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The mechanism of severe hyperlipidemia in a 54-year-old woman with multiple myeloma and monoclonal immunoglobulin A (IgA) gammopathy was investigated. Her plasma total cholesterol and triglyceride concentrations were 29.7 mmol/l (1,150 mg/dl) and 11.9 mmol/l (1,060 mg/dl), respectively. Western blot analysis demonstrated that her low density lipoproteins (LDL) contained IgA. This IgA also was shown to bind to control LDL and inhibited 125I-LDL binding to fibroblasts, suggesting that by binding to the LDL, IgA interfered with LDL binding to LDL receptors. These findings indicate that an inhibitory monoclonal IgA against LDL binding may explain, at least in part, the severe hyperlipidemia observed in this case.

internal medicine

Autoimmune Hyperlipidemia with Inhibitory Monoclonal Antibodies against Low Density Lipoprotein Binding to Fibroblasts in a Case with Multiple Myeloma.