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Genetic disorder affecting lipid metabolism






Apolipoprotein B deficiency is a rare genetic disorder that affects the body's ability to properly metabolize lipids, leading to various health complications. This condition is primarily characterized by low levels of apolipoprotein B (ApoB), a crucial component of lipoproteins that are responsible for the transport of lipids in the bloodstream.

Genetics

Apolipoprotein B deficiency is typically inherited in an autosomal dominant pattern, meaning that a single copy of the altered gene in each cell is sufficient to cause the disorder. The gene responsible for this condition is the APOB gene, which provides instructions for making the ApoB protein. Mutations in the APOB gene can lead to reduced levels or dysfunctional forms of ApoB, impairing the formation and secretion of low-density lipoprotein (LDL) and other lipoproteins.

Diagram showing autosomal dominant inheritance pattern.

Pathophysiology

Apolipoprotein B is essential for the assembly and secretion of chylomicrons and very low-density lipoproteins (VLDL) from the liver and intestines. In individuals with ApoB deficiency, the impaired production of these lipoproteins leads to decreased levels of LDL cholesterol in the blood. This can result in a condition known as hypobetalipoproteinemia, characterized by abnormally low levels of cholesterol and triglycerides.

Clinical Features

Patients with apolipoprotein B deficiency may present with a variety of symptoms, although some individuals remain asymptomatic. Common clinical features include:

  • Fat malabsorption
  • Steatorrhea (fatty stools)
  • Growth retardation in children
  • Neurological symptoms due to vitamin E deficiency

Diagnosis

The diagnosis of apolipoprotein B deficiency is based on clinical evaluation, family history, and laboratory tests. Blood tests typically reveal low levels of LDL cholesterol and ApoB. Genetic testing can confirm mutations in the APOB gene.

Management

Management of apolipoprotein B deficiency focuses on dietary modifications and supplementation to address nutritional deficiencies. Patients may require:

  • A low-fat diet to reduce fat malabsorption
  • Vitamin E supplementation to prevent neurological complications
  • Regular monitoring of lipid levels and nutritional status

Prognosis

The prognosis for individuals with apolipoprotein B deficiency varies depending on the severity of the condition and the presence of complications. With appropriate management, many patients can lead normal lives, although ongoing monitoring and treatment are often necessary.

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Contributors: Prab R. Tumpati, MD