Hepatic LDL Receptor Expression Research Articles

Abstract 123: Reciprocal Regulation of Plasma PCSK9 and Cell-surface Low-density Lipoprotein Receptor

Proprotein convertase subtilisin/kexin type 9 (PCSK9) modulates low-density lipoprotein (LDL) receptor (LDLR) degradation, thus influencing serum cholesterol levels. On the other hand, LDLR binds to and clears PCSK9 from the circulation, thus modulating its serum levels. To study the global and reciprocal effects of PCSK9 and LDLR on serum cholesterol, we developed transgenic mice expressing human (h) PCSK9 and characterized its activity, serum levels, and tissue distribution. Serum hPCSK9 concentration in transgenic mice was 2181±423 ng/ml, about 10 times higher than normal level in human serum. Although hPCSK9 was expressed mainly in the kidney, LDLR degradation activity was most evident in the liver and small intestine. In contrast, LDLR levels were not affected by hPCSK9 expression in the adrenals and large intestine. On a chow diet, hPCSK9 transgenic mice on either C57BL/6 (wild-type, WT) or LDLR -/- background had higher cholesterol levels than their non-transgenic counterparts. Human PCSK9 transgenic mice had over a 4-fold increase in murine (m) PCSK9 serum levels compared to WT controls. However, transgenic expression of hPCSK9 in LDLR -/- mice did not affect the already elevated levels of mPCSK9. On the other hand, induction of hLDLR expression in transgenic mice caused a dramatic decrease in mPCSK9 levels. In addition hPCSK9 levels were increased by 2 fold in transgenic mice under LDLR -/- compare to WT background. Turnover studies with native PCSK9 showed rapid serum clearance in WT mice (half-life 5.2 min), whereas clearance was much slower in LDLR -/- recipient mice (50.5 min), and faster in hLDLR transgenic mice (2.9 min). In WT mice the injected PCSK9 accumulated in the liver and kidney but not in the adrenal gland. Ultracentrifugation and FLPC analysis showed that approximately one quarter of circulating hPCSK9 is associated with LDL, and that the LDL-associated PCSK9 is mainly in monomeric form. Our results show a reciprocal regulation between LDLR and PCSK9, which determines serum PCSK9 levels, hepatic LDLR expression, and serum LDL levels. Understanding these interactions will increase our knowledge of serum cholesterol homeostasis and should provide the basis for an intelligent design of anti-PCSK9 therapies.

Abstract 61: LXR Agonist Treatment of Nonhuman Primates Increases LDL Cholesterol due to Decreased Hepatic LDL Receptor Expression

Reverse cholesterol transport (RCT) is a process whereby cholesterol from foam cells in atherosclerotic plaques is removed by HDL, transported to the liver, secreted into bile, and excreted in the feces. Treatment of mice with LXR agonist can significantly increase RCT and inhibit atherosclerosis. Therefore, it would be anticipated that LXR agonists would also increase RCT and be anti-atherogenic in humans. However, cynomolgus monkeys treated with the LXR agonist GW3965 had significant increases in LDLc, which could be due to elevated hepatic expression of the inducible degrader of the LDL receptor (IDOL). IDOL is an E3 ubiquitin ligase that promotes the ubiquitination of the LDL receptor (LDLR) on its cytoplasmic domain, thereby targeting it for degradation. We recently discovered that GW3965 treatment of mice caused an ~3-fold increase in IDOL expression in the small intestine and consequently increased the turnover of the LDLR. In livers of GW3965 treated mice, LDLR protein was unchanged and IDOL expression was only increased by ~20%. However, treatment of human hepatoma cells with GW3965 increased IDOL 7-fold resulting in very low levels of LDLR protein expression. Therefore, we hypothesized that in humans and nonhuman primates, LXR agonist treatment would increase LDLc by inducing IDOL-dependent degradation of hepatic LDLR. After treating cynomolgus monkeys with GW3965 for 7 days, we found that HDLc was increased by ~20% while LDLc was increased by ~100%. The increase in LDLc was accompanied by a dramatic increase in plasma apoB100 and apoE concentration and a significant decrease in hepatic LDLR protein. We are currently determining the potential role of hepatic IDOL expression on these effects. We also found that unlike mice, monkeys treated with GW3965 did not display an increase in hepatic lipids, biliary cholesterol, and fecal neutral sterol excretion. These findings show that LXR activation has very different effects on lipoprotein metabolism and RCT in monkeys compared to mice. Our data suggest that LXR agonists are likely to exert both pro- and anti-atherosclerotic effects in primates and that these complex effects must be considered in the development of LXR agonists as drugs.

HYPOCHOLESTEROLEMIC EFFECT OF DIETARY APPLE POLYPHENOL IS ASSOCIATED WITH ALTERATIONS IN HEPATIC GENE EXPRESSION RELATED TO CHOLESTEROL METABOLISM IN RATS

Apple polyphenol (AP) mainly consists of procyanidins and has been reported to improve blood cholesterol levels and promote excretion of cholesterol in rats fed high-cholesterol diets. To understand the molecular mechanisms underlying the effects of AP, we investigated whether dietary AP changed the hepatic expression of genes related to cholesterol metabolism and steroid transport. Four-week-old male Sprague-Dawley rats were pair-fed with diets containing 0.5% cholesterol together with 0% (control), 0.2%, and 0.5% AP, respectively, for 30 days. Administration of 0.5% AP was found to improve serum total cholesterol levels (0.69fold vs. control, p < 0.05), and increase hepatic LDL receptor (LDLR) mRNA (1.59-fold vs. control, p < 0.0001). There was a negative correlation between serum non-HDL cholesterol and LDLR mRNA (p < 0.001). Administration of 0.5% AP increased excretion of primary bile acids (2.96-fold vs. control, p < 0.0001) and up-regulated the expression of steroid catabolism genes such as sterol 12αhydroxylase (CYP8B1). However, improvements in cholesterol levels were not associated with the hepatic expression of cholesterol 7α-hydroxylase (CYP7A1), the rate-limiting enzyme in bile acid biosynthesis. Expression of farnesoid X receptor (FXR), which is involved in the regulation of bile acid biosynthesis, was up-regulated by 0.5% AP (1.56-fold vs. control, p < 0.01), and FXR mRNA levels correlated positively with bile acid excretion (p < 0.01). These results show that dietary AP improved blood cholesterol levels with adequate intake of LDL from blood by increasing hepatic LDLR expression and promoting production of bile acid with an upregulation of genes related to steroid catabolism. KeywordsApple Polyphenol; Procyanidin; Cholesterol Metabolism; LDL Receptor

Effects of citrus flavonoids, 5-hydroxy-3,6,7,8,3′,4′-hexamethoxyflavone and 3,5,6,7,8,3′,4′-heptamethoxyflavone, on the activities of macrophage scavenger receptors and the hepatic LDL receptor

Epidemiological and animal studies point to a possible protective effect of citrus flavonoids against cardiovascular diseases. The aim of this study is to investigate the effects of citrus flavonoids, 5-hydroxy-3,6,7,8,3',4'-hexamethoxyflavone (5-OH-HxMF) and 3,5,6,7,8,3',4'-heptamethoxyflavone (HpMF), on the activities and expressions of macrophage scavenger receptors and the hepatic LDL receptor. Treatment of HpMF (20 μM) during THP-1 differentiation successfully attenuated 12-myristate 13-acetate (PMA)-mediated DiI-labeled oxidized low-density lipoprotein (oxLDL) uptake as evidenced by flow cytometry, indicating that the functions of scavenger receptors were blocked. RT-Q-PCR analysis suggests that the decrease in oxLDL uptake was due to the down-regulation of PMA-induced SR-A mRNA expression. In terminally differentiated THP-1 macrophages, 5-OH-HxMF and HpMF could significantly reduce DiI-oxLDL uptake, with the former having a greater effect. 5-OH-HxMF attenuated oxLDL-mediated CD36 and SR-A expression; while HpMF only decreased CD36 expression. The effects of these two flavonoids on the activity and expression of the hepatic LDL receptor (LDLR) were further investigated in HepG2 cells. 5-OH-HxMF (10-20 μM) enhanced DiI-LDL uptake by 1.33-fold due to the enhanced LDLR expression. These results imply that HpMF is better at inhibiting PMA-induced oxLDL uptake during THP-1 differentiation, while 5-OH-HxMF is more powerful in attenuating oxLDL-induced scavenger receptor expression and activity in terminally differentiated THP-1 macrophages. Furthermore, 5-OH-HxMF may have hypolipidemic activity due to its up-regulating hepatic LDLR expression.

Effect of pigeon pea (Cajanus cajan L.) on high-fat diet-induced hypercholesterolemia in hamsters

Obesity is associated with increased systemic and airway oxidative stress, which may result from a combination of adipokine imbalance and antioxidant defenses reduction. Obesity-mediated oxidative stress plays an important role in the pathogenesis of dyslipidemia, vascular disease, and nonalcoholic hepatic steatosis. The antidyslipidemic activity of pigeon pea were evaluated by high-fat diet (HFD) hamsters model, in which the level of high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), and total triglyceride (TG) were examined. We found that pigeon pea administration promoted cholesterol converting to bile acid in HFD-induced hamsters, thereby exerting hypolipidemic activity. In the statistical results, pigeon pea significantly increased hepatic carnitine palmitoyltransferase-1 (CPT-1), LDL receptor, and cholesterol 7α-hydroxylase (also known as cytochrome P450 7A1, CYP7A1) expression to attenuate dyslipidemia in HFD-fed hamsters; and markedly elevated antioxidant enzymes in the liver of HFD-induced hamsters, further alleviating lipid peroxidation. These effects may attribute to pigeon pea contained large of unsaturated fatty acids (UFA; C18:2) and phytosterol (β-sitosterol, campesterol, and stigmasterol). Moreover, the effects of pigeon pea on dyslipidemia were greater than β-sitosterol administration (4%), suggesting that phytosterone in pigeon pea could prevent metabolic syndrome.

Thyroid Hormone Receptor Agonists Reduce Serum Cholesterol Independent of the LDL Receptor

The majority of cholesterol reduction therapies, such as the statin drugs, work primarily by inducing the expression of hepatic low-density lipoprotein receptors (LDLRs), rendering these therapeutics only partially effective in animals lacking LDLRs. Although thyroid hormones and their synthetic derivatives, often referred to as thyromimetics, have been clearly shown to reduce serum cholesterol levels, this action has generally been attributed to their ability to increase expression of hepatic LDLRs. Here we show for the first time that the thyroid hormone T(3) and the thyroid hormone receptor-β selective agonists GC-1 and KB2115 are capable of markedly reducing serum cholesterol in mice devoid of functional LDLRs by inducing Cyp7a1 expression and stimulating the conversion and excretion of cholesterol as bile acids. Based on this LDLR-independent mechanism, thyromimetics such as GC-1 and KB2115 may represent promising cholesterol-lowering therapeutics for the treatment of diseases such as homozygous familial hypercholesterolemia, a rare genetic disorder caused by a complete lack of functional LDLRs, for which there are limited treatment options because most therapeutics are only minimally effective.

Using in vivo electroporation to identify hepatic LDL receptor promoter elements and transcription factors mediating activation of transcription by T3

The technique of in vivo electroporation was adapted to investigate the promoter elements and transcription factors mediating the rapid induction of hepatic LDL receptor expression in response to thyroid hormone. Direct comparisons between wild type and mutant promoter constructs were made within the same animal. It was demonstrated that both TREs at bp −612 and −156 were required for the l-triiodothyronine (T3) response. ChIP analysis showed that binding of TRβ1 to the −612 and −156 TREs was markedly stimulated by T3in vivo. Introduction of siRNAs against TRβ1/RXRα with LDL receptor promoter-luciferase construct by in vivo electroporation demonstrated that these transcription factors play the major physiological role in the activation of hepatic LDL receptor transcription. The findings agree with those made by transfecting H4IIE cells in vitro thus validating this technique for in vivo studies of mechanisms of transcriptional regulation. The findings reported herein also indicated, for the first time, that PPARα and USF-2 were required for maximum transcriptional activation of the LDL receptor in response to T3 treatment.

Delineation of molecular pathways that regulate hepatic PCSK9 and LDL receptor expression during fasting in normolipidemic hamsters

BackgroundPCSK9 has emerged as a key regulator of serum LDL-C metabolism by promoting the degradation of hepatic LDL receptor (LDLR). In this study, we investigated the effect of fasting on serum PCSK9, LDL-C, and hepatic LDLR expression in hamsters and further delineated the molecular pathways involved in fasting-induced repression of PCSK9 transcription. ResultsFasting had insignificant effects on serum total cholesterol and HDL-C levels, but reduced LDL-C, triglyceride and insulin levels. The decrease in serum LDL-C was accompanied by marked reductions of hepatic PCSK9 mRNA and serum PCSK9 protein levels with concomitant increases of hepatic LDLR protein amounts. Fasting produced a profound impact on SREBP1 expression and its transactivating activity, while having modest effects on mRNA expressions of SREBP2 target genes in hamster liver. Although PPARα mRNA levels in hamster liver were elevated by fasting, ligand-induced activation of PPARα with WY14643 compound in hamster primary hepatocytes did not affect PCSK9 mRNA or protein expressions. Further investigation on HNF1α, a critical transactivator of PCSK9, revealed that fasting did not alter its mRNA expression, however, the protein abundance of HNF1α in nuclear extracts of hamster liver was markedly reduced by prolonged fasting. ConclusionFasting lowered serum LDL-C in hamsters by increasing hepatic LDLR protein amounts via reductions of serum PCSK9 levels. Importantly, our results suggest that attenuation of SREBP1 transactivating activity owing to decreased insulin levels during fasting is primarily responsible for compromised PCSK9 gene transcription, which was further suppressed after prolonged fasting by a reduction of nuclear HNF1α protein abundance.

Peroxisome Proliferator-activated Receptor γ Activation by Ligands and Dephosphorylation Induces Proprotein Convertase Subtilisin Kexin Type 9 and Low Density Lipoprotein Receptor Expression

Proprotein convertase subtilisin kexin type 9 (PCSK9) plays an important role in cholesterol homeostasis by enhancing the degradation of LDL receptor (LDLR) protein. Peroxisome proliferator-activated receptor γ (PPARγ) has been shown to be atheroprotective. PPARγ can be activated by ligands and/or dephosphorylation with ERK1/2 inhibitors. The effect of PPARγ on PCSK9 and LDLR expression remains unknown. In this study, we investigated the effects of PPARγ on PCSK9 and LDLR expression. At the cellular levels, PPARγ ligands induced PCSK9 mRNA and protein expression in HepG2 cells. PCSK9 expression was induced by inhibition of ERK1/2 activity but inhibited by ERK1/2 activation. The mutagenic study and promoter activity assay suggested that the induction of PCSK9 expression by ERK1/2 inhibitors was tightly linked to PPARγ dephosphorylation. However, PPARγ activation by ligands or ERK1/2 inhibitors induced hepatic LDLR expression. The promoter assay indicated that the induction of LDLR expression by PPARγ was sterol regulatory element-dependent because PPARγ enhanced sterol regulatory element-binding protein 2 (SREBP2) processing. In vivo, administration of pioglitazone or U0126 alone increased PCSK9 expression in mouse liver but had little effect on PCSK9 secretion. However, the co-treatment of pioglitazone and U0126 enhanced both PCSK9 expression and secretion. Similar to in vitro, the increased PCSK9 expression by pioglitazone and/or U0126 did not result in decreased LDLR expression and function. In contrast, pioglitazone and/or U0126 increased LDLR protein expression and membrane translocation, SREBP2 processing, and CYP7A1 expression in the liver, which led to decreased total and LDL cholesterol levels in serum. Our results indicate that although PPARγ activation increased PCSK9 expression, PPARγ activation induced LDLR and CYP7A1 expression that enhanced LDL cholesterol metabolism.

Chitosan oligosaccharides promote reverse cholesterol transport and expression of scavenger receptor BI and CYP7A1 in mice

Chitosan oligosaccharides (COS) are beneficial in improving plasma lipids and diminishing atherosclerotic risks. In this study, we examined the effects of COS on reverse cholesterol transport (RCT) in C57BL/6 mice. (3)H-cholesterol-laden macrophages were injected intraperitoneally into mice fed with various dosage of COS (250, 500, 1000 mg/kg mouse weight, respectively) or vehicle by gastric gavages. Plasma lipid level was determined and (3)H-cholesterol was traced in plasma, liver, bile and feces. The effects of COS on hepatic cholesterol 7 alpha-hydroxylase (CYP7A1) and scavenger receptor BI (SR-BI) expression were also investigated. COS administration led to a significant decrease in plasma total cholesterol and low-density lipoprotein (LDL) cholesterol and a significant increase in peritoneal macrophage-derived (3)H-cholesterol in liver and bile as well as in feces. Liver protein expressions of CYP7A1, SR-BI and LDL receptor (LDL-R) were improved in a dosage-dependent manner in COS-administered mice. Our findings provide the first in vivo demonstration of a positive role for COS in RCT pathway and hepatic CYP7A1 and SR-BI expression in mice. Additionally, the LDL cholesterol lowering effect might be relative to hepatic LDL-R expression stimulated by COS in mice.

Resveratrol increases the expression and activity of the low density lipoprotein receptor in hepatocytes by the proteolytic activation of the sterol regulatory element-binding proteins

Objective The hepatocyte low density lipoprotein receptor (LDLR) plays a pivotal role in lipoprotein metabolism by lowering plasma LDL-cholesterol, a risk factor for atherosclerosis. The present study was conducted to investigate the effects of grape polyphenols on LDLR gene expression in human hepatocyte models. Methods and results Among the 14 phenolic compounds in red wine, we found that a stilbene trans-resveratrol most strongly up-regulated LDLR gene expression in HepG2 cells. Trans-resveratrol increased the LDLR protein and uptake of fluorescent -labeled LDL. Moreover, it enhanced LDLR gene promoter activity through the proteolytic activation of the sterol regulatory element-binding protein-2 (SREBP-2) as well as SREBP-1. However, sterols completely abolished trans-resveratrol-induced SREBP activation and LDLR gene expression. Finally, AMP-activated protein kinase (AMPK) knockdown analyses by siRNA revealed that AMPK activation was unnecessary for the effects of trans-resveratrol. Conclusions Trans-resveratrol up-regulated hepatic LDLR expression via proteolytic activation of SREBPs. We concluded that trans-resveratrol exhibits the anti-atherogenic effect, at least in part, by increased hepatic LDLR expression and subsequent LDL uptake.

Synthesis of Carboxymethylated and Quaternized Chitosans and Their Therapeutic Effect on Nonalcoholic Fatty Liver Disease

O-Carboxymethyl chitosan (O-CMCs) and N-((2-hydroxy-3-N,N-dimethylhexadecylammonium)propyl)chitosan chloride (N-CQCs) were synthesized for nonalcoholic fatty liver disease (NAFLD) treatment. The weight-average weight and substitution degree of O-CMCs and N-CQCs were 6.5 × 10(4) and 0.72 and 7.9 × 10(4) and 0.21, respectively. O-CMCs was negatively charged with a zeta-potential value of -31.82 mV, whereas that of N-CQCs was +36.1 mV, and both showed low cytotoxcity. Serum lipid level and liver fat accumulation were reduced with chitosan and its two derivatives. Furthermore, mRNA and protein expression assay of hepatic lipid metabolism enzymes and low-density lipoprotein receptor (LDL-R) were observed by RT-PCR and Western blot. Results showed that N-CQCs exhibited a more evident desired effect than chitosan and O-CMCs, indicating that amphiphilicity, solubility, and surface charge of chitosan and its two derivatives played roles in the expression of hepatic lipid metabolism enzymes and LDL-R. Therefore, dietary supplementation of O-CMCs and N-CQCs can alleviate the high fat diet induced aberrations related to NAFLD by their antilipidemic property.

Effects of chitosan, O-carboxymethyl chitosan and N-[(2-hydroxy-3-N,N-dimethylhexadecyl ammonium)propyl]chitosan chloride on lipid metabolism enzymes and low-density-lipoprotein receptor in a murine diet-induced obesity

O-carboxymethyl chitosan (O-CM-chitosan) and N-[(2-hydroxy-3-N,N-dimethylhexadecyl ammonium)propyl]chitosan chloride (N-CQ-chitosan) were prepared, and the therapeutic effect of them and chitosan in hepatocyte were simultaneously evaluated. The parameters of high-fat diet-induced rats in vivo indicated that chitosan and its two derivatives not only have low cytotoxicity but can alleviate the hepatic fat accumulation. Furthermore, results of the mRNA expression assay showed that chitosan of 10 kDa elevated HMG-CoA, hepatic lipase (HL), lecithin cholesterol acyltransferase (LCAT) and low-density-lipoprotein receptor (LDL-R) by 402%, 177%, 427% and 56%, and N-CQ-chitosan which was synthesized by chitosan of 50 kDa increased HMG-CoA, HL, LCAT and LDL-R by 543%, 162%, 122% and 2% respectively. It was concluded that the mRNA expression of hepatic lipid metabolism enzymes and LDL-R was positively associated with chitosan and its two derivatives, but the therapeutic degree varied by the molecular weight and surface charge of chitosan, O-CM-chitosan and N-CQ-chitosan.

Citrus flavonoid 5‐demethylnobiletin suppresses scavenger receptor expression in THP‐1 cells and alters lipid homeostasis in HepG2 liver cells

Nobiletin, a polymethoxyflavone from the peel of citrus fruits, has been reported to inhibit modified LDL uptake in macrophages and enhance hepatic LDL receptor expression and activity. We report the anti-atherogenic effect and mechanism of 5-demethylnobiletin, an auto-hydrolysis product of nobiletin. 5-Demethylnobiletin significantly attenuated phorbol 12-myristate 13-acetate-induced gene expression and activity of scavenger receptors, CD36, scavenger receptor-A and lectin-like oxidized LDL receptor-1. The inhibitory effect is partly associated with the inhibition of protein-kinase C activity and c-Jun NH(2) -terminal kinase 1/2 phosphorylation, thereby inhibiting the activation of activator protein-1 and nuclear factor-κB. 5-Demethylnobiletin treatment also led to reduction of oxidized LDL-induced CD36 mRNA expression and blockade of 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanide perchlorate-modified LDL uptake in THP-1-derived macrophages. In the human hepatoma cell line HepG2, 5-demethylnobiletin significantly induced LDL receptor activity and transcription, at least in part, through steroid-response element-binding protein-2 activation. 5-Demethylnobiletin also decreased the mRNA expression of acyl CoA:diacylglycerol acyltransferase 2, the key enzyme involved in the hepatic triacylglycerol biosyntheses. Current results suggest that 5-demethylnobiletin has diverse anti-atherogenic bioactivities. It is more potent in inhibiting monocyte-to-macrophage differentiation and foam cell formation than its permethoxylated counterpart, nobiletin. It exhibits similar hypolipidemic activity as nobiletin and both can enhance LDL receptor gene expression and activity and decreased acyl CoA:diacylglycerol acyltransferase 2 expression.

Enhanced Hypocholesterolemic Effects of Interesterified Oils Are Mediated by Upregulating LDL Receptor and Cholesterol 7-α- Hydroxylase Gene Expression in Rats

The concentration of LDL cholesterol in plasma is strongly influenced by the amount and type of lipid in the diet. Our studies have shown that positional changes in the fatty acids in blended oil introduced using lipase-catalyzed interesterification differentially modulate circulating LDL levels in rats compared with those observed in rats given a physical blend of oils. To investigate the molecular basis of these differences, transcriptional profiling of genes involved in cholesterol homeostasis was studied after feeding rats with a semipurified diet containing 10% fat from native oils; coconut oil (CNO), rice bran oil (RBO), or sesame oil (SESO); blended (B); CNO+RBO(B) or CNO+SESO(B) and interesterified oil (I); CNO+RBO(I) or CNO+SESO(I) for 60 d. Hepatic LDL receptor (LDL-R) expression significantly increased in rats fed interesterified oils by 100-200% compared with rats fed blended oils and by 400-500% compared with rats fed CNO. Positional alteration in fatty acids of oils used in the diet induced changes in LDL-R expression, which was accompanied by parallel changes in cholesterol-7α-hydroxylase (CYP7A1) and SREBP-2 genes. This suggested that not only the fatty acid type but also its position in the TG of dietary lipids play an important role in maintaining plasma cholesterol levels by suitably modulating gene expression for LDL-R in rat liver.

Suppression of Idol expression is an additional mechanism underlying statin-induced up-regulation of hepatic LDL receptor expression

Recent studies have identified proprotein convertase subtilisin/kexin type 9 (PCSK9) and Idol as negative regulators of low density lipoprotein receptor (LDLR) protein stability. While the induction of PCSK9 transcription has been recognized as a limitation to the statin cholesterol-lowering efficacy at higher doses, it is unknown whether Idol is involved in the statin-mediated up-regulation of the hepatic LDLR. Here we report that statins exert opposite effects on PCSK9 and Idol gene expression in human hepatoma-derived cell lines and primary hepatocytes isolated from hamsters and rats. While PCSK9 expression was induced, the level of Idol mRNA rapidly declined in statin-treated cells in a dose-dependent manner. This differs from the effect of the liver X receptor ligand, GW3965, which increased the expression of both PCSK9 and Idol. We further show that cellular depletion of Idol by siRNA transfection did not change PCSK9 expression levels in control and statin-treated cells; however, the basal level of LDLR protein increased by 60% in Idol siRNA transfected HepG2 cells. More importantly, the increase in LDLR protein abundance by rosuvastatin and atorvastatin treatment was compromised by Idol siRNA transfection. Collectively, our present findings suggest that the suppression of Idol gene expression in liver cells is an additional mechanism underlying the statin-induced up-regulation of hepatic LDLR expression. This may contribute to the hypocholesterolemic effects of statins observed in clinical settings.

Up-regulation of hepatic low-density lipoprotein receptor–related protein 1: a possible novel mechanism of antiatherogenic activity of hydroxymethylglutaryl–coenzyme A reductase inhibitor: Atorvastatin and hepatic LRP1 expression

Low-density lipoprotein receptor–related protein 1 (LRP1) binds to apolipoprotein E and serves as a receptor for remnant lipoproteins in the liver, thus playing an important role in clearing these atherogenic particles. In this study, we investigated the effect of atorvastatin, a hydroxymethylglutaryl–coenzyme A reductase inhibitor, on hepatic LRP1 expression. We used HepG2 and Hep3B cells for in vitro study, and Otsuka Long-Evans Tokushima fatty and Sprague-Dawley rats for in vivo study. We used relatively high pharmacologic dose of atorvastatin in this study (in vitro, 0.5 μmol/L in culture media, for 48 hours; in vivo, 20 mg/[kg d], for 6 weeks). Atorvastatin increased LRP1 and low-density lipoprotein (LDL) receptor expression in HepG2 and Hep3B cells and induced hepatic LRP1 and LDL receptor expression in chow diet-fed Sprague-Dawley rats and high-fat diet–fed Otsuka Long-Evans Tokushima fatty rats. Atorvastatin decreased intracellular sterol level and increased the amount of the nuclear form of sterol response element-binding protein–2 (SREBP-2) in both HepG2 and Hep3B cells as well as in two animal models. Treatment of HepG2 cells with LDL increased intracellular sterol level and reduced LRP1, LDL receptor, and SREBP-2. When SREBP-2 in HepG2 cells was knocked down by small interfering RNA, the induction of LRP1 expression by atorvastatin did not take place. In conclusion, up-regulation of hepatic LRP1 might be a novel mechanism by which statin treatment decreases remnant lipoproteins. In addition, SREBP-2 acts as a mediator of atorvastatin-induced up-regulation of hepatic LRP1. Future studies using standard doses of atorvastatin in humans are needed to elucidate clinical relevance of these findings.

Beyond LDL Cholesterol, a New Role for PCSK9

Elevated low-density lipoprotein cholesterol (LDLC) levels in the plasma is the most important causative factor of atherosclerosis and associated ischemic cardiovascular diseases. The LDL receptor (LDLR) is the preferential pathway through which LDLs are cleared from the circulation. LDLs bound to the LDLR are internalized into clathrin-coated pits and subsequently undergo lysosomal degradation, whereas the LDLR is recycled back to the plasma membrane. See accompanying article on page 1333 Familial hypercholesterolemia (FH) is an autosomal dominant disorder associated with elevated LDL levels and premature coronary heart disease. FH is caused primarily by mutations of the LDLR or of apolipoprotein B100 (apoB100), the protein component of LDL that interacts with the LDLR. In 2003, “gain of function” mutations on a newly identified gene, proprotein convertase subtilisin/kexin type 9 ( PCSK9), were associated with FH. In 2005, a causative association was established between “loss of function” mutations in PCSK9 and low LDLC levels in 2% of the African-American population. The coronary heart disease risk in these individuals was reduced by 88%. As a result of these landmark studies (reviewed in Reference 1), PCSK9 became the subject of intensive research to discover the underlying mechanisms. PCSK9 is a serine protease mainly expressed in the liver and the intestine. It acts by reducing the amount of LDLR in hepatocytes. This was demonstrated in vitro and in mouse models …

Severe dyslipidaemia, atherosclerosis, and sudden cardiac death in mice lacking all NO synthases fed a high-fat diet

The precise role of the nitric oxide synthase (NOS) system in lipid metabolism remains to be elucidated. We addressed this point in mice that we have recently developed and that lack all three NOS isoforms. Wild-type (WT), singly, doubly, and triply NOS(-/-) mice were fed either a regular or high-cholesterol diet for 3-5 months. The high-cholesterol diet significantly increased serum low-density lipoprotein (LDL) cholesterol levels in all the genotypes when compared with the regular diet. Importantly, when compared with the WT genotype, the serum LDL cholesterol levels in the high-cholesterol diet were significantly and markedly elevated only in the triply NOS(-/-) genotype, but not in any singly or doubly NOS(-/-) genotypes, and this was associated with remarkable atherosclerosis and sudden cardiac death, which occurred mainly in the 4-5 months after the high-cholesterol diet. Finally, hepatic LDL receptor expression was markedly reduced only in the triply NOS(-/-) genotype, accounting for the diet-induced dyslipidaemia in the genotype. These results provide the first direct evidence that complete disruption of all NOS genes causes severe dyslipidaemia, atherosclerosis, and sudden cardiac death in response to a high-fat diet in mice in vivo through the down-regulation of the hepatic LDL receptor, demonstrating the critical role of the whole endogenous NOS system in maintaining lipid homeostasis.

EP2300 Compounds: Focusing on the Antiatherosclerotic Properties of Squalene Synthase Inhibitors

Although treatment with statins significantly reduces adverse cardiovascular outcomes, several studies have shown that cardiovascular events continue to occur in two thirds of all patients. A logical pharmacologic approach to further reduce cardiovascular disease mortality should be focused on direct modifiers of atherosclerosis or lipid-modifying agents with different mechanism of action than existing drugs against dyslipidemia. Squalene synthase inhibitors can decrease circulating low-density lipoprotein (LDL)-cholesterol by an increased expression of hepatic LDL receptors in a similar manner to statins. Also, depending on their structure, they may possess antiatherosclerotic properties independent of their lipid-modifying effects. This review, following a brief introduction to different classes of squalene synthase inhibitors and representative molecules, presents the accumulating in vitro and in vivo experimental evidence relevant to squalene synthase inhibitors EP2306 and EP2302 and discusses their properties. EP2306 and EP2302 show a similar inhibitory effect in the progression of atherosclerosis in the cholesterol-fed rabbit. Moreover, EP2306 showed a significant long-term antiatherosclerotic effect not shared by simvastatin or their combination in this animal model. EP2302 also showed a favorable effect in the regression of pre-established atherosclerotic lesions. It is reasonable to hypothesize that EP2302, due to its NO-releasing and enhancing properties, could have additional advantages compared to EP2306. Treatment with EP2300 compounds did not adversely affect liver transaminases or cause toxicity on various organs of the cholesterol-fed rabbit. The satisfactory safety profile of EP2300 compounds in this animal model is a promising finding in view of future clinical studies.