Pages 235-242
Atherosclerosis

Research paper
Familial defective apolipoprotein B-100: detection in the United Kingdom and Scandinavia, and clinical characteristics of ten cases

https://doi.org/10.1016/0021-9150(90)90031-DGet rights and content

Abstract

Familial defective apolipoprotein B-100 (FDB) is a recently identified, dominantly inherited genetic disorder, which leads to increased serum concentration of low density lipoprotein (LDL) cholesterol with reduced affinity for the LDL receptor. This disorder is associated with a G to A mutation in exon 26 of the apolipoprotein B (apo B) gene which creates a substitution of glutamine for arginine in the codon for amino acid 3500. We have searched for this mutation in 374 unrelated individuals with hyperlipidaemia from the United Kingdom, and in 371 unrelated individuals with a primary clinical diagnosis of atherosclerosis from the United Kingdom and Scandinavia. Ten individuals, 9 from the U.K. and 1 from Denmark, were identified. The frequency of the mutation was 3% in individuals classified clinically as having familial hypercholesterolaemia (FH) and 3% in individuals with type IIa hyperlipidaemia without FH, and was not found in patients with types IIb and III hyperlipidaemia. The mutation was rare in individuals with a primary clinical diagnosis of atherosclerosis. Plasma lipid levels and clinical characteristics of the ten patients identified in the present study are similar to those reported for heterozygous FH. Thus, in our study, FDB is associated with moderate to severe hypercholesterolaemia, and appears to be a serious disorder causing premature cardiovascular disease. Individuals with this mutation can be identified unambiguously using routine molecular screening techniques.

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    These studies were all carried out using a design with simultaneously injection of labeled carrier LDL and differently labeled non-carrier LDL into the same individual, thus reducing interindividual variation, because carrier and non-carrier LDL is metabolized at the same time under exact the same conditions. The R3500Q/W mutations are known to cause familial defective apolipoprotein B-100 (FDB, OMIM 144010) characterized by severe hypercholesterolemia (Fig. 7) [11,50,56]. Both mutations have reduced LDL fractional catabolic rate by 33–70% in human in vivo turnover studies [13,57,58], and similarly reduced LDL receptor affinity by 75% in in vitro fibroblast binding studies [10,51,54,55,59].

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    Homozygotes with FDB may also have milder hypercholesterolemia and cardiovascular complications than homozygotes with FH [34,35]. However, other groups reported no differences in lipid parameters between FDB and FH patients [39]. Our probands with FDB had no significant differences in total cholesterol and LDL-cholesterol when compared with FH.

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