Apolipoprotein E gene mutations in subjects with mixed hyperlipidemia and a clinical diagnosis of familial combined hyperlipidemia
Abstract
Objective Rare mutations in the APOE gene, undetectable with the usual genotyping technique, are responsible for dominant familial dysbetalipoproteinemia (FD) and therefore could be easily misclassified as familial combined hyperlipidemia (FCHL). We aimed to identify APOE mutations associated with dominant combined hyperlipoproteinemia and to establish their frequency in subjects with a clinical diagnosis of FCHL. Methods and results In 279 unrelated subjects with FCHL in whom a functional LDLR mutation was excluded, sequencing of the entire APOE gene detected 9 carriers of a rare mutation: 5 subjects (1.8%) with the R136S mutation (arginine at residue 136 changed to serine) and 4 subjects (1.4%) with the p.Leu149del mutation, a 3-bp inframe deletion that results in the loss of leucine at position 149. Both genetic defects were detected with similar frequency (2.5% and 1.3%, respectively) in an independent group of 160 FCHL subjects from other locations in Spain. Family studies demonstrated cosegregation of these APOE mutations with hyperlipoproteinemia. R136S carriers showed dysbetalipoproteinemia, while the lipid phenotype of p.Leu149del carriers was IIa or IIb. Conclusions Rare APOE mutations are responsible for approximately 3.5% of FCHL cases in our population. APOE R136S and p.Leu149del induce autosomal dominant FD and a phenotype indistinguishable from FCHL, respectively.
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The APOE p.Leu167del mutation was reported in subjects with FCHL and in the HC126 family reported here with a bona fide ADH.
“The APOE p.Leu167del mutation was reported in subjects with familial combined hyperlipidemia (FCHL, type III dyslipoproteinemia) (Solanas-Barca M et al. 2012) and in the HC126 family reported here with a bona fide ADH.”
From Description of a Large Family with Autosomal Dominant Hypercholesterolemia Associated with the<i>APOE</i>p.Leu167del Mutation (2013) · cites this paper as Solanas-Barca M et al. 2012
The APOE p.Leu167del mutation was reported in subjects with familial combined hyperlipidemia (FCHL).
“The APOE p.Leu167del mutation was also reported in subjects with familial combined hyperlipidemia (FCHL, type III dyslipoproteinemia) (Solanas-Barca M et al. 2012).”
From Description of a Large Family with Autosomal Dominant Hypercholesterolemia Associated with the<i>APOE</i>p.Leu167del Mutation (2013) · cites this paper as Solanas-Barca M et al. 2012
The APOE p.Leu167del mutation was previously reported associated with sea-blue histiocytosis and familial combined hyperlipidemia.
“previously reported associated with sea-blue histiocytosis and familial combined hyperlipidemia”
From Description of a Large Family with Autosomal Dominant Hypercholesterolemia Associated with the<i>APOE</i>p.Leu167del Mutation (2013) · cites this paper as Solanas-Barca M et al. 2012
APOE p.Leu167del (Leu149del) was originally reported to be associated with sea blue histiocytosis and familial combined hyperlipidemia.
“As another example of an APOE variant, APOE p.Leu167del (Leu149del) was originally reported to be associated with sea blue histiocytosis and familial combined hyperlipidemia115-117).”
From Impact of Apolipoprotein E Variants: A Review of Naturally Occurring Variants and Clinical Features (2025) · cites this paper as [117]
APOE p.Leu167del was also erroneously reported as APOE p.Leu149del.
“This variant was also erroneously reported as APOE p.Leu149del116, 117).”
From Impact of Apolipoprotein E Variants: A Review of Naturally Occurring Variants and Clinical Features (2025) · cites this paper as [117]
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Self-citation
- Authors
- Solanas-Barca, M., de Castro-Orós, I., Mateo-Gallego, R., Cofán, M., Plana, N., Puzo, J., Burillo, E., Martín-Fuentes, P., Ros, E., Masana, L., Pocoví, M., Civeira, F., & Cenarro, A.
- Affiliations
- Hospital Universitario Miguel Servet (ES)
- Instituto de Salud Carlos III (ES)
- Hospital General San Jorge (ES)
- Corresponding author
- Cenarro, Ana
- Venue
- Atherosclerosis
- Publisher
- Elsevier BV
- Published
- 2012-06
- Volume
- 222
- Issue
- 2
- Pages
- 449-455
- ISSN
- 0021-9150 (ISSN-L)
- OpenAlex
- W2085921423
- Cited by
- 74
- References
- 32
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 11 · 2020: 1 · 2019: 5 · 2018: 3 · 2017: 8 · 2016: 11 · 2015: 1 · 2014: 8 · 2013: 6 · 2012: 1
- FWCI
- 3.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Atherosclerosis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Spanish Ministry of Health (FIS PS09/0673, FIS PS09/0665, FIS PI10/00387, RETIC C06/01 RD06/0014/0029)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- apolipoprotein E, familial combined hyperlipidemia, familial dysbetalipoproteinemia, mixed dyslipidemia, autosomal dominant inheritance, co-segregation, misdiagnosis, lipid phenotypes
- MeSH terms
- Adult, Analysis of Variance, Apolipoproteins E, DNA Mutational Analysis, Female, Gene Frequency, Humans, Hyperlipoproteinemia Type II, Hyperlipidemia, Familial Combined, Male, Middle Aged, Mutation, Pedigree, Phenotype, Receptors, LDL, Spain, Chi-Square Distribution, Odds Ratio, Genetic Predisposition to Disease
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