Spectrum of LDL receptor gene mutations in Denmark: implications for molecular diagnostic strategy in heterozygous familial hypercholesterolemia

Heterozygous familial hypercholesterolemia (FH) is one of the most common p otentially fatal single-gene diseases leading to premature coronary artery disease, but the majority of heterozygous FH patients have not been diagnos ed. FH is due to mutations in the gene coding for the low-density lipoprote in (LDL) receptor, and molecular genetic diagnosis may facilitate identific ation of more FH subjects. The Danish spectrum of 29 different mutations, f ive of which account for almost half of heterozygous FH, is intermediate be tween that of countries such as South Africa, where three mutations cause 9 5% of heterozgous FH in the Afrikaners, and Germany or England, where there are many more mutations. In clinical practice, a strategy for the genetic diagnosis of heterozygous FH, tailored to the mutational spectrum of patien ts likely to be seen at the particular hospital/region of the country, will be more efficient than screening of the whole LDL receptor gene by techniq ues such as single-strand conformation polymorphism (SSCP) analysis in ever y heterozygous FH candidate. In Aarhus, Denmark, we have chosen to examine all heterozygous FH candidates for the five most common LDL receptor gene m utations (W23X, W66G, W556S, 313 + 1G --> A, 1846 - 1G --> A) and the apoB- 3500 mutation by rapid restriction fragment analysis. Negative samples are examined for other mutations by SSCP analysis followed by DNA sequencing of the exon indicated by SSCP to contain a mutation. If no point mutation or small insertion/deletion is detected, Southern blot or Long PCR analysis is performed to look for the presence of large gene rearrangements. In conclu sion, our data suggest that an efficient molecular diagnostic strategy depe nds on the composition of common and rare mutations in a population. (C) 19 99 Elsevier Science Ireland Ltd. All rights reserved.