Atherosclerosis and Lipoproteins |
From The Winship Cancer Institute (T.L.C., J.N.W.), Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Ga, and CV Therapeutics, Inc (R.M.L., D.P.W.), Palo Alto, Calif.
Correspondence to Josiah N. Wilcox, PhD, Emory University, The Winship Cancer Institute, Division of Hematology/Oncology, 1639 Pierce Dr, Room 1115 WMRB, Atlanta, GA 30322. E-mail medjnw{at}emory.edu
| Abstract |
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Key Words: HDL cholesterol atherosclerosis ATP-binding cassette transporter 1 (ABC1) ATB-binding cassette transporter A1 (ABCA1)
| Introduction |
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Because tissue macrophages may not represent the source of ABC1 in all organs, we used in situ hybridization to localize its expression in human and baboon tissues. Although its presence in macrophages in arterial lesions supports an expected role in the process of atherosclerosis, detection of ABC1 mRNA in liver hepatocytes, villi of the small intestine, tubule cells in the kidney, and cells of the central nervous system serves notice that ABC1 plays a number of roles in lipid transport and homeostasis in addition to the early lipidation of nascent HDL particles in the vascular wall.
| Methods |
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Tissue samples were fixed overnight in 4% (wt/vol) paraformaldehyde in 0.1 mol/L sodium phosphate (pH 7.4) at 4°C and then processed by using standard paraffin techniques. Other tissue samples were collected, immediately immersed in 4% (wt/vol) paraformaldehyde in 0.1 mol/L sodium phosphate (pH 7.4) at 4°C for 3 to 4 hours, cryoprotected in 15% (wt/vol) sucrose/isotonic PBS overnight at 4°C, and processed for frozen sections as previously described. Equivalent in situ hybridization results were obtained with both methods.
In Situ Hybridization
In situ hybridization was performed on paraffin
sections with the use of human-specific
35S-labeled riboprobes as previously
described.13 In situ
hybridization results were photographed by polarized light
epiluminescence microscopy (Leitz) so that the silver grains appeared
white. The results were evaluated by 2 individuals and graded (-, +,
++, and +++) on the basis of the number of cells expressing ABC1 mRNA
in each tissue type.
Probes
A plasmid template for the synthesis of sense and
antisense riboprobes to ABC1 mRNA was constructed by the ligation of
sequences from base pairs 350 to 1805 of the ABC1 cDNA (GenBank
AF285167) into vector pGEM 3Zf- (Promega). RNA probes constituting
either strand of this sequence were synthesized by in vitro
transcription from the T7 or SP6 RNA polymerase promoters flanking the
insert after linearization of the plasmid by restriction digestion.
Probe specificity was confirmed by hybridization of a
32P-labeled probe containing this insert
sequence to Southern blots of human genomic DNA that had been digested
with KpnI,
BamHI, or
EcoRI. Only the bands expected
from restriction enzyme fragment prediction based on the human ABC1
gene sequence (GenBank accession numbers AF287262 and AF287263) were
observed.
Immunohistochemistry
Immunohistochemistry was used on serial sections to
identify cells containing ABC1 mRNA. The following antibodies were
used: CD68 for macrophages (Dako, 1:50 dilution), CD20 for B
cells (Pharmagen, 1:125 dilution), CD3 for T cells (Dako, 1:25
dilution), and SM1 for smooth muscle cell
-actin (Sigma Chemical Co,
1:800 dilution). Sections were predigested with proteinase K (1 mg/mL,
Sigma) or pronase E (1 mg/mL, Sigma), the primary antibodies were
applied at the indicated dilutions, and the slides were stained by
using ABC-AP (Vector Labs) as
described.14 Serial sections
treated with secondary antibodies only or with nonimmune IgG did not
show any staining.
| Results |
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In the liver, ABC1 was expressed in some, but not all,
hepatocytes
(Figure 1
). Strong consistent hybridization was seen
in scattered CD68-positive macrophages and Kupffer cells. At
least some of the hybridizing cells in the liver were likely to be B
cells, as determined by serial section immunohistochemistry with the
CD20 antibody (Figure 1
, available online at
http://atvb.ahajournals.org). Strong hybridization was found in the
region surrounding the portal vein and appeared to consist of
connective tissue cells and CD68- and CD20-positive lymphocytes found
in this region. The small intestine was found to have numerous
ABC1-positive macrophages in the lamina propria of the
intestinal villi. ABC1 mRNA was not detected in the epithelial cells
lining the small intestine. In the spleen and lymph nodes,
hybridization was found in regions consistent with the
localization of macrophages and B cells. Some hybridization to
T cells was likely in the marginal zone but could not be confirmed. In
the testis, ABC1-positive cells were found in the Leydig cells
surrounding the seminiferous tubules. In the kidney, strong
hybridization that was localized to scattered tissue
macrophages as well as cells lining the proximal and distal
tubules in the cortex and medulla (Figure 2
, available online at
http://atvb.ahajournals.org) was found. In a section of the baboon
cerebellum, ABC1 mRNA was detected in glial cells in the white matter
as well as in cells within the granular layer. Purkinje cells did not
express ABC1 mRNA (Figure 3
, available online at
http://atvb.ahajournals.org). In the lung, ABC1 was expressed by
pulmonary microphages (Figure 4, available online at http:
//atvb.ahajournals.org).
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Normal baboon aorta and carotid artery did not express ABC1
mRNA. Consistent with this result, no ABC1-expressing cells
were found in samples of human internal mammary artery or normal
nonatherosclerotic aortas
(Table 2
). Atherosclerotic vessels demonstrated expression
of ABC1 mRNA in scattered lipid-filled macrophages in early
fatty streaks
(Figure 2
) as well as in the shoulder region of advanced
lesions (see http://atvb.ahajournals.org). Nonatherosclerotic regions
of these same vessel cross sections contained no ABC1-hybridizing
cells. In at least 1 vessel, strong hybridization was found in an
inflammatory zone filled with scattered macrophages without
lipids
(Figure 3
). In the same tissue section, a portion of the
vessel had a diffuse intimal thickening without inflammatory cells,
which showed no ABC1 hybridization. In all cases, serial section
staining of these vessels with CD68 suggested that ABC1 hybridization
was to macrophages in the atherosclerotic vessels. No
CD20-positive cells were found in the vascular tissues, so it is
unlikely that B cells are the source of ABC1 mRNA; scattered
CD3-positive T cells were present but differed morphologically from
the ABC1-positive cells
(Figures 2
and 3
). However, it should be emphasized that not
all CD68-positive macrophages hybridized with the ABC1
riboprobe. ABC1 mRNA was not detected in a number of
nonlipid-associated CD68-positive cells found scattered in other
parts of the vessel, especially in the
adventitia.
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| Discussion |
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Patients with Tangier disease experience cholesterol deposition in many tissues, not only in the enlarged orange tonsils, noted as the hallmark of this disease, but in liver, spleen, intestinal mucosa, lymph nodes, cornea, and Schwann cells.10 22 Major clinical symptoms include not only HDL deficiency and increased incidence of cardiovascular disease but splenomegaly and neuropathy as well. The results in the present study support the role of ABC1 in the development of arterial lesions as well as a broader function in lipid distribution. Previous studies detected the presence of ABC1 message by blot hybridization to whole-organ RNA samples from heart, liver, spleen, kidney, lung, small intestine, and brain.11 23 In situ hybridization data have now confirmed and extended these observations to the level of individual cells within these tissues.
ABC1 RNA is readily detected in fatty macrophages in
early atherosclerotic lesions
(Figure 2
). However, not all macrophages in the
plaque specimens are positive. This raises the intriguing issue of the
signals and responses that control its synthesis. Cell culture studies
have demonstrated sterol-induced ABC1 transcription in parallel with
enhancement of cholesterol efflux from such
cells.24 This may be an
adaptive response to maintain cholesterol homeostasis in
cells containing scavenger receptors that allow unregulated uptake of
oxidized or otherwise modified LDL. Cultured THP-1
macrophages show a steady increase of ABC1 RNA during 4 days of
exposure to oxidized LDL.25
It remains to be determined whether some plaque macrophages
fail to express ABC1 as a result of an insufficient signaling input or
a lack of response due to signal overload or because they
represent a unique subclass of macrophages. At this
point, such questions remain unanswered, yet it is suggestive that we
have detected less ABC1 RNA in macrophage-rich regions of
plaques considered to be of an advanced nature. We speculate that these
macrophages may represent foam cells incapable of
ABC1-mediated cholesterol efflux.
A substantial portion of the ABC1 RNA detected in spleen, lung, liver, and small intestine can be attributed to resident macrophages. Splenomegaly with lipid-filled macrophages occurs in some patients with Tangier disease, supporting a role of ABC1 in sterol efflux from macrophages that must cope with a large flux of cholesterol derived from the uptake by the spleen of phagocytic cells and senescent cells.10 Expression of ABC1 in alveolar macrophages in the lung is consistent with a role in lipid homeostasis in these cells that are involved in the uptake and clearance of surfactant phospholipids and cholesterol, as well as diseased and damaged cells.
Much of the expression of ABC1 in liver resides in macrophages and Kupffer cells. However, cells lining the portal vein, B cells, and some hepatocytes are also positive. It can be suggested that in hepatocytes the primary function of ABC1 is to mediate the formation of nascent HDL through the provision of cholesterol and phospholipid to lipid-free apolipoproteins rather than to promote the efflux of excess cholesterol as in macrophages. Such divergent functions may require ABC1 gene regulation to differ in these tissue types. Indeed, Costet et al26 have recently provided evidence that Hep G2 cells produce a variant of ABC1 mRNA that uses a distinct 5' exon, containing a different transcription and translation start site than that expressed in macrophages and cultured fibroblasts.24 26 27 , Because only the initial 22 amino acids of the protein are predicted to differ in the liver form of ABC1,26 potential differences in transcriptional response of the gene may be a more important consequence of the alternatively spliced variants.
ABC1 expression in Leydig cells of the testes implies a role in cholesterol homeostasis in tissues that synthesize steroid hormones, as also noted by the detection of ABC1 message by blot hybridization to adrenal RNA.11 Synthesis of ABC1 in the kidney suggests a role in sterol transport during filtration and reabsorption. Because apoA-I is known to be filtered in the kidney, renal clearance of poorly lipidated apoA-Icontaining particles may play a key role in their scarcity in the plasma of patients with Tangier disease and potentially other individuals with low levels of HDL.28 29 The HDL-binding proteins megalin and cubilin are expressed in the kidney and have been proposed to mediate the uptake of apoA-I dissociated from the lipoprotein particle.30 Our detection of ABC1 gene expression in tubules and collecting ducts in the kidney medulla suggest a renal function for ABC1 as well as these other proteins in secreting or recapturing cholesterol and not merely the dissociated protein components of HDL.
It had been suggested that the neuropathology associated with Tangier disease could be linked to the low concentrations of apoA-I and HDL, which could impair the unloading of cholesterol from macrophages and Schwann cells during myelination.10 The detection of ABC1 synthesis in neuronal tissue suggests that this protein plays a direct role in the redistribution of cholesterol and phospholipid in the nervous system, as do other components of lipid transport pathways, such as apoE and members of the LDL receptor family.31
The role of ABC1 in the intestine was not appreciated before the discovery that mice with a targeted disruption of this gene showed an increased absorption of cholesterol from the gut.8 A more recent report of drug-induced increase in ABC1expression and reduction in cholesterol uptake in the mouse intestine supports this activity.32 This suggests that ABC1 acts as a unidirectional transporter to efflux some percentage of absorbed cholesterol back to the intestinal lumen. The cell type and the presumed acceptor apolipoprotein in this process remain to be determined. Although we detect a clear ABC1 RNA signal in intestinal villi, it appears to be uniformly distributed throughout the lamina propria, where it colocalizes with macrophages, not with epithelial cells. Thus, our data may not support a proposed role of ABC1 in cholesterol absorption by the intestine. Alternatively, they may suggest that the "barrier" to absorption may be occurring not in the epithelial layer but in macrophages within the lamina propria. This might be consistent with the report that cultured intestinal epithelioid CaCo2 cells did not show apoA-Istimulated cholesterol efflux.33 However, until the full nature of the induction of this pathway in the intestine is elucidated, we cannot exclude the possibility that intestinal epithelial cells may not express ABC1 under certain conditions.
The discovery that ABC1 represents the defective gene in Tangier disease and plays a key role in the efflux of cholesterol and phospholipids from macrophages to nascent HDL particles was a key step in clarifying the initiating events in reverse cholesterol transport. Conditions that are known to increase cholesterol efflux from macrophages, including cholesterol loading, cAMP signaling, and treatment with ligands of nuclear hormone receptors, are now known to affect ABC1 transcription in parallel.26 24 33 34 Most cells regulate intracellular cholesterol by controlling its synthesis or its uptake by LDL receptormediated endocytosis. Macrophages that ingest cell debris and modified lipoproteins by scavenger receptors that are not downregulated are more dependent on the efflux pathway in which ABC1 may be a rate-limiting component.35 The studies of Chimini and colleagues19 21 add to this the involvement of ABC1 in membrane phospholipid distribution in the process of phagocytosis. However, the distribution of ABC1 gene expression suggests a function beyond that appropriate for phagocytic cells. It can be proposed that ABC1 serves not only to aid in the net efflux of lipids from nonpolarized cells, such as macrophages. It can be hypothesized that in polarized cells lining blood and lymphatic vessels or kidney tubules, ABC1 is involved in the physiological redistribution of lipids via transcytosis, delivering its cargo out of a luminal or basolateral surface. Further definition of all the functions of ABC1 will be gained by the development and use of additional tools, which include genetically manipulated mice, inhibiting antibodies, and selective drugs that alter the quantity or activity of this protein.
| Acknowledgments |
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Received October 5, 2000; accepted December 5, 2000.
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D. M. Selva, V. Hirsch-Reinshagen, B. Burgess, S. Zhou, J. Chan, S. McIsaac, M. R. Hayden, G. L. Hammond, A. W. Vogl, and C. L. Wellington The ATP-binding cassette transporter 1 mediates lipid efflux from Sertoli cells and influences male fertility J. Lipid Res., June 1, 2004; 45(6): 1040 - 1050. [Abstract] [Full Text] [PDF] |
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A. E. Bortnick, E. Favari, J.-Q. Tao, O. L. Francone, M. Reilly, Y. Zhang, G. H. Rothblat, and S. R. Bates Identification and characterization of rodent ABCA1 in isolated type II pneumocytes Am J Physiol Lung Cell Mol Physiol, October 1, 2003; 285(4): L869 - L878. [Abstract] [Full Text] [PDF] |
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C. L. Wellington, L. R. Brunham, S. Zhou, R. R. Singaraja, H. Visscher, A. Gelfer, C. Ross, E. James, G. Liu, M. T. Huber, et al. Alterations of plasma lipids in mice via adenoviral-mediated hepatic overexpression of human ABCA1 J. Lipid Res., August 1, 2003; 44(8): 1470 - 1480. [Abstract] [Full Text] [PDF] |
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C. M. Desrumaux, P. A. Mak, W. A. Boisvert, D. Masson, D. Stupack, M. Jauhiainen, C. Ehnholm, and L. K. Curtiss Phospholipid transfer protein is present in human atherosclerotic lesions and is expressed by macrophages and foam cells J. Lipid Res., August 1, 2003; 44(8): 1453 - 1461. [Abstract] [Full Text] [PDF] |
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R. J. Aiello, D. Brees, and O. L. Francone ABCA1-Deficient Mice: Insights Into the Role of Monocyte Lipid Efflux in HDL Formation and Inflammation Arterioscler. Thromb. Vasc. Biol., June 1, 2003; 23(6): 972 - 980. [Abstract] [Full Text] [PDF] |
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C. Joyce, L. Freeman, H. B. Brewer Jr, and S. Santamarina-Fojo Study of ABCA1 Function in Transgenic Mice Arterioscler. Thromb. Vasc. Biol., June 1, 2003; 23(6): 965 - 971. [Abstract] [Full Text] [PDF] |
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R. S. Kiss, D. C. McManus, V. Franklin, W. L. Tan, A. McKenzie, G. Chimini, and Y. L. Marcel The Lipidation by Hepatocytes of Human Apolipoprotein A-I Occurs by Both ABCA1-dependent and -independent Pathways J. Biol. Chem., March 14, 2003; 278(12): 10119 - 10127. [Abstract] [Full Text] [PDF] |
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H. Fukumoto, A. Deng, M. C. Irizarry, M. L. Fitzgerald, and G. W. Rebeck Induction of the Cholesterol Transporter ABCA1 in Central Nervous System Cells by Liver X Receptor Agonists Increases Secreted Abeta Levels J. Biol. Chem., December 6, 2002; 277(50): 48508 - 48513. [Abstract] [Full Text] [PDF] |
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J. W. Burgess, R. S. Kiss, H. Zheng, S. Zachariah, and Y. L. Marcel Trypsin-sensitive and Lipid-containing Sites of the Macrophage Extracellular Matrix Bind Apolipoprotein A-I and Participate in ABCA1-dependent Cholesterol Efflux J. Biol. Chem., August 23, 2002; 277(35): 31318 - 31326. [Abstract] [Full Text] [PDF] |
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J. J. Repa, K. E. Berge, C. Pomajzl, J. A. Richardson, H. Hobbs, and D. J. Mangelsdorf Regulation of ATP-binding Cassette Sterol Transporters ABCG5 and ABCG8 by the Liver X Receptors alpha and beta J. Biol. Chem., May 17, 2002; 277(21): 18793 - 18800. [Abstract] [Full Text] [PDF] |
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H. Liao, T. Langmann, G. Schmitz, and Y. Zhu Native LDL Upregulation of ATP-Binding Cassette Transporter-1 in Human Vascular Endothelial Cells Arterioscler. Thromb. Vasc. Biol., January 1, 2002; 22(1): 127 - 132. [Abstract] [Full Text] [PDF] |
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T. Mikita, G. Porter, R. M. Lawn, and D. Shiffman Oxidized Low Density Lipoprotein Exposure Alters the Transcriptional Response of Macrophages to Inflammatory Stimulus J. Biol. Chem., November 30, 2001; 276(49): 45729 - 45739. [Abstract] [Full Text] [PDF] |
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J. F. Oram and R. M. Lawn ABCA1: the gatekeeper for eliminating excess tissue cholesterol J. Lipid Res., August 1, 2001; 42(8): 1173 - 1179. [Abstract] [Full Text] [PDF] |
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N. Wang, D. L. Silver, C. Thiele, and A. R. Tall ATP-binding Cassette Transporter A1 (ABCA1) Functions as a Cholesterol Efflux Regulatory Protein J. Biol. Chem., June 22, 2001; 276(26): 23742 - 23747. [Abstract] [Full Text] [PDF] |
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