eMedicine Specialties > Endocrinology > Metabolic Disorders

Lecithin-Cholesterol Acyltransferase Deficiency: Treatment & Medication

Author: Vasudevan A Raghavan, MBBS, MD, MRCP, Assistant Professor, Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, Ohio State University
Coauthor(s): Weerapan Khovidhunkit, MD, PhD, Clinical Instructor, Department of Medicine, Division of Endocrinology and Metabolism, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thailand
Contributor Information and Disclosures

Updated: Sep 18, 2007

Treatment

Medical Care

Symptomatic treatment for anemia, renal insufficiency, and atherosclerosis is indicated.

  • LCAT gene therapy or liver transplantation theoretically would be a treatment of choice to correct the underlying pathophysiology, but neither procedure has been reported.
  • Short-term whole blood or plasma transfusion has been tried to replace the LCAT enzyme in some patients with familial LCAT deficiency, but it did not correct anemia, proteinuria, or lipoprotein abnormalities.
  • Renal replacement by dialysis is necessary in those individuals who develop kidney failure.

Surgical Care

  • Kidney transplantation is indicated in patients with familial LCAT deficiency and renal failure.
  • Corneal transplantation is indicated in patients with corneal opacities with severely reduced vision.

Consultations

  • Endocrinologist: Consultation should allow accurate diagnosis and dietary therapy to improve the abnormal lipid findings of hypertriglyceridemia and low HDL.
  • Ophthalmologist: Schedule follow-up to monitor visual acuity, the presence of papilledema, and the need for interventions such as corneal transplantation.
  • Nephrologist: Consultation is useful in the staging and replacement of kidney function if the kidneys become compromised by LCAT deficiency.

Diet

Restriction of fat intake may be advisable in patients with familial LCAT deficiency, but no evidence supports its potential benefits.

Activity

Because of the small but measurable risk of atherosclerosis in persons with LCAT deficiency, exercise, under the guidance of a physician, theoretically would have a role in prevention of this complication.

Medication

Because of the rarity of LCAT deficiency, pharmacologic therapy has not been specifically studied in a systematic fashion.

More on Lecithin-Cholesterol Acyltransferase Deficiency

Overview: Lecithin-Cholesterol Acyltransferase Deficiency
Differential Diagnoses & Workup: Lecithin-Cholesterol Acyltransferase Deficiency
Treatment & Medication: Lecithin-Cholesterol Acyltransferase Deficiency
Follow-up: Lecithin-Cholesterol Acyltransferase Deficiency
References
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References

  1. Bérard AM, Clerc M, Brewer B, Santamarina-Fojo S. A normal rate of cellular cholesterol removal can be mediated by plasma from a patient with familial lecithin-cholesterol acyltransferase (LCAT) deficiency. Clin Chim Acta. Dec 2001;314(1-2):131-9. [Medline].

  2. Elkhalil L, Majd Z, Bakir R, et al. Fish-eye disease: structural and in vivo metabolic abnormalities of high-density lipoproteins. Metabolism. May 1997;46(5):474-83. [Medline].

  3. Hirano K, Kachi S, Ushida C, Naito M. Corneal and macular manifestations in a case of deficient lecithin: cholesterol acyltransferase. Jpn J Ophthalmol. Jan-Feb 2004;48(1):82-4. [Medline].

  4. Kuivenhoven JA, Pritchard H, Hill J, et al. The molecular pathology of lecithin:cholesterol acyltransferase (LCAT) deficiency syndromes. J Lipid Res. Feb 1997;38(2):191-205. [Medline].

  5. Mertens A, Verhamme P, Bielicki JK, et al. Increased low-density lipoprotein oxidation and impaired high-density lipoprotein antioxidant defense are associated with increased macrophage homing and atherosclerosis in dyslipidemic obese mice: LCAT gene transfer decreases atherosclerosis. Circulation. Apr 1 2003;107(12):1640-6. [Medline].

  6. Pritchard PH, Hill JS. Genetic disorders of lecithin:cholesterol acyltransferase. In: Betterridge J, Illingworth R, Sheperd J, eds. Lipoproteins in Health and Disease. 799-814. ed. London, England: Hodder and Stoughton; 1999:799-814.

  7. Santamarina-Fojo S, Hoef J, Assmann G. Lecithin: cholesterol acyltransferase deficiency and fish-eye disease. In: Wonsiewicz M, Noujaim S, Boyle P, eds. The Metabolic and Molecular Bases of Inherited Disease. 8th ed. New York, NY: McGraw-Hill; 2001:2817-33.

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Further Reading

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Keywords

LCAT deficiency, familial lecithin-cholesterol acyltransferase deficiency, familial LCAT deficiency, cholesterol acyltransferase deficiency, fish-eye disease, fish eye disease, high-density lipoprotein, HDL, low-density lipoprotein, LDL, atherosclerosis, renal failure, kidney failure, corneal opacities, visual impairment, hypoalphalipoproteinemia, opaque cornea, corneal opacity, progressive corneal opacification

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Contributor Information and Disclosures

Author

Vasudevan A Raghavan, MBBS, MD, MRCP, Assistant Professor, Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, Ohio State University
Vasudevan A Raghavan, MBBS, MD, MRCP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, Endocrine Society, National Lipid Association, and Royal College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Weerapan Khovidhunkit, MD, PhD, Clinical Instructor, Department of Medicine, Division of Endocrinology and Metabolism, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thailand
Weerapan Khovidhunkit, MD, PhD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

David M Klachko, MBBCh, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri
David M Klachko, MBBCh is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kent Wehmeier, MD, Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine
Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MD, Head, Vascular Division, Baker Medical Research Institute; Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, Director of General Internal Medicine, St Louis University
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

 
 
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