J. Lipid Res.
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A more recent version of this article appeared on December 1, 2004

Papers In Press, published online ahead of print September 16, 2004
J. Lipid Res., doi:10.1194/jlr.M400310-JLR200
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Submitted on August 13, 2004
Revised on September 2, 2004
Accepted on September 14, 2004

Phenotypic heterogeneity of sitosterolemia

Jian Wang, Tisha Joy, David Mymin, Jiri Frohlich, and Robert A. Hegele

Robarts Research Institute, London, Ontario N6C 5E6

Corresponding Author: hegele{at}robarts.ca

Sitosterolemia is a rare autosomal recessive disorder of lipoprotein metabolism, characterized by xanthomas and elevated plasma concentrations of plant sterols, such as sitosterol. Causative mutations occur in either the ABCG5 or ABCG8 genes, each of which encodes a sterol half-transporter expressed in the intestine. We report five Canadian subjects with nonsense mutations in these half-transporters: four related Caucasian subjects were homozygous for the ABCG8 S107X mutation, and one unrelated Japanese Canadian subject was homozygous for a complex insertion/deletion (I/D) mutation in ABCG5 exon 3. A female subject with each mutation was symptomatic with coronary atherosclerosis: a 5 year-old ABCG8 S107X homozygote and a 75 year-old ABCG5 exon 3 I/D homozygote; these represent the extreme ends of the spectrum of vascular involvement in sitosterolemia. The largest reductions in plasma concentrations of sitosterol and LDL-cholesterol were seen with ezetimibe or bile acid sequestrant treatment, and less dramatic reductions were seen with statin drug treatment. Thie findings extend the range of clinical phenotypes in sitosterolemia due to nonsense mutations in either ABCG5 or ABCG8.


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