Autoimmune hyperlipidemia in a patient

Lewis, Lena A.; deWolfe, Victor G.; Butkus, Antanas; Page, Irvine H.

doi:10.1016/0002-9343(75)90355-1

Cited by 20 publications

(4 citation statements)

References 21 publications

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“…Numerous studies have demonstrated that Ig can interact with apoproteins and lipoproteins (4)(5)(6)(12)(13)(14). In a few instances these interactions have been shown to alter the metabolism of lipoproteins.…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous xanthoma occurring in association with paraproteinemia is a well-documented clinical abnormality that is seen in patients with multiple myeloma, benign monoclonal gammapathies, and other reticular endothelial disorders (1)(2)(3)(4)(5)(6). In many of these individuals the occurrence of xanthoma is associated with hyperlipidemia, but it should be recognized that cutaneous xanthoma in association with paraproteinemia can be observed in individuals whose plasma lipid levels are within the normal range (1,3,5,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…It is more likely, however, that the majority of cases of hyperlipidemia that occur in association with paraproteinemia are secondary to the direct interaction of Ig with lipoproteins. Several studies have shown that Ig obtained from patients with reticular endothelial disorders interact with lipoproteins (4)(5)(6)(12)(13)(14). Furthermore, such interactions can result in alterations in lipoprotein metabolism.…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous xanthoma in association with paraproteinemia in the absence of hyperlipidemia.

Feingold¹,

Castro²,

Ishikawa³

et al. 1989

J. Clin. Invest.

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In the present report we describe a patient with multiple myeloma and long-standing paraproteinemia who developed xanthoma in the absence of an elevation in plasma cholesterol or triglyceride concentrations. Studies demonstrated that our patient's monoclonal IgG antibody interacted with apoprotein B-100. The LDL-antibody complex isolated from our patient did not affect the degradation of LDL by human fibroblasts, indicating that while IgG derived from our patient interacted with LDL it did not alter the metabolism of this lipoprotein by the LDL receptor pathway. Since the LDL receptor pathway is the major route of LDL metabolism, this probably explains why our patient was not hyperlipidemic. In contrast to an absence of effect on the LDL receptor, our patient's LDL-antibody complex stimulated cholesterol esterification within macrophages indicating the uptake and degradation of the LDLantibody complex. The LOL-antibody complex inhibited the degradation of acetyl LDL by macrophages (scavenger pathway), demonstrating that our patient's LDL-antibody complex was recognized as a modified LDL. Moreover, mixing Ig from our patient with normal LDL also resulted in the normal LDL increasing the esterification of cholesterol by macrophages.One can hypothesize that our patient's monoclonal IgG-LDL complex interacted with the macrophage scavenger receptor, thereby resulting in the occurrence of xanthoma in the absence of hyperlipidemia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cutaneous xanthoma in association with paraproteinemia in the absence of hyperlipidemia.

Feingold¹,

Castro²,

Ishikawa³

et al. 1989

J. Clin. Invest.

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“…Even though the unusual lipid patterns, occasionally manifesting as a grossly lipemic and highly viscous serum were studied extensively in some cases, the underlying mechanism of HLM remains unknown. According to one hypothesis, the paraprotein binds to lipoproteins and, thereby, inhibits their degradation [2,4,6,13,37,63]. This view has been challenged, and evidence for an affinity of the paraprotein to heparin or the low-density lipoprotein (LDL) receptor was provided, leaving the matter open for debate [12,13,52,66].…”

Section: Introductionmentioning

confidence: 99%

Hyperlipidemic myeloma: review of 53 cases

et al. 2009

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Hyperlipidemic myeloma is a rare and poorly understood variant of multiple myeloma. We report the case of a 53-year-old woman with hyperlipidemic myeloma, skin xanthomas and hyperviscosity syndrome who underwent allogeneic bone marrow transplantation. A comprehensive literature search identified 52 additional cases with plasma cell disease and hyperlipidemia. A detailed analysis revealed several characteristics of these patients as compared to multiple myeloma with normal lipid status: (1) IgA paraprotein was present in the majority (53% vs. 21% in classical multiple myeloma). (2) Skin xanthomas, especially in the palmar creases, elbows, and knees were common (70%). (3) Hyperviscosity syndrome occurred more often (26% vs. 2-6%). While conventional lipid-lowering therapy had only marginal effects, successful anti-myeloma therapy also reduced hyperlipidemia. Analyses of the mechanisms leading to hyperlipidemia documented complexes of paraprotein and lipoprotein in 75% of the 32 cases tested, suggesting an inhibitory role of the paraprotein on lipid degradation. In conclusion, the clinical characteristics, the therapeutic options, and the pathophysiologic mechanisms of hyperlipidemic myeloma are comprehensively reported using the available data from all 53 published cases in the literature.

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