Background
Dysbetalipoproteinemia, also known as type III hyperlipoproteinemia (type III HL),
is characterized by the accumulation of β-very low density lipoprotein (β-VLDL). However,
demonstration of the presence of β-VLDL is not easy because it requires preparative
ultracentrifugation of lipoproteins. The primary genetic defect in type III HL is
the presence of apolipoprotein (apo) E2, a mutant form of apoE. However, another metabolic
defect, such as overproduction of VLDL, is also required for the full phenotype. Patients
with only E2 homozygosity usually do not have HL. Because apoE genotyping is expensive,
the selection of patients for this analysis by effective use of common clinical measures
would be very helpful.
Objective
We examined the non-HDL-C/apoB ratio as an index for type III HL screening.
Methods
We studied nine patients with type III HL. Most patients with type III HL show mixed
hyperlipidemia. We compared the plasma of patients with combined hyperlipidemia and
the dyslipidemia of hypothyroidism with those with type III HL. The serum levels of
total cholesterol, triglyceride, and high-density lipoprotein cholesterol (HDL-C),
as well as the serum apoB and apoE levels, were measured by routine laboratory methods.
Results
Individual values of serum lipids and apolipoproteins did not distinguish type III
HL from the two other types of HL. The non-HDL-C/apoB ratio in type III HL was significantly
greater than that in the two comparison groups, with no overlap.
Conclusion
The non-HDL-C/apoB ratio is a novel index that appears to be reliable for screening
of patients for type III HL, and the index can be determined at regular clinical laboratories
without the need for any complicated lipoprotein analysis. Thus, we propose the clinical
usefulness of this index.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical LipidologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Type III hyperlipoproteinemia (dysbetalipoproteinemia): the role of apolipoprotein E in normal and abnormal lipoprotein metabolism.in: Scriber C.R. Beaudet A.L. Aly W.S. Vallo O. The Metabolic and Molecular Basis of Inherited Disease. 8th ed. McGraw-Hill, New York, NY2001: 2835-2855
- Type III hyperlipoproteinemia: analysis of two contemporary deficiencies.Ann Intern Med. 1975; 82: 150-157
- Screening for dysbetalipoproteinemia by plasma cholesterol and apolipoprotein B concentrations.Clin Chem. 2005; 51: 904-907
- Diagnosis of type III hyperlipoproteinemia from total cholesterol, triglyceride, and apolipoprotein B.J Clin Lipidol. 2007; 1: 256-263
- Apolipoprotein E to B ratio: a marker for type III hyperlipoproteinemia.Eur J Clin Chem Clin Biochem. 1993; 31: 743-747
- Detailed analysis of serum lipids and lipoproteins from Japanese type III hyperlipoproteinemia with apolipoprotein E2/2 phenotype.Clin Chim Acta. 2004; 348: 35-40
- Hyperlipidaemia in patients with hypopituitarism.Acta Endocrinol. 1985; 110: 456-460
- Accumulation of intermediate density lipoprotein in the plasma of cholesterol-fed hypothyroid rats.Metabolism. 1983; 32: 146-150
- A novel apolipoprotein E2 variant, E2Toranomon (Q187E), identified in a type III hyperlipoproteinemia patient with coronary atherosclerosis.Atherosclerosis. 1988; 140: 187-190
- Particle size analysis of high density lipoproteins in patients with genetic cholesteryl ester transfer protein deficiency.Clin Chim Acta. 2000; 301: 103-117
- Plasma apolipoprotein E levels in hypertriglyceridemia.Horm Metab Res. 1982; 14: 303-306
- Heterogeneous mutations in the human lipoprotein lipase gene in patients with familial lipoprotein lipase deficiency.J Clin Invest. 1991; 88: 1856-1864
- A G+1 to C mutation in a donor splice site of intron 2 in the apolipoprotein (apo) C-II gene deficiency and apoE4 in a severely hypertriglyceridemic patient.Atherosclerosis. 1997; 130: 153-160
- Evaluation of methods for measurement of HDL-cholesterol: from ultracentrifugation to homogeneous assays.Clin Chem. 2001; 47: 1579-1596
- Pancreatitis caused by hypertriglyceridemia in a patient compound heterozygous for Leu334Phe and —514C→T in the hepatic lipase gene.Pancreas. 2009; 38: 233-235
- A novel APOA5 splicing mutation IVS2+1g>a in a Japanese chylomicronemia patient.Atherosclerosis. 2009; 207: 24-25
Article info
Publication history
Published online: February 01, 2010
Accepted:
January 24,
2010
Received:
December 16,
2009
Identification
Copyright
© 2010 National Lipid Association. Published by Elsevier Inc. All rights reserved.
