Abstract 424: Transintestinal Cholesterol Excretion Can Drive Massive Cholesterol Elimination in Mice

Abstract

High plasma cholesterol levels increase the risk of cardiovascular disease (CVD). Transintestinal Cholesterol Excretion (TICE) is a recently emerged pathway of cholesterol removal and has the potential to lower plasma cholesterol levels and confer protection against CVD. Under control conditions, TICE accounts for about 30% of fecal cholesterol loss in mice. Using a panel of knock-out and transgenic mice as well as pharmacological manipulations we show that in mice TICE is regulated by intestinal activation of the Farnesoid X Receptor (FXR), via its target Fibroblast Growth Factor 15/19 (FGF15/19). Activation of FXR by the agonist PX20606 (PX) resulted in a >10-fold increased fecal cholesterol excretion as well as TICE and 40% reduced plasma cholesterol levels. The induction of fecal cholesterol excretion and TICE was absent in PX-treated intestine-specific FXR-null mice but was regained when those mice were co-treated with FGF19. Moreover, FGF19 treatment alone was sufficient to induce fecal cholesterol loss to a similar extend as was observed in PX-treated wild-type mice. PX treatment resulted in an increased muricholate/cholate-ratio and thereby induced a more hydrophilic bile salt pool. Not surprisingly, cholesterol absorption was reduced in PX-treated mice. However, experiments in which mice were co-treated with PX and the cholesterol absorption inhibitor ezetimibe revealed that the stimulating effect of PX on fecal neutral sterol excretion and TICE were completely independent of differences in cholesterol absorption. Of note, treatment of mice with a combination of PX and ezetimibe stimulated fecal cholesterol loss and TICE so strongly that those mice lost about 60% of their entire estimated body cholesterol content each day. The stimulation of fecal cholesterol loss and TICE by PX and PX/ezetimibe treatment was severely blunted in Abcg8-KO mice and this could not be restored by hepatic reintroduction of Abcg8, indicating a decisive role for intestinal ABCG5/G8 in PX-induced fecal cholesterol loss and TICE. Our data strongly suggest that hydrophilic bile acids stimulate ABCG5/G8 activity in the intestine, leading to an increased flux of cholesterol from the body into the intestinal lumen that is subsequently excreted with the feces.