Boris Hansel1, Alain Carrié2, Nathalie Brun-Druc3, Geoffroy Leclert4, Sandrine Chantepie5, Anne-Sophie Coiffard6, Jean-François Kahn4, M John Chapman7, Eric Bruckert8. 1. Département d'Endocrinologie, Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France; Université Paris-Diderot, Paris 7, Paris, France. Electronic address: boris.hansel@gmail.com. 2. Institute of Cardiometabolism and Nutrition, Paris, France; Service de Biochimie endocrinienne et oncologique, Centre de Génétique Moléculaire et Chromosomique, AP-HP, Hôpital de la Pitié, Paris, France; Dyslipidemia and Atherosclerosis Research Unit, INSERM-UMRS 939, Hôpital de la Pitie, Paris, France. 3. Unité de Néphrologie-Métabolisme pédiatrique, Département de Pédiatrie, Hôpitaux Universitaires de Genève, Genève, Switzerland. 4. Service d'Endocrinologie-Métabolisme, AP-HP, Hôpital de la Pitié, Paris, France. 5. Laboratoire CRRET, EAC/CNRS-7149, Université Paris Est Créteil, Faculté des Sciences et Technologie, 61 av du Général de Gaulle, 94010 Créteil, France. 6. Institute of Cardiometabolism and Nutrition, Paris, France; Service de Biochimie endocrinienne et oncologique, Centre de Génétique Moléculaire et Chromosomique, AP-HP, Hôpital de la Pitié, Paris, France. 7. Institute of Cardiometabolism and Nutrition, Paris, France; Dyslipidemia and Atherosclerosis Research Unit, INSERM-UMRS 939, Hôpital de la Pitie, Paris, France. 8. Institute of Cardiometabolism and Nutrition, Paris, France; Dyslipidemia and Atherosclerosis Research Unit, INSERM-UMRS 939, Hôpital de la Pitie, Paris, France; Service d'Endocrinologie-Métabolisme, AP-HP, Hôpital de la Pitié, Paris, France.
Abstract
OBJECTIVE: Phytosterolemia is a rare autosomal recessive disorder characterized by dramatically elevated circulating levels of plant sterols (PS). Phytosterolemia is believed to be responsible for severe premature atherosclerosis. The clinical, biological and molecular genetic features of 5 patients with phytosterolemia and transient severe hypercholesterolemia challenge this hypothesis. METHODS: Our patients were referred for suspected homozygous familial hypercholesterolemia. Despite the phenotype, this diagnosis was invalidated and phytosterolemia was confirmed by the identification of mutations in the ABCG5/ABCG8 transporter complex. Plasma PS were analyzed with a mass spectrometric-gas chromatographic procedure. Vascular status was assessed with carotid ultrasonography and completed (for 4 of the 5 patients) with femoral ultrasonography; additional examinations of cardiovascular status included a stress test, determination of coronary calcium score, echocardiography, non-invasive assessment of endothelium-dependent dilatation and coronarography. RESULTS: The 5 patients displayed markedly elevated levels of both β-sitosterol and campesterol (15-30 fold higher than normal values). However, none displayed significant signs of infraclinical premature atherosclerosis (respectively at the ages of 32, 27, 29, 11 and 11 years). All patients were characterized by very high levels of total (>450 mg/dl) and LDL-cholesterol (>350 mg/dl) at diagnosis which decreased markedly on dietary intervention alone. Treatment with cholestyramine or Ezetimibe ± atorvastatin normalized cholesterol levels, although plasma PS concentrations remained elevated. CONCLUSION: The clinical and biological characteristics of our patients, considered together with reports of cases which equally lack CVD, support the contention that the premature atherosclerosis associated with phytosterolemia in some patients may be due at least in part to mechanisms independent of elevated circulating phytosterol levels.
OBJECTIVE:Phytosterolemia is a rare autosomal recessive disorder characterized by dramatically elevated circulating levels of plant sterols (PS). Phytosterolemia is believed to be responsible for severe premature atherosclerosis. The clinical, biological and molecular genetic features of 5 patients with phytosterolemia and transient severe hypercholesterolemia challenge this hypothesis. METHODS: Our patients were referred for suspected homozygous familial hypercholesterolemia. Despite the phenotype, this diagnosis was invalidated and phytosterolemia was confirmed by the identification of mutations in the ABCG5/ABCG8 transporter complex. Plasma PS were analyzed with a mass spectrometric-gas chromatographic procedure. Vascular status was assessed with carotid ultrasonography and completed (for 4 of the 5 patients) with femoral ultrasonography; additional examinations of cardiovascular status included a stress test, determination of coronary calcium score, echocardiography, non-invasive assessment of endothelium-dependent dilatation and coronarography. RESULTS: The 5 patients displayed markedly elevated levels of both β-sitosterol and campesterol (15-30 fold higher than normal values). However, none displayed significant signs of infraclinical premature atherosclerosis (respectively at the ages of 32, 27, 29, 11 and 11 years). All patients were characterized by very high levels of total (>450 mg/dl) and LDL-cholesterol (>350 mg/dl) at diagnosis which decreased markedly on dietary intervention alone. Treatment with cholestyramine or Ezetimibe ± atorvastatin normalized cholesterol levels, although plasma PS concentrations remained elevated. CONCLUSION: The clinical and biological characteristics of our patients, considered together with reports of cases which equally lack CVD, support the contention that the premature atherosclerosis associated with phytosterolemia in some patients may be due at least in part to mechanisms independent of elevated circulating phytosterol levels.
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Authors: Marina Cuchel; Eric Bruckert; Henry N Ginsberg; Frederick J Raal; Raul D Santos; Robert A Hegele; Jan Albert Kuivenhoven; Børge G Nordestgaard; Olivier S Descamps; Elisabeth Steinhagen-Thiessen; Anne Tybjærg-Hansen; Gerald F Watts; Maurizio Averna; Catherine Boileau; Jan Borén; Alberico L Catapano; Joep C Defesche; G Kees Hovingh; Steve E Humphries; Petri T Kovanen; Luis Masana; Päivi Pajukanta; Klaus G Parhofer; Kausik K Ray; Anton F H Stalenhoef; Erik Stroes; Marja-Riitta Taskinen; Albert Wiegman; Olov Wiklund; M John Chapman Journal: Eur Heart J Date: 2014-07-22 Impact factor: 35.855