[A case of familial hypercholesterolemia associated with Schnyder's corneal dystrophy].
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Biomedical subjects
Publications and source records attributed to H Mabuchi.
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In hemodialyzed patients, the serum albumin concentration determined by the bromcresol purple (BCP) method was lower than that determined by an immunological method. The degree of underestimation appeared to be well correlated to the serum concentration of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), a major endogenous ligand substance present in uremic serum. CMPF inhibited in vitro the binding of BCP to serum protein and human serum albumin. Our results suggest that CMPF is a major interferent in the underestimation of the serum albumin concentration by the BCP method in uremia.
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We describe a new low density lipoprotein (LDL) apheresis system using dextran sulfate cellulose column in an automated column regenerating unit (LDL continuous apheresis). Two columns containing 150 ml of dextran sulfate cellulose were used, and the whole extracorporeal circulation was about 400 ml in volume. After 600 ml of plasma was adsorbed into the first column, the second column was used as an adsorbent and meanwhile the first column was regenerated. Thus, the 2 columns were used alternately without losing the potency of the columns. As the apparatus was automatically controlled by a computerized unit, no extra manipulation is necessary compared with the conventional single-column method. By treating 4-5 liters of plasma, non-high density lipoprotein (HDL)-cholesterol levels decreased by 63-71%, and HDL-cholesterol levels remained unchanged. Thus, this new method of LDL apheresis can safely reduce LDL-cholesterol to any desired level and will be applicable for the treatment of child and adult family hypercholesterolemic patients with severe coronary heart disease.
Coronary angiographic findings were analyzed in 51 consecutive patients (36 males and 15 females) with heterozygous familial hypercholesterolemia (FH) and 279 consecutive patients (216 males and 63 females) without FH (non-FH). The coronary stenosis index and over 75% stenosis vessel subset were almost three times as high in the FH group. The incidence of myocardial infarction was almost twice as high in the FH group. Levels of total cholesterol and its lipoprotein fractions, except HDL-cholesterol, were almost twice as high in the FH group. In the FH group aged under 50 years, the two parameters of coronary angiogram and the incidence of myocardial infarction were significantly higher in males than in females. However, in the group aged over 50 years, all three parameters were not significantly different between those in males and females. The level of HDL-cholesterol was significantly lower in males than in females. A significantly higher incidence (18%) of coronary ectasia was observed in the FH group compared with the incidence (2%) in non-FH. All patients with coronary ectasia were males, except one female with FH. On comparison of the males among the FH patients with those among the non-FH patients matched for total cholesterol, age and other risk factors, the FH patients were associated with a significantly higher degree of coronary atherosclerosis and lower level of HDL-cholesterol. Seven FH patients with a normal coronary angiogram were observed. However, any factors as regards age, total cholesterol, HDL-cholesterol and Achilles tendon thickness failed to distinguish between the FH patients with a normal coronary angiogram and those without.(ABSTRACT TRUNCATED AT 250 WORDS)
Effects of CS-514, a new competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, on serum lipoprotein lipid and apolipoprotein levels were studied in 13 heterozygous patients with familial hypercholesterolemia. Treatment with 10 mg of CS-514 twice daily reduced total serum cholesterol, low-density lipoprotein (LDL), and intermediate-density lipoprotein (IDL) cholesterol levels by 25%, 33%, and 33%, respectively, and increased high-density lipoprotein (HDL) cholesterol levels by 15%. Apolipoprotein B, E, and C-II levels decreased by 24%, 20%, and 19%, and apolipoproteins A-I and A-II levels increased by 10% and 7%, respectively. One patient showed abnormally high levels of SGOT, SGPT, and serum alkaline phosphatase, which returned to normal levels immediately after the cessation of CS-514. No other adverse effects were observed. Thus, CS-514 reduces atherogenic lipoproteins and apolipoprotein B, and increases HDL and apolipoprotein A-I and A-II, and appears to be a useful drug for heterozygous familial hypercholesterolemia.
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A 36-year-old woman was treated with tamoxifen for lung metastasis of breast cancer and had marked hyperlipoproteinemia with giant fatty liver, high plasma triglyceride levels (3673 mg/dl), and increased levels of very low density lipoprotein (VLDL) and intermediate density lipoprotein (UDL). A low level of activity of both plasma lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) was also noted. Our observations support the concept that, in some patients, the weak estrogen-like activity of tamoxifen is amplified and, in severe lipemia, reduction of the activities of LPL and HTGL might impede the conversion of VLDL to LDL, thus causing the amplification of the effect.
A 23-year-old man with homozygous familial hypercholesterolemia was found to have coronary ectasia by coronary angiography. This case showed generalized xanthomatosis and severe hyper low density lipoproteinemia, and his cultured skin fibroblasts showed LDL receptor activities compatible with the receptor-defective homozygous type of familial hypercholesterolemia. Coronary angiography showed fusiform aneurysmal involvements in the right coronary artery and left circumflex artery, and 50% stenosis in the right coronary artery and left anterior descending artery. Thus, homozygous familial hypercholesterolemia produces coronary ectasia as well as premature coronary stenosis.
Two homozygous patients with familial hypercholesterolemia were treated by double-filtration plasmapheresis. The plasma separated by the first filter was subsequently led to the second filter of ethylene vinylalcohol co-polymer hollow fibers, which trap very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL) and low density lipoprotein (LDL) preferentially to other plasma constituents. Serum, VLDL, IDL, LDL cholesterol levels decreased by 55, 68, 59 and 55%, respectively. HDL cholesterol levels decreased by 39%. Immunoglobulins and fibrinogen levels decreased significantly. Cutaneous and tendinous xanthomas became smaller. off
Five out of 15 homozygotes and 41 out of 527 heterozygotes of familial hypercholesterolemia (FH) died during the past 10 years. Sudden death or heart failure was the cause of death in each of the 5 deceased homozygotes. Twenty heterozygotes died of myocardial infarction, 9 of sudden death, and 1 died after AC bypass surgery. Thus, 30 heterozygotes (73.2%) died of coronary heart disease (CHD). The mean age of death was significantly younger in male heterozygotes (54 years) than in the females (68 years). Rate of death from CHD in heterozygotes was 11 times higher than in the general population in Japan. Rate of death from pancreas cancer in FH was significantly higher than in the general population. These results suggest that FH is highly associated with pancreas cancer as well as CHD.
The profiling of endogenous ligand solutes in sera of patients with uremia was performed by using an ultrafiltration device and high-performance liquid chromatography. Seventeen endogenous ligand solutes, which are ultraviolet-absorbing substances, were detected in a sample volume of 40 microliters, and four ligand solutes were tentatively identified as indoxylsulfate, hippuric acid, 2-hydroxybenzoylglycine, and 3-indoleacetic acid. One of these ligand solutes designated as peak P was thought to be a candidate for a major drug-binding inhibitor in uremia.
Isolation of an endogenous ligand solute from uremic serum was performed by high-performance liquid chromatography. This ligand solute inhibited the binding of diphenylhydantoin and tryptophan to plasma protein, and was considered to be one of the endogenous drug-binding inhibitors present in uremic serum. The gas chromatographic-mass spectrometric analysis revealed that this inhibitor is 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid, which is known to be a constituent of urine.