Protected: Alzheimer’s Disease: The Role of Apolipoprotein E
Rare Disease Day raises awareness of rare diseases and how patients’ lives are affected. Many rare diseases remain incurable and many go undiagnosed. 1 in 20 people will live with a rare disease at some point in their life and this is why it is so important to raise awareness.1
What is a rare disease?
There is no single definition for a rare disease, as many countries identify them differently. In the United States, the Rare Diseases Act of 2002 defines a rare disease by its prevalence: “any disease or condition that affects fewer than 200,000 people in the United States”. However, the EU defines a rare disease as a condition that affects less than 5 in 10,000 of the population. There are approximately 7000 rare diseases and disorders and 50% of people affected by rare diseases are children.2,3
Hyperlipoproteinemia type III
This rare disease day, Randox will be raising awareness of hyperlipoproteinemia type III. Hyperlipoproteinemia type III, also known as dysbetalipoproteinemia or broad beta disease, is a rare genetic disorder characterised by improper breakdown of lipids, specifically cholesterol and triglycerides. The condition is caused by mutations in the Apo-E gene, however the inheritance of this condition is complicated due to the development of symptoms having to be triggered by a secondary factor to raise lipid levels. These factors include diabetes, obesity or hypothyroidism.
It is unknown exactly what the prevalence of the condition is, but it is estimated to affect approximately 1 in 5,000 – 10,000 of the general population and it has been found that it affects males more often than females, with women rarely being affected until after menopause.4,5
Figure A. Example of cholesterol and lipid build-up 
Symptoms for hyperlipoproteinemia type III will vary for each individual and some people may even be asymptomatic. The most common symptom is the development of xanthomas which are deposits of fatty material, the lipids, in the skin and underlying tissue. Xanthomas may appear on the palms of the hands, eyelids, soles of the feet or on the tendons of the knees and elbows.
> Chest pain or other signs of coronary artery disease
> Cramps in the calves when walking
> Sores on toes
> Stroke-like symptoms such as trouble speaking, dropping on one side of the face, weakness in an arm or a leg and a loss of balance6
Complications can arise if the condition is left untreated and these can include: myocardial infarction, ischemic stroke, peripheral vascular disease, intermittent claudication and gangrene of the lower extremities.7
Although there is no specific diagnostic test for hyperlipoproteinemia type III, diagnosis is based on clinical evaluation and identification of symptoms. Research has indicated that an algorithm comprising a number of dysbetalipoproteinemia indices may be helpful in the diagnosis of the disease. These include:
> Low apolipoprotein B to total cholesterol ratio
> Elevated levels of triglycerides
> Elevated levels of total cholesterol8
Managing the condition
The condition cannot be cured but treatment is to control conditions such as obesity, hypothyroidism and diabetes. Most patients will go through dietary therapy to control their intake of cholesterol and saturated fat. This prevents xanthomas, high levels of lipids in the blood, exercise will also help to lower lipid levels. However, dietary changes may not be effective for some individuals and this is where drugs may be used to lower lipid levels instead.
How Randox can Help
Randox offer a range of routine and niche assays within the lipid testing panel to monitor lipid levels and to identify associated complications. Some of these tests include:
The Randox Apolipoprotein B tests utilises an immunoturbidimetric method, offers a wide measuring range and is available liquid ready-to-use for convenience and ease of use.
The Randox Total Cholesterol test utilises the CHOD-PAP method and offers an extensive measuring range with a wide range of kits available to suit a wide range of laboratory sizes.
The Randox Triglycerides test utilises the GPO-PAP method while offering an extensive measuring range with both liquid and lyophilised formats available offering choice and flexibility.
Want to know more?
Contact us or download our Cardiology and Lipid Testing brochure to learn more.
Lipid Panel Page
 Rare Disease Day. What is Rare Disease Day? Rare Disease Day. [Online] 2019. [Cited: February 21, 2019.] https://www.rarediseaseday.org/article/what-is-rare-disease-day
 Genetic Alliance UK. What is a Rare Disease? Rare Disease UK. [Online] 2018. [Cited: February 21, 2019.] https://www.raredisease.org.uk/what-is-a-rare-disease/
 NZORD. Rare Disease Facts and Figures. NZORD. [Online] 2019. [Cited: February 21, 2019.] https://www.nzord.org.nz/helpful-information/rare-disease-facts-and-figures.
 NORD. Hyperlipoproteinemia Type III. NORD. [Online] 2019. [Cited: February 21, 2019.] https://rarediseases.org/rare-diseases/hyperlipoproteinemia-type-iii/
 GARD. Hyperlipidemia Type 3. National Centre for Advanciing Translational Sciences. [Online] December 29, 2016. [Cited: February 21, 2019.] https://rarediseases.info.nih.gov/diseases/6703/hyperlipidemia-type-3
 Falck, Suzanne. Everything you need to know about hyperlipidemia. Medical News Today. [Online] December 21, 2017. [Cited: February 21, 2019.] https://www.medicalnewstoday.com/articles/295385.php
 Medline Plus. Familial Dysbetalipoproteinemia. Medline Plus. [Online] May 16, 2018. [Cited: February 21, 2019.] https://medlineplus.gov/ency/article/000402.htm.
 Dysbetalipoproteinemia: Two cases report and a diagnostic algorithm. Kei, Anastazia, et al. 4, s.l. : World Journal of Clinical Cases, 2015, Vol. 3.
Cardiovascular disease (CVD) is the number one cause of death globally and more people die annually from CVD than any other disease state. On World Heart Day 2018, Randox Reagents are committed to developing niche and superior performance assays for the early detection of CVD risk with the hope to change this statistic and improve the heart health of millions worldwide.
There are a number of influencing factors that can lead to a patient experiencing a cardiovascular event. The risk factors for this multifactorial disease include: genetic predisposition, age, gender, smoking, hypertension, stress, dietary habits and physical inactivity. Little evidence exists explaining the mechanism of the Apolipoproteins in the body and their contribution to the causes of some of these cardiac diseases.
Apolipoprotein E (Apo E) is a lipid transport and signalling protein found in the blood which is synthesized mostly by the liver. Apo E has been found to have many roles in the body including the promotion of antiatherogenic properties. Essentially the main function of Apo E is to act as a ligand to the LDL receptor. This relationship plays a critical role in metabolism by promoting cellular uptake of lipoproteins. Through this process Apo E acts as a major component of overall plasma cholesterol homeostasis which facilitates the hepatic uptake of lipoproteins by binding to their receptors. It works to stabilise the equilibrium of cholesterol in the blood by transporting the cholesterol between cells preventing platelet aggregation. Apo E deficiency can influence the plasma concentration and metabolic destination of LDL creating an increased risk of CVD.
Apolipoprotein C-III is another apolipoprotein found in the circulatory system. Its metabolic actions have been found to be actively different to ApoE. The Apo C-III has been found to prevent binding of VLDL cellular receptors resulting in the conversion of VLDL to LDL rather than promoting the clearance of the circulatory system. In addition, it specifically and directly encourages proatherogenic changes in monocytes and endothelial cells. Research has found that the plasma concentration of LDL with Apo C-III strongly predicts the incidence of recurrent cardiovascular events.
Working together to lower CVD Risk
The conflicting roles of Apo E and Apo C-III in the circulatory system has created interest amongst researchers and has raised the question ‘Could the ApoE content of LDL Cholesterol with Apo C-III reduce the proatherogenic nature of Apo C-III reducing a patient’s risk of a CVD event?’.
In fact, studies have now found that the presence of ApoE is associated with lower atherogenicity of LDL Cholesterol containing Apo C-III. The abundance ApoE relative to the abundance of LDL Cholesterol with Apo C-III is a protective factor against coronary heart disease. This relationship is further supported by the antagonistic relationship between the two apolipoproteins. The idea that Apo E may be able to effectively protect against the effects of the combination of LDL Cholesterol with Apo C-III is important to consider due to their strong links with CVD.
The Randox Apolipoprotein E and Apolipoprotein C-III reagent allows for prompt and accurate diagnosis of Apolipoprotein levels, an influencing factor in cardiovascular disease.
The Randox Apolipoprotein E reagent
The benefits of the Randox Apo E assay includ:
- Excellent working reagent stability when stored at +2 to +8 ̊C
- A wide measuring range of 1.04 -12.3 mg/dl enabling the comfortable detection of levels outside of the health range, 2.7-4.5 mg/dl
- Liquid ready-to-use reagent for convenience and ease-of-use
- Immunoturbidimetric method
The Randox Apolipoprotein C-III reagent
The key benefits of the Randox C-III assay include:
- Liquid ready-to-use reagent for convenience and ease-of-use
- Excellent Linearity of 21.7 mg/dl. The approximate normal upper limit for Apo CIII is 9.5 mg/dl therefore the Randox assay will comfortably detect elevated, potentially harmful levels of Apo C-III
- Limited interference from Bilirubin, Haemoglobin, Intralipid and Triglycerides for truly accurate results
- Applications are available detailing instrument-specific settings for a wide range of clinical chemistry analyzers
- Immunoturbidimetric method
- Apolipoprotein E in VLDL and LDL with Apolipoprotein C-III is Associated with a Lower Risk of Coronary Heart Disease. Mendivil, Carlos, et al. s.l. : Journal of the American Heart Association , 2013.