Key result
Biallelic and monoallelic APOA5 loss-of-function variants are linked to severe hypertriglyceridemia, primarily via premature truncation.
Why the study?
Heterozygosity for rare APOA5 pathogenic loss-of-function variants is associated with highly variable triglyceride phenotypes ranging from normal to severe hypertriglyceridemia, prompting an updated overview of rare APOA5 variants in hypertriglyceridemia.
Biallelic and monoallelic loss-of-function variants in APOA5 are associated with severe hypertriglyceridemia, with premature truncation serving as the principal definitive mechanism of pathogenicity.
APOA5 variant screening may aid severe hypertriglyceridemia evaluation; leaves open prospective outcome studies and functional validation of missense variants.
PURPOSE OF REVIEW: While biallelic rare APOA5 pathogenic loss-of-function (LOF) variants cause familial chylomicronemia syndrome, heterozygosity for such variants is associated with highly variable triglyceride phenotypes ranging from normal to severe hypertriglyceridemia, often in the same individual at different time points. Here we provide an updated overview of rare APOA5 variants in hypertriglyceridemia. RECENT FINDINGS: Currently, most variants in APOA5 that are considered to be pathogenic according to guidelines of the American College of Medical Genetics and Genomics are those resulting in premature termination codons. There are minimal high quality functional data on the impact of most rare APOA5 missense variants; many are considered as variants of unknown or uncertain significance. Furthermore, particular common polymorphisms of APOA5 , such as p.Ser19Trp and p.Gly185Cys in Caucasian and Asian populations, respectively, are statistically overrepresented in hypertriglyceridemia cohorts and are sometimes misattributed as being causal for chylomicronemia, when they are merely risk alleles for hypertriglyceridemia. SUMMARY: Both biallelic and monoallelic LOF variants in APOA5 are associated with severe hypertriglyceridemia, although the biochemical phenotype in the monoallelic state is highly variable and is often exacerbated by secondary factors. Currently, with few exceptions, the principal definitive mechanism for APOA5 pathogenicity is through premature truncation. The pathogenic mechanisms of most missense variants in APOA5 remain unclear and require additional functional experiments or family studies.
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Perera et al. (2023) conducted a review in hypertriglyceridemia. APOA5 genetic variants was evaluated. Both biallelic and monoallelic loss-of-function variants in APOA5 are associated with severe hypertriglyceridemia, principally through premature truncation.
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