A Rare Loss-of-Function Variant in Scavenger Receptor Class B Type I (SCARB1) Raises HDL Cholesterol and Increases Risk of Coronary Disease

Scavenger receptor BI (SR-BI) is the major receptor for high-density lipoprotein (HDL)<br/>cholesterol (HDL-C). In humans, high amounts of HDL-C in plasma are associated with a<br/>lower risk of coronary heart disease (CHD). Mice that have depleted Scarb1 (SR-BI<br/>knockout mice) have markedly elevated HDL-C levels but, paradoxically, increased<br/>atherosclerosis. The impact of SR-BI on HDL metabolism and CHD risk in humans remains<br/>unclear. Through targeted sequencing of coding regions of lipid-modifying genes in 328<br/>individuals with extremely high plasma HDL-C levels, we identified a homozygote for a lossof-function<br/>variant, in which leucine replaces proline 376 (P376L), in SCARB1, the gene<br/>encoding SR-BI. The P376L variant impairs posttranslational processing of SR-BI and<br/>abrogates selective HDL cholesterol uptake in transfected cells, in hepatocyte-like cells<br/>derived from induced pluripotent stem cells from the homozygous subject, and in mice.<br/>Large population-based studies revealed that subjects who are heterozygous carriers of<br/>the P376L variant have significantly increased levels of plasma HDL-C. P376L carriers have<br/>a profound HDL-related phenotype and an increased risk of CHD (odds ratio = 1.79, which is<br/>statistically significant).