Leucine 10 allelic variant in signal peptide of PCSK9 increases the LDL cholesterol-lowering effect of statins in patients with familial hypercholesterolaemia

Pisciotta, L.; Sallo, R.; Rabacchi, C.; Wunsch, A.; Calandra, S.; Bertolini, S.

doi:10.1016/j.numecd.2011.04.003

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Leucine 10 allelic variant in signal peptide of PCSK9 increases the LDL cholesterol-lowering effect of statins in patients with familial hypercholesterolaemia

L. Pisciotta
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, I-16132 Genoa, Italy
R. Sallo
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, I-16132 Genoa, Italy
C. Rabacchi
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Via Campi 287, I-41100 Modena, Italy
A. Wunsch
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Via Campi 287, I-41100 Modena, Italy
S. Calandra
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Via Campi 287, I-41100 Modena, Italy
- Corresponding author. Tel.: +39 059 2055423; fax: +39 059 2055426.
S. Bertolini
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, I-16132 Genoa, Italy
- Corresponding author. Tel.: +39 010 3537992; fax: +39 010 3537797.

Received 4 January 2011; received in revised form 31 March 2011; accepted 5 April 2011. published online 15 September 2011.
Corrected Proof

Abstract

Background and aims

In the normal population, carriers of an additional leucine residue in a stretch of nine leucines in the signal peptide of PCSK9 (L10) have lower total (TC) and low-density lipoprotein cholesterol (LDL-C) than homozygotes for the wild-type allele (L9/L9). A similar effect was detected in familial hypercholesterolaemia (FH) patients with the p.C681X mutation of LDL-receptor (LDLR). We investigated the effect of L10 variant on basal lipid profile and response to statins in molecularly characterised FH patients.

Methods and results

Plasma lipids were determined in 322 FH patients screened for the L9/L10/L11 polymorphism and in a subgroup of 54 patients carrying the same LDLR mutation (p.Q474HfsX63). Plasma lipids were also determined in 42 FH patients carrying the L10 variant and in a parallel group of 42 FH patients, L9/L9 homozygotes, matched for gender, age, type of LDLR gene mutation, as well as for type, dose and duration of statin treatment. In FH patients, no difference in the basal plasma TC and LDL-C levels was observed between carriers of L10 variant (L9/L10+L10/L10) and L9/L9 homozygotes. The same was true in FH patients carrying the p.Q474HfsX63 LDLR mutation. In the subgroups of statin-treated patients, the reduction of TC and LDL-C was greater in carriers of L10 (−34.0% and −42.5%, respectively) than in L9/L9 homozygotes (−27.5% and −34.3%, respectively) (P<0.001).

Conclusion

The variant L10 of the leucine repeats in PCSK9 signal peptide is to be considered as a factor capable of modulating the lipid-lowering effects of statins in FH.

Keywords: PCSK9 signal peptide polymorphism, Familial hypercholesterolaemia (FH), Statins, LDL cholesterol (LDL-C)