Cited by 447Lipid metabolism and disordersLipoproteins and Cardiovascular HealthCholesterol and Lipid Metabolism

Pathogenesis of type III hyperlipoproteinemia (dysbetalipoproteinemia): questions, quandaries, and paradoxes

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Mahley, Robert W., Huang, Yadong, Rall, Stanley C.·1999·Journal of Lipid Research

Abstract

Type III hyperlipoproteinemia (HLP) is a genetic disorder characterized by accumulation of remnant lipoproteins in the plasma and development of premature atherosclerosis. Although receptor binding-defective forms of apolipoprotein (apo) E are the common denominator in this disorder, a number of apparent paradoxes concerning its pathogenesis still exist. However, studies in transgenic animals are resolving the mechanisms underlying this disorder. PARADOX I: Defective apoE (commonly apoE2) is essential but not sufficient to cause overt type III HLP. In fact, most apoE2 homozygotes are hypolipidemic. Studies in apoE2 transgenic models have demonstrated the impact of other genes or hormones in converting the hypolipidemia to hyperlipidemia. PARADOX II: Among apoE2 homozygotes, men are more susceptible than women to type III HLP. Transgenic studies have shown that estrogen affects both LDL receptor expression and lipolytic processing, explaining the resistance of women to this disorder until after menopause. PARADOX III: ApoE deficiency is associated with hypercholesterolemia, whereas the type III HLP phenotype is characterized by both hypercholesterolemia and hypertriglyceridemia. The hypercholesterolemia is caused by impaired receptor-mediated clearance, whereas the hypertriglyceridemia is caused primarily by impaired lipolytic processing of remnants and increased VLDL production associated with increased levels of apoE. PARADOX IV: ApoE2 is associated with recessive inheritance of this disorder, whereas other defective apoE variants are associated with dominant inheritance. Determinants of the mode of inheritance are the differential binding of apoE variants to the LDL receptor versus the HSPG/LRP complex and the preference of certain apoE variants for specific lipoproteins. Thus, the pathogenesis of this sometimes mysterious disorder has been clarified.

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Crossref · 10.1016/s0022-2275(20)32417-2

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  • Compared with ApoE3, ApoE2 and ApoE3ch show 98% and 60% reductions in LDLR binding, respectively.

    “Previous reports showed that compared to ApoE3, ApoE2 and ApoE3ch are associate with a 98% and 60% reductions in LDLR binding, respectively11,14.”
  • Carriers of APOEch and other rare mutations in APOE's LDLR-binding region commonly have hyperlipoproteinemia type III, similar to 5-10% of APOE2 homozygotes.

    “Carriers of APOEch and other rare mutations in APOE’s low density lipoprotein receptor (LDLR) binding region commonly have hyperlipoproteinemia type III (HLP-III), similar to that observed in 5–10% of APOE2 homozygotes11.”
  • The R136S mutation lies in an APOE region known to participate in binding to lipoprotein receptors and heparan sulfate proteoglycans.

    “The R136S mutation is located in a region of APOE known to play a role in binding to lipoprotein receptors and heparan sulfate proteoglycans (HSPG)11.”
  • The APOE3ch homozygote individual had unusually high PET measurements of Aβ plaque burden, relatively limited PET measurements of PHF tau burden, minimal cerebral glucose hypometabolism in AD-affected brain regions, and Type III hyperlipoproteinemia.

    “Interestingly, this individual had unusually high PET measurements of Aβ plaque burden, relatively limited PET measurements of PHF tau (neurofibrillary tangle) burden, minimal cerebral glucose hypometabolism in AD-affected brain regions, and like some APOE2 homozygotes, Type III hyperlipoproteinemia5,6.”
  • Dysbetalipoproteinemia is caused in part by a mutation in the APOE gene, resulting in impairment in the hepatic uptake of apoE-containing lipoproteins and reduction in the conversion of VLDL and IDL to LDL particles.

    “Dysbetalipoproteinemia, also called type III hyperlipoproteinemia or remnant removal disease, is caused in part by a mutation in the APOE gene, resulting in impairment in the hepatic uptake of apoE-containing lipoproteins and reduction in the conversion of VLDL and IDL to LDL particles (121).”

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Authors
Mahley, R. W., Huang, Y., & Rall, S. C.
Affiliations
University of California, San Francisco (US)
Corresponding author
Mahley, Robert W.
Venue
Journal of Lipid Research
Publisher
Elsevier BV
Published
1999-11
Volume
40
Issue
11
Pages
1933-1949
ISSN
0022-2275 (ISSN-L)
OpenAlex
W2129883875
Cited by
447
References
130
Citations by year
2026: 17 · 2025: 17 · 2024: 16 · 2023: 20 · 2022: 23 · 2021: 17 · 2020: 18 · 2019: 14 · 2018: 14 · 2017: 15 · 2016: 11 · 2015: 12 · 2014: 20 · 2013: 17 · 2012: 14
FWCI
9.45
Type
journal article
Language
en
Open access
Locations
  • Journal of Lipid Research (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institutes of Health (5p01hl047660-10)
  • National Heart, Lung, and Blood Institute (HL-47660)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
Keywords
type III hyperlipoproteinemia, dysbetalipoproteinemia, apolipoprotein E, APOE2, remnant lipoproteins, LDL receptor, hypertriglyceridemia, hypercholesterolemia, estrogen, sex differences, transgenic animal models, mode of inheritance, premature atherosclerosis
MeSH terms
Animals, Apolipoproteins E, Arteriosclerosis, Female, Homozygote, Humans, Hyperlipoproteinemia Type III, Lipoproteins, Male, Apolipoprotein E2

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