Identification of Novel and Known LDLR Variants Triggering Severe Familial Hypercholesterolemia in Saudi Families

Fahad Alnouri, Faisal A Al-Allaf, Mohammad Athar, Khalid Al-Rasadi, Dalal Alammari, Menwar Alanazi, Zainularifeen Abduljaleel, Zuhier Awan, Abdellatif Bouazzaoui, Ghida Dairi, Wafa M Elbjeirami, Hussam Karra, Abdulhalim J Kinsara, Mohiuddin M Taher

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


BACKGROUND: Familial hypercholesterolemia (FH) is a common illness mainly caused by variants occurring in the low-density lipoprotein receptor (LDLR) gene. FH is a leading cause of coronary artery disease. OBJECTIVE: This study aims to determine genetic defect(s) in homozygous and heterozygous FH index patients and their first-degree blood relatives and understand the genotype-phenotype correlation. METHODS: This study employed the genetic screening of FH-related genes by next-generation sequencing and cascade screening by capillary sequencing. RESULTS: We identified the presence of a novel frameshift variant [c.335_336insCGAG, p.(F114Rfs*17)] and three known missense variants [c.622G>A, p.(E208K)], [c.1474G>A, p.(D492N)], [c.1429G>A, p.(D477N)] in the LDLR gene of four unrelated Saudi families with FH. In proband 1, a nonsense variant c.1421C>G, p.(S474*) was also detected at exon 9 of the lipoprotein lipase gene. The segregation arrangement of the identified variants corresponded with the clinical characteristics. In this study, all the detected variants were confined in the ligand-binding domain and epidermal growth factor (EGF)-precursor homology domain of the LDLR protein, which portrayed severe clinical phenotypes of FH. Moreover, these LDLR variants were in a highly conserved residue of the proteins. CONCLUSION: In addition to the finding of the novel variant in the LDLR gene that extends the spectrum of variants causing FH, the results of this study also support the need for diagnostic screening and cascade genetic testing of this high-risk condition and to understand the genotype-phenotype correlation, which could lead to better prevention of coronary artery disease.

Original languageEnglish
Pages (from-to)361-369
Number of pages9
JournalCurrent Vascular Pharmacology
Issue number4
Early online dateMar 4 2022
Publication statusPublished - Jul 1 2022


  • coronary artery disease
  • low-density lipoprotein receptor
  • next-generation sequencing
  • variant
  • cholesterol
  • Familial hypercholesterolemia
  • Hyperlipoproteinemia Type II/diagnosis
  • Humans
  • Saudi Arabia/epidemiology
  • Coronary Artery Disease/diagnosis
  • Homozygote
  • Phenotype
  • Mutation
  • Receptors, LDL/genetics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology


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