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ISSN 0582-9879                                        ACTA BIOCHIMICA et BIOPHYSICA SINICA 2002, 34(6): 780-785                                     CN 31-1300/Q

 

Short Communication

Relationship between a Novel Polymorphism of Hepatic Lipase Gene and Coronary Artery Disease

SU Zhi-Guang, ZHANG Si-Zhong*, HOU Yi-Ping1, ZHANG Li2, HUANG De-Jia2

LIAO Lin-Chuan1, XIAO Cui-Ying

( Department of Medical Genetics, West China Hospital, Sichuan University, Chengdu 610041, China

1Institute of Forensic Medicine, West China Medical Center, Sichuan University, Chengdu 610041, China

2Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China )

Abstract    Hepatic lipase (HL) is a lipolytic enzyme involved in the catabolism of plasma lipoproteins,  and is an important determinant of high density lipoproteins(HDL) concentration and low density lipoproteins(LDL) subclass distribution. Accordingly, HL activity may influence body's susceptibility to coronary artery disease (CAD). Association on the single nucleotide polymorphisms (SNPs) in the HL gene to post-heparin plasma HL activity and the plasma HDL-cholesterol concentration have been investigated thoroughly, but to date, little is known about this in Chinese. In present study, the SNPs of the HL gene were analyzed. The promoter region and all the 9 exons with their flanking sequences of the HL gene were amplified from the Chinese patients with CAD and normal controls by PCR technique, and the PCR products were detected by denaturing high performance liquid chromatography (DHPLC) and sequenced with a dideoxy terminal termination method. As the result, a novel SNP-2TC in the promoter of HL gene was found. Compared with the control group,  more CAD patients carried the -2C allele(TC+CC) (57.9% versus 42.7%, c2 =4.181, df=2, P=0.041). The prevalence of the -2C allele was significantly higher in the CAD patients than in control subjects (c2=3.988, df=1, P=0.046) and the odds ratio(OR) of -2C allele associated with the risk of CAD is 1.58 [95% confidence interval(CI): 1.01-2.47]. The -2C allele homozygous carriers in the CAD patients had a significantly higher HDL-cholesterol level than the noncarriers [(1.13±0.24) mmol/L versus (0.91±0.14) mmol/L, P<0.05]. These suggest that a TC substitution at -2 of the HL promoter may be associated with the variation of  HDL-cholesterol concentration and therefore affect the risk of CAD in Chinese.

Key words    hepatic lipase gene; single nucleotide polymorphism (SNP); coronary artery disease; high density lipoprotein (HDL); denaturing high performance liquid chromatography (DHPLC)

Human hepatic lipase (HL, triacylglycerol, EC3.3.3.3) is a glycoprotein synthesized primarily in hepatocytes. Following secretion, the enzyme binds to the hepatic sinusoidal endothelial surface, where it hydrolyzes triglycerides and phospholipids in plasma lipoproteins[1, 2]. Hepatic lipase has been suggested to play a role in HDL metabolism. Evidence demonstrated that HDL-cholesterol (HDL-C) level was at least partly regulated by hepatic lipase level and on this basis it had been thought that lowering HL would increase HDL-cholesterol[3]. HL deficiency leads to elevation in HDL-cholesterol, increased levels of triglyceride in HDL and LDL, and impaired metabolism of post-prandial glyceride-rich lipoproteins[4, 5], and all of these are considered to be risk factors for premature atherosclerosis. Although HL seems to be an important enzyme with multiple functions, the exact role of HL in lipoprotein metabolism has not yet been established.

The human HL gene has been assigned to chromosome 15q21[6] and spans over 35 kb with 9 exons encoding a cognate mRNA of 1.6 kb that is translated into a mature 476-amino acid protein[7]. Several polymorphisms have now been described in the HL gene,  including a number of mutation associated with the rare HL deficiency condition[5, 8-10]. Recent studies demonstrated that polymorphisms in the promoter of the HL gene are related to variants in plasma HDL-C concentrations,  and the associations between HL gene promoter variants and HL activity have been reported[11-15]. It seems clear that a reduction of HL activity by some mutations in HL gene should lead to increased susceptibility of the body to coronary artery disease(CAD). But the findings were contradictory, some studies reported lower HL activity in patients with CAD than in health controls[16], whereas others found that HL activity was similar in cases and controls[17], or elevated in men with coronary disease[18].

The present work was to study the polymorphisms of HL gene in Chinese Hans which accounts for 95 percent Chinese population and test the relationships between the polymorphisms and the CAD or plasma HDL cholesterol concentration.

1  Materials and Methods

1.1  Subjects

102 patients with coronary artery disease were from the First University Hospital of West China of Medical Center Sichuan University. All of them were examined by coronary angiography using the Judkins technique. For the coronary score,  main coronary artery branches(left anterior descending, left circumflex artery,  right coronary artery) having at least one stenosis of 60% were recorded. Meanwhile, 82 unrelated age-matched subjects selected via health-screening at the same hospital free of any clinical and biochemical signs of CAD were used as controls for the study.

1.2  Measurement of lipids and lipoproteins

Blood samples were collected at baseline from patients and controls after an overnight fast. Plasma separated from cells by centrifugation at 500 g for 10 min at room temperature was used immediately for lipid and lipoprotein analysis. The levels of plasma cholesterol and triglyceride were determined with an enzymatic kit (Boehringer Mannheim) and calibrated with a serum calibrator. HDL-cholesterol was measured in the supernatant after precipitation of apoB-containing lipoproteins with a 4% sodium phosphotungstate solution after centrifugation. LDL-cholesterol (LDL-C) was calculated by use of the Friedewald Formula. The apolipoproteins apoA1 and apoB levels were determined by immunonephelometric assay (Behring Nephelometer).

1.3  DNA preparation and PCR amplification

Genomic DNA was prepared from peripheral blood leukocytes using the salting-out procedure[19] and stored at 4 . Individual exon of the HL gene including all exon-intron boundaries was amplified by PCR. Designing of the oligonucleotide primers (Table 1) for PCR were based on GenBank M35425, M35426, M35427, M35428, M35429,  M35430, M35431, M35432, M35433 and X58779 information. Each PCR amplification mixture contained 0.1 mg genomic DNA, 40 pmol of each primer, 25 pmol dNTPs and standard PCR buffer in a total volume of 50 ml. The reaction mixture was heated at 94 for 4 min. Subsequently, 0.4 u Taq polymerase was added. The 30 rounds of PCR amplification strategy was denaturation for 45 s at 94 , annealing for 30 s at 55-61 and extension for 30 s at 72 . The reactions were carried out in a Perkin Elmer GeneAmp 9600 PCR System (Perkin Elmer).

1.4  Denaturing high performance liquid chromato-graphy(DHPLC)

The search for single base change by DHPLC scanning was performed on an automated HPLC instrument (Hewlett Packard Instrument) identical to that described by Su et al[20]. PCR products were eluted with a linear acetonitrile gradient of 1.8% per minute at a flow-rate of 0.8 ml/min, the start and end points of the gradient were adjusted according to the size of the PCR products. The temperature for successful resolution of heteroduplex molecules was predicted by the DHPLC algorithm available athttp://insertion.stanford.edu/melt.html. In the present work,  the appropriate temperature of analysis for each amplification was determined empirically by running it at different temperatures until a good resolution between homo- and hetero-duplexes was obtained. The temperatures of DHPLC for the 10 amplifications of HL gene are 61 , 55 , 57 , 56 , 60 , 59 , 58 , 55 , 61 and 57 , respectively.

1.5  DNA sequencing

The location and chemical nature of the mismatch was confirmed by sequencing of the re-amplified product. The heterozygous and homozygous samples were cloned in T-Easy vector(Promage), then sequenced in both directions on the ALFexpress DNA automated sequencer, using the dye-terminator cycle Thermal sequenase sequencing kit (Usb company).

1.6  Statistical analysis

The lipid phenotypic data between the CAD patients and controls were age and sex adjusted, and were statistically analyzed using the Student t-test. Deviation of the genotype counts from the Hardy-Weinberg equilibrium were tested with HWE using Linkage Utility Programs[21]. Differences between the patients with CAD and the controls with respect to the allele frequencies and genotype distributions were analyzed by Fisher exact test. Adjusted odds ratio(OR) for CAD were derived from the logistic equation.

2  Results

2.1  Lipoprotein and apolipoprotein profiles

Plasma lipid levels were compared between CAD and control groups. As seen in Table 2,  the parameters used for HDL-cholesterol,  triglyceride and ApoAI were significantly different between the two groups (P<0.001).

2.2  A novel polymorphism TC(HL-2) in the HL promoter

Screening for base variant of the entire coding region,  as well as the flanking regions of every exon of the HL gene with DHPLC in CAD patients and controls revealed that there was a variation in some samples. As is known,  anny mismatched base pair in a heteroduplex molecule is generally eluted ahead of the homoduplex,  resulting in one additional DHPLC peak (data not shown). The character of varied base was then identified by sequence analysis. As the result,  a new base variation,  namely -2TC transition was discovered (Fig.1).

Fig.1  Sequence analysis of SNP in the promoter region of HL gene

The arrow indicates the -2TC. (A) T allele; (B) C allele.

2.3  Distribution of the TC(HL-2) in CAD patients and controls

To determine the prevalence of the TC substitution,  we screened this variation in all the 102 CAD patients and 82 controls. The genotype distribution and allele frequencies are listed in Table 3. No deviation from Hardy-Weinberg equilibrium (c2 =0.016, df=1, P=0.899 for CAD group; c2=0.884, df=1, P=0.347 for controls) was noted in both CAD and control groups. As the result, excess carriers of the -2TC substitution were detected in the CAD patients compared with the nonsymptomatic control subjects (57.9% versus 42.7%,  c2 =4.181, df=2, P=0.041). The prevalence of the -2C allele was significantly higher in the CAD patients than in control subjects (c2 =3.988, df=1, P=0.046). The OR of -2C allele associated with the risk of CAD is 1.58 (95% confidence interval: 1.01-2.47).

2.4  Association between TC substitution and plasma lipids

Studies on the relation between TC (HL-2) and plasma lipid showed that neither cholesterol and triglyceride,  nor LDL-cholesterol was different significantly between subjects with or without this gene variant. However,  HDL cholesterol levels did differ among different genotypes(P<0.05). The subjects homozygous for the C allele (HL-2) had the highest HDL-cholesterol values [(1.13±0.24 ) mmol/L] and subjects homozygous for the -2T allele had the lowest [(0.91±0.34) mmol/L],  while the heterozygote had the intermediate value [( 0.98±0.43) mmol/L,  see Table 4].  

3  Discussion

In present study, a novel base variation (-2TC ) in the HL promoter region was found through DHPLC and DNA sequencing. This polymorphism was present in about 58% of patients with angio-graphically established coronary artery disease and in about 43% of nonsymptomatic control subjects. The TC allele was significantly more frequent in the patient with CAD than in the control subjects.

There is considerable evidence that hepatic lipase activity is an important determinant of plasma HDL-C concentrations. Clinical studies have consistently found an inverse relationship between hepatic lipase activity measured in post heparin plasma and plasma HDL-C concentrations[22-24]. Association studies showed that the -2TC variation may account for the variation in plasma HDL-C concentration, at least in the tested Chinese. Since we did not measure the hepatic lipase activity in the present study, so we can only speculate that the -2TC polymorphism may affect the activity of this enzyme and thereby influence the plasma HDL-C. Given the well established inverse relationship between hepatic lipase activity and HDL-C concentrations, however,  it seems very likely that the -2C is associated with low hepatic lipase activity by directly affecting hepatic lipase expression or through linkage disequilibrium with another polymorphism that directly decreases the enzyme activity. Since no linkage of the -2TC variant with other polymorphisms in the first 668 bp of the HL promoter was found,  it suggests that the base substitution may lead to a lowered hepatic lipase expression.

The promoter sequence variant -514T in the HL gene has been shown to be significantly associated with low post-heparin hepatic lipase activity[11, 12]. Some studies have also found that the -514T variant is associated with elevation in plasma HDL-cholesterol[13-15]. We tested for associations of the same HL -514T with plasma lipoprotein traits in Chinese CAD patients and normal controls. The HL -514T allele frequencies in these two groups were 0.224 and 0.315,  respectively, no significant association was found between HL -514T and plasma HDL-cholesterol, after adjusting for covariates including gender and body mass index, although the plasma HL activity was not available for analyses. There was no consistent relationship between the population mean plasma HDL-cholesterol concentration and the population HL -514T frequency. Our findings are consistent with the idea that the common promoter variation in HL, which has been reported to be associated with variation in post heparin HL activity and HDL triglyceride concentration, is not always associated with variation in plasma HDL-cholesterol concentration,  possibly due to yet unspecified environmental or genetic factors.

In summary, we have identified a novel base change in the promoter of HL gene in Chinese CAD patients and normal controls, The association between HL genotype and HDL was significant at the 0.05 level, which suggests that genetic variation at the HL locus is involved in the determination of lipid and lipoprotein profiles and the predisposition to CAD. Further studies are needed to elucidate the molecular mechanism and the transcription factors involved.

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Received: April 1, 2002    Accepted: May 31, 2002

This work was supported by grants from the National Natural Science Foundation of China (No.39993420), and the National High Technology Research and Development Program of China (863 Program) (No.2001AA224021-03)

*Corresponding author: Tel,86-28-85422749; Fax,86-28-85501518; e-mail, [email protected]