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DOI: 10.1055/s-2004-861492
Apolipoprotein E and Familial Dysbetalipoproteinemia: Clinical, Biochemical, and Genetic Aspects
Publication History
Publication Date:
03 January 2005 (online)
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ABSTRACT
In humans, apolipoprotein E (apoE) is a polymorphic protein of which three common isoforms can be distinguished, designated apoE2, apoE3, and apoE4. This genetic variation is associated with different plasma lipoprotein levels, different response to diet and lipid-lowering therapy, and a variable risk for cardiovascular disease and Alzheimer's disease. An example of an apoE-mediated, autosomal recessive, lipid disorder is familial dysbetalipoproteinemia (FD), caused by mutations in the apolipoprotein E gene. Homozygosity for APOE*2 (1 in 170 persons) causes FD or type III hyperlipoproteinemia in less than 20% of the adult APOE*2 homozygotes. Less common, dominant negative mutations may also cause the disorder. The patients may present with typical skin lesions and elevated plasma levels of cholesterol and triglycerides, mainly in very-low-density lipoprotein remnants and intermediate-density lipoproteins. The disorder is associated with peripheral and coronary artery disease. Additional gene and environmental factors are necessary for the expression of this hyperlipoproteinemia. Hyperinsulinemia and defects in genes involved in the hydrolysis of triglycerides are associated with this lipid disorder. Diet and weight reduction are effective but usually not sufficient to normalize the lipid levels. Additional therapy with statins or fibrates is necessary and effective in most patients.
KEYWORDS
Familial dysbetalipoproteinemia - apolipoprotein E - apoE - remnants - type III hyperlipoproteinemia
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Dr.
A.H. M. Smelt
Department of General Internal Medicine
B3-Q, P.O. Box 9600, Leiden 2300 RC, The Netherlands