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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15:1287-1293.)
© 1995 American Heart Association, Inc.

Articles

Two New Immunogenetic Polymorphisms of the ApoB Gene and Their Effect on Serum Lipid Levels and Responses to Changes in Dietary Fat Intake

Marja Ilmonen; Tiina Heliö; René Bütler; Aarno Palotie; Pirjo Pietinen; Jussi K. Huttunen; Matti J. Tikkanen

From the Department of Medicine, Division of Cardiology, Helsinki University Central Hospital (M.I., T.H., M.J.T.), the Department of Clinical Chemistry, University of Helsinki (A.P.), the National Public Health Institute (P.P., J.K.H.), Helsinki, Finland, and the Blood Transfusion Service of the Swiss Red Cross, Bern, Switzerland (R.B.).

Correspondence to Marja Ilmonen, MD, Helsinki University Central Hospital, Department of Medicine, Laboratory of Biochemistry L222, Haartmaninkatu 4, FIN-00290 Helsinki, Finland.

	Abstract

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Abstract In previous studies, apoB polymorphisms have been shown to modify serum lipid responses to changes in dietary fat intake. The functionally important apoB DNA change or changes underlying these effects have, however, remained unknown. Using a single-strand conformation polymorphism analysis–based screening method, we identified two previously unreported apoB polymorphisms located close to each other in the 5' region of apoB gene exon 26. This DNA segment corresponds to the binding site of monoclonal anti-apoB antibody D7.2. The two AG changes at apoB cDNA nucleotides 5869 and 5896 produced an AsnSer change at amino acid 1887 and a HisArg change at amino acid 1896. In the Finnish population, allele frequencies of the rare alleles of the apoB 1887 (AsnSer) and apoB 1896 (HisArg) polymorphisms were .02 and .11, respectively. Both polymorphisms were shown to have an independent effect on the binding affinity of LDL with monoclonal antibody D7.2. The effect of these polymorphisms on serum lipid levels and responses to changes in dietary fat intake in 102 healthy free-living subjects was assessed. The apoB 1896 Arg allele was associated with a higher serum LDL cholesterol level during a low-fat, low-cholesterol diet in men.

Key Words: apoB gene polymorphisms • apoB antigenic polymorphisms • low-fat, low-cholesterol diet

	Introduction

Top Abstract Introduction Methods Results Discussion References

 
The first polymorphisms described for apoB were protein polymorphisms detected by use of alloantibodies produced in multiply transfused patients.¹ These Ag polymorphisms were based on antigens a₁/d, c/g, h/i, t/z, and x/y, which appeared to be products of five closely linked allele pairs.² The Ag(x/y)³ and Ag(c/g)⁴ polymorphisms were shown to be slightly but significantly associated with serum lipid levels. Further studies have characterized DNA changes in the apoB gene corresponding to each of the five Ag epitopes.^{5 6 7 8 9 10 11 12} The silent Xba I restriction fragment length polymorphism of apoB^{13 14} was shown to be associated with the Ag system^{5 6 15 16 17 18} as well as with serum apoB, cholesterol, and triglyceride levels in many^{16 17 19 20 21 22 23} but not all^{24 25 26 27 28} studies. These findings suggested that apoB DNA sequence changes contributed in some yet undefined way to the regulation of serum lipid levels.

Our previous studies gave preliminary indications that common apolipoprotein polymorphisms modified serum lipid responses to changes in dietary fat intake^{29 30 31 32 33} and thereby influenced lipid levels. The apoB DNA change or changes presumably underlying these effects remain unknown. On this basis, we set out to screen the coding regions of the apoB gene for yet unknown functionally important DNA changes by using an SSCP^{34 35} procedure developed for this purpose.³⁶ Initial SSCP analyses indicated allelic variations in the 5' region of exon 26, a DNA segment corresponding to the binding site of Mab D7.2.^{37 38} We describe two previously unreported polymorphisms located close to each other in this region and their associations with serum lipoprotein levels and responses to changes in dietary fat intake. These polymorphisms were associated with changes in the binding affinity of LDL with Mab D7.2, generating a new immunogenetic apoB polymorphism.

	Methods

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Subjects
Serum and DNA samples were obtained as described earlier³⁰ from 102 apparently healthy subjects (48 men and 54 women) who had participated in three dietary intervention studies in North Karelia that were reported in 1982-1985^{39 40 41} ; these subjects belonged to identical intervention groups in these studies. The diet intervention consisted of a 2-week baseline period, a 6- or 12-week intervention period with a low-fat, low-cholesterol diet with a ratio of polyunsaturated to saturated fatty acids equal to 1, and a 5- to 6-week switchback period. During the baseline and switchback periods, the participants were on their normal free-choice diets. Serum and DNA samples were also obtained from family members of the two study participants showing the most marked shifts in their Mab D7.2 displacement curves.

Lipid and Lipoprotein Determinations
Blood was drawn after an overnight fast. Serum cholesterol and triglyceride concentrations were determined by use of an enzymatic assay (Boehringer Mannheim). HDL cholesterol was measured after precipitation of VLDL and LDL with dextran sulfate–magnesium chloride.⁴² Serum LDL cholesterol concentration was calculated by use of the Friedewald approximation.⁴³ The concentration of apoB was determined with a radial immunodiffusion method (Behring-Werke AG). LDL (d=1.019 to 1.050 g/mL) was isolated by sequential ultracentrifugation.⁴⁴

Antibody Binding Assays and Ag Phenotyping
A solid-phase enzyme-linked immunosorbent assay⁴⁵ with a large panel of monoclonal antibodies was used to screen for apoB variants. The evaluation of Ag antigenic determinants was carried out on the LDL of all diet study participants by passive hemagglutination inhibition according to the technique developed by Bütler and coworkers^{46 47} with human antisera used against the Ag factors (x, y, a₁, d, c, g, t, z, h, and i). Antibody D7.2 was a generous gift from Dr Gus Schonfeld and Dr Elaine Krul (Lipid Research Center, Washington University, St. Louis, Mo.).

DNA Analyses
Genomic DNA was isolated from frozen whole blood by a Triton X-100 lysis method.⁴⁸ SSCP analysis from a 1366-bp fragment located in the 5' end of apoB gene exon 26 containing cDNA nucleotides 5641 to 7007⁴⁹ and spanning amino acids 1811 to 2266 was carried out as described earlier.³⁶ The primers used in the PCR were 5' ACATCTATGCCATCTCTTCTG (upstream [A]; nucleotides 5641 to 5661) and 5' ATCAATAGCCTCAATGTGTTG (downstream [B]; nucleotides 6987 to 7007). Amplification reactions were conducted in an automatic Perkin Elmer/Cetus Thermal Cycler using Taq DNA polymerase (Promega). Reaction conditions after the initial denaturation step (5 minutes at 95°C) were 29 cycles of 94°C (1 minute), then 60°C (1 minute), then 72°C (5 minutes). The amplification products were further split with restriction enzymes (New England Biolabs) Ban I (cutting site at nucleotide 6063) and EcoRI (cutting site at nucleotide 6506) into 422-, 443-, and 501-bp segments. SSCP analyses were carried out in 0% to 10% glycerol, 0.5x to 1xTris-borate/EDTA, nondenaturing 5% polyacrylamide gels.

The 422-bp segment cut from the amplified PCR fragment by BanI was sequenced according to a slightly modified method described by Syvänen et al.⁵⁰ Genomic DNA was amplified by use of primers C (5' CCTACCAAAATAATGAAATAAAAC [upstream; nucleotides 5617 to 5640]) and D (5' TCTTGAGTTTCCAGGTGCCT [downstream; nucleotides 6062 to 6081]), primer C being biotinylated at its 5' end. After initial denaturation, 27 cycles of 94°C (1 minute), then 58°C (1 minute), then 72°C (2 minutes) followed. The biotinylated amplified 461-bp DNA strands were purified with avidin-coated polystyrene particles,³⁶ after which procedure the single-stranded amplification product was sequenced by the Sanger dideoxynucleotide termination method⁵¹ with T7 DNA polymerase (Sequenase version 2.0, United States Biochemical) and oligonucleotide D as the sequencing primer.

Genotyping of the apoB 1887 (AsnSer) and apoB 1896 (HisArg) changes was carried out by amplification of the 441-bp segment (nucleotides 5641 to 6081) containing these nucleotide changes with primers A and D and digestion of the amplification product with restriction endonucleases (New England Biolabs) BsrDI (apoB 1887) and Rsa I (apoB 1896). The digestion reactions were conducted in a total volume of 30 µL containing 10 µL of the PCR product in conditions recommended by the manufacturer (incubation at 65°C for BsrDI and 37°C for Rsa I). The presence or absence of cutting sites of each enzyme was verified by use of 3% agarose electrophoresis gels followed by ethidium bromide staining. In the 441-bp amplification product, normal digestion reactions with BsrDI (at nucleotides 5813 and 5873) produce three digestion fragments that are 60, 173, and 208 bp in size. In the absence of the 5873 cutting site, only 173- and 268-bp fragments are produced. Rsa I normally has no cutting site in the 441-bp fragment. The variant nucleotide 5897 cutting site results in two fragments, 185 and 256 bp in size, in the digestion reaction.

ApoB 3'VNTR genotyping was carried out as described by Heliö⁵² by amplification of the DNA segment overlapping the 3'VNTR region and separating the different-sized alleles with denaturing polyacrylamide gel electrophoresis. In this study, the terminology established by Boerwinkle et al⁵³ to define the number of repeats was used. The apoB Xba I polymorphism was genotyped by Xba I digestion, Southern blotting, and hybridization techniques.³⁰

Statistical Methods
Statistical analysis was carried out with the BMDP statistical software package (BMDP Statistical Software Inc). The mean values of serum lipid and lipoprotein levels between different genotypes were compared by ANOVA. With regard to differences in serum lipid responses in different genotypes, statistical calculations were repeated after adjustment for changes in body mass index. The associations between the apoB 1887 (AsnSer) and apoB 1896 (HisArg) polymorphisms and the Mab D7.2 antigenic polymorphism were estimated by both ² analysis and Fisher's exact test.

	Results

Top Abstract Introduction Methods Results Discussion References

 
Studies on the Immunoreactivity of LDL ApoB
LDLs obtained from the diet study participants were tested for apoB variants with a panel of monoclonal antibodies. In 18 of the 102 subjects, a marked shift to the right of displacement curves against antibody D7.2 could be detected. In 2 individuals, this change in binding affinity was clearly stronger than in the remaining 16. The strong displacement curve shifts were evident in some of the family members of these probands, suggesting that the change was genetically determined (Fig 1a to 1c). With other antibodies, including antibody B1B3, which was used as a reference standard, the LDLs reacted uniformly, as expected (Fig 1d). The epitope of antibody D7.2 is between amino acids 1878 and 2148, and the epitope of B1B3 is between amino acid residues 3506 and 3635.³⁸ Antibody B1B3⁵⁴ but not antibody D7.2³⁷ inhibits the binding of LDL to the LDL receptor.

View larger version (27K): [in this window] [in a new window]   Figure 1. a, Graph shows results of Mab D7.2 binding assay demonstrating genetically determined alterations in LDL binding affinity. LDLs from the proband (AK) and two of her sisters (see pedigree A in Fig 3) reacted with Mab D7.2 with low affinity, those from one sister reacted with intermediate affinity, and those from the spouse of the proband reacted with high (normal) affinity. b, Graph shows results of Mab D7.2 binding assay from a family (see Fig 3, pedigree C) with the apoB 1887 (AsnSer) polymorphism. The assay shows reduced binding of plasma LDL of the Asn/Ser heterozygotes HP, IP, and PP with Mab D7.2. In this family, only plasma samples instead of LDL were available. c, Mab D7.2 binding curve of a family (Fig 3, pedigree D) shows reduced binding of the LDLs from the apoB 1896 His/Arg heterozygotes ET and HT. std indicates curve produced by wild-type control LDL used as standard in assays on different microtiter plates. d, Reference antibody B1B3 binding curve from family D shows uniform reactivity of their LDL against the antibody.

SSCP Analysis and Sequencing Reactions
To explore the DNA sequence changes causing the altered binding affinity of apoB with Mab D7.2, SSCP analysis of the DNA fragment containing the sequence coding for the epitope of Mab D7.2 was carried out (Fig 2a). In this analysis, the 422-bp digestion product cut from the amplified fragment by Ban I showed a complex mobility pattern suggesting either a three-allelic polymorphism or two closely located mutations.

View larger version (43K): [in this window] [in a new window]   Figure 2. a, Photograph shows SSCP analysis from family A. A complex polymorphic moving pattern in the 422-bp DNA fragment cut from the original PCR product with Ban I is seen. Lanes 1 to 5 (see pedigree A in Fig 3) represent the first generation (from left to right) and lanes 6 and 7 represent the two sons of the proband. Four different moving patterns indicating at least three different alleles are seen. Lanes 2, 3, and 5 originating from DNA samples from the three sisters exhibiting low binding affinity to Mab D7.2 are identical. Lanes 6 and 7 come from the two sons of the proband who later proved to be heterozygotes for the apoB 1896 Arg allele. Lane 1 represents the sister of the proband, and has intermediate binding affinity carrying the apoB 1887 Ser allele, and lane 4 represents the spouse of the proband, and has normal binding affinity. b, Photograph shows sequencing reactions from a compound heterozygote (lanes G, T, A, and C on the left) showing AG nucleotide changes at locations 5869 and 5896 and from a simple apoB 1896 His/Arg heterozygote (lanes G, T, A, and C on the right) showing an AG change at nucleotide 5896 only.

Sequencing reactions in samples obtained from the family members revealed two DNA changes: an AG change at nucleotide 5869, changing the code for amino acid 1887 from AAT to AGT with an AsnSer change, and another AG change at nucleotide 5896 with a change from CAT to CGT (HisArg) at amino acid 1896 (Fig 2b). Segregation of both DNA variations was demonstrated in these (Fig 1a through 1c) and in several other families (Fig 3). Both probands who were originally identified with the Mab binding assay were compound heterozygotes for the two mutations. 3'VNTR analysis in their families showed that the two DNA variations were not located on the same apoB allele. The relationship between each of the DNA variations and the binding affinity of LDL apoB with Mab D7.2 is illustrated in Fig 1b and 1c. Neither of the DNA variations seemed to affect any lipid parameters in these mainly normolipidemic families (data not shown).

View larger version (21K): [in this window] [in a new window]   Figure 3. Pedigrees from four Finnish families show the inheritance of the apoB 1887 (AsnSer) and apoB 1896 (HisArg) polymorphisms on different apoB 3'VNTR alleles. Mab D7.2 binding curves from the members of families A, C, and D are seen in Fig 1. The probands of families A and B were the two compound heterozygotes originally showing the most markedly reduced binding of their LDLs to Mab D7.2. Dagger indicates a family member who was dead at the time of the study.

Genotyping of the ApoB 1887 (AsnSer) and ApoB 1896 (HisArg) Polymorphisms in the Diet Study Participants
The nucleotide 5869 (AG) change producing the apoB 1887 Ser allele removes a BsrDI cutting site located at nucleotide 5873. The nucleotide 5896 (AG) variation with the apoB 1896 Arg allele produces a new Rsa I cutting site at nucleotide 5897. Both DNA changes can thus be easily detected by simple PCR amplification, restriction enzyme digestion, and agarose gel electrophoresis followed by ethidium bromide staining (see "DNA Analyses"). BsrDI digestion revealed 97 apoB 1887 Asn/Asn genotypes, 5 Asn/Ser genotypes, and no Ser/Ser genotypes among the 102 diet study participants (Table 1), with an allele frequency of the rare Ser allele of .02. According to the results of Rsa I digestion, 81 subjects were genotyped as apoB 1896 His/His, 20 as His/Arg, and 1 as Arg/Arg (Table 1), corresponding to an allele frequency of the rare Arg allele of .11. No association was detected between the apoB 1887 (AsnSer) and the apoB 1896 (HisArg) polymorphisms (²=1.416, P=.4926; Fisher's exact test, P1.0000). The Mab D7.2 binding affinity changes and the newly described DNA variations were compared in the diet study participants. Of the 78 subjects homozygous for the common alleles of both polymorphisms, all except 1 had originally been classified as showing normal immunoreactivity with Mab D7.2. All 5 subjects carrying the apoB 1887 Ser allele, irrespective of their apoB 1896 (HisArg) genotype, showed reduced binding. The Arg allele of the apoB 1896 (HisArg) polymorphism did not always associate with detectable shifts in the displacement curves: only 11 of the 18 apoB 1896 His/Arg (apoB 1887 Asn/Asn) heterozygotes had originally been classified as having impaired binding to Mab D7.2. However, a combination of both variant alleles was associated with a shift of the displacement curves even further to the right, suggesting a possible additive effect on the immunoreactivity of LDL with Mab D7.2. The association of the Mab D7.2 polymorphism with the apoB 1887 Asn/Ser and apoB 1896 His/Arg polymorphisms was statistically significant (²=49.712, P<.0001, and ²=46.261, P<.0001, respectively).

View this table: [in this window] [in a new window]   Table 1. ApoB 1887 Asn/Ser and ApoB 1896 His/Arg Genotypes in Diet Study Participants

Association of the ApoB 1896 (HisArg) Polymorphism With Antigenic and Other ApoB Genetic Variants
Ag phenotyping, 3'VNTR genotyping, and Xba I RFLP analysis of the diet study participants showed that all subjects carrying the apoB 1896 Arg allele (His/Arg heterozygotes) were either homozygous or heterozygous for the xa₁gti-3'VNTR 35-X- (Xba I restriction site absent) haplotype. In all families with the apoB 1896 (HisArg) polymorphism studied, the Arg allele was also coinherited with the apoB 3'VNTR 35 and X- alleles (Fig 3). With regard to the apoB 1887 AsnSer polymorphism, no common haplotype was shared by the subjects carrying the rare allele, in accordance with family studies in this report showing the Ser allele in association with at least two apoB 3'VNTR alleles (33 and 37).

Effect of ApoB 1887 (AsnSer) and 1896 (HisArg) Polymorphisms on Serum Lipid Levels and Response to Dietary Intervention
Statistical calculations in the diet study participants were performed separately for men and women. For the apoB 1887 (AsnSer) polymorphism, with only 3 and 2 individuals in the male and female groups, respectively, carrying the apoB 1887 Ser allele, no significant differences in lipid or lipoprotein levels between genotypes were observed (data not shown).

With respect to the apoB 1896 (HisArg) polymorphism, no significant differences in baseline or switchback levels of serum lipids or lipoproteins could be seen between the His/His and His/Arg groups in men (Table 2). During the intervention period, men with the genotype His/Arg tended to have slightly higher serum total cholesterol (P=.0792), LDL cholesterol (P=.0494), and apoB levels (P=.0814) compared with the His/His men. Serum total cholesterol, LDL cholesterol, and apoB responses to dietary intervention in the His/His and His/Arg men are illustrated in Fig 4, showing slightly smaller reductions in total and LDL cholesterol in the His/Arg men after the low-fat diet and smaller increases in total cholesterol (P=.0490), LDL cholesterol (P=.0533), and apoB (P=.0340) after they switched back to the original high-fat (free-choice) diet. In women, no significant differences were seen during any study period (data not shown).

View this table: [in this window] [in a new window]   Table 2. Serum Lipid and Lipoprotein Levels in Men According to ApoB 1896 (HisArg) Genotype During Baseline, Intervention, and Switchback Diets

View larger version (12K): [in this window] [in a new window]   Figure 4. Bar graphs show the effects of the apoB 1896 (HisArg) polymorphism on the total cholesterol (Chol), LDL cholesterol (LDLchol), and apoB response to diet intervention in 37 His/His men (open bars) and 10 His/Arg men (gray bars). I indicates change (mean±SEM) from the baseline diet to the intervention diet; S, change from the intervention to the switchback diet. Adjustment for the change in body mass index after intervention (-0.41±0.36 kg/m2 and -0.35±0.24 kg/m2 in His/His and His/Arg men, respectively) or switchback (0.04±0.33 kg/m2 and -0.01±0.30 kg/m2, respectively) had no effect on the results.

	Discussion

Top Abstract Introduction Methods Results Discussion References

 
Since the description of the five Ag antigen pairs and recognition of some of them with monoclonal antibodies, this is the first report of a new immunochemical polymorphism of LDL apoB. Our original unpublished observation of the polymorphism detected with Mab D7.2 dates back several years and was puzzling at that time because the binding curve patterns of the pedigrees studied did not fit into a common two-allelic genetic model. The systematic SSCP-based apoB gene screening system³⁶ provided the means for clarifying the DNA sequence changes responsible for the binding defect. SSCP analyses and subsequent sequencing studies uncovered the presence of two separate, closely located DNA changes, both associated with alterations in the binding affinity of LDL apoB with Mab D7.2. Two probands with the most marked impairment of binding proved to be compound heterozygote for the new polymorphisms, explaining the difficulties in the interpretation of the original binding curves.

Haplotype analysis of the diet study population demonstrated that the apoB 1896 Arg allele was associated with the Ag haplotype xa₁gti, the apoB 3'VNTR 35 allele, and the X- allele, whereas no common haplotype could be determined for the apoB 1887 Ser allele. This is in accordance with our family studies showing coinheritance of the apoB 1896 Arg allele and apoB 3'VNTR allele 35, in contrast to the association of the apoB 1887 Ser allele with two different 3'VNTR alleles (33 and 37). With allele frequencies for the rare alleles above .01, both DNA changes described here represent polymorphisms of the apoB gene. In this sample, no association between the two polymorphisms could be detected. However, association tests are not necessarily valid in small samples, and further studies are needed to exclude an association.

The two new apoB polymorphisms are located in a region not believed to have any direct role in the apoB–LDL receptor interaction. Some changes in the surface structure of LDL apoB due to the amino acid changes are, however, likely because the immunoreactivity against Mab D7.2 of LDL apoB was impaired in the carriers of the mutant alleles. The diet study suggested that the LDL cholesterol levels were higher in the His/Arg men during the low-fat diet. This could be related to the tendency in these men to show a reduced total cholesterol and LDL cholesterol response to dietary change, both during intervention and during switchback to the original diet (see Fig 4). These findings may represent an example of the variability gene concept.^{55 56 57} According to this concept, the apoB 1896 Arg allele could exert a restrictive influence on lipid changes. The trends were, however, of borderline significance, and were observed in men only. Thus, our results cannot prove or exclude a true effect of the apoB 1896 polymorphism on lipid metabolism.

In summary, we have characterized a new immunogenetic apoB polymorphism associated with two separate, closely located DNA changes, both of which affect the amino acid sequence of apoB. The possible role of the apoB 1896 (HisArg) polymorphism in the regulation of serum lipid levels could not be confirmed or ruled out. Further investigations on dietary response in conjunction with turnover studies using labeled apoB 1896 Arg LDL are warranted.

	Selected Abbreviations and Acronyms

 

3'VNTR = 3' variable number of tandem repeats Ag = antigen group Mab = monoclonal antibody PCR = polymerase chain reaction SSCP = single-strand conformation polymorphism

	Acknowledgments

 
This work was supported in part by the State Medical Research Council, Academy of Finland, and by grants from the Finnish Foundation for Cardiovascular Research, the Sigrid Juselius and Paavo Nurmi Foundations. The excellent technical assistance of our laboratory personnel, Terhi Hakala, Päivi Ruha, and Tuula Soppela-Loponen, is gratefully acknowledged.

Received April 4, 1995; accepted June 20, 1995.

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