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Fairoozy RH, Futema M, Vakili R, Abbaszadegan MR, Hosseini S, Aminzadeh M, Zaeri H, Mobini M, Humphries SE, Sahebkar A. The Genetic Spectrum of Familial Hypercholesterolemia (FH) in the Iranian Population. Sci Rep 2017; 7:17087. [PMID: 29213121 PMCID: PMC5719081 DOI: 10.1038/s41598-017-17181-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/15/2017] [Indexed: 12/16/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant disorder associated with premature cardiovascular disease (CVD). Mutations in the LDLR, APOB, and PCSK9 genes are known to cause FH. In this study, we analysed the genetic spectrum of the disease in subjects from the Iranian population with a clinical diagnosis of FH. Samples were collected from 16 children and family members from five different cities of Iran. Probands were screened for mutations in the LDLR, APOB, and PCSK9 genes using next generation sequencing, with results confirmed by Sanger sequencing. The likely pathology of identified variants was examined using in silico tools. Of the probands, 14 had a clinical diagnosis of homozygous FH and two of heterozygous FH. No mutations were found in either APOB or PCSK9, but nine probands were homozygous for seven different LDLR mutations, with p.(Trp577Arg) occurring in three and p.Val806Glyfs*11 occurring in two patients. Two mutations were novel: p.(Leu479Gln) and p.(Glu668*). Seven probands with a clinical diagnosis of FH were mutation negative. This pilot study, integrating clinical and molecular-based techniques, begins to elucidate the FH heterogeneity and the mutation spectrum in the Iranian population. Such information is important for future disease management and cost savings.
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Affiliation(s)
- R H Fairoozy
- Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom.,Molecular Diagnostic Unit, Clinical Laboratory Department, King Abdullah Medical city in Makkah, Makkah, Saudi Arabia
| | - M Futema
- Centre for Cardiology in the Young, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - R Vakili
- Department of Pediatric Endocrinology and Metabolism, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M R Abbaszadegan
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S Hosseini
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Aminzadeh
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - H Zaeri
- Neonatal and Children Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - M Mobini
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S E Humphries
- Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - A Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Fahed AC, Khalaf R, Salloum R, Andary RR, Safa R, El-Rassy I, Moubarak E, Azar ST, Bitar FF, Nemer G. Variable expressivity and co-occurrence of LDLR and LDLRAP1 mutations in familial hypercholesterolemia: failure of the dominant and recessive dichotomy. Mol Genet Genomic Med 2016; 4:283-91. [PMID: 27247956 PMCID: PMC4867562 DOI: 10.1002/mgg3.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The familial inherited genetic disorder of lipoprotein metabolism affects more than 10 million individuals around the world. Lebanon is one of the several endemic areas for familial hypercholesterolemia (FH) with a founder mutation in the low-density lipoprotein cholesterol receptor (LDLR) gene, responsible for most of the cases. We have previously shown that 16% of all familial cases with hypercholesterolemia do not show genotype segregation of LDLR with the underlying phenotype. METHODS We used Sanger sequencing to genotype 25 Lebanese families with severe FH for the gene encoding the LDLR-associated protein (LDLRAP1), responsible for the recessive form of the disease starting with the four families that did not show any genotype-phenotype correlation in our previous screening. RESULTS We showed that the previously reported p.Q136* variant is linked to the hypercholesterolemia phenotype in the four families. In addition, we showed a variable phenotype between families and between members of the same family. One family exhibits mutations in both LDLR and LDLRAP1 with family members showing differential phenotypes unexplained by the underlying genotypes of the two genes. CONCLUSION The p.Q136* variant in LDLRAP1 is yet another founder mutation in Lebanon and coupled with the LDLR p.C681* variant explains all the genetic causes of FH in Lebanon.
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Affiliation(s)
- Akl C Fahed
- Department of Biochemistry and Molecular GeneticsAmerican University of BeirutBeirutLebanon; Department of GeneticsHarvard Medical School and Department of Internal MedicineMassachusetts General HospitalBostonMassachusetts
| | - Ruby Khalaf
- Department of Biochemistry and Molecular Genetics American University of Beirut Beirut Lebanon
| | - Rony Salloum
- Department of Biochemistry and Molecular Genetics American University of Beirut Beirut Lebanon
| | - Rabih R Andary
- Department of Biochemistry and Molecular Genetics American University of Beirut Beirut Lebanon
| | - Raya Safa
- Department of Biochemistry and Molecular Genetics American University of Beirut Beirut Lebanon
| | - Inaam El-Rassy
- Department of Biochemistry and Molecular Genetics American University of Beirut Beirut Lebanon
| | - Elie Moubarak
- National LDL Apheresis Center Dahr El-Bashek Governmental University Hospital Roumieh Lebanon
| | - Sami T Azar
- Department of Internal Medicine American University of Beirut Beirut Lebanon
| | - Fadi F Bitar
- Department of Pediatrics and Adolescent Medicine American University of Beirut Beirut Lebanon
| | - Georges Nemer
- Department of Biochemistry and Molecular Genetics American University of Beirut Beirut Lebanon
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Mollaki V, Progias P, Drogari E. Familial Hypercholesterolemia in Greek children and their families: genotype-to-phenotype correlations and a reconsideration of LDLR mutation spectrum. Atherosclerosis 2014; 237:798-804. [PMID: 25463123 DOI: 10.1016/j.atherosclerosis.2014.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/10/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Familial Hypercholesterolemia (FH) is a common lipid metabolism disease, resulting in premature atherosclerosis, even from childhood. We aimed to define the genetic basis of FH in children and their families, to refine the spectrum of Low-Density Lipoprotein Receptor gene (LDLR) mutations and identify genotype-to-phenotype correlations in patients of Greek origin. METHODS LDLR was analyzed in 561 patients from 262 families, by whole-gene sequencing. RESULTS Children with identified LDLR mutations showed higher lipid levels compared to non-carriers. Molecular analysis identified a mutation in 53.4% of index cases. Twenty six LDLR mutations were identified, including 19 point mutations, 2 nonsense mutations, 3 splice site mutations and 2 small insertions. Amongst patients with common mutations, carriers of c.1646G > A and c.1285G > A showed higher lipid levels, whereas carriers of c.858C > A and c.81C > G showed a milder phenotype. CONCLUSIONS The spectrum of LDLR mutations in Greece is refined and expanded, with more patients analyzed by whole-gene sequencing. Although a quick screening method is feasible for the Greek population, whole-gene sequencing is essential to identify rare variants. Children with border line lipid levels and a family history of hypercholesterolemia should be considered for molecular diagnosis, since carriers of certain mutations show milder phenotypes and may be missed during clinical diagnosis.
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Affiliation(s)
- Vasiliki Mollaki
- Unit of Metabolic Diseases, Choremio Research Laboratory, 1st Department of Paediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Greece.
| | - Pavlos Progias
- Unit of Metabolic Diseases, Choremio Research Laboratory, 1st Department of Paediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Greece
| | - Euridiki Drogari
- Unit of Metabolic Diseases, Choremio Research Laboratory, 1st Department of Paediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Greece
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Soufi M, Kurt B, Schweer H, Sattler AM, Klaus G, Zschocke J, Schaefer JR. Genetics and kinetics of familial hypercholesterolemia, with the special focus on FH-(Marburg) p.W556R. ATHEROSCLEROSIS SUPP 2011; 10:5-11. [PMID: 20129366 DOI: 10.1016/s1567-5688(09)71802-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Familial hypercholesterolemia (FH) is an autosomal dominant inherited disorder, caused by mutations in the low density lipoprotein receptor (LDLR) gene. FH is characterized by elevated plasma LDL cholesterol, premature atherosclerosis and high risk of premature myocardial infarction. Extended work has been done to understand both, the primary genetic defect as well as the in vivo kinetic consequences of this disease. Both approaches, genetics and kinetics, are challenging but also fruitful approaches for a better understanding of this devastating disease. For this we reviewed the recent literature and used our in vitro and in vivo data on one of the most frequently occurring types of FH, the FH(Marburg) p.W556R. METHODS To identify the primary genetic defect of the FH(Marburg) we used denaturing gradient gel electrophoresis (DGGE) mutation analysis. In vivo kinetic studies were performed in a heterozygote FH(Marburg) subject and in 5 healthy control subjects utilizing a stable isotope tracer kinetic approach with 3D-leucine. RESULTS DGGE screening of the LDLR gene identified a tryptophan (W) to arginine (R) substitution at residue 556 (p.W556R) in the fifth conserved YWTD repeat of the LDLR-beta-propeller in FH(Marburg). In vivo kinetic studies in a heterozygote FH subject for FH(Marburg) and in 5 healthy control subjects demonstrated a severe decrease in LDL FCR and a mild increase of LDL PR in FH compared to healthy controls. CONCLUSIONS The LDLR mutation p.W556R is a frequent and severe defect for FH. This defect has a major influence on the in vivo lipoprotein kinetics and lipid levels. In a heterozygote FH patient we found a dual defect for the increase in LDL cholesterol, namely a decrease in the fractional catabolic rate (FCR) of LDL but also an increase in LDL production rate (PR). By this a well defined, single genetic defect may have a series of different in vivo metabolic consequences which could be used for potential therapeutic approaches to this disease.
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Affiliation(s)
- Muhidien Soufi
- Department of Internal Medicine, Cardiology, Philipps-University, Marburg, Germany
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An APEX-based genotyping microarray for the screening of 168 mutations associated with familial hypercholesterolemia. Atherosclerosis 2011; 216:139-45. [DOI: 10.1016/j.atherosclerosis.2011.01.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/03/2011] [Accepted: 01/10/2011] [Indexed: 12/20/2022]
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Fouchier SW, Kastelein JJP, Defesche JC. Update of the molecular basis of familial hypercholesterolemia in The Netherlands. Hum Mutat 2005; 26:550-6. [PMID: 16250003 DOI: 10.1002/humu.20256] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autosomal-dominant hypercholesterolemia (ADH) has been identified as a major risk factor for coronary vascular disease (CVD) and is associated with mutations in the low-density lipoprotein receptor (LDLR) and the apolipoprotein B (APOB) gene. Since 1991 DNA samples from clinically diagnosed ADH patients have been routinely analyzed for the presence of LDLR and APOB gene mutations. As of 2001, 1,641 index patients (164 index patients per year) had been identified, while from 2001 onward a more sensitive, high-throughput system was used, resulting in the identification of 1,177 new index patients (average=294 index patients per year). Of these 1,177 index cases, 131 different causative genetic variants in the LDLR gene and six different causative mutations in the APOB gene were new for the Dutch population. Of these 131 mutations, 83 LDLR and four APOB gene mutations had not been reported before. The inclusion of all 2,818 index cases into the national screening program for familial hypercholesterolemia (FH) resulted in the identification of 7,079 relatives who carried a mutation that causes ADH. Screening of the LDLR and APOB genes in clinically diagnosed FH patients resulted in approximately 77% of the patients being identified as carriers of a causative mutation. The population of patients with ADH was divided into three genetically distinct groups: carriers of an LDLR mutation (FH), carriers of an APOB mutation (FDB), and non-LDLR/non-APOB patients (FH3). No differences were found with regard to untreated cholesterol levels, response to therapy, and onset of CVD. However, all groups were at an increased risk for CVD. Therefore, to ultimately identify all individuals with ADH, the identification of new genes and mutations in the genes that cause ADH is of crucial importance for the ongoing national program to identify patients with ADH by genetic cascade screening.
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Affiliation(s)
- Sigrid W Fouchier
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Varret M, Rabès JP, Saint-Jore B, Cenarro A, Marinoni JC, Civeira F, Devillers M, Krempf M, Coulon M, Thiart R, Kotze MJ, Schmidt H, Buzzi JC, Kostner GM, Bertolini S, Pocovi M, Rosa A, Farnier M, Martinez M, Junien C, Boileau C. A third major locus for autosomal dominant hypercholesterolemia maps to 1p34.1-p32. Am J Hum Genet 1999; 64:1378-87. [PMID: 10205269 PMCID: PMC1377874 DOI: 10.1086/302370] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Autosomal dominant hypercholesterolemia (ADH), one of the most frequent hereditary disorders, is characterized by an isolated elevation of LDL particles that leads to premature mortality from cardiovascular complications. It is generally assumed that mutations in the LDLR and APOB genes account for ADH. We identified one large French pedigree (HC2) and 12 additional white families with ADH in which we excluded linkage to the LDLR and APOB, implicating a new locus we named "FH3." A LOD score of 3.13 at a recombination fraction of 0 was obtained at markers D1S2892 and D1S2722. We localized the FH3 locus to a 9-cM interval at 1p34.1-p32. We tested four regional markers in another set of 12 ADH families. Positive LOD scores were obtained in three pedigrees, whereas linkage was excluded in the others. Heterogeneity tests indicated linkage to FH3 in approximately 27% of these non-LDLR/non-APOB ADH families and implied a fourth locus. Radiation hybrid mapping located four candidate genes at 1p34.1-p32, outside the critical region, showing no identity with FH3. Our results show that ADH is genetically more heterogeneous than conventionally accepted.
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Affiliation(s)
- M Varret
- Hôpital Necker-Enfants Malades, Institut National de la Santé et de la Recherche Médicale, Unit 383, Université René Descartes, 75743 Paris Cedex 15, France
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