β-Thalassemia Is a Modifying Factor of the Clinical Expression of Familial Hypercholesterolemia

Sebastiano Calandra; Stefano Bertolini; Giovanni Mario Pes; Luca Deiana; Patrizia Tarugi; Livia Pisciotta; Salvatore Li Volti; Giovanni Li Volti; Carmela Maccarone

doi:10.1055/s-2004-861495

Seminars in Vascular Medicine, Table of Contents

Semin Vasc Med 2004; 04(3): 271-278
DOI: 10.1055/s-2004-861495

β-Thalassemia Is a Modifying Factor of the Clinical Expression of Familial Hypercholesterolemia

Sebastiano Calandra¹ , Stefano Bertolini² , Giovanni Mario Pes³ , Luca Deiana³ , Patrizia Tarugi¹ , Livia Pisciotta² , Salvatore Li Volti⁴ , Giovanni Li Volti⁴ , Carmela Maccarone⁴

¹Department of Biomedical Sciences, University of Modena & Reggio Emilia, Modena
²Department of Internal Medicine, University of Genova, Genova
³Institute of Clinical Biochemistry, University of Sassari, Sassari
⁴Department of Pediatrics, University of Catania, Catania, Italy

Abstract

ABSTRACT

Familial hypercholesterolemia (FH) is a codominant disorder due to a variety of mutations of the low-density lipoprotein (LDL) receptor gene that result in an elevation of plasma LDL-cholesterol (LDL-C). Plasma levels of LDL-C show large interindividual variation even in subjects carrying the same mutation of the LDL receptor gene. This variability may be due to genetic factors (modifier genes). Several surveys indicate that the overall contribution of common polymorphisms of modifier genes (such as the genes encoding apolipoproteins E and B) to this variability is less than 10%. In contrast, β-thalassemia has a profound LDL-lowering effect. This was documented in FH patients identified on the island of Sardinia, in Italy, where 12% of the inhabitants are carriers of β-thalassemia due to a single mutation (Q39X) of the β-globin gene that abolishes the synthesis of β-globin chain of hemoglobin (β°-thalassemia). Plasma LDL-C in FH heterozygotes carrying the β°-thalassemia trait is 25% lower than in noncarriers, regardless of the LDL receptor gene mutation. It is likely that this effect is due to two main mechanisms: (1) increased uptake of LDL by the bone marrow to provide cholesterol for the increased proliferation of erythroid progenitor cells and (2) increased production of inflammatory cytokines that reduce the hepatic secretion and increase the catabolism of LDL. In view of its LDL-C-lowering effect, β-thalassemia trait may protect FH heterozygotes against premature coronary atherosclerosis.

KEYWORDS

Familial hypercholesterolemia - low-density lipoproteins - β-thalassemia - cardiovascular risk - LDL receptor

Full Text

References

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Sebastiano Calandra

Department of Biomedical Sciences, University of Modena & Reggio Emilia

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