Flow cytometry with a monoclonal antibody to the low density lipoprotein receptor compared with gene mutation detection in diagnosis of heterozygous familial hypercholesterolemia

¹ Department of Internal Medicine and Cardiology, Aarhus Amtssygehus University Hospital, DK-8000 Aarhus C, Denmark.

² Department of Cardiology, Skejby Sygehus University Hospital, DK-8200 Aarhus N, Denmark.
^a Address correspondence to this author at: Department of Internal Medicine and Cardiology, Aarhus Amtssygehus University Hospital, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark. Fax 45 89 49 76 19; e-mail rau{at}dadLnet.dk.

We used a fluorescence flow cytometry assay with a monoclonal low density lipoprotein (LDL) receptor-specific antibody to detect LDL receptor expression on blood T lymphocytes and monocytes. We prepared peripheral blood mononuclear cells from patients with genetically verified LDL receptor-defective (Trp⁶⁶-Gly mutation, n = 17) or receptor-negative (Trp²³-stop mutation, n = 17) heterozygous familial hypercholesterolemia (FH) and from healthy individuals (n = 24). The cells were stimulated to express the maximum amount of LDL receptor by preincubation in lipoprotein-deficient medium. A dual-labeling technique allowed flow cytometric analysis of LDL receptor expression on cells identified by fluorescently conjugated surface marker antibodies. Knowing the LDL receptor gene mutation of the FH patients allowed us to compare the diagnostic capability of this functional assay with the DNA diagnosis and to validate the assay with molecular genetics instead of clinical indices of heterozygous FH. T lymphocytes expressed more LDL receptors and gave better diagnostic results than monocytes, and cells from patients with either the Trp⁶⁶-Gly or the Trp²³-stop mutation had variable but significantly reduced LDL receptor expression. The data indicate that this fluorescence flow cytometry assay is unsuitable for diagnosis of individual cases of heterozygous FH but that it may be useful for functionally characterizing mutations in the LDL receptor gene.

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