The concurrent presence of the APOE p.G145D mutation may havecontributed to the severe dyslipidemia seen here.12 The apo E isoform containing this amino acid change in the pre-genomic erawas referred to as “E1” and subsequently as “apo E-Bethesda.”14, , -17 Protein sequencing and DNAsequencing revealed that this variant had aspartic acid substituted for glycine atresidue 127.16,17 This was laterrenumbered as residue 145 to account for the apo E pro-peptide sequence. The gene discussed is APOE; the disease is metabolic syndrome.