家族性高胆固醇血症样表型遗传异质性的分子基础

家族性高胆固醇血症(FH)是由于低密度脂蛋白受体(LDL—R)基因突变,致使细胞表面LDL-R蛋白功能缺陷,导致血浆低密度脂蛋白(LDL)大幅度增高,并可导致早发冠心病。“FH”已经成为携带LDL-R基因突变患者的同意词,但日益增多的研究证实,其他6种基因突变也可通过不同机制导致FH样表型。这些致病基因的发现．促进胆固醇代谢的研究进入新领域,有助于深入探讨胆固醇代谢的调节机制,并将为FH样表型的诊断和治疗提供新的理论依据。文章就有关FH样表型遗传异质性的分子基础研究的近况作一简要综述．以引起人们的关注。     

家族性高胆固醇血症患者低密度脂蛋白受体基因新突变位点的鉴定

家族性高胆固醇血症(hypercholesterolemia familial,FH)是由于低密度脂蛋白受体(low density lipoprotein receptor,LDLR)基因突变导致的常染色体显性遗传性疾病,临床上表现为多发黄色瘤、高水平血浆LDL、早发性冠心病及有阳性家族史。本研究通过临床症状结合血脂测定诊断出一个FH家系,其纯合子FH患者的血浆总胆固醇水平高达19．05mmol／L,LDL达17．06mmol／L,并有黄色瘤;而杂合子FH患者的血浆总胆固醇水平为7．96mmol／L,LDL为5．55mmol/L,并有心绞痛症状和黄色瘤。我们对该FH家系患者LDLR基因的PCR扩增DNA片段进行测序,发现纯合子FH患者LDLR基因Exon4区域内发生了GAG683GCG突变,即编码LDLR第683位的谷氨酸被丙氨酸替换,而杂合子FH患者该位点呈现杂合突变。此基因型与临床诊断遗传谱完全一致。同时,利用获得Epstein-Barr(EB)病毒转化型人永生淋巴细胞株(EBV-Ls)与荧光探针DiI标记的LDL结合反应,再通过流式细胞仪检测结果显示,具有功能性LDLR的EBV-Ls细胞比例,在纯合子FH患者(7．02％)和杂合子FH患者(62．64％)均比健康对照者(84．69％)低,纯合子FH患者LDLR活性仅为健康对照者的8．29％、而杂合子FH患者LDLR活性约为健康对照者的73．96％,前者呈现非常显著的降低。这些EBV-Ls细胞LDLR的功能变化分析,有力地支持了该FH家系的临床诊断和DNA测序结果。经查阅最新的UMD-LDLR完全版证实,本研究发现鉴定的GAG683GCG突变是人LDLR基因的新突变位点。     

家族性高胆固醇血症低密度脂蛋白受体第13外显子突变分析

目的:探讨本课题组收集家族性高胆固醇血症(FH)患者中存在低密度脂蛋白受体(LDLR)第13外显子(E13)基因突变患者临床生化和心血管系统损害特点.方法:对9例临床诊断为FH、基因检测到LDLR基因E13突变的患者进行回顾性分析.结果:(1)临床诊断FH纯合子患者7名,其总胆固醇(TC)水平15.12～26.14 mmol/L,杂合子患者2名,TC水平11.30～11.75 mrnol/L.(2)均可见不同程度黄色瘤;(3)FH纯合子3例心电图出现ST-T改变;4例儿童和1例青年患者出现瓣膜损害,冠脉血流储备(CVFR)减低;杂合子心电图检查均正常,1例出现瓣膜损害,CVFR均正常.(4)核苷酸序列分析证实:9例E13突变患者中,A606T纯舍突变3名;D601Y纯合突变2名;A606T+、W462X和A606T+D601Y复合杂合突变各1名;A606T和D601Y杂合突变各1名.结论:FH严重损害患儿心血管系统和皮肤,LDLR基因E13出现的A606T和D601Y突变可能成为中国FH人群的高频突变位点.     

家族性高胆固醇血症患者管理策略的近况

家族性高胆固醇血症(FH)是一种常染色体显性遗传性疾病,是脂质代谢疾病中最严重的一种.FH引起动脉粥样硬化(As)病变,导致早期发生较为严重的冠心病(CAD).初步估计.目前世界范围内FH患者约10 000 000例,将其作为重点目标人群进行早期针时性干预对于CAD预防至关重要.FH已经成为世界性健康问题,国外已经制定相应的诊断、治疗指南来规范管理FH患者,而我国这方面的研究工作极为缺乏.因此,制定我国FH患者相应的管理指南迫在眉睫,本文综述FH患者管理相关的研究进展.     

LDL受体介导的血浆低密度脂蛋白胆固醇的内吞

胆固醇是动物细胞细胞膜的重要组成成分,其做为细胞和环境之间的屏障调节细胞膜的流动性。胆固醇是体内所有的类固醇激素和胆酸合成的前体物质,参与体内代谢。同时胆固醇在神经系统的发育中也起着重要的作用。在血浆中胆固醇以低密度脂蛋白和高密度脂蛋白这两种胆固醇运载血脂蛋白的形式运输。动物细胞通过细胞表面的低密度脂蛋白受体(LDL receptor,LDLR)介导的内吞可以从血液中摄取富含胆固醇的低密度脂蛋白,当细胞表面的LDLR的功能缺陷时,可以导致高胆固醇血症,继而引起动脉粥样硬化、冠心病和中风等严重疾病。本文综述了LDL受体的概述及其通过内吞调节血液中低密度脂蛋白胆固醇水平的作用,并对LDL受体的调节进行了阐述。     

PCSK9降解低密度脂蛋白受体分子机制研究进展

血清低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)水平的升高是导致心血管疾病发生的主要危险因素。低密度脂蛋白受体(LDL receptor, LDLR)介导的低密度脂蛋白(low density lipoprotein, LDL)清除是决定循环中LDL-C水平的主要因素。LDL与细胞表面的LDLR结合后通过经典的网格蛋白小窝(clathrin-coated vesicles)内化进入细胞。在酸性核内体中,LDLR与LDL解离并循环回到细胞表面,释放的LDL将被运送到溶酶体中降解。前蛋白转化酶枯草溶菌素9 (proprotein convertase subtilisin kexin type 9, PCSK9)编码一种肝脏分泌型蛋白,其突变与LDL-C水平密切相关。前期研究已经证明,PCSK9直接与细胞表面的LDLR相互作用,二者一起通过网格蛋白小窝内化进入细胞。然而,在酸性核内体中,PCSK9和LDLR形成紧密的复合物,并进入溶酶体中进行降解,从而减少肝细胞表面LDLR的水平,降低肝脏对LDL-C的清除,该过程对于维持血浆中LDL在相对恒定的水平具有重要作用。因此,阻断PCSK9功能已成为治疗高胆固醇血症的新策略。本文综述了PCSK9的功能和机制研究的最新进展,并着重介绍了PCSK9抑制剂的研究进展,旨在为PCSK9-LDLR通路的研究和胆固醇代谢的调控提供参考。     

一种新的延胡索酸水合酶抗体的制备及功能研究

延胡索酸水合酶(fumarate hydratase,FH)是三羧酸循环(tricarboxylic acid cycle,TCA)中的一个关键性酶。FH的基因突变将导致延胡索酸合酶缺乏症、遗传性平滑肌瘤和肾细胞癌(hereditary leiomyomatosis and renal cell carcinoma,HLRCC)等疾病。FH缺失导致HLRCC分子的确切生物学机制尚不明确。作者将FH基因片段克隆到原核表达载体上,在大肠杆菌中表达GST-FH(400-510)融合蛋白。该融合蛋白为抗原免疫小鼠获得抗体,通过免疫印迹实验证明了该抗体的特异性并发现FH在心脏和肝脏中的含量较高。通过免疫共沉淀实验发现,在大鼠肝脏组织中FH可能与多个蛋白形成蛋白复合物。     

银灵通胶囊调节实验性高脂饮食大鼠血脂的研究

目的:探究银灵通胶囊对脂质代谢的影响及其机制。方法:建立大鼠高脂模型,用药后检测其血脂、丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)的活性,检测肝脏组织的高密度脂蛋白受体SR-BI、低密度脂蛋白受体(LDLR)、氧化低密度脂蛋白(ox-LDH)受体CD36蛋白表达的mRNA表达水平,检测血管组织学变化。结果:高脂饮食明显升高大鼠血清中总胆固醇(CH)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和动脉硬化指数(AI值),银灵通胶囊组可降低上述指标,且呈一定的浓度依赖;高脂饮食可增加肝脏中SR-BI及CD36表达,降低LDLR表达,银灵通胶囊引起SR-BI的过度表达,使LDLR表达增加,CD36表达下降。高脂饮食使血清中MDA的含量增加,给予银灵通胶囊后,明显降低血清MDA的含量。结论:银灵通胶囊具有调节脂质代谢,抗动脉粥样硬化(AS)及抗脂质过氧化作用。其机制与银灵通胶囊能引起肝脏中SR-BI的过度表达及LDLR表达增加,降低肝脏中CD36表达和血清MDA含量有关。     

PCSK9/LDLR通路介导姜黄素烟酸酯促进HepG2摄取脂质

为研究PCSK9/LDLR通路介导姜黄素烟酸酯(CurTn)降低血浆低密度脂蛋白胆固醇(LDL-C),减少动脉内膜下脂质沉积的分子机制,用5、10、15μmo/L姜黄素烟酸酯与25 mg/L LDL共孵育Hep G2细胞24 h,分别采用油红O染色、胆固醇荧光定量试剂盒、Di I-LDL摄取检测细胞内胆固醇含量及LDL摄取情况,用逆转录定量聚合酶链反应(RT-Q-PCR)检测LDLR及SREBP2的m RNA表达,蛋白质印迹检测LDLR、SREBP2及PCSK9蛋白表达.随姜黄素烟酸酯作用浓度的增高细胞内脂滴显著增多,细胞内游离胆固醇(FC)、总胆固醇(TC)含量增高,细胞内胆固醇摄取增多;RT-Q-PCR和蛋白质印迹检测发现,与对照组(Control)比较,5、10、15μmo/L姜黄素烟酸酯处理组LDLR蛋白表达增高,SREBP2 mRNA表达水平升高,PCSK9蛋白表达降低,但对LDLR mRNA及SREBP2蛋白表达无影响.结果表明:姜黄素烟酸酯通过降低PCSK9、减少LDLR降解、升高LDLR蛋白表达,促进HepG2细胞胆摄取胆固醇.初步说明CurTn可能通过抑制PCSK9介导LDLR溶酶体降解,促进肝脏清除血浆LDL-C水平.     

研究: PCSK9/LDLR通路介导姜黄素烟酸酯促进HepG2摄取脂质

为研究PCSK9/LDLR通路介导姜黄素烟酸酯(CurTn)降低血浆低密度脂蛋白胆固醇(LDL-C),减少动脉内膜下脂质沉积的分子机制,用5、10、15 μmo/L姜黄素烟酸酯与25 mg/L LDL共孵育HepG2细胞24 h,分别采用油红O染色、胆固醇荧光定量试剂盒、DiI-LDL摄取检测细胞内胆固醇含量及LDL摄取情况,用逆转录定量聚合酶链反应(RT-Q-PCR)检测LDLR及SREBP2的mRNA表达,蛋白质印迹检测LDLR、SREBP2及PCSK9蛋白表达．随姜黄素烟酸酯作用浓度的增高细胞内脂滴显著增多,细胞内游离胆固醇(FC)、总胆固醇(TC)含量增高,细胞内胆固醇摄取增多;RT-Q-PCR和蛋白质印迹检测发现,与对照组(Control)比较,5、10、15 μmo/L 姜黄素烟酸酯处理组LDLR 蛋白表达增高,SREBP2 mRNA表达水平升高,PCSK9蛋白表达降低,但对LDLR mRNA及SREBP2 蛋白表达无影响．结果表明：姜黄素烟酸酯通过降低PCSK9、减少LDLR降解、升高LDLR蛋白表达,促进HepG2细胞胆摄取胆固醇．初步说明CurTn可能通过抑制PCSK9介导LDLR溶酶体降解,促进肝脏清除血浆LDL-C水平．     

A novel pathogenic variant of the LDLR gene in the Asian population and its clinical correlation with familial hypercholesterolemia

Familial hypercholesterolemia (FH) is a disease implicated with defects in either, Low density lipoprotein receptor gene (LDLR), Apolipoprotein B-100 gene (APOB), the Proprotein convertase subtilisin/kexin type 9 gene (PCSK9) or other related genes of the lipid metabolism pathway. The general characterization of heterozygous FH is by elevated low-density lipoprotein (LDL) cholesterol and early-onset cardiovascular diseases, while the more severe type, the homozygous FH results in extreme elevated levels of LDL cholesterol and usually death of an affected individual by early twenties. We present here a novel non-synonymous, missense mutation in exon 14 of the LDLR gene in two siblings of the Malay ethnicity discovered during an in-house genetic test. We postulate that their elevated cholesterol is due to this novel mutation and they are positive for homozygous FH. This is the first report of a C711Y mutation in patients with elevated cholesterol in Asia.     

The impact of severe LDL receptor mutations on SREBP-pathway regulation in homozygous familial hypercholesterolemia (FH)

Familial hypercholesterolemia (FH), Niemann-Pick disease type C (NPC) and Tangier disease (TD) are genetic inherited disorders with impaired processing of cholesterol, caused by mutations in genes that regulate cellular uptake, intracellular movement and transport of cholesterol. Various studies have shown a crucial regulatory role of the SREBP-pathway for cellular cholesterol homeostasis in these diseases. Since cholesterol is an essential structural component of cells, we assessed the impact of a severe FH causing LDLR mutation (FH p.W556R) on the SREBP pathway in primary FH fibroblasts. Primary FH fibroblasts derived from patients with the LDL receptor mutation p.W556R were used for gene expression experiments. Gene expression studies revealed increased expressions of SREBP regulated genes HMGCR, LDLR, SREBP-2, SREBP-1, SR-BI, INSIG-1, but interestingly not SCAP. In contrast expression of ABCA1, was strongly decreased in homozygous, but not in heterozygous p.W556R fibroblasts. Gene expression experiments with LDL receptor lacking primary FH fibroblasts, revealed that SR-BI and ABCA1 are important regulators for cholesterol acquisition in FH cells, consistent with findings in cells from NPC and TD patients.     

Molecular genetic testing for familial hypercholesterolemia in the Netherlands: a stepwise screening strategy enhances the mutation detection rate

Familial hypercholesterolemia (FH) has been identified as a major risk factor for coronary vascular disease and is associated with mutations in the low-density liporotein receptor (LDLR) and apolipoprotein B (APOB) gene. The molecular basis of FH in the Dutch population is well understood. Approximately 160 different LDLR and APOB gene defects have been identified with a panel of 9 LDLR gene and 1 APOB gene frequently occurring mutations accounting for approximately 30% of all clinically diagnosed FH cases. As molecular diagnosis of FH is becoming increasingly widely applied, a variety of mutation detection rates is reported, ranging from as low as 30% and up to 80%. This variability appears to depend on the clinical criteria applied to identify patients with FH and on the strategies and methodologies used for mutation screening. In this study we describe the application of a stepwise screening approach, combining different methodologies, to detect mutations of the LDLR gene and APOB gene in 1465 patients with FH. A mutation was found in approximately 44% of the patients, which demonstrates that this is an effective strategy for the molecular diagnosis of FH.     

Software and database for the analysis of mutations in the human LDL receptor gene.

The low-density lipoprotein receptor (LDLr) plays a pivotal role in cholesterol homeostasis. Mutations in the LDLr gene (LDLR), which is located on chromosome 19, cause familial hypercholesterolemia (FH), an autosomal dominant disorder characterized by severe hypercholesterolemia associated with premature coronary atherosclerosis. To date almost 300 mutations have been identified in the LDLR gene. To facilitate the mutational analysis of the LDLR gene, and promote the analysis of the relationship between genotype and phenotype, a software package along with a computerized database (currently listing 210 entries) have been created.     

Two mutations in LDLR gene were found in two Chinese families with familial hypercholesterolemia

Familial hypercholesterolemia (FH) (OMIM 143890) is an autosomal dominantly inherited disease mainly caused by mutations of the gene encoding the low density lipoprotein receptor (LDLR) and Apolipoprotein (Apo) B. First the common mutation R3500Q in ApoB gene was determined using PCR/RFLP method. Then the LDLR gene was screened for mutations using Touch-down PCR, SSCP and sequencing techniques. Furthermore, the secondary structure of the LDLR protein was predicted with ANTHEPROT5.0. The R3500Q mutation was absent in these two families. A heterozygous p.W483X mutation of LDLR gene was identified in family A which caused a premature stop codon, while a homozygous mutation p.A627T was found in family B. The predicted secondary structures of the mutant LDLR were altered. We identified two known mutations (p.W483X, p.A627T) of the LDLR gene in two Chinese FH families respectively.     

Clinical course of homozygous familial hypercholesterolemia during childhood: report on 4 unrelated patients with homozygous or compound heterozygous mutations in theLDLR gene

Natural history of the disease in 4 unrelated Polish children with homozygous familial hypercholesterolemia (FH) is described. Their phenotypic homozygosity was established by identification of known LDLR gene mutations on both alleles, respectively: p.G592E & p.G592E in Patient 1; p.G592E & p.C667Y in Patient 2; p.S177L & p.R350X in Patient 3; and p.G592E & deletion in the promoter region, exons 1 and 2 in Patient 4. Heterozygosity of the mutations was revealed in all patients' mothers and fathers (obligatory heterozygotes) and in 1 out of 4 siblings studied. FH was diagnosed at the age of 4 months to 9 years by cholesterol screening among family members of patients with early cardiovascular disease episodes. At the time of FH detection, the children were asymptomatic. Only in 2, some skin eruptions were found. Antihyperlipidemic therapy was started, including a lipid-lowering diet, cholestyramine, and HMG-CoA inhibitors if necessary. No cardiovascular symptoms appeared during the observation up to the age of 18, 20, 19, and 17 years, respectively. An increase in external carotid artery diameter was found in a patient at the age of 9 years, and LDL-apheresis was introduced in his therapy. We conclude that the analysis of LDLR gene mutations in the studied FH children made it possible to identify 4 presymptomatic FH homozygotes and to introduce early appropriate treatment. Multicenter analysis of such persons would finally determine if the early lipid-lowering procedures can significantly reduce the risk of premature cardiovascular disease in homozygous FH.     

Analysis of low density lipoprotein receptor gene mutations and microsatellite haplotypes in Greek FH heterozygous children: six independent ancestors account for 60% of probands

This study reports the characterization of 60% of low density lipoprotein receptor (LDLR) gene mutations in 150unrelated Greek familial hypercholes-terolaemia (FH) heterozygous children by the analysis of six LDLR gene mutations. The linkage disequilibrium of two polymorphic microsatellites (D19S394 and D19S221) flanking the LDLR gene on chromosome19 to the four most common mutations strongly suggests that each mutation is identical-by-descent in the probands included in this study (this is also supported by the geographical distribution of FH families with these mutations throughout Greece) and permits an estimation of the number of generations from a common ancestor for each mutation. The characterization of 60% of LDLR mutations in a representative sample of Greek FH heterozygotes provides a basis for the diagnosis of FH through DNA analysis in Greece, by using single-strand conformation polymorphism analysis followed by allele-specific oligonucleotide hybridization (exon6 mutations) or restriction endonuclease analysis (C152R, V408M). A rapid diagnostic assay positive for the mutation has been developed for the most common mutation, G528D. The application of simple DNA diagnostic assays for LDLR mutation analysis are appropriate for the early identification of FH heterozygotes in Greece and are useful for the primary prevention of coronary artery disease. Received: 7 July 1997 / Accepted: 5 November 1997     

Genetic susceptibility to heart disease in Canada: lessons from patients with familial hypercholesterolemia.

Much of the recent progress in treating patients with heart disease due to narrowed coronary arteries has resulted from studying disease evolution in patients with rare monogenic forms of disease. For instance, autosomal dominant familial hypercholesterolemia (FH, MIM (Mendelian Inheritance in Man) 143890) typically results from heterozygous mutations in LDLR encoding the low-density lipoprotein (LDL) receptor. Deficient LDLR activity results in elevated circulating LDL cholesterol, which accumulates within blood vessel walls, forming arterial plaques that can grow and eventually occlude the arterial lumen. Heterozygous LDLR mutations are usually detected using exon-by-exon sequence analysis (EBESA) of genomic DNA, a technology that has identified approximately 50 mutations in heterozygous FH (HeFH) subjects in Ontario. However, approximately 35% of Ontario HeFH patients had no EBESA-identified LDLR mutation. The diagnostic gap relates both to the genetic heterogeneity of FH and also to inadequate sensitivity of EBESA to detect certain mutation types, such as large deletions or insertions in LDLR. By means of a dedicated method to detect copy number variations (CNVs), additional heterozygous mutations in LDLR ranging from approximately 500 to >15 000 bases were uncovered, accounting for most of the remainder of Ontario HeFH patients. The appreciation of the key role of genomic CNVs in disease coincides with recent genome-wide mapping studies demonstrating that CNVs are common in apparently healthy people. CNVs thus represent a new level of genomic variation that is both an important mechanism of monogenic disease and a contributor to genomic variation in the general population; as well, it may have implications for evolution, biology, and possibly susceptibility to common complex diseases.     

Hypercholesterolemia and atherosclerosis in low density lipoprotein receptor mutant rats

To establish low density lipoprotein receptor (LDLR) mutant rats as a hypercholesterolemia and atherosclerosis model, we screened the rat LDLR gene for mutations using an N-ethyl-N-nitrosourea mutagenesis archive of rat gene data, and identified five mutations in its introns and one missense mutation (478T>A) in exon 4. The C160S mutation was located in the ligand binding domain of LDLR and was revealed to be equivalent to mutations (C160Y/G) identified in human familial hypercholesterolemia (FH) patients. The wild type, heterozygous, and homozygous mutant rats were fed a normal chow diet or a high fat high cholesterol (HFHC) diet from the age of 10 weeks for 16 weeks. The LDLR homozygous mutants fed the normal chow diet showed higher levels of plasma total cholesterol and LDL cholesterol than the wild type rats. When fed the HFHC diet, the homozygous mutant rats exhibited severe hyperlipidemia and significant lipid deposition from the aortic arch to the abdominal aorta as well as in the aortic valves. Furthermore, the female homozygous mutants also developed xanthomatosis in their paws. In conclusion, we suggest that LDLR mutant rats are a useful novel animal model of hypercholesterolemia and atherosclerosis.