1
|
Chait A. Multifactorial chylomicronemia syndrome. Curr Opin Endocrinol Diabetes Obes 2024; 31:78-83. [PMID: 37994661 DOI: 10.1097/med.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The aim of this review was to understand the role of multifactorial chylomicronemia syndrome (MFCS) as a cause of severe hypertriglyceridemia; to distinguish it from other causes of severe hypertriglyceridemia; and to provide a rational approach to treatment. RECENT FINDINGS There have been advances in understanding the genetic underpinning of MFCS, and a better appreciation as to how to differentiate it from the much rarer familial chylomicronemia syndrome, in which there are substantial differences in the approach to their treatment. New approaches to triglyceride lowering will help reduce the risk of pancreatitis, the major complication of MFCS. SUMMARY MCSF is a condition in which plasma triglyceride levels are severely elevated, usually to due exacerbation of common genetic forms of hypertriglyceridemia by secondary causes of hypertriglyceridemia and/or triglyceride-raising drugs. Triglyceride-induced pancreatitis can be prevented by markedly reducing triglyceride levels by treating secondary causes and/or eliminating of triglyceride-raising drugs, and by using triglyceride-lowering drugs, especially fibrates. MFCS also increases cardiovascular disease risk, for which lifestyle measures and drugs are required.
Collapse
Affiliation(s)
- Alan Chait
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, USA
| |
Collapse
|
2
|
Xia Y, Zheng W, Du T, Gong Z, Liang L, Wang R, Yang Y, Zhang K, Lu D, Chen X, Sun Y, Sun Y, Xiao B, Qiu W. Clinical profile, genetic spectrum and therapy evaluation of 19 Chinese pediatric patients with lipoprotein lipase deficiency. J Clin Lipidol 2023; 17:808-817. [PMID: 37858495 DOI: 10.1016/j.jacl.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Lipoprotein lipase (LPL) deficiency, the most common familial chylomicronemia syndrome (FCS), is a rare autosomal recessive disease characterized by chylomicronemia and severe hypertriglyceridemia (HTG), with limited clinical and genetic characterization. OBJECTIVE To describe the manifestations and management of 19 pediatric patients with LPL-FCS. METHODS LPL-FCS patients from 2014 to 2022 were divided into low-fat (LF), very-low-fat (VLF) and medium-chain-triglyceride (MCT) groups. Their clinical data were evaluated to investigate the effect of different diets. The genotype-phenotype relationship was assessed. Linear regression comparing long-chain triglyceride (LCT) intake and TG levels was analyzed. RESULTS Nine novel LPL variants were identified in 19 LPL-FCS pediatric patients. At baseline, eruptive xanthomas occurred in 3/19 patients, acute pancreatitis in 2/19, splenomegaly in 6/19 and hepatomegaly in 3/19. The median triglyceride (TG) level (30.3 mmol/L) was markedly increased. The MCT group and VLF group with LCT intakes <20 en% (energy percentage) had considerably lower TG levels than the LF group (both p<0.05). The LF group presented with severe HTG and significantly decreased TG levels after restricting LCT intakes to <20 en% (p<0.05). Six infants decreased TG levels to <10 mmol/L by keeping LCT intake <10 en%. TG levels and LCT intake were positively correlated in both patients under 2 years (r=0.84) and those aged 2-9 years (r=0.89). No genotype-phenotype relationship was observed. CONCLUSIONS This study broadens the clinical and genetic spectra of LPL-FCS. The primary therapy for LPL-FCS pediatric patients is restricting dietary LCTs to <10 en% or <20 en% depending on different ages. MCTs potentially provide extra energy.
Collapse
Affiliation(s)
- Yu Xia
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Wanqi Zheng
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Taozi Du
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Zizhen Gong
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Lili Liang
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Ruifang Wang
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Yi Yang
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Kaichuang Zhang
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Deyun Lu
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Xiaohong Chen
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Dr Chen)
| | - Yuning Sun
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu)
| | - Yu Sun
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu); Departement of Clinical Genetics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Sun, Xiao).
| | - Bing Xiao
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu); Departement of Clinical Genetics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Sun, Xiao).
| | - Wenjuan Qiu
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, School of Medicine, Shanghai Institute of Pediatric Research, Shanghai Jiao Tong University, 1665 KongJiang Road, Shanghai 200092, China (Drs Xia, Zheng, Du, Gong, Liang, Wang, Yang, Zhang, Lu, Sun, Sun, Xiao, Qiu).
| |
Collapse
|
3
|
Malick WA, Do R, Rosenson RS. Severe hypertriglyceridemia: Existing and emerging therapies. Pharmacol Ther 2023; 251:108544. [PMID: 37848164 DOI: 10.1016/j.pharmthera.2023.108544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
Severe hypertriglyceridemia (sHTG), defined as a triglyceride (TG) concentration ≥ 500 mg/dL (≥ 5.7 mmol/L) is an important risk factor for acute pancreatitis. Although lifestyle, some medications, and certain conditions such as diabetes may lead to HTG, sHTG results from a combination of major and minor genetic defects in proteins that regulate TG lipolysis. Familial chylomicronemia syndrome (FCS) is a rare disorder caused by complete loss of function in lipoprotein lipase (LPL) or LPL activating proteins due to two homozygous recessive traits or compound heterozygous traits. Multifactorial chylomicronemia syndrome (MCS) and sHTG are due to the accumulation of rare heterozygous variants and polygenic defects that predispose individuals to sHTG phenotypes. Until recently, treatment of sHTG focused on lifestyle interventions, control of secondary factors, and nonselective pharmacotherapies that had modest TG-lowering efficacy and no corresponding reductions in atherosclerotic cardiovascular disease events. Genetic discoveries have allowed for the development of novel pathway-specific therapeutics targeting LPL modulating proteins. New targets directed towards inhibition of apolipoprotein C-III (apoC-III), angiopoietin-like protein 3 (ANGPTL3), angiopoietin-like protein 4 (ANGPTL4), and fibroblast growth factor-21 (FGF21) offer far more efficacy in treating the various phenotypes of sHTG and opportunities to reduce the risk of acute pancreatitis and atherosclerotic cardiovascular disease events.
Collapse
Affiliation(s)
- Waqas A Malick
- Metabolism and Lipids Program, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert S Rosenson
- Metabolism and Lipids Program, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
4
|
Aljouda L, Nagy L, Schulze A. Long-Term Treatment of Lipoprotein Lipase Deficiency with Medium-Chain Triglyceride-Enriched Diet: A Case Series. Nutrients 2023; 15:3535. [PMID: 37630727 PMCID: PMC10458522 DOI: 10.3390/nu15163535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Background: Lipoprotein lipase (LPL) deficiency is a genetic condition. Affected individuals typically develop symptoms related to severe and persistent hypertriglyceridemia, such as abdominal pain and recurrent pancreatitis, before 10 years of age. No pharmacological treatment sustainably lowering triglycerides (TGs) in LPL deficiency patients has been proven to be effective. This study investigated whether a long-chain triglyceride (LCT)-restricted, medium-chain triglyceride (MCT)-supplemented diet enables a meaningful reduction in TGs and reduces LPL-related symptoms in children with LPL deficiency. Methods: A single-center retrospective case series study of LPL deficiency patients treated at the Hospital of Sick Children between January 2000 and December 2022 was carried out. Data, extracted from hospital charts, included demographics, diagnosis confirmation, clinical and imaging observations, and biochemical profiles. Results: Seven patients with hypertriglyceridemia > 20 mmol/L suspected of an LPL deficiency diagnosis were included. Six patients had a confirmed molecular diagnosis of LPL deficiency, and one had glycogen storage disease type 1a (GSD1a). Clinical presentation was at a median of 30 days of age (range 1-105), and treatment start, excluding one late-treated patient, was at a median of 42 days (range 2-106). The observation and treatment period of the LPL patients was 48.0 patient years (median 7.1, range 4.3-15.5). The LCT-restricted and MCT-supplemented diet led to an immediate drop in TGs in six out of six LPL patients. TGs improved from a median of 40.9 mmol/L (range 11.4-276.5) pre-treatment to a median of 12.0 mmol/L (range 1.1-36.6) during treatment, total cholesterol from 7.6 mmol/L (4.9-27.0) to 3.9 mmol/L (1.7-8.2), and pancreatic lipase from 631 IU/L (30-1200) to 26.5 IU/L (5-289). In 48 patient years, there was only one complication of pancreatitis and no other disease-specific manifestations or complications. Catch-up growth was observed in one late-treated patient. All patients maintained normal growth and development. As expected, the diet failed to treat hypertriglyceridemia in the GSD1a patient. Conclusions: The dietary restriction of LCT in combination with MCT supplementation as long-term management of pediatric patients with LPL deficiency was feasible, well tolerated, and clinically effective in reducing TG levels and in preventing LPL-related complications.
Collapse
Affiliation(s)
- Liali Aljouda
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada (L.N.)
| | - Laura Nagy
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada (L.N.)
| | - Andreas Schulze
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada (L.N.)
- Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A1, Canada
| |
Collapse
|
5
|
Jones A, Peers K, Wierzbicki AS, Ramachandran R, Mansfield M, Dawson C, Ochoa-Ferraro A, Soran H, Jenkinson F, McDowell I, Downie P, Hamilton P, Jones RD. Long-term effects of volanesorsen on triglycerides and pancreatitis in patients with familial chylomicronaemia syndrome (FCS) in the UK Early Access to Medicines Scheme (EAMS). Atherosclerosis 2023; 375:67-74. [PMID: 37253281 DOI: 10.1016/j.atherosclerosis.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIMS The VOL4002 study assessed the efficacy and safety of volanesorsen in 22 adults with genetically confirmed familial chylomicronaemia syndrome (FCS) treated in the UK Early Access to Medicines Scheme (EAMS), with ("prior exposure") or without ("treatment naive") previous treatment in the APPROACH and/or APPROACH-OLE volanesorsen phase 3 studies. METHODS Data collection focused on triglyceride (TG) levels, platelet counts and pancreatitis events. Pancreatitis incidence during volanesorsen treatment was compared against the 5-year period preceding volanesorsen exposure. Volanesorsen 285 mg was self-administered subcutaneously once every 2 weeks. RESULTS Individual patient volanesorsen exposure ranged from 6 to 51 months (total cumulative exposure, 589 months). Among treatment-naive patients (n = 12), volanesorsen treatment resulted in an averaged median 52% reduction (-10.6 mmol/L) from baseline (26.4 mmol/L) in TG levels at 3 months, which were maintained through time points over 15 months of treatment (47%-55% reductions). Similarly, prior-exposure patients (n = 10) experienced a 51% reduction (-17.8 mmol/L) from pre-treatment baseline (28.0 mmol/L), with reductions of 10%-38% over 21 months of treatment. A comparison of pancreatitis event rates found a 74% reduction from the 5-year period before (one event/2.8 years) and during (one event/11.0 years) volanesorsen treatment. Platelet declines were consistent with observations in phase 3 clinical trials. No patient recorded a platelet count <50 × 109/L. CONCLUSIONS This longitudinal study supports the efficacy of volanesorsen in patients with FCS for lowering TG levels over treatment periods up to 51 months with no apparent safety signals related to increased duration of exposure.
Collapse
Affiliation(s)
- Alan Jones
- Birmingham Heartlands Hospital, Bordesley Green East, Bordesley Green, Birmingham, West Midlands, B9 5SS, UK.
| | - Katherine Peers
- Birmingham Heartlands Hospital, Bordesley Green East, Bordesley Green, Birmingham, West Midlands, B9 5SS, UK
| | | | | | - Michael Mansfield
- Leeds Teaching Hospitals, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Charlotte Dawson
- University Hospitals, Trust Headquarters, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2GW, UK
| | - Antonio Ochoa-Ferraro
- University Hospitals, Trust Headquarters, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2GW, UK
| | - Handrean Soran
- Manchester University, Cobbett House, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Fiona Jenkinson
- Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne, NE1 4LP, UK
| | - Ian McDowell
- Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, UK
| | - Paul Downie
- Salisbury District General Hospital, Odstock Rd, Salisbury, SP2 8BJ, UK
| | - Paul Hamilton
- Centre for Medical Education, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Richard D Jones
- Akcea Therapeutics, St James House, 72 Adelaide Road, Dublin 2, D02 YO17, Ireland
| |
Collapse
|
6
|
Witztum JL, Gaudet D, Arca M, Jones A, Soran H, Gouni-Berthold I, Stroes ESG, Alexander VJ, Jones R, Watts L, Xia S, Tsimikas S. Volanesorsen and triglyceride levels in familial chylomicronemia syndrome: Long-term efficacy and safety data from patients in an open-label extension trial. J Clin Lipidol 2023; 17:342-355. [PMID: 37100699 DOI: 10.1016/j.jacl.2023.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Familial chylomicronemia syndrome (FCS) is a rare, autosomal recessive genetic disorder characterized by a marked increase in plasma triglyceride (TG) levels and recurrent episodes of pancreatitis. The response to conventional TG-lowering therapies is suboptimal. Volanesorsen, an antisense oligonucleotide that targets hepatic apoC-III mRNA, has been shown to significantly reduce TGs in patients with FCS. OBJECTIVE To further evaluate the safety and efficacy of extended treatment with volanesorsen in patients with FCS. METHODS This phase 3 open-label extension study evaluated the efficacy and safety of extended treatment with volanesorsen in three groups of patients with FCS: Those who had previously received volanesorsen or placebo in the APPROACH and COMPASS studies, and treatment-naive patients not participating in either study. Key endpoints included change in fasting TG and other lipid measurements, and safety over 52 weeks. RESULTS Volanesorsen treatment resulted in sustained reductions in plasma TG levels in previously treated patients from the APPROACH and COMPASS studies. Volanesorsen-treated patients from the three populations studied had mean decreases in fasting plasma TGs from index study baseline to months 3, 6, 12 and 24 as follows: decreases of 48%, 55%, 50%, and 50%, respectively (APPROACH); decreases of 65%, 43%, 42%, and 66%, respectively (COMPASS); and decreases of 60%, 51%, 47%, and 46%, respectively (treatment-naive). Common adverse events were injection site reactions and platelet count decrease, consistent with previous studies. CONCLUSION Extended open-label treatment with volanesorsen in patients with FCS resulted in sustained reductions of plasma TG levels and safety consistent with the index studies.
Collapse
Affiliation(s)
- Joseph L Witztum
- Department of Medicine, University of California San Diego, Room 1081, 9500 Gilman Drive, La Jolla, CA 92093 USA (Drs Joseph L. Witztum; Sotirios Tsimikas).
| | - Daniel Gaudet
- Lipidology Unit, Community Genomic Medicine Center, Department of Medicine, Université de Montréal and ECOGENE-21, 930 Jacques-Cartier Est, Chicoutimi, Quebec G7H 7K9, Canada (Dr Daniel Gaudet)
| | - Marcello Arca
- Department of Translational and Precision Medicine, Viale Università, La Sapienza University of Rome, 37 - 00185, Rome, Italy (Dr Marcello Arca)
| | - Alan Jones
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green E, Birmingham B9 5SS, United Kingdom (Dr Alan Jones)
| | - Handrean Soran
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Rd, Manchester M13 9WL, United Kingdom (Dr Handrean Soran)
| | - Ioanna Gouni-Berthold
- Center for Endocrinology, Diabetes, and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital, Kerpener, Str. 62, Cologne 50937, Germany (Dr Ioanna Gouni-Berthold)
| | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, AZ Amsterdam 1105, the Netherlands (Dr Erik S. G. Stroes)
| | - Veronica J Alexander
- Ionis Pharmaceuticals, 2855 Gazelle Court, Carlsbad, CA 92010, USA (Drs Veronica J. Alexander; Lynnetta Watts; Shuting Xia; Sotirios Tsimikas)
| | - Richard Jones
- Akcea Therapeutics, St. James House, 72 Adelaide Road 2 D02 Y017, Dublin, Ireland (Dr Richard Jones)
| | - Lynnetta Watts
- Ionis Pharmaceuticals, 2855 Gazelle Court, Carlsbad, CA 92010, USA (Drs Veronica J. Alexander; Lynnetta Watts; Shuting Xia; Sotirios Tsimikas)
| | - Shuting Xia
- Ionis Pharmaceuticals, 2855 Gazelle Court, Carlsbad, CA 92010, USA (Drs Veronica J. Alexander; Lynnetta Watts; Shuting Xia; Sotirios Tsimikas)
| | - Sotirios Tsimikas
- Department of Medicine, University of California San Diego, Room 1081, 9500 Gilman Drive, La Jolla, CA 92093 USA (Drs Joseph L. Witztum; Sotirios Tsimikas); Ionis Pharmaceuticals, 2855 Gazelle Court, Carlsbad, CA 92010, USA (Drs Veronica J. Alexander; Lynnetta Watts; Shuting Xia; Sotirios Tsimikas)
| |
Collapse
|
7
|
Rosenson RS, Gaudet D, Ballantyne CM, Baum SJ, Bergeron J, Kershaw EE, Moriarty PM, Rubba P, Whitcomb DC, Banerjee P, Gewitz A, Gonzaga-Jauregui C, McGinniss J, Ponda MP, Pordy R, Zhao J, Rader DJ. Evinacumab in severe hypertriglyceridemia with or without lipoprotein lipase pathway mutations: a phase 2 randomized trial. Nat Med 2023; 29:729-737. [PMID: 36879129 PMCID: PMC10033404 DOI: 10.1038/s41591-023-02222-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/19/2023] [Indexed: 03/08/2023]
Abstract
Severe hypertriglyceridemia (sHTG) is an established risk factor for acute pancreatitis. Current therapeutic approaches for sHTG are often insufficient to reduce triglycerides and prevent acute pancreatitis. This phase 2 trial ( NCT03452228 ) evaluated evinacumab (angiopoietin-like 3 inhibitor) in three cohorts of patients with sHTG: cohort 1, familial chylomicronemia syndrome with bi-allelic loss-of-function lipoprotein lipase (LPL) pathway mutations (n = 17); cohort 2, multifactorial chylomicronemia syndrome with heterozygous loss-of-function LPL pathway mutations (n = 15); and cohort 3, multifactorial chylomicronemia syndrome without LPL pathway mutations (n = 19). Fifty-one patients (males, n = 27; females, n = 24) with a history of hospitalization for acute pancreatitis were randomized 2:1 to intravenous evinacumab 15 mg kg-1 or placebo every 4 weeks over a 12-week double-blind treatment period, followed by a 12-week single-blind treatment period. The primary end point was the mean percent reduction in triglycerides from baseline after 12 weeks of evinacumab exposure in cohort 3. Evinacumab reduced triglycerides in cohort 3 by a mean (s.e.m.) of -27.1% (37.4) (95% confidence interval -71.2 to 84.6), but the prespecified primary end point was not met. No notable differences in adverse events between evinacumab and placebo treatment groups were seen during the double-blind treatment period. Although the primary end point of a reduction in triglycerides did not meet the prespecified significance level, the observed safety and changes in lipid and lipoprotein levels support the further evaluation of evinacumab in larger trials of patients with sHTG. Trial registration number: ClinicalTrials.gov NCT03452228 .
Collapse
Affiliation(s)
- Robert S Rosenson
- Metabolism and Lipids Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | | | - Seth J Baum
- Excel Medical Clinical Trials and Department of Integrated Medical Sciences, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Jean Bergeron
- Departments of Laboratory Medicine and of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Erin E Kershaw
- Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick M Moriarty
- Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paolo Rubba
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | - Jian Zhao
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Daniel J Rader
- Department of Genetics and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
8
|
Wang S, Cheng Y, Shi Y, Zhao W, Gao L, Fang L, Jin X, Han X, Sun Q, Li G, Zhao J, Xu C. Identification and Characterization of Two Novel Compounds: Heterozygous Variants of Lipoprotein Lipase in Two Pedigrees With Type I Hyperlipoproteinemia. Front Endocrinol (Lausanne) 2022; 13:874608. [PMID: 35923617 PMCID: PMC9339609 DOI: 10.3389/fendo.2022.874608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Type I hyperlipoproteinemia, characterized by severe hypertriglyceridemia, is caused mainly by loss-of-function mutation of the lipoprotein lipase (LPL) gene. To date, more than 200 mutations in the LPL gene have been reported, while only a limited number of mutations have been evaluated for pathogenesis. OBJECTIVE This study aims to explore the molecular mechanisms underlying lipoprotein lipase deficiency in two pedigrees with type 1 hyperlipoproteinemia. METHODS We conducted a systematic clinical and genetic analysis of two pedigrees with type 1 hyperlipoproteinemia. Postheparin plasma of all the members was used for the LPL activity analysis. In vitro studies were performed in HEK-293T cells that were transiently transfected with wild-type or variant LPL plasmids. Furthermore, the production and activity of LPL were analyzed in cell lysates or culture medium. RESULTS Proband 1 developed acute pancreatitis in youth, and her serum triglycerides (TGs) continued to be at an ultrahigh level, despite the application of various lipid-lowering drugs. Proband 2 was diagnosed with type 1 hyperlipoproteinemia at 9 months of age, and his serum TG levels were mildly elevated with treatment. Two novel compound heterozygous variants of LPL (c.3G>C, p. M1? and c.835_836delCT, p. L279Vfs*3, c.188C>T, p. Ser63Phe and c.662T>C, p. Ile221Thr) were identified in the two probands. The postheparin LPL activity of probands 1 and 2 showed decreases of 72.22 ± 9.46% (p<0.01) and 54.60 ± 9.03% (p<0.01), respectively, compared with the control. In vitro studies showed a substantial reduction in the expression or enzyme activity of LPL in the LPL variants. CONCLUSIONS Two novel compound heterozygous variants of LPL induced defects in the expression and function of LPL and caused type I hyperlipoproteinemia. The functional characterization of these variants was in keeping with the postulated LPL mutant activity.
Collapse
Affiliation(s)
- Shuping Wang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Endocrinology and Metabolism, Dongying People’s Hospital, Dongying, China
| | - Yiping Cheng
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yingzhou Shi
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wanyi Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ling Gao
- Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, China
| | - Li Fang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaolong Jin
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoyan Han
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qiuying Sun
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- *Correspondence: Jiajun Zhao, ; Guimei Li, ; Chao Xu,
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Jiajun Zhao, ; Guimei Li, ; Chao Xu,
| | - Chao Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Jiajun Zhao, ; Guimei Li, ; Chao Xu,
| |
Collapse
|
9
|
Tünnemann-Tarr A, Scharnagl H, Katzmann JL, Stürzebecher P, Laufs U. Familial chylomicronemia syndrome due to a heterozygous deletion of the chromosome 8 treated with the apoCIII inhibitor volanesorsen: A case report. Medicine (Baltimore) 2021; 100:e27573. [PMID: 34678899 PMCID: PMC8542157 DOI: 10.1097/md.0000000000027573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Familial chylomicronemia syndrome is a congenital, severe form of hypertriglyceridemia associated with increased risk of acute pancreatitis. Treatment options are limited. PATIENT CONCERNS A 52-year-old woman was referred with recurrent pancreatitis and severe hypertriglyceridemia to our lipid clinic. DIAGNOSIS Laboratory examination showed elevated serum triglyceride concentrations of 8090 mg/dL (90 mmol/L). Lipid electrophoresis showed a type V phenotype with positive chylomicrons. Genetic investigation revealed a novel heterozygous large deletion of the lipoprotein lipase gene on chromosome 8. A familial chylomicronemia syndrome was diagnosed. Other causes of hypertriglyceridemia were excluded. INTERVENTIONS Fibrates and diet did not lower triglyceride levels. Therefore, treatment with the apolipoprotein CIII (apoCIII) inhibitor volanesorsen was initiated. OUTCOMES After 3 months of treatment, a 90% reduction of triglycerides was observed. ApoCIII concentrations were reduced by 90% in the total and by 61% in the chylomicron-free serum. Treatment was well tolerated with only minor local reaction after the first application. The platelet count was monitored weekly and did not decrease <150 cells/μL. LESSONS This case report shows that inhibition of apoCIII potently reduces serum triglycerides in patients with heterozygous monogenetic deletion of the lipoprotein lipase gene. Follow-up will show the effect on recurrent episodes of pancreatitis.
Collapse
Affiliation(s)
| | - Hubert Scharnagl
- Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Austria
| | - Julius L. Katzmann
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Paulina Stürzebecher
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| |
Collapse
|
10
|
Gouni-Berthold I, Alexander VJ, Yang Q, Hurh E, Steinhagen-Thiessen E, Moriarty PM, Hughes SG, Gaudet D, Hegele RA, O'Dea LSL, Stroes ESG, Tsimikas S, Witztum JL. Efficacy and safety of volanesorsen in patients with multifactorial chylomicronaemia (COMPASS): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Diabetes Endocrinol 2021; 9:264-275. [PMID: 33798466 DOI: 10.1016/s2213-8587(21)00046-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Volanesorsen is an antisense oligonucleotide that targets hepatic apolipoprotein C-III synthesis and reduces plasma triglyceride concentration. The aim of this study was to explore the safety and efficacy of volanesorsen in patients with multifactorial chylomicronaemia syndrome. METHODS The COMPASS trial was a randomised, placebo-controlled, double-blind, phase 3 study done at 38 international clinical sites in Canada, France, Germany, the Netherlands, UK, and USA. Eligible patients were aged 18 years or older with multifactorial severe hypertriglyceridaemia or familial chylomicronaemia syndrome, who had a BMI of 45 kg/m2 or less and fasting plasma triglyceride of 500 mg/dL or higher. Patients were randomly assigned (2:1) with an interactive response system using an allocation sequence and permuted block randomisation to receive subcutaneous volanesorsen (300 mg) or a matched volume of placebo (1·5 mL) once a week for 26 weeks. After 13 weeks of treatment, dosing was changed to 300 mg of volanesorsen or placebo every 2 weeks for all patients, except those who had completed 5 months or more of treatment as of May 27, 2016. Participants, investigators, sponsor personnel, and clinical research staff were all masked to the treatment assignments. The primary outcome was percentage change from baseline to 3 months in fasting triglyceride in the full analysis set (all patients who were randomly assigned and received at least one dose of study drug and had a baseline fasting triglyceride assessment). This trial is registered with ClinicalTrials.gov, NCT02300233 (completed). FINDINGS Between Feb 5, 2015, and Jan 24, 2017, 408 patients were screened for eligibility. 294 were excluded and 114 randomly assigned to receive either volanesorsen (n=76) or placebo (n=38). One patient in the volanesorsen group discontinued before receiving the study drug. The total number of dropouts was 28 (four in the placebo group and 24 in the treatment group). Volanesorsen reduced mean plasma triglyceride concentration by 71·2% (95% CI -79·3 to -63·2) from baseline to 3 months compared with 0·9% (-13·9 to 12·2) in the placebo group (p<0·0001), representing a mean absolute reduction of fasting plasma triglycerides of 869 mg/dL (95% CI -1018 to -720; 9·82 mmol/L [-11·51 to -8·14]) in volanesorsen compared with an increase in placebo of 74 mg/dL (-138 to 285; 0·83 mmol/L [-1·56 to 3·22]; p<0·0001). In the key safety analysis, five adjudicated events of acute pancreatitis occurred during the study treatment period, all in three of 38 patients in the placebo group. The most common adverse events were related to tolerability and included injection-site reactions (average of 24% of all volanesorsen injections vs 0·2% of placebo injections), which were all mild or moderate. One participant in the volanesorsen group had a platelet count reduction to less than 50 000 per μL and one patient had serum sickness, both of which were regarded as serious adverse events. INTERPRETATION Volanesorsen significantly reduced triglyceride concentrations in patients with multifactorial chlyomicronaemia and might reduce acute pancreatitis events in these patients. FUNDING Ionis Pharmaceuticals and Akcea Therapeutics.
Collapse
Affiliation(s)
- Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | - Daniel Gaudet
- Department of Medicine, Université de Montréal, Saguenay, QC, Canada
| | - Robert A Hegele
- Robarts Research Institute, Western University, London, ON, Canada
| | | | - Erik S G Stroes
- Department Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Sotirios Tsimikas
- Ionis Pharmaceuticals, Carlsbad, CA, USA; Department of Medicine, University California San Diego, La Jolla, CA, USA
| | - Joseph L Witztum
- Department of Medicine, University California San Diego, La Jolla, CA, USA.
| | | |
Collapse
|
11
|
Witztum JL, Gaudet D, Freedman SD, Alexander VJ, Digenio A, Williams KR, Yang Q, Hughes SG, Geary RS, Arca M, Stroes ESG, Bergeron J, Soran H, Civeira F, Hemphill L, Tsimikas S, Blom DJ, O'Dea L, Bruckert E. Volanesorsen and Triglyceride Levels in Familial Chylomicronemia Syndrome. N Engl J Med 2019; 381:531-542. [PMID: 31390500 DOI: 10.1056/nejmoa1715944] [Citation(s) in RCA: 302] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Familial chylomicronemia syndrome is a rare genetic disorder that is caused by loss of lipoprotein lipase activity and characterized by chylomicronemia and recurrent episodes of pancreatitis. There are no effective therapies. In an open-label study of three patients with this syndrome, antisense-mediated inhibition of hepatic APOC3 mRNA with volanesorsen led to decreased plasma apolipoprotein C-III and triglyceride levels. METHODS We conducted a phase 3, double-blind, randomized 52-week trial to evaluate the safety and effectiveness of volanesorsen in 66 patients with familial chylomicronemia syndrome. Patients were randomly assigned, in a 1:1 ratio, to receive volanesorsen or placebo. The primary end point was the percentage change in fasting triglyceride levels from baseline to 3 months. RESULTS Patients receiving volanesorsen had a decrease in mean plasma apolipoprotein C-III levels from baseline of 25.7 mg per deciliter, corresponding to an 84% decrease at 3 months, whereas patients receiving placebo had an increase in mean plasma apolipoprotein C-III levels from baseline of 1.9 mg per deciliter, corresponding to a 6.1% increase (P<0.001). Patients receiving volanesorsen had a 77% decrease in mean triglyceride levels, corresponding to a mean decrease of 1712 mg per deciliter (19.3 mmol per liter) (95% confidence interval [CI], 1330 to 2094 mg per deciliter [15.0 to 23.6 mmol per liter]), whereas patients receiving placebo had an 18% increase in mean triglyceride levels, corresponding to an increase of 92.0 mg per deciliter (1.0 mmol per liter) (95% CI, -301.0 to 486 mg per deciliter [-3.4 to 5.5 mmol per liter]) (P<0.001). At 3 months, 77% of the patients in the volanesorsen group, as compared with 10% of patients in the placebo group, had triglyceride levels of less than 750 mg per deciliter (8.5 mmol per liter). A total of 20 of 33 patients who received volanesorsen had injection-site reactions, whereas none of the patients who received placebo had such reactions. No patients in the placebo group had platelet counts below 100,000 per microliter, whereas 15 of 33 patients in the volanesorsen group had such levels, including 2 who had levels below 25,000 per microliter. No patient had platelet counts below 50,000 per microliter after enhanced platelet-monitoring began. CONCLUSIONS Volanesorsen lowered triglyceride levels to less than 750 mg per deciliter in 77% of patients with familial chylomicronemia syndrome. Thrombocytopenia and injection-site reactions were common adverse events. (Funded by Ionis Pharmaceuticals and Akcea Therapeutics; APPROACH Clinical Trials.gov number, NCT02211209.).
Collapse
Affiliation(s)
- Joseph L Witztum
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Daniel Gaudet
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Steven D Freedman
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Veronica J Alexander
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Andres Digenio
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Karren R Williams
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Qingqing Yang
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Steven G Hughes
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Richard S Geary
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Marcello Arca
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Erik S G Stroes
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Jean Bergeron
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Handrean Soran
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Fernando Civeira
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Linda Hemphill
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Sotirios Tsimikas
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Dirk J Blom
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Louis O'Dea
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| | - Eric Bruckert
- From the Department of Medicine, University of California San Diego, La Jolla (J.L.W., S.T.), and Ionis Pharmaceuticals, Carlsbad (V.J.A., Q.Y., S.G.H., R.S.G., S.T.) - both in California; the Department of Medicine, Université de Montréal and ECOGENE 21, Chicoutimi, QC (D.G.), and the Department of Medicine and Laboratory Medicine, Centre Hospitalier Universitaire de Québec-University Laval, Quebec, QC (J.B.) - both in Canada; the Department of Medicine, Beth Israel Deaconess Medical Center (S.D.F.), and the Department of Medicine, Massachusetts General Hospital (L.H.), Boston, and Akcea Therapeutics, Cambridge (A.D., K.R.W., L.O.) - all in Massachusetts; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome (M.A.); Academic Medical Center, Department of Vascular Medicine, Amsterdam (E.S.G.S.); the Department of Medicine, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom (H.S.); the Department of Internal Medicine, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain (F.C.); the Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa (D.J.B.); and the Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Institut de Création et d'Animation Numériques, Paris (E.B.)
| |
Collapse
|
12
|
Patni N, Quittner C, Garg A. Orlistat Therapy for Children With Type 1 Hyperlipoproteinemia: A Randomized Clinical Trial. J Clin Endocrinol Metab 2018; 103:2403-2407. [PMID: 29659879 PMCID: PMC6456945 DOI: 10.1210/jc.2018-00369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with type 1 hyperlipoproteinemia (T1HLP), a rare genetic disorder, have extreme chylomicronemia and recurrent episodes of acute pancreatitis. Currently, the only therapeutic option is to consume an extremely low-fat diet because the triglyceride-lowering medications are not efficacious. OBJECTIVE To determine the efficacy of orlistat, a gastric and pancreatic lipase inhibitor, in reducing serum triglyceride levels in patients with T1HLP. DESIGN AND SETTING We conducted a randomized, open-label, clinical trial with a four-period, two-sequence ("orlistat" and "off orlistat" for 3 months), crossover study design. PATIENTS Two unrelated young Asian Indian males (11 and 9 years old) with T1HLP due to homozygous large GPIHBP1 deletions were enrolled at the UT Southwestern Medical Center. The patients were randomized to receive 3 months of orlistat or no therapy (off), then crossed over to the other arm, and this sequence was then repeated. Fasting serum triglyceride levels, fat-soluble vitamins, and gastrointestinal side effects were assessed. RESULTS Compared with the two off periods, orlistat therapy reduced serum triglycerides by 53.3% and 53.0% in patient 1 and 45.8% and 62.2% in patient 2. There was no deficiency of fat-soluble vitamin levels, and their growth continued. There were no serious adverse effects of orlistat; patient 1 had a mild increase in passage of gas and bloating, and patient 2 had constipation with mild stool leakage. CONCLUSION Orlistat is safe and highly efficacious in lowering serum triglycerides in children with T1HLP and should be the first-line therapy in conjunction with an extremely low-fat diet.
Collapse
Affiliation(s)
- Nivedita Patni
- Division of Pediatric Endocrinology, Department of Pediatrics and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas
| | - Claudia Quittner
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas
- Correspondence and Reprint Requests: Abhimanyu Garg, MD, Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390. E-mail:
| |
Collapse
|
13
|
Gabcova-Balaziova D, Stanikova D, Vohnout B, Huckova M, Stanik J, Klimes I, Raslova K, Gasperikova D. Molecular-genetic aspects of familial hypercholesterolemia. Endocr Regul 2016; 49:164-81. [PMID: 26238499 DOI: 10.4149/endo_2015_03_164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Familial hypercholesterolemia (FH) is the world's most abundant and the most common heritable disorder of lipid metabolism. The prevalence of the disease in general population is 1:500. Therefore the approximate number of FH patients all over the world is 14 million. From the genetic point of view the disease originates as a result of mutations in genes affecting the processing of LDL particles from circulation, resulting in an increase in LDL cholesterol and hence total cholesterol. These are mutations in genes encoding LDL receptor, apolipoprotein B, proprotein convertase subtilisin/kexin 9 and LDL receptor adaptor protein 1. Cholesterol depositing in tissues and blood vessels of individuals creates tendon xanthoma, xanthelesma and arcus lipoides cornae. Due to the increased deposition of cholesterol in blood vessels, atherosclerosis process is accelerated, what leads to a significantly higher risk of premature cardiovascular diseases. Therefore, early clinical diagnosis confirmed by the DNA analysis, and effective treatment are crucial to reduce the mortality and high risk of premature atherosclerotic complications.
Collapse
|
14
|
Lima-Martínez MM, Piñango M, Lima-Ostos M. Primary hyperchylomicronemia syndrome treated with ciprofibrate in childhood. Endocrinol Nutr 2016; 63:98-99. [PMID: 26704984 DOI: 10.1016/j.endonu.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Marcos M Lima-Martínez
- Departamento de Ciencias Fisiológicas, Escuela de Ciencias de la Salud, Universidad de Oriente, Ciudad Bolívar, Venezuela; Unidad de Endocrinología, Diabetes, Metabolismo y Nutrición, Anexo A, Centro Médico Orinoco, Ciudad Bolívar, Venezuela.
| | - Martha Piñango
- Departamento de Ciencias Fisiológicas, Escuela de Ciencias de la Salud, Universidad de Oriente, Ciudad Bolívar, Venezuela
| | - Miguel Lima-Ostos
- Departamento de Ciencias Fisiológicas, Escuela de Ciencias de la Salud, Universidad de Oriente, Ciudad Bolívar, Venezuela; Consultorio Dermatológico «Lima-Ostos», Ciudad Bolívar, Venezuela
| |
Collapse
|
15
|
Geary RS, Baker BF, Crooke ST. Clinical and preclinical pharmacokinetics and pharmacodynamics of mipomersen (kynamro(®)): a second-generation antisense oligonucleotide inhibitor of apolipoprotein B. Clin Pharmacokinet 2015; 54:133-46. [PMID: 25559341 PMCID: PMC4305106 DOI: 10.1007/s40262-014-0224-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Mipomersen (Kynamro®), a second-generation 2′-O-methoxyethyl chimeric antisense oligonucleotide (ASO), inhibits the synthesis of apolipoprotein B (apoB) and is indicated in the US as an adjunct therapy for homozygous familial hypercholesterolemia (HoFH) at a dose of 200 mg subcutaneously (SC) once weekly. The pharmacokinetic (PK) properties of mipomersen are generally consistent across all species studied, including mouse, rat, monkey, and humans. After SC administration, mipomersen is rapidly and extensively absorbed. It has an apparent plasma and tissue terminal elimination half-life of approximately 30 days. Mipomersen achieves steady-state tissue concentrations within approximately 4–6 months of once-weekly dosing. It does not exhibit PK-based drug–drug interactions with other concomitant medications, either involving competition for plasma protein binding or alterations in disposition of any evaluated drugs. Furthermore, mipomersen does not prolong the corrected QT (QTc) interval. There have been no ethnic- or gender-related differences in PK observed. In clinical trials, both as a single agent and in the presence of maximal lipid-lowering therapy, mipomersen has demonstrated significant dose-dependent reductions in all measured apoB-containing atherogenic lipoproteins. Overall, mipomersen has well-characterized PK and pharmacodynamic properties in both animals and humans, and is an efficacious adjunct treatment for patients with HoFH.
Collapse
Affiliation(s)
- Richard S Geary
- Isis Pharmaceuticals, Inc., 2855 Gazelle Court, Carlsbad, CA, 92010, USA,
| | | | | |
Collapse
|
16
|
Gaudet D, Brisson D, Tremblay K, Alexander VJ, Singleton W, Hughes SG, Geary RS, Baker BF, Graham MJ, Crooke RM, Witztum JL. Targeting APOC3 in the familial chylomicronemia syndrome. N Engl J Med 2014; 371:2200-6. [PMID: 25470695 DOI: 10.1056/nejmoa1400284] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The familial chylomicronemia syndrome is a genetic disorder characterized by severe hypertriglyceridemia and recurrent pancreatitis due to a deficiency in lipoprotein lipase (LPL). Currently, there are no effective therapies except for extreme restriction in the consumption of dietary fat. Apolipoprotein C-III (APOC3) is known to inhibit LPL, although there is also evidence that APOC3 increases the level of plasma triglycerides through an LPL-independent mechanism. We administered an inhibitor of APOC3 messenger RNA (mRNA), called ISIS 304801, to treat three patients with the familial chylomicronemia syndrome and triglyceride levels ranging from 1406 to 2083 mg per deciliter (15.9 to 23.5 mmol per liter). After 13 weeks of study-drug administration, plasma APOC3 levels were reduced by 71 to 90% and triglyceride levels by 56 to 86%. During the study, all patients had a triglyceride level of less than 500 mg per deciliter (5.7 mmol per liter) with treatment. These data support the role of APOC3 as a key regulator of LPL-independent pathways of triglyceride metabolism.
Collapse
Affiliation(s)
- Daniel Gaudet
- From the ECOGENE-21 Clinical Research Center, Chicoutimi Hospital, Chicoutimi, and the Department of Medicine, Université de Montréal, Montreal - both in Canada (D.G., D.B., K.T.); and Isis Pharmaceuticals, Carlsbad (V.J.A., W.S., S.G.H., R.S.G., B.F.B., M.J.G., R.M.C.), and the Department of Medicine, Division of Endocrinology-Metabolism, University California, San Diego, School of Medicine, La Jolla (J.L.W.) - both in California
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
|
19
|
Carpentier AC, Frisch F, Labbé SM, Gagnon R, de Wal J, Greentree S, Petry H, Twisk J, Brisson D, Gaudet D. Effect of alipogene tiparvovec (AAV1-LPL(S447X)) on postprandial chylomicron metabolism in lipoprotein lipase-deficient patients. J Clin Endocrinol Metab 2012; 97:1635-44. [PMID: 22438229 DOI: 10.1210/jc.2011-3002] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lipoprotein lipase-deficient (LPLD) individuals display marked chylomicronemia and hypertriglyceridemia associated with increased pancreatitis risk. The aim of this study was to determine the effect of i.m. administration of an adeno-associated viral vector (AAV1) for expression of LPL(S447X) in muscle (alipogene tiparvovec, AAV1-LPL(S447X)) on postprandial chylomicron metabolism and on nonesterified fatty acid (NEFA) and glycerol metabolism in LPLD individuals. METHODOLOGY In an open-label clinical trial (CT-AMT-011-02), LPLD subjects were administered alipogene tiparvovec at a dose of 1 × 10(12) genome copies per kilogram. Two weeks before and 14 wk after administration, chylomicron metabolism and plasma palmitate and glycerol appearance rates were determined after ingestion of a low-fat meal containing (3)H-palmitate, combined with (continuous) iv infusion of [U-(13)C]palmitate and [1,1,2,3,3-(2)H]glycerol. PRINCIPAL FINDINGS After administration of alipogene tiparvovec, the triglyceride (TG) content of the chylomicron fraction and the chylomicron-TG/total plasma TG ratio were reduced throughout the postprandial period. The postprandial peak chylomicron (3)H level and chylomicron (3)H area under the curve were greatly reduced (by 79 and 93%, 6 and 24 h after the test meal, respectively). There were no significant changes in plasma NEFA and glycerol appearance rates. Plasma glucose, insulin, and C-peptide also did not change. CONCLUSIONS/SIGNIFICANCE Intramuscular administration of alipogene tiparvovec resulted in a significant improvement of postprandial chylomicron metabolism in LPLD patients, without inducing large postprandial NEFA spillover.
Collapse
Affiliation(s)
- André C Carpentier
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, Québec, Canada J1H 5N4.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Yanai H, Tomono Y, Yoshida H, Tada N. [Therapeutic application of diacylglycerol oil for the metabolic syndrome]. Rinsho Byori 2010; 58:39-44. [PMID: 20169943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Excess adiposity has been shown to play a crucial role in the development of the metabolic syndrome. Characteristics for dyslipidemia in the metabolic syndrome are elevated fasting and postprandial triglyceride (TG) and decreased high-density lipoprotein-cholesterol (HDL-C). Diacylglycerol(DAG) has been suggested to suppress postprandial hyperlipidemia and promote negative caloric balance by increasing energy expenditure, due to intestinal physiochemical dynamics that differ from triacylglycerol (TAG). Our study (Study 1) demonstrated that DAG suppressed postprandial increase in TG-rich lipoprotein, very low density lipoprotein (VLDL), and insulin as compared with TAG in young male individuals. Further, our another study using the apolipoprotein C-II deficient subject demonstrated that DAG suppressed postprandial increase in VLDL-cholesterol and remnant-like particle-cholesterol compared with TAG, suggesting that DAG suppress postprandial TG-rich lipoprotein independent of lipoprotein lipase. Study 1 also showed that DAG significantly increased plasma serotonin, which is mostly present in intestine and mediates thermogenesis, proposing a possible mechanism for a postprandial increase in energy expenditure by DAG. Our studies presented DAG-mediated amelioration in postprandial TG-rich lipoprotein, insulin, and energy metabolism, indicating the therapeutic application of DAG for the metabolic syndrome.
Collapse
Affiliation(s)
- Hidekatsu Yanai
- Department of Internal Medicine, International Medical Center of Japan Kohnodai Hospital, Ichikawa, Chiba 272-8516, Japan.
| | | | | | | |
Collapse
|
21
|
Burnett JR, Hooper AJ. Alipogene tiparvovec, an adeno-associated virus encoding the Ser(447)X variant of the human lipoprotein lipase gene for the treatment of patients with lipoprotein lipase deficiency. Curr Opin Mol Ther 2009; 11:681-691. [PMID: 20072945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Amsterdam Molecular Therapeutics BV is developing alipogene tiparvovec (Glybera, AMT-011, AAV1-LPLS447X), a Ser(447)X variant of the human lipoprotein lipase (LPL) gene (LPLSer(447)X) in an adeno-associated virus vector, as a potential intramuscular gene therapy for the treatment of LPL deficiency. Familial LPL deficiency is a rare, autosomal-recessive disorder of lipoprotein metabolism that is characterized by severe hypertriglyceridemia with episodes of abdominal pain, acute pancreatitis and eruptive cutaneous xanthomatosis. The lack of functional LPL in patients with LPL deficiency causes an accumulation of triglyceride (TG)-rich lipoproteins in the plasma. The LPLSer(447)X variant is associated with decreased levels of plasma TGs and increased HDL cholesterol concentrations compared with wild-type LPL. Preclinical studies evaluating alipogene tiparvovec in a mouse model of LPL deficiency demonstrated a long-term, dose-dependent correction of the lipid abnormalities. The first clinical trials in patients with LPL deficiency appear promising, with a significant decrease in the levels of plasma TGs observed in the first 3 months following the administration of alipogene tiparvovec, and an increase in local LPL activity and protein levels observed after 6 months. In addition, a decrease in pancreatitis frequency was observed during a 3-year follow-up period. At the time of publication, a phase II/III trial in patients with LPL deficiency, being conducted to further support the submission of an MAA to the EMEA for alipogene tiparvovec, was ongoing. The compound is also under investigation for the treatment of type V hyperlipoproteinemia, Syndrome X and non-alcoholic steatohepatitis.
Collapse
Affiliation(s)
- John R Burnett
- Royal Perth Hospital, Department of Core Clinical Pathology & Biochemistry, PathWest Laboratory Medicine WA, Wellington Street, GPO Box X2213, Perth, WA 6847, Australia.
| | | |
Collapse
|
22
|
|
23
|
Tasaki H, Miyamoto M, Kubara T, Kamezaki F, Tanaka S, Yamashita K, Tsutsui M, Nakashima Y. Cross-Over Trial of Intensive Monotherapy With Atorvastatin and Combined Therapy With Atorvastatin and Colestimide for Japanese Familial Hypercholesterolemia. Circ J 2006; 70:14-20. [PMID: 16377918 DOI: 10.1253/circj.70.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In familial hypercholesterolemia (FH), low-density lipoprotein-cholesterol (LDL-C)-lowering therapy is important to avoid predisposition to coronary artery disease. This study investigated the advantages of combined therapy with atorvastatin and colestimide vs intensive monotherapy with atorvastatin. METHODS AND RESULTS The trial used a randomized cross-over design consisting of 2 16-week periods of open-label drug therapy. Among the 24 initial patients, 17 heterozygous FH patients (age: 54.1 years; 5 males) were enrolled after 20 mg/day atorvastatin failed to achieve their target level. The patients received 20 mg/day atorvastatin and 3 g/day colestimide or 40 mg/day atorvastatin. Fifteen patients completed the trial and their LDL-C reduced from 5.07 +/- 1.10 mmol/L to 3.76 +/- 0.90 mmol/L with the combined therapy and to 3.81 +/- 0.50 mmol/L with the intensive monotherapy. Although the 2 therapies showed comparable mean effects for decreasing LDL-C, similar adverse reaction and cost, each therapy was predominantly more effective in some patients than in others. The triglyceride and high-density lipoprotein cholesterol levels were similar in both therapies. CONCLUSIONS To achieve the therapeutic target of LDL-C level for refractory FH, the LDL-C-lowering therapy selected can be either intensive monotherapy or combined therapy as the next to standard statin therapy.
Collapse
Affiliation(s)
- Hiromi Tasaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu 807-8555, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Mohrschladt MF, Westendorp RGJ, Gevers Leuven JA, Smelt AHM. Cardiovascular disease and mortality in statin-treated patients with familial hypercholesterolemia. Atherosclerosis 2004; 172:329-35. [PMID: 15019543 DOI: 10.1016/j.atherosclerosis.2003.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2001] [Revised: 10/21/2003] [Accepted: 11/05/2003] [Indexed: 10/26/2022]
Abstract
Patients with familial hypercholesterolemia (FH) are at an increased risk of premature cardiovascular disease (CVD). The benefits of statin therapy are not well known since no placebo controlled studies have been performed in these patients. The aim of this study was to determine the CVD event and mortality risk in statin-treated patients with FH. A total of 345 FH patients were followed prospectively for 8 years. Mortality from CVD was compared to that of the general population. The absolute risk of CVD in patients without a previous history of CVD was 3% per year for men and 1.6% for women. Mortality from CVD in patients without a previous history was 1.4-fold (95% CI = 0.6-3.3) increased and ischaemic heart disease (IHD) mortality was 2.6-fold (95% CI = 1.1-6.3) higher compared to the general population. This mortality risk was highest in patients aged 40-59 years. Female FH patients had no increased CVD or IHD mortality risk. Over a period of 8 years the event risk of patients with a history of CVD was almost 30% per year under age 40 years and 15% in patients aged 60 years and over. When compared to the general population, mortality from other causes than CVD was lower for patients with FH, the relative risks not reaching statistical significance. The relative risk of mortality from all causes was 1.5 (P < 0.05) for men and 1.0 for women. In conclusion, male patients with FH, treated from middle-age with statins remain at an increased risk of developing CVD.
Collapse
Affiliation(s)
- M F Mohrschladt
- Department of General Internal Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | | | | | | |
Collapse
|
25
|
García-Otín AL, Civeira F, Peinado-Onsurbe J, Gonzalvo C, Llobera M, Pocoví M. Acquired lipoprotein lipase deficiency associated with chronic urticaria. A new etiology for type I hyperlipoproteinemia. Eur J Endocrinol 1999; 141:502-5. [PMID: 10576767 DOI: 10.1530/eje.0.1410502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Type I hyperlipoproteinemia (type I HLP) is a rare disorder of lipid metabolism characterized by fasting chylomicronemia and reduced postheparin plasma lipoprotein lipase (LPL) activity. Most cases of type I HLP are due to genetic defects in the LPL gene or in its activator, the apolipoprotein CII gene. Several cases of acquired type I HLP have also been described in the course of autoimmune diseases due to the presence of circulating inhibitors of LPL. Here we report a case of type I HLP due to a transient defect of LPL activity during puberty associated with chronic idiopathic urticaria (CIU). The absence of any circulating LPL inhibitor in plasma during the disease was demonstrated. The LPL genotype showed that the patient was heterozygous for the D9N variant. This mutation, previously described, can explain only minor defects in the LPL activity. The presence of HLP just after the onset of CIU, and the elevation of the LPL activity with remission of the HLP when the patient recovered from CIU, indicate that type I HLP was caused by CIU. In summary, we report a new etiology for type I HLP - a transient decrease in LPL activity associated with CIU and with absence of circulating inhibitors. This is the first description of this association, which suggests a new mechanism for type I HLP.
Collapse
Affiliation(s)
- A L García-Otín
- Departments of Biochemistry, Molecular Biology and Medicine, University of Zaragoza, Hospital Miguel Servet, Av. Isabel La Católica 1-3, 50009, Zaragoza, Spain
| | | | | | | | | | | |
Collapse
|
26
|
Heaney AP, Sharer N, Rameh B, Braganza JM, Durrington PN. Prevention of recurrent pancreatitis in familial lipoprotein lipase deficiency with high-dose antioxidant therapy. J Clin Endocrinol Metab 1999; 84:1203-5. [PMID: 10199753 DOI: 10.1210/jcem.84.4.5617] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
We describe a dramatic response to antioxidant therapy in three patients with familial lipoprotein lipase deficiency complicated by frequent severe episodes of pancreatitis who had failed to respond to other dietary and pharmacological measures. Antioxidant therapy may be an important advance in the management of this type of patient.
Collapse
Affiliation(s)
- A P Heaney
- University of Manchester, Department of Medicine, Manchester Royal Infirmary, United Kingdom
| | | | | | | | | |
Collapse
|
27
|
|
28
|
Shirai K, Kobayashi J, Inadera H, Ohkubo Y, Mori S, Saito Y, Yoshida S. Type I hyperlipoproteinemia caused by lipoprotein lipase defect in lipid-interface recognition was relieved by administration of medium-chain triglyceride. Metabolism 1992; 41:1161-4. [PMID: 1435285 DOI: 10.1016/0026-0495(92)90003-s] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have previously reported lipoprotein lipase with a defect of lipid-interface recognition in a patient with type I hyperlipoproteinemia. In this patient, lipoprotein lipase from post-heparin plasma (PHP) hydrolyzed monomeric substrate tributyrin, but scarcely hydrolyzed triolein emulsified with Triton X-100 and that in very-low-density lipoproteins ([VLDL] d < 1.006 g/mL), and did not bind to VLDL. The triglyceride (TG) level of this patient did not decrease to less than 1,000 mg/dL with a low-fat diet (1,400 kcal containing 10 g fat/d). When the patient took 30 g medium-chain TG (MCT) in addition to the 1,400-kcal diet, her serum TG level decreased to 250 mg/dL and her clinical signs improved. The low clearance rate of serum TG with heparin injection improved after intake of MCT. Caproic acid levels were maintained at 1.4% and 2.6% in chylomicrons and VLDL after MCT intake, respectively. The patient's lipoprotein lipase hydrolyzed triolein emulsified with 2% tricaprin at the same rate as that of control lipoprotein lipase. The patient's lipoprotein lipase-catalyzed hydrolyzing rate of triolein in chylomicrons obtained after MCT administration was also enhanced up to 70% of that of control lipoprotein lipase. These findings suggest that hypertriglyceridemia caused by lipoprotein lipase with a defect in lipid-interface recognition could be relieved with the administration of medium-chain TG, and that one of the mechanisms of this effect might be a modification of TG-rich lipoproteins by MCT.
Collapse
Affiliation(s)
- K Shirai
- Second Department of Internal Medicine, School of Medicine, Chiba University, Japan
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Primary familial forms of chylomicronemia can lead to acute life-threatening complications, especially acute pancreatitis. The main aim of therapy is to avoid this so-called chylomicronemia syndrome. In 12 patients with primary chylomicronemia due to familial hypertriglyceridemia, the addition of 2.16 g omega-3 fatty acids over 4 weeks and 4.32 g for 8 weeks resulted in a decrease of serum triglyceride levels from 1,624 +/- 333 to 894 +/- 241 mg/dL after 12 weeks. Cholesterol and triglyceride levels in the chylomicron fraction were reduced concomitantly, the apolipoprotein B-100/B-48 ratio increased, very--low-density lipoprotein (VLDL) triglycerides, VLDL cholesterol, and total cholesterol levels decreased, and low-density lipoprotein (LDL) cholesterol showed a tendency to increase, but this finding did not reach significance. High-density lipoprotein (HDL) cholesterol levels remained unchanged, as did the levels of apolipoproteins A-I, A-II, and E, and lipoprotein(a). Apolipoprotein B levels decreased significantly. The decrease of triglyceride levels to still-elevated concentrations was accompanied by a substantial decrease in plasma and whole-blood viscosity and erythrocyte aggregation, which reached normal values. As in chylomicronemia, complications usually occur at triglyceride levels higher than 1,500 mg/dL; patients can still profit from treatment with omega-3 fatty acids, even though triglyceride levels are still substantially elevated. No clinically relevant side effects occurred, with the exception of the manifestation of diabetes mellitus in one patient, which could be reversed after discontinuation of treatment.
Collapse
Affiliation(s)
- W O Richter
- Medical Department II, University of Munich, Germany
| | | | | | | |
Collapse
|
30
|
Bustos P, Fernández E, Radrigán E. [Hyperlipoproteinemia type I]. Rev Chil Pediatr 1987; 58:481-4. [PMID: 3506219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
31
|
Medina León A, Fernández Alepuz R, Moreno Díaz MJ. [Clinical response to platelet antiaggregation treatment in a patient with hyperlipoproteinemia type I and a hypersomnic course]. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1983; 11:423-7. [PMID: 6660070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
32
|
|