New methods for rapid detection of low-density lipoprotein receptor and apolipoprotein B gene mutations causing familial hypercholesterolemia

Due to a genetic founder effect, five mutations in the low-density lipoprotein receptor gene account for approximately 83% of familial hypercholesterolemia (FH) diagnosed in French-Canadians. The most frequent mutation, present in 61% of heterozygotes, is a > 10 kb deletion of the 5′ region of the gene that removes the promoter and the first exon, resulting in a null allele. Other less prevalent mutations include a gene deletion of approximately 5 kb, which removes exons 2 and 3 (2% of cases) and three missense mutations: Trp 66 → Gly (exon 3) (12%), Glu 207 → Lys (exon 4) (3%), and Cys 646 → Tyr (exon 14) (6%). The apoB Arg 3500 → Gln mutation was absent in 228 French-Canadians with the FH phenotype. Taking adbantage of the availability of fluorescent DNA detection, we have substantially improved the assays for these mutations.