Reduced Plasma Cholesterol Levels Research Articles

Cardiovascular events with PCSK9 inhibitors: an updated meta-analysis of randomised controlled trials

The therapy with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors efficiently reduces plasma cholesterol levels, which has been recently associated with improvement in cardiovascular outcomes. This meta-analysis aimed at investigating the safety and efficacy of treatment with the clinically available anti-PCSK9 monoclonal antibodies (mAbs) in all published randomized clinical trials (RCTs), updating the available results with the recently published ODYSSEY OUTCOMES trial.Data search was carried out using PubMed/MEDLINE and EMBASE (inception – January 2019). Inclusion criteria were: (1) phase 2 or 3 RCTs; (2) comparing anti-PCSK9 mAbs (specifically evolocumab and alirocumab) with placebo; (3) with effects on outcomes reported; (4) with treatment duration longer than 8 weeks. Odds ratios (ORs) with 95% CIs were used as summary statistics. We pooled the estimates by using both the DerSimonian & Laird method (random-effects model). Between-study heterogeneity was tested by Cochrane’s Q test and measured with the I2 statistics.Twenty-eight RCTs comprising 62,281 participants (33,204 in the mAb arm, 29,077 in the placebo arm) were included in the meta-analysis. The treatment follow-up ranged from 8 weeks up to 208 weeks. Overall, no significant difference in all-cause mortality was observed between the two groups (OR 0.93 [95% CI, 0.85–1.03]). The treatment with an anti-PCSK9 mAb was associated with a significant reduction of CV events compared with placebo (OR 0.83 [95% CI, 0.78–0.87]), being the FOURIER and ODYSSEY OUTCOMES studies the major contributors. Both myocardial infarction and stroke were significantly reduced following the treatment with an anti-PCSK9 mAb. No significant difference was observed in cardiovascular mortality (OR 0.94 [95% CI, 0.83–1.07]). The incidence of serious adverse events was similar in the two groups (OR: 0.95, [95% CI, 0.91–0.99]).Thus, the pharmacological approach with anti-PCSK9 mAbs significantly and safely improves cardiovascular outcomes. Despite that, the pooled analysis failed to show a significant cardiovascular mortality benefit with anti-PCSK9 mAb treatment, suggesting that specific longer-term studies are warranted to address this issue. We suggest that the observed delay between the rapid effect on plasma cholesterol levels and the emergence of the clinical benefit, observed both in FOURIER and ODYSSEY OUTCOMES trials, might explain this finding.

Impact of phytosterols on liver and distal colon metabolome in experimental murine colitis model: an explorative study

Phytosterols are known to reduce plasma cholesterol levels and thereby reduce cardiovascular risk. Studies conducted on human and animal models have demonstrated that these compounds have also anti-inflammatory effects. Recently, an experimental colitis model (dextran sulphate sodium-induced) has shown that pre-treatment with phytosterols decreases infiltration of inflammatory cells and accelerates mucosal healing. This study aims to understand the mechanism underlying the colitis by analysing the end-products of the metabolism in distal colon and liver excised from the same mice used in the previous work. In particular, an unsupervised gas chromatography-mass spectrometry (GC-MS) and NMR based metabolomics approach was employed to identify the metabolic pathways perturbed by the dextran sodium sulphate (DSS) insult (i.e. Krebs cycle, carbohydrate, amino acids, and nucleotide metabolism). Interestingly, phytosterols were able to restore the homeostatic equilibrium of the hepatic and colonic metabolome.

Abstract 417: CXCR4 Distinguishes and Maintains Atheroprotective IgM-producing B-1 cells

B1 cells exert protective effects in atherosclerosis through production of anti-inflammatory IgM antibodies recognizing oxidation-specific epitopes, such as MDA-LDL, present in diseased arteries. However, factors mediating B1 IgM production are currently unclear. We evaluated MDA-LDL binding and chemokine receptor expression on human B1 cells in a cohort of subjects undergoing intravascular ultrasound (IVUS) for coronary artery assessment. Results demonstrate that a subset of human B1 cells (~35%) is able to bind MDA-LDL. Moreover, expression of the chemokine receptor CXCR4 on circulating B1 cells associates with increased plasma levels of anti-MDA-LDL IgM antibodies (p=0.0009), and decreased plaque burden in coronary arteries (p=0.0002). Mice with B cell-specific loss of CXCR4 on the atherogenic ApoE -/- background (CXCR4 BKO ) demonstrate fewer B1a cells (n=6-8,p<0.0001) and IgM antibody-secreting cells (n=6,p<0.01) in the bone marrow, and reduced plasma IgM levels (n=6-8,p<0.05), relative to littermate controls (CXCR4 WT ). Furthermore, retroviral-mediated overexpression of CXCR4 on B1a cells in vivo is associated with increased B1a localization to the bone marrow (p<0.01) and increased circulating levels of anti-MDA-LDL IgM antibodies (p<0.05). To determine the atheroprotective role of CXCR4 on the B1a cell subset, we adoptively transferred CXCR4 WT or CXCR4 BKO B1a cells into lymphocyte-deficient Rag1 -/- ApoE -/- mice. After 16 weeks of Western diet feeding, recipients given CXCR4 BKO B1a cells demonstrate reduced plasma IgM levels (n=7,p<0.001), and fewer donor B1a cells in the bone marrow and spleen (n=7,p<0.05) compared to recipients given CXCR4 WT B1a cells. Intriguingly, B1a transfer reduces plasma cholesterol levels in mice regardless of CXCR4 expression (n=7,p<0.05). However, CXCR4 further strengthens the atheroprotective ability of B1a cells, as recipients given CXCR4 WT B1a cells have reduced aortic lesion area compared to PBS controls (n=7,p<0.01) while recipients given CXCR4 BKO B1a cells did not attain the same level of protection. Overall, these data suggest that CXCR4 is an important regulator of IgM production and B1a-mediated atheroprotection.

Effects of Stigmasterol and β-Sitosterol on Nonalcoholic Fatty Liver Disease in a Mouse Model: A Lipidomic Analysis.

To study the effects of stigmasterol and β-sitosterol on high-fat Western diet (HFWD)-induced nonalcoholic fatty liver disease (NAFLD), lipidomic analyses were conducted in liver samples collected after 33 weeks of the treatment. Principal component analysis showed these phytosterols were effective in protecting against HFWD-induced NAFLD. Orthogonal projections to latent structures-discriminate analysis (OPLS-DA) and S-plots showed that triacylglycerols (TGs), phosphatidylcholines, cholesteryl esters, diacylglycerols, and free fatty acids (FFAs) were the major lipid species contributing to these discriminations. The alleviation of NAFLD is mainly associated with decreases in hepatic cholesterol, TGs with polyunsaturated fatty acids, and alterations of free hepatic FFA. In conclusion, phytosterols, at a dose comparable to that suggested for humans by the FDA for the reduction of plasma cholesterol levels, are shown to protect against NAFLD in this long-term (33-week) study.

Formulation and Evaluation of Pulsatile Drug Delivery of Lovastatin

In the present study, an attempt was made to develop the pulsatile drug delivery of Lovastatin to reduce plasma cholesterol levels and to prevent cardiovascular diseases. Formaldehyde treated Capsule bodies were used for the preparation of pulsincaps. It was sealed with unhardened cap of the capsule. The microspheres were prepared by emulsion solvent evaporation technique. Hydrogel plug (karaya gum and lactose in 1:1 ratio) having 4.5kg/cm2 hardness and 100 mg weight was placed in the capsule opening and found that it was satisfactory to retard the drug release in small intestinal fluid and to eject out the plug in colonic fluid and releasing the microspheres into colonic fluid after a lag time criterion of 5 hours. The sealed capsules were completely coated by dip coating method with 5% cellulose acetate phthalate to prevent variable gastric emptying. Optimized microsphere formulations were selected based on dissolution studies. Dissolution studies of pulsatile capsule device in media with different pH (1.2, 7.4 and6.8) showed that drug release in colon could be modulated by optimizing the concentration of polymers in the microspheres. Drug–polymer interaction studies indicated no interaction in between the drug and the polymer. Among all the formulations Lovastatin microspheres prepared with Ethyl cellulose, in 1:3 ratio shown prolonged release for a period of 11 hours. The obtained results showed the capability of the system in delaying drug release for a programmable period of time and to deliver the drug in the early morning hours when cholesterol synthesis are more prevalent.

Global inactivation of carboxylesterase 1 (Ces1/Ces1g) protects against atherosclerosis in Ldlr\u2212/\u2212 mice

Atherosclerotic cardiovascular disease is a leading cause of death in the western world. Increased plasma triglyceride and cholesterol levels are major risk factors for this disease. Carboxylesterase 1 (Ces1/Ces1g) has been shown to play a role in metabolic control. So far, the role of mouse Ces1/Ces1g deficiency in atherosclerosis is not elucidated. We generated Ces1/Ces1g−/− mice. Compared to wild-type mice, Ces1/Ces1g−/− mice had reduced plasma cholesterol levels. We then generated Ces1g−/−Ldlr−/− double knockout (DKO) mice, which were fed a Western diet for 16 weeks. Compared to Ldlr−/− mice, DKO mice displayed decreased plasma cholesterol and TG levels and reduced atherosclerotic lesions. Interestingly, knockdown of hepatic Ces1/Ces1g in Apoe−/− mice resulted in hyperlipidemia and exacerbated Western diet-induced atherogenesis. Mechanistically, global inactivation of Ces1/Ces1g inhibited intestinal cholesterol and fat absorption and Niemann-Pick C1 like 1 expression, and increased macrophage cholesterol efflux by inducing ATP-binding cassette subfamily A member 1 (ABCA1) and ABCG1. Ces1/Ces1g ablation also promoted M2 macrophage polarization and induced hepatic cholesterol 7α-hydroxylase and sterol 12α-hydroxylase expression. In conclusion, global loss of Ces1/Ces1g protects against the development of atherosclerosis by inhibiting intestinal cholesterol and triglyceride absorption and promoting macrophage cholesterol efflux.

Inhibition of cholesterol biosynthesis through RNF145-dependent ubiquitination of SCAP.

Cholesterol homeostasis is maintained through concerted action of the SREBPs and LXRs. Here, we report that RNF145, a previously uncharacterized ER membrane ubiquitin ligase, participates in crosstalk between these critical signaling pathways. RNF145 expression is induced in response to LXR activation and high-cholesterol diet feeding. Transduction of RNF145 into mouse liver inhibits the expression of genes involved in cholesterol biosynthesis and reduces plasma cholesterol levels. Conversely, acute suppression of RNF145 via shRNA-mediated knockdown, or chronic inactivation of RNF145 by genetic deletion, potentiates the expression of cholesterol biosynthetic genes and increases cholesterol levels both in liver and plasma. Mechanistic studies show that RNF145 triggers ubiquitination of SCAP on lysine residues within a cytoplasmic loop essential for COPII binding, potentially inhibiting its transport to Golgi and subsequent processing of SREBP-2. These findings define an additional mechanism linking hepatic sterol levels to the reciprocal actions of the SREBP-2 and LXR pathways.

LB.01.07] ALLIANCE STUDY

Objective: The aim of study was to evaluate the efficiency and safety of fixed combination of lisinopril 10/20 mg + amlodipine 5/10 mg usage in patients with essential arterial hypertension. Design and method: the study included male and female patients over 18 years with a new onset or previous treatment uncontrolled hypertension (blood pressure> 140/90 mm Hg). Office blood pressure (BP) was measured and biochemical blood assay was done to all patients on baseline and in the follow-up periods. At the beginning of the study all previous antihypertensive therapy was cancelled. After randomization lisinopril/amlodipine has been administered to patients in accordance to their blood pressure levels. If the patient was newly diagnosed with blood pressure or had previously untreated hypertension and blood pressure in the range 140–179/90–109 mm Hg, lisinopril/amlodipine were administered at a dose of 5/10 mg per day. Patients who previously had an antihypertensive therapy but blood pressure kept to a level 140–179/90–109 mm Hg, lisinopril/amldipine were administered at an initial dose of 20/10 mg per day. If blood pressure was higher than 180/110 mm Hg, betablockers, diuretics and statins were administered according to indications. The study lasted over 60 days. Results: 6069 patients were involved to the study. According to data gained from the office of blood pressure monitoring essential reduction of blood pressure levels (from 169.3 ± 0.2/98.1 ± 0.1 mm Hg at baseline to 131.9 ± 0.1/81.1 ± 0.1 mm Hg at the end of the study) was achieved through lisinopril/amlodipine treatment. 57.1% of patients achieved targeted blood pressure levels. Patients who were treated with lisinopril/amlodipine without statins had demonstrated significant reduction in plasma cholesterol levels from 5.75 ± 0.02 mmol/l to 5.09 ± 0.1 mmol/l. In the end of study was observed a significant decrease of number of patients with proteinuria/microalbuminuria who followed lisinopril/amlodipine therapy— from 667 persons (11.0%) to 244 persons (4.0%). Lisinopril/amlodipine therapy was well tolerated by patients. Serious adverse events were not observed. Conclusions: Results of the study proved the effectiveness of the strategy to prescribe fixed combination lisinopril + amlodipine for the patients with hypertension in daily clinical practice in Ukraine for the prevention of cardiovascular and cerebrovascular complications.

In Vivo Base Editing of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) as a Therapeutic Alternative to Genome Editing.

High-efficiency genome editing to disrupt therapeutic target genes, such as PCSK9 (proprotein convertase subtilisin/kexin type 9), has been demonstrated in preclinical animal models, but there are safety concerns because of the unpredictable nature of cellular repair of double-strand breaks, as well as off-target mutagenesis. Moreover, precise knock-in of specific nucleotide changes-whether to introduce or to correct gene mutations-has proven to be inefficient in nonproliferating cells in vivo. Base editors comprising CRISPR-Cas9 (clustered regularly interspaced short palindromic repeats [CRISPR]-CRISPR-associated 9) fused to a cytosine deaminase domain can effect the alteration of cytosine bases to thymine bases in genomic DNA in a sequence-specific fashion, without the need for double-strand DNA breaks. The efficacy of base editing has not been established in vivo. The goal of this study was to assess whether in vivo base editing could be used to modify the mouse Pcsk9 gene in a sequence-specific fashion in the liver in adult mice. We screened base editors for activity in cultured cells, including human-induced pluripotent stem cells. We then delivered a base editor into the livers of adult mice to assess whether it could introduce site-specific nonsense mutations into the Pcsk9 gene. In adult mice, this resulted in substantially reduced plasma PCSK9 protein levels (>50%), as well as reduced plasma cholesterol levels (≈30%). There was no evidence of off-target mutagenesis, either cytosine-to-thymine edits or indels. These results demonstrate the ability to precisely introduce therapeutically relevant nucleotide variants into the genome in somatic tissues in adult mammals, as well as highlighting a potentially safer alternative to therapeutic genome editing.

Abstract 402: Post-transcriptional Regulation of Bile Acid Metabolism by the RNA binding protein ZFP36L1

Bile acids are detergents and important signaling molecules that activate the nuclear receptor FXR to control key metabolic processes, including feedback mechanisms to maintain bile acid homeostasis. Activation of FXR decreases the mRNA levels of several bile acid synthetic genes, including the rate-limiting enzyme Cyp7a1 . Here we show that Cyp7a1 mRNA levels are very rapidly reduced following FXR activation, indicative of a post-transcriptional mechanism. We identify the RNA binding protein Zfp36l1 as an FXR target gene and show that hepatic overexpression of ZFP36L1 in mice decreases Cyp7a1 mRNA levels. In contrast, Zfp36l1 L -KO mice have increased levels of Cyp7a1 mRNA and biliary bile acids as well as reduced plasma cholesterol levels. Zfp36l1 L -KO mice fed a Western diet have reduced diet-induced obesity and steatosis, likely due to impaired lipid absorption, consistent with increased Cyp7a1 levels. Thus, the ZFP36L1-dependent regulation of bile acid metabolism is an important metabolic contributor of dyslipidemia, obesity and hepatosteatosis.

Melanocortin 1 Receptor Signaling Regulates Cholesterol Transport in Macrophages.

The melanocortin 1 receptor (MC1-R) is expressed by monocytes and macrophages, where it exerts anti-inflammatory actions on stimulation with its natural ligand α-melanocyte-stimulating hormone. The present study was designed to investigate the specific role of MC1-R in the context of atherosclerosis and possible regulatory pathways of MC1-R beyond anti-inflammation. Human and mouse atherosclerotic samples and primary mouse macrophages were used to study the regulatory functions of MC1-R. The impact of pharmacological MC1-R activation on atherosclerosis was assessed in apolipoprotein E-deficient mice. Characterization of human and mouse atherosclerotic plaques revealed that MC1-R expression localizes in lesional macrophages and is significantly associated with the ATP-binding cassette transporters ABCA1 and ABCG1, which are responsible for initiating reverse cholesterol transport. Using bone marrow-derived macrophages, we observed that α-melanocyte-stimulating hormone and selective MC1-R agonists similarly promoted cholesterol efflux, which is a counterregulatory mechanism against foam cell formation. Mechanistically, MC1-R activation upregulated the levels of ABCA1 and ABCG1. These effects were accompanied by a reduction in cell surface CD36 expression and in cholesterol uptake, further protecting macrophages from excessive lipid accumulation. Conversely, macrophages deficient in functional MC1-R displayed a phenotype with impaired efflux and enhanced uptake of cholesterol. Pharmacological targeting of MC1-R in atherosclerotic apolipoprotein E-deficient mice reduced plasma cholesterol levels and aortic CD36 expression and increased plaque ABCG1 expression and signs of plaque stability. Our findings identify a novel role for MC1-R in macrophage cholesterol transport. Activation of MC1-R confers protection against macrophage foam cell formation through a dual mechanism: It prevents cholesterol uptake while concomitantly promoting ABCA1- and ABCG1-mediated reverse cholesterol transport.

Rev-erb regulation of cholesterologenesis

REV-ERBα and REV-ERBβ are heme regulated nuclear receptors that are known to regulate metabolic pathways. We previously demonstrated that treatment of mice with synthetic REV-ERB agonists suppressed plasma cholesterol levels and the hepatic levels of the rate limiting enzyme in cholesterol biosynthesis (3-hydroxy-3-methylglutaryl-CoA reductase). Here, we characterize the role of REV-ERB on the cholesterol biosynthetic pathway in greater detail. The REV-ERB agonist SR9009 reduced plasma cholesterol levels in both wild type C57Bl/6 and low density lipoprotein receptor (LDLR) null mice as well as reducing the expression of an array of genes within the cholesterol biosynthetic pathway. Consistent with these data, we observed increased expression of these genes in mice deficient in expression of Rev-erbα. Analysis of global run-on and deep sequencing (GRO-Seq) and chromatin immunoprecipitation deep sequencing (ChIP-Seq) data revealed that Rev-erb directly binds to the majority of genes involved in cholesterol biosynthesis and directly suppresses their expression. This study reveals insight into the complex mechanism by which Rev-erb directly and indirectly (via inhibition of Srebf2 expression) regulates cholesterol biosynthesis and provides information of how cholesterol levels are regulated in a circadian fashion. Additionally, these studies suggest that targeting Rev-erb may be an effective method for suppressing LDL cholesterol levels in the clinic.

Effects of G6pc2 deletion on body weight and cholesterol in mice.

Genome-wide association study (GWAS) data have linked the G6PC2 gene to variations in fasting blood glucose (FBG). G6PC2 encodes an islet-specific glucose-6-phosphatase catalytic subunit that forms a substrate cycle with the beta cell glucose sensor glucokinase. This cycle modulates the glucose sensitivity of insulin secretion and hence FBG. GWAS data have not linked G6PC2 to variations in body weight but we previously reported that female C57BL/6J G6pc2-knockout (KO) mice were lighter than wild-type littermates on both a chow and high-fat diet. The purpose of this study was to compare the effects of G6pc2 deletion on FBG and body weight in both chow-fed and high-fat-fed mice on two other genetic backgrounds. FBG was reduced in G6pc2 KO mice largely independent of gender, genetic background or diet. In contrast, the effect of G6pc2 deletion on body weight was markedly influenced by these variables. Deletion of G6pc2 conferred a marked protection against diet-induced obesity in male mixed genetic background mice, whereas in 129SvEv mice deletion of G6pc2 had no effect on body weight. G6pc2 deletion also reduced plasma cholesterol levels in a manner dependent on gender, genetic background and diet. An association between G6PC2 and plasma cholesterol was also observed in humans through electronic health record-derived phenotype analyses. These observations suggest that the action of G6PC2 on FBG is largely independent of the influences of environment, modifier genes or epigenetic events, whereas the action of G6PC2 on body weight and cholesterol are influenced by unknown variables.

Bioactivity of Phytosterols and Their Production in Plant in Vitro Cultures.

Phytosterols are a kind of plant metabolite belonging to the triterpene family. These compounds are essential biomolecules for human health, and so they must be taken from foods. β-Sitosterol, campesterol, and stigmasterol are the main phytosterols found in plants. Phytosterols have beneficial effects on human health since they are able to reduce plasma cholesterol levels and have antiinflammatory, antidiabetic, and anticancer activities. However, there are many difficulties in obtaining them, since the levels of these compounds produced from plant raw materials are low and their chemical synthesis is not economically profitable for commercial exploitation. A biotechnological alternative for their production is the use of plant cell and hairy root cultures. This review is focused on the biosynthesis of phytosterols and their function in both plants and humans as well as the different biotechnological strategies to increase phytosterol biosynthesis. Special attention is given to describing new methodologies based on the use of recombinant DNA technology to increase the levels of phytosterols.

Monocytic MKP-1 is a Sensor of the Metabolic Environment and Regulates Function and Phenotypic Fate of Monocyte-Derived Macrophages in Atherosclerosis

Diabetes promotes the S-glutathionylation, inactivation and subsequent degradation of mitogen-activated protein kinase phosphatase 1 (MKP-1) in blood monocytes, and hematopoietic MKP-1-deficiency in atherosclerosis-prone mice accelerates atherosclerotic lesion formation, but the underlying mechanisms were not known. Our aim was to determine the mechanisms through which MKP-1 deficiency in monocytes and macrophages promotes atherogenesis. Transplantation of MKP-1-deficient bone marrow into LDL-R−/− (MKP-1LeuKO) mice accelerated high-fat diet (HFD)-induced atherosclerotic lesion formation. After 12 weeks of HFD feeding, MKP-1LeuKO mice showed increased lesion size in both the aortic root (1.2-fold) and the aorta (1.6-fold), despite reduced plasma cholesterol levels. Macrophage content was increased in lesions of MKP-1LeuKO mice compared to mice that received wildtype bone marrow. After only 6 weeks on a HFD, in vivo chemotactic activity of monocytes was already significantly increased in MKP-1LeuKO mice. MKP-1 deficiency in monocytes and macrophages promotes and accelerates atherosclerotic lesion formation by hyper-sensitizing monocytes to chemokine-induced recruitment, predisposing macrophages to M1 polarization, decreased autophagy and oxysterol-induced cell death whereas overexpression of MKP-1 protects macrophages against metabolic stress-induced dysfunction. MKP-1 serves as a master-regulator of macrophage phenotype and function and its dysregulation by metabolic stress may be a major contributor to atherogenesis and the progression of atherosclerotic plaques.

MicroRNA-30c Mimic Mitigates Hypercholesterolemia and Atherosclerosis in Mice

High plasma cholesterol levels are a major risk factor for atherosclerosis. Plasma cholesterol can be reduced by inhibiting lipoprotein production; however, this is associated with steatosis. Previously we showed that lentivirally mediated hepatic expression of microRNA-30c (miR-30c) reduced hyperlipidemia and atherosclerosis in mice without causing hepatosteatosis. Because viral therapy would be formidable, we examined whether a miR-30c mimic can be used to mitigate hyperlipidemia and atherosclerosis without inducing steatosis. Delivery of a miR-30c mimic to the liver diminished diet-induced hypercholesterolemia in C57BL/6J mice. Reductions in plasma cholesterol levels were significantly correlated with increases in hepatic miR-30c levels. Long term dose escalation studies showed that miR-30c mimic caused sustained reductions in plasma cholesterol with no obvious side effects. Furthermore, miR-30c mimic significantly reduced hypercholesterolemia and atherosclerosis in Apoe(-/-) mice. Mechanistic studies showed that miR-30c mimic had no effect on LDL clearance but reduced lipoprotein production by down-regulating microsomal triglyceride transfer protein expression. MiR-30c had no effect on fatty acid oxidation but reduced lipid synthesis. Additionally, whole transcriptome analysis revealed that miR-30c mimic significantly down-regulated hepatic lipid synthesis pathways. Therefore, miR-30c lowers plasma cholesterol and mitigates atherosclerosis by reducing microsomal triglyceride transfer protein expression and lipoprotein production and avoids steatosis by diminishing lipid syntheses. It mitigates atherosclerosis most likely by reducing lipoprotein production and plasma cholesterol. These findings establish that increasing hepatic miR-30c levels is a viable treatment option for reducing hypercholesterolemia and atherosclerosis.

Statins increase hepatic cholesterol synthesis and stimulate fecal cholesterol elimination in mice

Statins are competitive inhibitors of HMG-CoA reductase, the rate-limiting enzyme of cholesterol synthesis. Statins reduce plasma cholesterol levels, but whether this is actually caused by inhibition of de novo cholesterol synthesis has not been clearly established. Using three different statins, we investigated the effects on cholesterol metabolism in mice in detail. Surprisingly, direct measurement of whole body cholesterol synthesis revealed that cholesterol synthesis was robustly increased in statin-treated mice. Measurement of organ-specific cholesterol synthesis demonstrated that the liver is predominantly responsible for the increase in cholesterol synthesis. Excess synthesized cholesterol did not accumulate in the plasma, as plasma cholesterol decreased. However, statin treatment led to an increase in cholesterol removal via the feces. Interestingly, enhanced cholesterol excretion in response to rosuvastatin and lovastatin treatment was mainly mediated via biliary cholesterol secretion, whereas atorvastatin mainly stimulated cholesterol removal via the transintestinal cholesterol excretion pathway. Moreover, we show that plasma cholesterol precursor levels do not reflect cholesterol synthesis rates during statin treatment in mice. In conclusion, cholesterol synthesis is paradoxically increased upon statin treatment in mice. However, statins potently stimulate the excretion of cholesterol from the body, which sheds new light on possible mechanisms underlying the cholesterol-lowering effects of statins.

Abstract 429: Structural Stability of Streptococcal Serum Opacity Factor

Despite its putative cardioprotective qualities, raising plasma high density lipoprotein-cholesterol (HDL-C) levels via pharmacologic means has failed to add protection against atherosclerosis, particularly when used as co-therapy with a statin. Two scenarios argue against the raising-plasma-HDL-is-better hypothesis and suggest that enhancing the final RCT step, hepatic cholesterol disposal, is a better cardioprotective strategy. First, probucol prevents CVD events and increases survival in humans and reduces CVD in SR-BI/apo E DKO mice. Despite its anti atherogenic properties, probucol lowers plasma HDL-C levels. Second, SR-BI over expressing vs. WT mice have lower plasma HDL-C but less atherosclerosis whereas the converse is true in SR-BI KO mice, suggesting that increasing HDL-C disposal is a rational cardioprotective strategy. One possible agent for therapeutic development is streptococcal serum opacity factor (SOF), a 100 kDa protein that clouds human serum via a novel HDL-targeting mechanism. SOF diverts HDL-CE to the LDL receptor and to bile acid secretion in vitro and in vivo, increases plasma HDL-C clearance in mice in an apo E-, LDLR-dependent mechanism thereby increasing hepatic CE uptake and reducing plasma cholesterol levels. SOF is active at 10 -14 M. Given its novel mechanism and potent reduction of plasma cholesterol levels in mice, we studied the structure and stability of SOF using its activity as a marker of its integrity versus several physicochemical challenges—extremes of pH, the denaturant, guanidinium chloride, heat, and ionic strength. SOF was highly resistant to all of these challenges. SOF has only one cysteine so it cannot be stabilized by internal disulfide bonds. Thus, SOF is an unusually stable protein that undergoes reversible unfolding-folding when challenged with a variety of physicochemical perturbants. These studies have helped us identify optimal conditions for crystallizing SOF for X-ray structure analysis.

Abstract 426: MicroRNA-30c Mimic Treatment Attenuates Hypercholesterolemia and Atherosclerosis in Mice

Background: High plasma cholesterol levels are a major risk factor for atherosclerosis. Plasma cholesterol can be reduced by inhibiting lipoprotein production; however, this is associated with steatosis. Previously we showed that lentiviral mediated hepatic over-expression of microRNA-30c (miR-30c) reduced hyperlipidemia and atherosclerosis in mice without causing hepatosteatosis. Since viral therapy would be formidable, we tested the hypothesis that a miR-30c oligonucleotide mimic can mitigate hyperlipidemia and atherosclerosis without causing steatosis. Methods and results: Delivery of a miR-30c mimic to the liver diminished Western diet-induced hypercholesterolemia in C57BL/6J wild type mice. Reductions in plasma cholesterol levels were significantly correlated with increases in hepatic miR-30c levels. Long-term dose escalation studies showed that miR-30c mimic causes sustained reductions in plasma cholesterol without increasing hepatic lipids and plasma transaminases. Further, miR-30c mimic significantly reduced hypercholesterolemia and atherosclerosis in Apoe –/– mice without causing steatosis or increasing plasma transaminases. Mechanistic studies indicated that miR-30c mimic reduced hepatic lipoprotein production, in part by reducing microsomal triglyceride transfer protein (MTP) activity. This is supported by the observation that miR-30c did not lower plasma cholesterol in liver-specific MTP deficient mice but did reduce hepatic lipid synthesis. In order to understand why there was no increase in hepatic lipids, we carried out whole transcriptome studies by RNA-sequencing. Bioinformatic analysis of the data revealed that genes down-regulated by miR-30c mimic are most significantly enriched for lipid synthesis pathways. Consistent with this finding, we showed that miR-30c mimic reduced fatty acid and glycerolipid synthesis in the liver but had no effect on hepatic β-oxidation. Conclusions: We conclude that miR-30c reduces plasma cholesterol by targeting MTP and prevents hepatosteatosis by repressing lipid synthesis programs in the liver. These findings suggest that increasing hepatic miR-30c levels may be a viable treatment modality for hypercholesterolemia and atherosclerosis.

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

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.