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1. Postprandial lipid absorption in seven heterozygous carriers of deleterious variants of MTTP in two abetalipoproteinemic families.

Author

Di Filippo, Mathilde, Varret, Mathilde, Boehm, Vanessa, Rabès, Jean-Pierre, Ferkdadji, Latifa, Abramowitz, Laurent, Dumont, Sabrina, Lenaerts, Catherine, Boileau, Catherine, Joly, Francisca, Schmitz, Jacques, Samson-Bouma, Marie-Elisabeth, and Bonnefont-Rousselot, Dominique

Subjects
LIPID metabolism, GENETIC disorders, LIPID metabolism disorders, APOLIPOPROTEINS, FATTY liver, GENETIC polymorphisms, INGESTION, LIVER function tests, MESSENGER RNA, TRIGLYCERIDES, EXTENDED families, GENETICS
Abstract

Background Abetalipoproteinemia, a recessive disease resulting from deleterious variants in MTTP (microsomal triglyceride transfer protein), is characterized by undetectable concentrations of apolipoprotein B, extremely low levels of low-density lipoprotein cholesterol in the plasma, and a total inability to export apolipoprotein B–containing lipoproteins from both the intestine and the liver. Objective To study lipid absorption after a fat load and liver function in 7 heterozygous relatives from 2 abetalipoproteinemic families, 1 previously unreported. Results Both patients are compound heterozygotes for p.(Arg540His) and either c.708_709del p.(His236Glnfs*11) or c.1344+3_1344+6del on the MTTP gene. The previously undescribed patient has been followed for 22 years with ultrastructure analyses of both the intestine and the liver. In these 2 families, 5 relatives were heterozygous for p.(Arg540His), 1 for p.(His236Glnfs*11) and 1 for c.1344+3_1344+6del. In 4 heterozygous relatives, the lipid absorption was normal independent of the MTTP variant. In contrast, in 3 of them, the increase in triglyceride levels after fat load was abnormal. These subjects were additionally heterozygous carriers of Asp2213 APOB in-frame deletion, near the cytidine mRNA editing site, which is essential for intestinal apoB48 production. Liver function appeared to be normal in all the heterozygotes except for one who exhibited liver steatosis for unexplained reasons. Conclusion Our study suggests that a single copy of the MTTP gene may be sufficient for human normal lipid absorption, except when associated with an additional APOB gene alteration. The hepatic steatosis reported in 1 patient emphasizes the need for liver function tests in all heterozygotes until the level of risk is established. Highlights • Genetic, clinical, ultrastructural, and biological characteristics of a new abetalipoproteinemia (ABL) case. • Postprandial studies in the new ABL case and 7 heterozygous carriers. • Normal lipid absorption in MTTP heterozygotes except if additional APOB alteration. • Need for genetic cascade screening in ABL relatives. • Need for liver and lipid absorption monitoring in ABL heterozygotes. [ABSTRACT FROM AUTHOR]

Published
2019
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2. Postprandial lipid absorption in seven heterozygous carriers of deleterious variants of MTTP in two abetalipoproteinemic families

Author

Jacques Schmitz, Mathilde Di Filippo, Dominique Bonnefont-Rousselot, Sabrina Dumont, Latifa Ferkdadji, Catherine Boileau, Mathilde Varret, V. Boehm, Francisca Joly, Jean-Pierre Rabès, Laurent Abramowitz, Catherine Lenaerts, Marie-Elisabeth Samson-Bouma, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Hôpital Robert Debré, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Amiens-Picardie, Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU), CHU Necker - Enfants Malades [AP-HP], Service de Biochimie Métabolique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Descartes - Paris 5 (UPD5), Unité de Technologies Chimiques et Biologiques pour la Santé (UTCBS - UM 4 (UMR 8258 / U1022)), Institut de Chimie du CNRS (INC)-Université de Paris (UP)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CarMeN, laboratoire, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)

Subjects
Male, Apolipoprotein B, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Liver steatosis, 030204 cardiovascular system & hematology, Compound heterozygosity, Microsomal triglyceride transfer protein, chemistry.chemical_compound, 0302 clinical medicine, 030212 general & internal medicine, Child, Fat malabsorption, Sequence Deletion, Nutrition and Dietetics, biology, medicine.diagnostic_test, Postprandial, Middle Aged, Postprandial Period, Abetalipoproteinemia, Pedigree, 3. Good health, [SDV] Life Sciences [q-bio], Liver, Child, Preschool, Cardiology and Cardiovascular Medicine, Adult, Heterozygote, medicine.medical_specialty, Adolescent, Genotype, Young Adult, 03 medical and health sciences, Malabsorption Syndromes, Internal medicine, Internal Medicine, medicine, Humans, Apolipoproteins B, Polymorphism, Genetic, Triglyceride, business.industry, Infant, Lipid Metabolism, medicine.disease, Genetic hypocholesterolemia, Endocrinology, chemistry, biology.protein, Liver function, Steatosis, Carrier Proteins, Liver function tests, business
Abstract

International audience; BACKGROUND: Abetalipoproteinemia, a recessive disease resulting from deleterious variants in MTTP (microsomal triglyceride transfer protein), is characterized by undetectable concentrations of apolipoprotein B, extremely low levels of low-density lipoprotein cholesterol in the plasma, and a total inability to export apolipoprotein B-containing lipoproteins from both the intestine and the liver. OBJECTIVE: To study lipid absorption after a fat load and liver function in 7 heterozygous relatives from 2 abetalipoproteinemic families, 1 previously unreported. RESULTS: Both patients are compound heterozygotes for p.(Arg540His) and either c.708\₇09del p.(His236Glnfs*11) or c.1344+3\₁344+6del on the MTTP gene. The previously undescribed patient has been followed for 22 years with ultrastructure analyses of both the intestine and the liver. In these 2 families, 5 relatives were heterozygous for p.(Arg540His), 1 for p.(His236Glnfs*11) and 1 for c.1344+3\₁344+6del. In 4 heterozygous relatives, the lipid absorption was normal independent of the MTTP variant. In contrast, in 3 of them, the increase in triglyceride levels after fat load was abnormal. These subjects were additionally heterozygous carriers of Asp2213 APOB in-frame deletion, near the cytidine mRNA editing site, which is essential for intestinal apoB48 production. Liver function appeared to be normal in all the heterozygotes except for one who exhibited liver steatosis for unexplained reasons. CONCLUSION: Our study suggests that a single copy of the MTTP gene may be sufficient for human normal lipid absorption, except when associated with an additional APOB gene alteration. The hepatic steatosis reported in 1 patient emphasizes the need for liver function tests in all heterozygotes until the level of risk is established.

Published
2019

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