家族性高胆固醇血症患者低密度脂蛋白受体基因复合杂合突变分析

目的:对1例临床确诊为纯合型家族性高胆固醇血症(FH)先证者及其核心家系成员进行基因检测分析,探讨患儿发病的分子病理基础.方法:收集先证者及父母血标本及临床资料,酚氯仿法提取基因组DNA,DNA直接测序方法检测低密度脂蛋白受体(LDL-R)基因18个外显子和启动子及载脂蛋白B(ApoB100)R3500Q位点,核苷酸序列分析结果与Gen Bank比对寻找突变.结果:(1)先证者三尖瓣轻度关闭不全,先证者父母双侧颈总动脉内-中膜增厚,先证者母亲左侧颈内动脉起始处后壁多发混合回声斑块(2)该家系排除ApoB100基因R3500Q突变;(3)先证者LDL-R基因第13外显子发生A606T和D601Y复合杂合突变,前者第1879位G→A碱基置换,导致丙氨酸改变为苏氨酸,后者为1864位G>T碱基置换,导致天冬氨酸改变为酪氨酸,其父为携带A606T突变的杂合子,其母为携带D601Y突变的杂合子.结论:先证者LDL-R基因存在A606T和D601Y复合杂合突变,它们分别来源于父系及母系遗传.     

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.     

中国人群家族性高胆固醇血症LDLR基因突变研究进展

家族性高胆固醇血症(Familial hypercholesterolemia,FH)主要是由于低密度脂蛋白受体(Low-density lipoprotein receptor,LDLR)基因突变导致的单基因显性遗传性疾病。FH患者LDLR基因突变导致细胞膜表面LDLR减少或缺如,机体代谢胆固醇能力降低,血浆胆固醇增高并沉积在不同的组织和器官,常伴有全身黄色瘤和早发冠心病,因此FH也是最常见的严重代谢性疾病。世界范围内对LDLR基因突变的报道总共有1741种,经整理我国目前报道的140例FH指示病例,包括108种LDLR基因突变类型。文章对已报道的中国FH患者LDLR基因突变特点进行系统分析和综述,旨在为FH诊断治疗提供参考依据。     

有氧运动对高胆固醇血症大鼠肝脏低密度脂蛋白受体活性调节…

本文研究了实验性在醇血症大鼠肝脏低密度脂蛋白受体（ＬＤＬ－Ｒ）活性变化及有氧运动时ＬＤＬ－Ｒ活性调节的影响,发现,高脂（ＨＣ）组肝组织匀浆ＬＤＬ－ＲＩ自古以来生较正常对照（ＮＣ）组降低３７％（Ｐ〈０．０５）,同时血清大醇（ＴＣ）、低密度脂收白胆固醇（ＬＤＬ－Ｃ）及血清栽脂蛋白Ｂ（ＡｐｏＢ）均显著高于ＮＣ组（Ｐ〈０．０１）;高脂＋运动（ＨＥ）组ＴＣ、ＬＤＬ－Ｃ及ＡｐｏＢ均明显低于ＨＣ组,而ＬＤＬ－Ｒ     

有氧运动对高胆固醇血症大鼠肝脏低密度脂蛋白受体活性调节的影响

本文研究了实验性高胆固醇血症大鼠肝脏低密度脂蛋白受体（ＬＤＬＲ）活性变化及有氧运动时ＬＤＬＲ活性调节的影响。发现,高脂（ＨＣ）组肝组织匀浆ＬＤＬＲ活性较正常对照（ＮＣ）组降低３７％（Ｐ＜０．０５）,同时血清总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬＣ）及血清载脂蛋白Ｂ（ＡｐｏＢ）均显著高于ＮＣ组（Ｐ＜０．０１）;高脂＋运动（ＨＥ）组ＴＣ、ＬＤＬＣ及ＡｐｏＢ均明显低于ＨＣ组,而ＬＤＬＲ活性则较ＨＣ组增高２６％（Ｐ＜０．０５）。结果提示：（１）高胆固醇负荷时细胞可通过下行调节影响ＬＤＬＲ活性;（２）运动可能通过增加对细胞内胆固醇利用和降解,反馈作用于下行调节过程影响ＬＤＬＲ的合成,增加对ＬＤＬＣ摄取而显著改善血脂水平。     

腺病毒相关病毒携带低密度脂蛋白受体基因对实验性高胆固醇血症的治疗作用

低密度脂蛋白受体 (LDL- R)对于血清胆固醇的清除和预防动脉粥样硬化的发生起重要作用 .用构建了含有LDL- R基因的重组腺病毒相关病毒 ,通过腺病毒包被蛋白脂质体 (Adenosome) ,转移至食饵性高脂血症家兔的肝脏内 ,证明可以降低血浆胆固醇水平 ,为高胆固醇血症的基因治疗提供一条新途径     

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。     

LDL受体基因内含子15结构分析及其在家族性高胆固醇血症基因诊断中的应用

为了解人类ＬＤＬ受体基因内含子１５的遗传背景,利用长链ＰＣＲ和锚定ＰＣＲ分离了ＬＤＬ受体基因外显子１５－内含子１５－外显子１６和内含子１５的３‘末端片段。利用Ｄｙｎａｌｂｅａｄｓ固相单链分离ＰＣＲ产物直接测序法测定了内含子１５ ３’末端１２２２个碱基序列。序列显示：３‘末端含有由１６个碱基组成的典型３’末端剪接位点;３‘端上游第３１个碱基处含有经典分支位点,除了经典分支位点外,在３’末端上游第２０     

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.     

单基因遗传性高胆固醇血症与非低密度脂蛋白受体致病基因的关系

家族性高胆固醇血症（FH）是一类异质性很强的单基因常染色体遗传性疾病。最近发现,除低密度脂蛋白受体和载脂蛋白B-100以外．前蛋白转化酶一枯草溶菌素9、衔接子蛋白、三磷酸腺苷结合盒转运蛋白G5和G8、胆固醇-7-α-羟化酶等多种基因的变异都能导致FH样表型。该文对利用基因剔除和过表达、RNA干扰、反义技术对单基因遗传性高胆固醇血症非低密度脂蛋白受体致病基因的功能和调控机制进行综述,有助于深入认识这些基因．从而为临床家族性高胆固醇血症的诊断和治疗提供新的思路。     

A missense mutation in the low density lipoprotein receptor gene causes familial hypercholesterolemia in Sephardic Jews

Familial hypercholesterolemia (FH) is an autosomal dominant disease caused by mutations in the low density lipoprotein (LDL) receptor gene. Here, we characterize an LDL receptor mutation that is associated with a distinct haplotype and that causes FH in the Jewish Sephardic population originating from Safed, a town in northern Israel. The mutation was found in eight FH families originating from this community comprising 10% of heterozygote FH index cases screened in Israel. The mutation was not found in four additional FH heterozygotes whose hypercholesterolemia co-segregated with an identical LDL receptor gene haplotype. A guanine to cytosine substitution results in a missense mutation (asp¹⁴⁷ to his) in the fourth repeat of the binding domain encoded by exon 4 of the LDL receptor gene. The mutant receptor protein was synthesized in cultured cells as a 120kDa precursor form that failed to undergo normal processing to a mature cell surface form. Most of the receptor precursors were degraded in the endoplasmic reticulum. The small number of mutant receptors on the cell surface were unable to bind LDL or very low density lipoprotein. The abnormal behavior of the mutant receptor was reproduced by site-directed mutagenesis and expression of the mutant protein in CHO cells. The mutation can be diagnosed by allele-specific oligonucleotide hybridization of polymerase chain reaction amplified DNA from FH patients.     

Identification of the 408 valine to methionine mutation in the low density lipoprotein receptor in a German family with familial hypercholesterolemia

Familial hypercholesterolemia (FH) is caused by different mutations in the gene encoding the low density lipoprotein receptor (LDLR). In Caucasian patients, at least three single point mutations have been identified causing FH. The asparagine₂₀₆ to glutamine, and valine₄₀₈ to methionine mutations were originally described in Afrikaners and recently identified in Dutch FH patients. The proline₆₆₄ to leucine mutations was previously identified in an FH homozygote of Asian Indian origin and later identified in patients from London. Any of these mutations can be identified using direct amplification of genomic DNA by the polymerase chain reaction (PCR) and restriction enzyme digestion of PCR products. In this study, 100 unrelated German FH patients were screened for these three mutations. The valine₄₀₈ to methionine mutation was identified in one individual and subsequently in the hypercholesterolemic child of the proband. Haplotype analysis with 7 restriction fragment length polymorphisms (RFLPs) revealed that the mutant allele carried the same haplotype as the previously described patients in South Africa and the Netherlands. Our finding supports the previous assumption of the European origin of the mutation.     

A combined LDL receptor/LDL receptor adaptor protein 1 mutation as the cause for severe familial hypercholesterolemia

Familial hypercholesterolemia (FH) results from impaired catabolism of plasma low density lipoproteins (LDL), thus leading to high cholesterol, atherosclerosis, and a high risk of premature myocardial infarction. FH is commonly caused by defects of the LDL receptor or its main ligand apoB, together mediating cellular uptake and clearance of plasma LDL. In some cases FH is inherited by mutations in the genes of PCSK9 and LDLRAP1 (ARH) in a dominant or recessive trait. The encoded proteins are required for LDL receptor stability and internalization within the LDLR pathway. To detect the underlying genetic defect in a family of Turkish descent showing unregular inheritance of severe FH, we screened the four candidate genes by denaturing gradient gel electrophoresis (DGGE) mutation analysis. We identified different combinatory mixtures of LDLR- and LDLRAP1-gene defects as the cause for severe familial hypercholesterolemia in this family. We also show for the first time that a heterozygous LDLR mutation combined with a homozygous LDLRAP1 mutation produces a more severe hypercholesterolemia phenotype in the same family than a homozygous LDLR mutation alone.     

Mutations of the low density lipoprotein receptor in Japanese kindreds with familial hypercholesterolemia

Summary Mutations of the low density lipoprotein (LDL) receptor in 16 Japanese kindreds with homozygous familial hypercholesterolemia (FH) were studied using an anti-LDL receptor antibody. The LDL receptor mutations in Japanese FH were heterogeneous and included defects in synthesis, posttranslational processing, ligand-binding activity, and internalization of the LDL receptor. Of the 16 kindreds, 10 were receptor-negative and 5, receptor-defective types and 1 was an internalization-defective type with respect to LDL binding. The receptor-negative group was further subdivided into four groups: those with cells producing (i) no immunodetectable receptor (five kindreds); (ii) 160-kd mature receptors, which were quite scarce (two kindreds); (iii) receptors that could not be processed to the mature receptor properly (two kindreds); and (iv) receptors with an apparent molecular weight smaller than normal (one kindred). The last kindred synthesized an about 155-kd mature receptor that was rapidly degraded. This finding is compatible with the low concentration of the cell surface LDL receptors and decreased binding activity for LDL in the cells of this kindred. The receptor-defective group, which could produce a residual amount of functional receptors, exhibited a lower tendency to coronary artery disease than the receptor-negative group.     

A mutation (-49C>T) in the promoter of the low density lipoprotein receptor gene associated with familial hypercholesterolemia.

We have identified a mutation (-49C>T) in the low-density lipoprotein receptor (LDLR) gene in a Spanish familial hypercholesterolemia (FH) patient. The mutation maps within repeat 3 of the LDLR gene promoter. This region binds Sp1 and collaborates with repeat 2 in the regulation of LDLR gene by sterols. To evaluate whether the mutation influenced the activity of the promoter, luciferase reporter plasmids containing 296 bp of the proximal promoter region were constructed. In transient transfection assays in HepG2 cells, the mutation resulted in an 80% reduction of promoter activity. Also, gel-shift assays demonstrated that the mutation severely affects Sp1 binding. However, the mutated promoter still retains the ability to respond to low sterol concentrations. As the analysis of the LDLR gene did not reveal any other changes, we conclude that the -49C>T mutation is the cause of FH in the patient. The analysis of the proband's pedigree indicated that not all the members of the family having the mutation disclose a FH phenotype.These results support the view that factors other than the presence of the mutation are important in the determination of the clinical phenotype in FH.     

Deletion of exon encoding cysteine-rich repeat of low density lipoprotein receptor alters its binding specificity in a subject with familial hypercholesterolemia

The proposed ligand binding domain of the low density lipoprotein (LDL) receptor consists of a 40-amino acid cysteine-rich unit that is repeated with some variation seven times. We describe here a mutant allele at the LDL receptor locus in which one of the seven repeats has been deleted. This mutation was found in a patient with the clinical syndrome of homozygous familial hypercholesterolemia. By molecular cloning, we show that the deletion arose by homologous recombination between repetitive Alu sequences in intron 4 and intron 5 of the gene. The deletion removes exon 5, which normally encodes the sixth repeat of the ligand binding domain. In the resultant mRNA, exon 4 is spliced to exon 6, preserving the reading frame. This mRNA produces a shortened protein that reaches the cell surface and reacts with anti-receptor antibodies but does not bind LDL, which contains apoprotein B-100 as its major protein component. Surprisingly, the deleted protein retains the ability to bind and internalize beta-migrating very low density lipoprotein, a lipoprotein that contains apoprotein E as well as apoprotein B-100. These data support the hypothesis that the seven repeated sequences in the receptor constitute the LDL binding domain. The data further indicate that the sixth repeat is required for binding of LDL, but not beta-migrating very low density lipoprotein, and that deletion of a single cysteine-rich repeat can alter the binding specificity of the LDL receptor.     

Reconstituted low density lipoprotein: A vehicle for the delivery of hydrophobic fluorescent probes to cells

Previous studies have shown that the cholesteryl ester core of plasma low density lipoprotein (LDL) can be extracted with heptane and replaced with a variety of hydrophobic molecules. In the present report we use this reconstitution technique to incorporate two fluorescent probes, 3-pyrenemethyl-23, 24-dinor-5-cholen-22-oate-3β-yl oleate (PMCA oleate) and dioleyl fluorescein, into heptane-extracted LDL. Both fluorescent lipoprotein preparations were shown to be useful probes for visualizing the receptor-mediated endocytosis of LDL in cultured human fibroblasts. When normal fibroblasts were incubated at 37°C with either of the fluorescent LDL preparations, fluorescent granules accumulated in the perinuclear region of the cell. In contrast, fibroblasts from patients with the homozygous form of familial hypercholesterolemia (FH) that lack functional LDL receptors did not accumulate visible fluorescent granules when incubated with the fluorescent reconstituted LDL. A fluorescence-activated cell sorter was used to quantify the fluorescence intensity of individual cells that had been incubated with LDL reconstituted with dioleyl fluorescein. With this technique a population of normal fibroblasts could be distinguished from a population of FH fibroblasts. The current studies demonstrate the feasibility of using fluorescent reconstituted LDL in conjunction with the cell sorter to isolate mutant cells lacking functional LDL receptors.     

Effect of adeno-associated virus-mediated transfer of low density lipoprotein receptor gene on treatment of hypercholesterolemia

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