Evaluation of plasma cholestane-3β,5α,6β-triol and 7-ketocholesterol in inherited disorders related to cholesterol metabolism

Abstract

Oxysterols are intermediates of cholesterol metabolism and are generated from cholesterol via either enzymatic or nonenzymatic pathways under oxidative stress conditions. Cholestan-3β,5α,6β-triol (C-triol) and 7-ketocholesterol (7-KC) have been proposed as new biomarkers for the diagnosis of Niemann-Pick type C (NP-C) disease, representing an alternative tool to the invasive and time-consuming method of fibroblast filipin test. To test the efficacy of plasma oxysterol determination for the diagnosis of NP-C, we systematically screened oxysterol levels in patients affected by different inherited disorders related with cholesterol metabolism, which included Niemann-Pick type B (NP-B) disease, lysosomal acid lipase (LAL) deficiency, Smith-Lemli-Opitz syndrome (SLOS), congenital familial hypercholesterolemia (FH), and sitosterolemia (SITO). As expected, NP-C patients showed significant increase of both C-triol and 7-KC. Strong increase of both oxysterols was observed in NP-B and less pronounced in LAL deficiency. In SLOS, only 7-KC was markedly increased, whereas in both FH and in SITO, oxysterol concentrations were normal. Interestingly, in NP-C alone, we observed that plasma oxysterols correlate negatively with patient's age and positively with serum total bilirubin, suggesting the potential relationship between oxysterol levels and hepatic disease status. Our results indicate that oxysterols are reliable and sensitive biomarkers of NP-C.

Keywords: Niemann-Pick type B disease; Niemann-Pick type C disease; Smith-Lemli-Opitz syndrome; acid lipase deficiency; congenital familial hypercholesterolemia; oxysterols.

Fig. 1.

Levels of C-triol and 7-KC in patients affected by NP-C (P < 0.0001), NP-B (P < 0.0001), and LAL deficiency (P < 0.001). C-triol in SLOS patients was normal (P > 0.05), whereas 7-KC was increased compared with control values (P < 0.0001). Levels of C-triol and 7-KC in patients affected by FH and SITO were normal (P > 0.05).

Fig. 2.

Correlations between plasma oxysterols and age (years) in NP-C patients and in aged-matched healthy controls.

Fig. 3.

Oxysterols correlate with t-bil in NP-C patients: subsequent samples at onset from patient 2 (A) and from patient 3 (B); age at blood sampling is expressed as years.