Cited by 133Lipoproteins and Cardiovascular HealthLipid metabolism and disordersCholesterol and Lipid Metabolism

The DOI matches its Crossref record; 32 of the 32 references it cites were found in a registry or an index; 4 of the 27 sources its claims cite were checked for support.

Description of a Large Family with Autosomal Dominant Hypercholesterolemia Associated with the APOE p.Leu167del Mutation

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Abstract

Apolipoprotein (apo) E mutants are associated with type III hyperlipoproteinemia characterized by high cholesterol and triglycerides levels. Autosomal dominant hypercholesterolemia (ADH), due to the mutations in the LDLR, APOB, or PCSK9 genes, is characterized by an isolated elevation of cholesterol due to the high levels of low-density lipoproteins (LDLs). We now report an exceptionally large family including 14 members with ADH. Through genome-wide mapping, analysis of regional/functional candidate genes, and whole exome sequencing, we identified a mutation in the APOE gene, c.500_502delTCC/p.Leu167del, previously reported associated with sea-blue histiocytosis and familial combined hyperlipidemia. We confirmed the involvement of the APOE p.Leu167del in ADH, with (1) a predicted destabilization of an alpha-helix in the binding domain, (2) a decreased apo E level in LDLs, and (3) a decreased catabolism of LDLs. Our results show that mutations in the APOE gene can be associated with bona fide ADH.

Overview

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Written from the paper’s full text.

TL;DR

This paper reports an exceptionally large French family with autosomal dominant hypercholesterolemia (ADH) in which linkage mapping and exome sequencing identified the APOE p.Leu167del mutation as the likely cause. The authors conclude that APOE mutations can be associated with bona fide ADH and that APOE screening is warranted alongside LDLR, APOB, and PCSK9 in ADH molecular diagnosis.

Key findings

  • In the HC126 family, genome-wide linkage gave a maximum LOD score of 2.55 (θ=0) at rs718087 on chromosome 19; multipoint analysis at 19q13.31–13.32 gave a maximum LOD score of 3.15 between rs1988065 and rs3513657 (19:43,374,601–45,439,163).
  • The APOE c.500_502delTCC (p.Leu167del) mutation was identified and was not detected in over 220 controls. Additional APOE variants p.Arg269Gly and p.Arg235Trp were found in non-LDLR/APOB/PCSK9 probands and were absent in over 500 French controls.
  • Two p.Leu167del carriers had total apo E levels of 4.09 mg/dL and 4.03 mg/dL, both within the normal range (2.30–6.30 mg/dL); apo E distribution showed a higher proportion in HDL (77% vs 63–69%) and a lower proportion in LDL (12% vs 18–25%).
  • In one carrier after a 2-month washout, lipid values were triglycerides 3.7, total cholesterol 10.5, LDL-cholesterol 8.1, and HDL-cholesterol 0.7 mmol/L; LDL kinetics resembled those of familial hypercholesterolemia patients, with an increased LDL pool due to increased LDL production and decreased LDL catabolism. No splenomegaly or thrombocytopenia was present in the 12 APOE p.Leu167del carriers of HC126 nor in the proband of HC512.

Methods

  • ADH families were recruited by the French National Research Network on Hypercholesterolemia; the HC126 family was initiated through proband II-2 and expanded to 27 individuals over 3 generations, exploring 23 meioses. Inclusion criteria included total and LDL-cholesterol above the 95th percentile, triglycerides below 1.5 mmol/L, and personal and/or documented familial xanthomas and/or early coronary artery disease.
  • The study combined genome-wide linkage mapping (with 100,000 simulations; av.ELOD 2.1, max.ELOD 4.8), regional microsatellite/multipoint analysis, candidate gene sequencing, and whole exome sequencing in three affected members (III-2, III-7, III-8).
  • APOE p.Leu167del was screened by direct fluorescent PCR in controls, and the APOE gene was sequenced in 153 non-LDLR/APOB/PCSK9 probands (55 French ADH and 98 Norwegian hyperlipidemics). The authors also performed homology modeling, measured apo E levels and lipoprotein distribution, and conducted in vivo apo B-100 kinetic studies in one patient after washout.

Limitations

  • Stated: the apo E distribution data need confirmation because they are based on only two patients, including one under lipid-lowering therapy; the kinetic data need confirmation because they are based on only one patient.
  • Stated: a LDL receptor-binding defect could not be directly excluded, and a prior in vitro competitive binding test with apo E from a heterozygous p.Leu167del carrier showed no significant binding defect, so the effect of the deleted mutant alone could not be observed.
  • Evident: the small number of mutation carriers limits biochemical and kinetic conclusions; the family also includes possible phenocopies (I-3 and II-14) and an unclassified patient (II-5), suggesting another lipid abnormality in the family remains unidentified.

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Integrity signals

Registry

Crossref · 10.1002/humu.22215

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

4 of 27 cited sources checked · 1 supported · 1 flagged · accuracy not yet measured

Show all 36 claims

  • Probably not a substantial claim. 16
  • It may state two separate claims as one. 24
  • The quote only partly states this claim. 1
33 of 33
  • The authors state this as an assumption.

    A compensatory increased activity of the normal apoE in the presence of the deleted mutant could mask a LDL receptor-binding defect.

    “under the hypothesis of a compensatory increased activity of the normal apoE in the presence of the deleted mutant”
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  • Cenarro study is cited with two different years

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    The text cites the 8q24.22 locus study as published in 2011, but the matching reference lists its publication year as 2010.

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  1. Mahley, 1989, The metabolic basis of inherited diseases, 1195

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Metadata

Authors
Marduel, M., Ouguerram, K., Serre, V., Bonnefont-Rousselot, D., Marques-Pinheiro, A., Erik Berge, K., Devillers, M., Luc, G., Lecerf, J.-M., Tosolini, L., Erlich, D., Peloso, G. M., Stitziel, N., Nitchké, P., Jaïs, J.-P., The French Research Network on ADH, Abifadel, M., Kathiresan, S., Leren, T. P., Rabès, J.-P., Boileau, C., & Varret, M.
Affiliations
  • Inserm (FR)
  • Medical Genetics Laboratory; Oslo University Hospital Rikshospitalet; Oslo; Norway
  • Université de Lille (FR)
  • Centre Hospitalier Universitaire de Lille (FR)
  • Université Paris Denis Diderot; Paris; France
  • Broad Institute (US)
  • Hôpital Necker-Enfants Malades (FR)
  • Oslo University Hospital (NO)
Corresponding author
Varret, Mathilde
Venue
Human Mutation
Publisher
Wiley
Published
2012-10-11
Volume
34
Issue
1
Pages
83-87
ISSN
1059-7794 (ISSN-L)
OpenAlex
W2072770085
Cited by
133
References
32
Citations by year
2026: 7 · 2025: 7 · 2024: 10 · 2023: 9 · 2022: 11 · 2021: 9 · 2020: 6 · 2019: 9 · 2018: 12 · 2017: 12 · 2016: 9 · 2015: 7 · 2014: 14 · 2013: 10 · 2012: 1
FWCI
10.45
Type
journal article
Language
en
Open access
Locations
  • Human Mutation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Agence Nationale de la Recherche (ANR-05-PCOD-0017, ANR-08-GENO-0002, ANR-06-MRAR-0038)
  • National Heart, Lung, and Blood Institute (R01HL107816)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
Keywords
autosomal dominant hypercholesterolemia, apolipoprotein E, familial hypercholesterolemia, LDL receptor, apolipoprotein B, PCSK9, type III hyperlipoproteinemia, LDL catabolism, family studies, exome sequencing, genome-wide mapping
MeSH terms
Adolescent, Adult, Apolipoproteins E, Child, Cholesterol, Chromosomes, Human, Pair 19, Family Health, Female, Haplotypes, Humans, Hyperlipoproteinemia Type II, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Models, Molecular, Mutation, Pedigree, Triglycerides, Gene Deletion, Protein Structure, Secondary, Protein Structure, Tertiary, Genetic Predisposition to Disease, Young Adult

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