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Serum sitosterol level predicting ABCG5 or ABCG8 genetic mutations.

Nobuko Kojima1, Hayato Tada1, Soichiro Usui1

  • 1Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|April 11, 2020
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Summary

Sitosterolemia diagnosis typically uses a serum sitosterol cutoff of 10 μg/ml. This study suggests a higher cutoff of 15 μg/ml for better accuracy in identifying patients with ABCG5/ABCG8 gene mutations.

Keywords:
ABCG5ABCG8Familial hypercholesterolemiaSitosterolSitosterolemia

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Area of Science:

  • Biochemistry
  • Genetics
  • Clinical Diagnostics

Background:

  • Sitosterolemia is diagnosed when serum sitosterol exceeds 10 μg/ml.
  • Genetic mutations in ABCG5 or ABCG8 genes are implicated in sitosterolemia.
  • Accurate diagnostic criteria are crucial for managing this condition.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of serum sitosterol levels for sitosterolemia.
  • To investigate the correlation between ABCG5/ABCG8 gene mutations and serum sitosterol concentrations.
  • To determine an optimal cutoff value for diagnosing sitosterolemia in dyslipidemic individuals.

Main Methods:

  • Retrospective analysis of 206 Japanese dyslipidemic subjects (2009-2018).
  • Assessment of serum sitosterol levels and screening for ABCG5/ABCG8 mutations.
  • Categorization of subjects into groups based on mutation status (none, single, double).

Main Results:

  • Identified 8 individuals with double mutations (sitosterolemia), 26 with single mutations, and 172 controls.
  • Serum sitosterol was significantly higher in patients with double mutations (45.2 μg/ml) compared to others.
  • A cutoff of 10 μg/ml perfectly distinguished double mutation patients from controls, but 6 carriers exceeded this level.
  • ROC analysis indicated an optimal cutoff value of 14.81 μg/ml for predicting double mutations.

Conclusions:

  • A serum sitosterol cutoff of 15 μg/ml is proposed for improved diagnostic accuracy.
  • This higher cutoff value demonstrates a better positive predictive value than the current 10 μg/ml criterion.
  • The findings support refining diagnostic thresholds for sitosterolemia based on genetic status.