Familial Hypercholesterolemia via the LDLRAP1 Gene

Summary and Pricing

Test Method

Exome Sequencing with CNV Detection
Test Code Test Copy GenesTest CPT Code Gene CPT Codes Copy CPT Codes Base Price
10699 LDLRAP1 81479 81479,81479 $890 Order Options and Pricing
Test Code Test Copy Genes Test CPT Code Gene CPT Codes Copy CPT Code Base Price
10699LDLRAP181479 81479 $890 Order Options and Pricing

Pricing Comments

Our favored testing approach is exome based NextGen sequencing with CNV analysis. This will allow cost effective reflexing to PGxome or other exome based tests. However, if full gene Sanger sequencing is desired for STAT turnaround time, insurance, or other reasons, please see link below for Test Code, pricing, and turnaround time information.

An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.

For Reflex to PGxome pricing click here.

The Sanger Sequencing method for this test is NY State approved.

For Sanger Sequencing click here.

Turnaround Time

18 days on average for standard orders or 14 days on average for STAT orders.

Once a specimen has started the testing process in our lab, the most accurate prediction of TAT will be displayed in the myPrevent portal as an Estimated Report Date (ERD) range. We calculate the ERD for each specimen as testing progresses; therefore the ERD range may differ from our published average TAT. View more about turnaround times here.

Targeted Testing

For ordering sequencing of targeted known variants, go to our Targeted Variants page.

EMAIL CONTACTS

Genetic Counselors

Geneticist

Clinical Features and Genetics

Clinical Features

Familial Hypercholesterolemia (FH) is characterized by elevated serum levels of total cholesterol, in particular, elevated levels of low density lipoprotein (LDL) cholesterol (LDL-C) (>160 mg/dL in persons under 20 years of age, and >190 mg/dL in adults over 20 years of age, Hopkins et al. 2011. PubMed ID: 21600530). Accumulation of LDL-C can cause early onset atherosclerosis and Coronary Heart Disease (CHD). FH is a genetic cause of premature CHD and is one of the most common diseases of lipid metabolism. By age 50, approximately 45% of male and 20% of female FH patients suffer from coronary artery disease, a causative factor for CHD (Goldstein et al. 2001).

The prevalence of heterozygous FH (autosomal dominant FH) is between 1:300 and 1:500 in most countries and is much higher within certain populations, for example, 1:67 in Ashkenazi Jews (Goldstein et al. 1973. PubMed ID: 4718953; Vuorio et al. 1997. PubMed ID: 9409302; Slack. 1979; Kalina et al. 2001. PubMed ID: 11137107; Austin et al. 2004. PubMed ID: 15321837). There are as many as 34 million people with FH worldwide, yet FH remains severely underdiagnosed with some studies suggesting <1% of possible FH patients have been identified in many countries (Sjouke et al. 2015. PubMed ID: 24585268; Nordestgaard et al. 2013. PubMed ID: 23956253). Other symptoms of FH include fatty skin deposits called xanthomas, cholesterol deposits in the eyelids, and chest pains associated with coronary artery disease. FH is present from birth and confers a lifelong risk of atherosclerosis and CHD. Overall, patients with FH respond well to drug treatment making early, accurate diagnosis key factors for reducing risk of atherosclerosis and CHD.

Genetics

Several genes are reported to be associated with FH, however ~86% of patients are found to harbor pathogenic variants in either LDLR, APOB, PCSK9, which are associated with autosomal dominant FH, or in LDLRAP1 which is associated with autosomal recessive hypercholesterolemia (ARH). Patients with biallelic variants in LDLR, APOB, or PCSK9, known as homozygous FH (HoFH), are rare and generally have a severe phenotype with a very high risk of early onset CHD.

LDLRAP1 encodes an adaptor protein required for LDL uptake in the liver and lymphocytes (Wilund et al. 2002. PubMed ID: 12417523; Garcia et al. 2001. PubMed ID: 11326085). Patients with ARH have decreased LDL uptake in the liver in the presence of apparently normal or only slightly reduced LDLR activity (Zuliani et al. 1995. PubMed ID: 7628519). LDLRAP1 carriers were reported at a frequency of 1:143 in the Sardinian population (Filigheddu et al. 2009. PubMed ID: 19477448), but are likely not as frequent in other populations; e.g. the prevalence of LDLRAP1-associated FH in Spain is only about 1 in 6.5 million (Sanchez-Hernandez et al. 2018. Pubmed ID: 29245109). Causative variants in LDLRAP1 include primarily loss of function variants such as splice site variants, small insertions or deletions resulting in frameshifts, and gross deletions involving one or more exons of the LDLRAP1 protein (Human Gene Mutation Database). Missense variants have also been reported in ARH patients. There is also some evidence to suggest that patients who harbor pathogenic variants in two FH genes, e.g. the LDLR and LDLRAP1 genes, may have a more severe form of FH or additional clinical characteristics that may not be present in patients that harbor a pathogenic variant in only one FH gene (Tada et al. 2011. PubMed ID: 21872251; Alnouri et al. 2018. PubMed ID: 30270081).

Clinical Sensitivity - Sequencing with CNV PGxome

Pathogenic variants in LDLR are the most frequent cause of heterozygous Familial Hypercholesterolemia (FH) followed by variants in APOB, PCSK9, and LDLRAP1. The exact proportion of pathogenic variants within these genes varies among populations, but data from several studies indicate the contribution of LDLR, APOB, and PCSK9 pathogenic variants to FH cases ranges from 37-97%, 0-7%, and 0-3%, respectively (Varret et al. 2008. PubMed ID: 18028451; Tosi et al. 2007. PubMed ID: 17094996; Bertolini et al. 2013. PubMed ID: 23375686). The frequency of LDLRAP1/ARH pathogenic variants in recessive FH is unclear, but the carrier frequency has been reported to be as high as 1:143 in the Sardinian population (Filigheddu et al. 2009. PubMed ID: 19477448), whereas the prevalence of LDLRAP1-related FH in Spain is only about 1 in 6.5 million (Sanchez-Hernandez et al. 2018. Pubmed ID: 29245109).

Large deletions or insertions in either the LDLR or LDLRAP1 genes are reported regularly in FH patients (Human Gene Mutation Database). Few large deletions or insertions in the APOB and PCSK9 genes have been reported.

Testing Strategy

This test provides full coverage of all coding exons of the LDLRAP1 gene plus 10 bases of flanking noncoding DNA in all available transcripts along with other non-coding regions in which pathogenic variants have been identified at PreventionGenetics or reported elsewhere. We define full coverage as >20X NGS reads or Sanger sequencing.

Since this test is performed using exome capture probes, a reflex to any of our exome based tests is available (PGxome, PGxome Custom Panels).

Indications for Test

Patients with high levels of LDL, and/or a strong family history of hypercholesterolemia or coronary heart disease. Patients with xanthomas, or angina. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in LDLRAP1.

Gene

Official Gene Symbol OMIM ID
LDLRAP1 605747
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT

Disease

Name Inheritance OMIM ID
Hypercholesterolemia, Autosomal Recessive AR 603813

Citations

  • Alnouri et al. 2018. PubMed ID: 30270081
  • Austin et al. 2004. PubMed ID: 15321837
  • Bertolini et al. 2013. PubMed ID: 23375686
  • Filigheddu et al. 2009. PubMed ID: 19477448
  • Garcia et al. 2001. PubMed ID: 11326085
  • Goldstein et al. 1973. PubMed ID: 4718953
  • Goldstein et al. 2001. In: The Metabolic and Molecular Basis of Inherited Disease - 8th edition (edited by C.R. Scriver et al.) New York: McGraw-Hill. 
  • Hopkins et al. 2011. PubMed ID: 21600530
  • Human Gene Mutation Database (Bio-base).
  • Kalina et al. 2001. PubMed ID: 11137107
  • Nordestgaard et al. 2013. PubMed ID: 23956253
  • Sanchez-Hernandez et al. 2018. PubMed ID: 29245109
  • Sjouke et al. 2015. PubMed ID: 24585268
  • Slack. 1979. Atherosclerosis Reviews. 5: 35-66.
  • Tada et al. 2011. PubMed ID: 21872251
  • Tosi et al. 2007. PubMed ID: 17094996
  • Varret et al. 2008. PubMed ID: 18028451
  • Vuorio et al. 1997. PubMed ID: 9409302
  • Wilund et al. 2002. PubMed ID: 12417523
  • Zuliani et al. 1995. PubMed ID: 7628519

Ordering/Specimens

Ordering Options

We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.

myPrevent - Online Ordering

  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.

Requisition Form

  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.

For Requisition Forms, visit our Forms page


Specimen Types

Specimen Requirements and Shipping Details

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ORDER OPTIONS

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2) Select Additional Test Options

STAT and Prenatal Test Options are not available with Patient Plus.

No Additional Test Options are available for this test.

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