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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15:2157-2164.)
© 1995 American Heart Association, Inc.

Articles

Apolipoprotein A-I Deficiency

Biochemical and Metabolic Characteristics

Dominic S. Ng; Camilla Vezina; Thomas S. Wolever; Arnis Kuksis; Robert A. Hegele; Philip W. Connelly

From the Department of Medicine, St Michael's Hospital, University of Toronto, and the C.H. Best Institute (A.K.), Toronto, Ontario, Canada.

Correspondence to Dr P.W. Connelly, J. Alick Little Lipid Research Laboratory, Room 104WA, 38 Shuter St, Toronto, Ontario M5B 1A6, Canada.

Abstract Familial HDL deficiencies are associated with variable susceptibility to premature coronary heart disease, but the mechanism underlying this association remains poorly understood. Three homozygotes with isolated complete apo A-I deficiency caused by an autosomal codominant apo A-I Q[-2]X mutation and one heterozygote developed coronary heart disease before age 40 years. We characterized the effects of this mutation on lipoprotein metabolism. LDL FC, phospholipid, and apo B were all significantly higher in homozygotes than in heterozygotes. The HDLs of the heterozygotes were apo A-I poor relative to apo A-II. Lecithin-cholesterol acyltransferase activity was 59% lower in homozygotes than in normal subjects or heterozygotes. Cholesteryl ester transfer activity was increased in a homozygote compared with a normolipidemic control subject. Postprandial lipid metabolism was studied in one homozygote and one heterozygote. Postprandial TG response in the homozygote was significantly exaggerated, while residual plasma HDL level remained unaffected. The homozygote also had delayed clearance of retinyl ester, a marker of chylomicron remnant metabolism. Thus, homozygosity and heterozygosity for apo A-I Q[-2]X are associated with qualitative, as well as quantitative, disturbances in plasma HDLs, LDLs, lipid-modifying enzyme activities, and postprandial retinyl ester metabolism. The observed elevation of atherogenic lipoproteins and reduction in antiatherogenic lipoproteins in the affected members of the apo A-I Q[-2]X kindred are consistent with the primary deficiency in apo A-I having pleiotropic effects that markedly enhance susceptibility for coronary heart disease.

Key Words: coronary heart disease • apolipoprotein A-I • reverse cholesterol transport • genetics • postprandial lipemia

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