Elevated levels of lipoprotein(a) [Lp(a)], an apoB100-containing lipoprotein, are an independent risk factor for atherosclerotic cardiovascular disease, even in the setting of effective reduction of plasma low-density lipoprotein (LDL) cholesterol. To date, the mechanisms whereby Lp(a) exerts its atherogenic effects remain poorly understood, and no treatments aimed at lowering Lp(a) have been approved. Two receptors - scavenger receptor-BI (SR-BI) and activin receptor-like kinase 1 (ALK1) - have been proposed to bind apoB100 and mediate the atherogenic uptake and transcytosis of LDL across the endothelial cell (EC) barrier. EC-specific SR-BI knockout reduces atherosclerosis in both apoE and LDLR knockout mice. We have shown that SR-BI also mediates EC uptake of nascent chylomicrons. Although binding of ALK1 to apoB is believed to occur through the N-terminus of apoB, the receptor is not involved in the uptake of chylomicrons. We assessed which if any of these receptors are involved in Lp(a) uptake by ECs. Despite the presence of apoB100, EC uptake of Lp(a), like apoB48 chylomicrons, was reduced by SR-BI, but not ALK1, knockdown. We then used a series of small N terminal apoB peptides (apoB3-apoB18, with sequences comprising the 3%, 8%, 12%, 15%, and 18% N terminus of apoB) to compete with Lp(a) uptake. Both chylomicron and Lp(a) uptake was inhibited by apoB15 and apoB18, whereas LDL uptake was additionally inhibited by apoB12. These observations suggest that a) the binding sequence to SR-BI is between residues 547-684 of apoB, and b) an additional sequence between residues 365-547 participates in apoB binding to ALK1. Our findings suggest that apo(a) alters the structure of apoB to make it a better ligand for SR-BI uptake by ECs. Because this uptake pathway leads to transcytosis, we hypothesize that the greater atherogenicity of Lp(a) is mediated by its increased binding to and uptake by ECs.
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