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Background
Apolipoprotein A-I or Apo-A1 is a functional and structural protein. It constitutes 70% of the HDL protein. This protein is produced in the intestines and liver. In peripheral tissues, it activates the LCAT (lecithin-cholesterol acyltransferase). It transfers the free cholesterol to the cholesterol ester. For the degradation, it facilitates the transportation to liver.
Indications/Applications
It is unclear to use Apo-A1 as an independent indicator for cardiovascular disease. It is helpful to measure Apo-A1 with Apo-B to determine the Apo-B/Apo-A1 ratio.
A high ratio indicates a high risk of cholesterol buildup in the arteries. It leads to atherosclerosis and cardiovascular disease.
As per the study of Xiao et al., the ratio of Apo-B/Apo-A1 is significantly associated with the abdominal aortic aneurysm (AAA) compared to the coronary heart disease (CHD). Apo-A1 has been found more protective to the AAA disease than the CHD.
As per the study of Henson et al., patients who have coronary artery disease, decreased level of immune complex Aop-A1 and IgG are distinct cause for adverse cardiovascular disease. So, as per the researchers, immune complex may be used as a potential biomarker to determine the progression of cardiovascular disease.
Apo-A1 is the blood biomarker which is used in the fibroTest. This test is a non-invasive test of the liver that has been validated for many liver diseases like hepatitis B, hepatitis C, Alcoholic liver disease, and non-alcoholic fatty liver disease.
Clinical Significance:
Serum apo-A1 test is not suggested as a routine test for cardiovascular disorder risk assessment.
Apo-A1 has a naturally existing mutant known as Apo-A1 Milano. It is linked to a very low HDL level but long lifespan and less atherosclerosis than predicated HDL-C level.
A mutation in Apo-A1 gene can lead to deficiency in HDL and systemic non-neuropathic amyloidosis.
Reference Range
The normal level of Apo-A1 in adult:
Men: 75 to 160 mg/dL
Women: 80 to 175 mg/dL
The normal level of Apo-A1 in newborns:
Men: 41 to 93 mg/dL
Women: 38 to 106 mg/dL
The normal level of Apo-A1 in men whose age is between 6 months to 4 years: 67 to 167 mg/dL
The normal level of Apo-A1 in women whose age is between 6 months to 4 years: 60 to 148 mg/dL
The normal level of Apo-A1 in children whose age is 5 to 17 years: 83 to 151 mg/dL
Interpretation
Low level of Apo- A1 leads to the high risk of cardiovascular disease and, importantly in, the increased level of Apo-B.
Conditions which are associated with the decreased level of Apo-A1 are like:
Chronic kidney disease
Chronic liver disease
Smoking
High level of triglyceride
Obesity
Familial hypoalphalipoproteinaemia or Tangier disease
Uncontrolled diabetes
Coronary artery disease
Conditions which are associated with the increased level of Apo-A1 are like:
Alcohol use
Pregnancy
Familial hyperalphalipoproteinaemia
Summer and spring seasons
cholesteryl ester transfer protein deficiency (CETP)
Collection And Panels
Sample type: Serum
Sample collection container: Lavender top (EDTA)
Unacceptable samples: Hemolyzed samples
Sample preparation: Serum is separated from the blood within 2 hours or as soon as possible after the blood collection. Seum is transfer in to 1 ml serum separator tube.
Storage or transport instructions: Refrigerated samples
Samples stability: Samples can be stored for 8 days in unfrozen condition and 3 months in frozen condition.
Considerations: Overnight fasting is not required but many laboratory still suggest for 12 to 14 hours of overnight fasting.
Panels: This test is not part of any panels or not included any other test.
Modifying factors: Some medications like androgens, diuretics, beta-blockers, progestins, and androgens may decrease the level of Apo-A1. Some medications like carbamazepine, phenytoin, estrogens, fibrates, lovastatin, ethanol, niacin, phenobarbital, oral contraceptives, simvastatin, and pravastatin may increase the level of Apo-A1.
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