Cholesteryl Ester Storage Disease (CESD) due to novel mutations in the LIPA gene

Livia Pisciotta, Raffaele Fresa, Antonella Bellocchio, Elisabetta Pino, Virgilia Guido, Alfredo Cantafora, Maja Di Rocco, Sebastiano Calandra, Stefano Bertolini

Research output: Contribution to journalArticlepeer-review


Cholesteryl Ester Storage Disease (CESD) is a rare recessive disorder due to mutations in LIPA gene encoding the lysosomal acidic lipase (LAL). CESD patients have liver disease associated with mixed hyperlipidemia and low plasma levels of high-density lipoproteins (HDL). The aim of this study was the molecular characterization of three patients with CESD. LAL activity was measured in blood leukocytes. In two patients (twin sisters) the clinical diagnosis of CESD was made at 9 years of age, following the fortuitous discovery of elevated serum liver enzymes in apparently healthy children. They had mixed hyperlipidemia, hepatosplenomegaly, reduced LAL activity (∼5% of control) and heteroalleic mutations in LIPA gene coding sequence: (i) the common c.894 G>A mutation and (ii) a novel nonsense mutation c.652 C>T (p.R218X). The other patient was an 80 year-old female who for several years had been treated with simvastatin because of severe hyperlipidemia associated with low plasma HDL. In this patient the sequence of major candidate genes for monogenic hypercholesterolemia and hypoalphalipoproteinemia was negative. She was found to be a compound heterozygote for two LIPA gene mutations resulting in 5% LAL activity: (i) c.894 G>A and (ii) a novel complex insertion/deletion leading to a premature termination codon at position 82. These findings suggest that, in view of the variable severity of its phenotypic expression, CESD may sometimes be difficult to diagnose, but it should be considered in patients with severe type IIb hyperlipidemia associated with low HDL, mildly elevated serum liver enzymes and hepatomegaly.

Original languageEnglish
Pages (from-to)143-148
Number of pages6
JournalMolecular Genetics and Metabolism
Issue number2
Publication statusPublished - Jun 2009


  • Cholesteryl Ester Storage Disease (CESD)
  • Hepatosplenomegaly
  • Hypoalphalipoproteinemia
  • LIPA gene mutations
  • Lysosomal acid lipase (LAL) deficiency
  • Mixed hyperlipidemia

ASJC Scopus subject areas

  • Biochemistry
  • Molecular Biology
  • Genetics
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism


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