© 1999 American Heart Association, Inc.
Original Contributions |
Characterization of a New Form of Inherited Hypercholesterolemia
Familial Recessive Hypercholesterolemia
From the Department of Internal Medicine, University of Ferrara, Ferrara (G.Z., G.B., R.F.), and the Institute of Terapia Medica Sistematica (M.A., F.C., A.M., G.R.) and Service of Nuclear Medicine (A.S., M.C.), Department of Internal Medicine II, University of Rome "La Sapienza," Rome, Italy; Vanderbilt University Medical School, Nashville, Tenn (S.F.); and the Institute of Pharmacological Science, University of Milan, Milan (S.B.), and the Department of Internal Medicine, University of Sassari, Sassari (M.M., A.P.), Italy.
Correspondence to Prof Renato Fellin, Istituto di Medicina Interna II, Universita' degli Studi, via Savonarola No. 9, 44100 Ferrara, Italy. E-mail flr{at}ifeuniv.unife.it
Abstract—We previously described a Sardinian family in which the probands had a severe form of hypercholesterolemia, suggestive of familial hypercholesterolemia (FH). However, low density lipoprotein (LDL) receptor activity in fibroblasts from these subjects and LDL binding ability were normal. The characteristics of the pedigree were consistent with an autosomal recessive trait. Sitosterolemia and pseudohomozygous hyperlipidemia were ruled out. A second Sardinian kindred with similar characteristics was identified. Probands showed severe hypercholesterolemia, whereas their parents and grandparents were normolipidemic. FH, familial defective apoprotein (apo) B, sitosterolemia, and cholesteryl ester storage disease were excluded by in vitro studies. We addressed the metabolic basis of this inherited disorder by studying the in vivo metabolism of LDL in 3 probands from these 2 families. 125I-LDL turnover studies disclosed a marked reduction in the fractional catabolic rate (0.19±0.01 versus 0.36±0.03 pools per day, respectively; P<0.001) and a significant increase in the production rate [20.7±4.4 versus 14.0±2.4 mg · kg-1 · d-1, respectively; P<0.01] of LDL apoB in the probands compared with normolipidemic controls. We then studied the in vivo biodistribution and tissue uptake of 99mtechnetium-labeled LDL in the probands and compared them with those in normal controls and 1 FH homozygote. The probands showed a significant reduction in hepatic LDL uptake, similar to that observed in the FH homozygote. A reduced uptake of LDL by the kidney and spleen was also observed in all patients. Our findings suggest that this recessive form of hypercholesterolemia is due to a marked reduction of in vivo LDL catabolism. This appears to be caused by a selective reduction in hepatic LDL uptake. We propose that in this new lipid disorder, a recessive defect causes a selective impairment of LDL receptor function in the liver.
Key Words: hypercholesterolemia • genetics • LDL turnover • LDL receptor • apoB
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