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Journal of Lipid Research, Vol. 43, 1602-1609, October 2002
Copyright © 2002 by Lipid Research, Inc.



* Vanderbilt University Medical Center, Departments of Medicine, Nashville, TN 37232
Pathology, Nashville, TN 37232
Pharmacology, Nashville, TN 37232
DOI 10.1194/jlr.M200108-JLR200
1 To whom correspondence should be addressed. e-mail: sergio.fazio{at}vanderbilt.edu or macrae.linton{at}vanderbilt.edu
| ABSTRACT |
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apoE-/-/LDLR-/-) produces progressive accumulation of apoE in plasma without affecting lipid levels. This model provides a tool to study the effects of physiologically regulated amounts of macrophage apoE on atherogenesis in hyperlipidemic animals. Ten-week-old male apoE-/-/LDLR-/- mice were transplanted with either apoE+/+/LDLR-/- (n = 11) or apoE-/-/LDLR-/- (n = 14) marrow. Although there were no differences between the two groups in lipid levels at baseline or at 5 and 9 weeks after transplantation, apoE levels in the apoE+/+LDLR-/-
apoE-/-/LDLR-/- mice increased to 4 times the apoE levels of normal mice. This resulted in a 60% decrease in aortic atherosclerosis in the apoE+/+/LDLR-/-
apoE-/-/LDLR-/- compared with the apoE-/-/LDLR-/-
apoE-/-/LDLR-/- controls, (15,957 ± 1907 vs. 40,115 ± 8302 µm2 ± SEM, respectively). In a separate experiment, apoE+/+/LDLR-/- mice were transplanted with either apoE+/+/LDLR-/- or apoE-/-/LDLR-/- marrow and placed on a high-fat diet for 8 weeks. In the absence of macrophage apoE, lesion area was increased by 75% in the aortic sinus and by 56% in the distal aorta. These data show that physiologic levels of macrophage apoE in the vessel wall are anti-atherogenic in conditions of severe hyperlipidemia and can affect later stages of plaque development.
Abbreviations: BMT, bone marrow transplant; HSPG, heparan sulfate proteoglycans; LDLR, low density lipoprotein receptor; LXR, liver X receptor; TNF
, tumor necrosis factor 
Supplementary key words apolipoprotein E low density lipoprotein receptor hyperlipidemia bone marrow transplant
| INTRODUCTION |
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For this reason, we studied the effect of physiological expression of macrophage apoE in a model that is unresponsive to the cholesterol-lowering effects of apoE, the apoE+/+/low density lipoprotein receptor (LDLR)-/-
apoE-/-/LDLR-/- mouse. In two separate experiments, we developed LDLR-/- mice with the expression of apoE either limited to the macrophage or deleted exclusively from the macrophage. The value of these models lies in the ability to analyze the effects of physiological expression of macrophage apoE in a "cholesterol clamp" environment, given that in either system the severe hyperlipidemia is not affected by macrophage apoE. In addition, the apoE production from these macrophages comes from the natural gene in the natural genomic position, and responds to physiological regulatory stimuli. Our studies show that the LDLR is not essential for the anti-atherogenic effects of apoE in the artery wall, and provide conclusive evidence that macrophage apoE partially over-rides the atherogenic influences of the massive hyperlipidemia induced by the combined deficiency of apoE and the LDLR.
| MATERIALS AND METHODS |
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Experimental design
Two separate BMT experiments were designed as follows: 1) Ten-week-old male recipient apoE-/-/LDLR-/- mice were transplanted with bone marrow from apoE-/-/LDLR-/- (control) or apoE+/+/LDLR-/- donors. Blood samples were collected for lipid analysis at 1 week pre-BMT and at 5 and 9 weeks post-BMT. Animals were sacrificed at 9 weeks post-BMT for lesion analysis. 2) Ten-week-old female apoE+/+/LDLR-/- mice were transplanted with either apoE+/+/LDLR-/- (control) or apoE-/-/LDLR-/- marrow. Four weeks after transplantation, mice were placed on a Western diet. Blood samples were collected at 4 weeks post-BMT, before initiation of the diet, and at 4 and 8 weeks post-diet (8 and 12 weeks post-BMT). Mice were sacrificed after 8 weeks on the diet for lesion area quantitation. Transplanted mice are designated as donor
recipient.
Bone marrow collection and transplantation
Bone marrow was collected from 6-week-old apoE-/-/LDLR-/- and apoE+/+/LDLR-/- donor mice by flushing femurs and tibias using RPMI-1640 media with 2% FBS and 5 U/ml heparin (Sigma), as previously described (9). One week prior to and 2 weeks following transplantation, all recipient mice were given 100 mg/l neomycin and 10 mg/l polymyxin B sulfate (Sigma) in acidified water. Recipient mice were lethally irradiated (9 Gy) from a cesium
source. Four hours later, the mice received 5 x 106 bone marrow cells in 300 µl RPMI-1640 media by tail vein injection.
Serum cholesterol and triglyceride analysis
Fasted blood samples were collected by retro-orbital venous plexus puncture and the concentrations of total cholesterol and triglycerides were determined as previously described (5) using Raichem reagent #80015VI and Sigma Reagent No. 339 adapted for microtiter plate assay, respectively.
Lipoprotein separation
Fast performance liquid chromatography analyses using a Superose 6 column from Pharmacia on an HPLC system model 600 (Waters) were conducted on serum samples as previously described (9). Fractions 1518 contain VLDL; fractions 1926 contain LDL and IDL; fractions 2731 contain HDL; and fractions 3240 contain non-lipoprotein associated proteins.
Western blot analysis of apoE
Serum samples were separated by electrophoresis on 12% SDS polyacrylamide gels, and proteins were transferred from the gel to a nitrocellulose membrane (Gelman). The membranes were incubated with rabbit anti-mouse apoE antibodies (BioDesign International) and then with HRP-conjugated goat anti-rabbit IgG antibody (Amersham). Signal was detected using the ECL kit according to manufacturer's instructions (Amersham).
Quantitation of arterial lesions
Mice were sacrificed and the aorta was flushed with 20 ml cold PBS by slow injection through the left ventricle. The heart with the proximal aorta was embedded in OCT and snap-frozen in liquid N2. Cryosections of 10-µm thickness were taken from the region of the proximal aorta starting from the end of the aortic sinus and for 300 µm distally, according to the method of Paigen et al. (10). Cryosections were stained with Oil Red O and counter-stained with hematoxylin. The images of the aorta were captured with a frame grabber (Vers.3.1 Kontron Electronik), using a color video camera mounted on an Axioskop microscope (Carl Zeiss Inc). Quantitative analysis of lipid-stained lesions was performed using an Imaging system KS300 (Release 2.0, Kontron Electronik). En face analysis was performed as previously described (11, 12).
Immunocytochemistry
After perfusing mice, liver and spleen were fixed in 4% paraformaldehyde in PBS for 2 days at 4°C and embedded in paraffin. Serial 5-µm liver paraffin sections and cryosections of the proximal aorta were stained for apoE and macrophages as described (13). The sections were pre-treated for 30 min with proteinase K (50 µg/ml; Promega) and 20 min with 10% normal goat serum, then incubated overnight at 4°C with either rabbit antisera to mouse apoE (BioDesign) or with monoclonal rat antibody MOMA-2 (Accurate Chemical and Scientific Corp.). The sections were treated with goat biotinylated antibodies to chicken IgG (Vector Laboratories) or to rat IgG (PharMingen) for 45 min at 37°C. Then sections were incubated with avidin-biotin complex labeled with alkaline phosphatase (Vector Lab.). Enzyme was visualized with Fast Red TR/Naphthol AS-NX substrate (Sigma Chemical Co.) and counter-stained with hematoxylin. Non-immune rabbit or rat serum in the place of primary antibody was used as a negative control.
In situ hybridization
ApoE mRNA message was detected essentially as described (3). Briefly, 35S-labeled 104-bp antisense and sense riboprobes for mouse apoE were prepared. Cryosection of the proximal aorta and paraffin sections of liver and spleen were treated for 15 min with proteinase K (5 µg/ml), and incubated with riboprobes in hybridization solution (0.3M NaCl, 20 mM Tris, pH 8.0, 5 mM EDTA, 1x Denhardt's solution, 10 mM dithiothreitol, 10% dextran sulfate, 50% formamide) overnight at 55°C. The sections were treated for 30 min with RNase A (20 µg/ml), washed, coated with autoradiographic emulsion (Kodak NTB-2), and exposed for 23 weeks. After development, the slides were counter-stained with hematoxylin. The sense probe was used in parallel as a negative control.
Statistical analyses
Statistical analyses were performed using the Student's t-test.
| RESULTS |
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apoE-/-/LDLR-/-, plasma lipid levels and lipoprotein profiles were not different between experimental and control mice (Fig. 2
and Table 1).
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apoE-/-/LDLR-/- mice (Fig. 3A)
. In situ hybridization, however, showed apoE mRNA in a small percentage of non-parenchimal cells in liver and in numerous cells in the spleen (Fig. 3C, E). Control apoE-/-/LDLR-/-
apoE-/-/LDLR-/- sections showed no evidence of apoE protein or mRNA in either tissue (Fig. 3B, D, F). In agreement with our previous report (13), hepatic apoE was exclusively found in the extra-cellular space between columns of hepatocytes and the endothelial lining of acinar capillaries. This is most likely due to the inability of extra-hepatic apoE to activate lipoprotein uptake and clearance in mice lacking both hepatic apoE and LDLR expression.
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apoE-/-/LDLR-/- mice but not controls (Fig. 5EF).
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apoE+/+/LDLR-/- but not in the apoE-/-/LDLR-/-
apoE+/+/LDLR-/- mice, and there were no detectable differences in plasma apoE levels (data not shown). In agreement with our previous results in C57Bl/6 mice (3), the absence of apoE increased lesion area by 75% in the aortic sinus (Fig. 6A)
and by 56% in the distal aorta (Fig. 6B).
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| DISCUSSION |
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The observation that apoE has a functional role in the artery wall, apart from its more systemic effects on lipoprotein clearance, has been reported in many studies. We, and others, have used the approach of bone marrow transplantation to express apoE from macrophages in the artery wall of apoE-/- mice. ApoE levels only 10% of wild-type caused the normalization of lipoprotein profiles and a 50-fold reduction in atherosclerotic lesion formation (9, 14, 15), but the reduction in plasma lipids did not allow for conclusions to be made regarding a direct effect of macrophage apoE in the artery wall. To answer this question, we expressed very low levels of apoE from retrovirus-transduced macrophages in apoE null mice recipients of bone marrow transplantation. This approach resulted in a decrease in lesion area during the early stages of atherosclerosis, but the effect was lost in advanced lesions (5). Moreover, using transgenic mouse models, Shimano et al. and Bellosta et al. have shown that low levels of apoE expression in the artery wall can lead to delayed atherosclerotic lesion formation (6, 7). The limitation of all these studies was in the need of using low level apoE expression as a way to avoid the cholesterol lowering effect of larger amounts of apoE. The importance of the present study is in the demonstration that physiologically normal expression of macrophage apoE has anti-atherogenic effects that are not limited to the foam cell lesion but extend into the more advanced stages of plaque growth on a setting of hyperlipidemia.
The current study provides a model of a "hyperlipidemic clamp" in which apoE gradually accrues but does not have any measurable effect on lipoprotein clearance. In this setting, it is possible to study and contrast the harmful effects of hyperlipidemia and the protective effects of apoE in atherogenesis. The results of this experiment are unequivocal: the presence of macrophage-derived apoE for about 6 weeks in the severely hyperlipidemic apoE-/-/LDLR-/- mice reduced atherosclerosis by 60% compared with controls. In fact, the extent of lesion area in the apoE-expressing, hypercholesterolemic mice was 15,000 µm2 per section, a level that corresponds to the extent of lesion area that is commonly found in 13-week-old irradiated apoE-/- mice (5), an indication that from the moment apoE began to accumulate, progression of atherogenesis was halted. Evidence in support of the protective effect of systemic apoE in the presence of dyslipidemia comes from studies in which apoE was over-expressed in the livers of LDLR-/- mice by adenoviral infection (16, 17). In these studies, a tremendous over-expression of apoE by the liver was acutely and transiently induced, and this human apoE accumulated in addition to the pre-existing endogenous apoE, thus producing a true supra-physiological systemic accumulation. In contrast, in our system the production of apoE occurred at physiological rate and from a physiological source, and because the study animals were apoE deficient and hyperlipidemic, macrophage apoE accumulated in VLDL particles in concentrations within the physiological range (13). This suggests a local effect of physiological levels of macrophage apoE capable to counter the strong atherogenic pressure of severe hypercholesterolemia.
ApoE is a strong physiological ligand for the LDLR, and also binds to other membrane receptors such as the LDLR-related protein and heparan sulfate proteoglycans (HSPG). We have demonstrated that macrophage expression of human apoE-2, a common isoform of apoE defective in binding to the LDLR, does not affect atherosclerotic lesion formation in setting of hyperlipidemia, whereas apoE-3 reduces foam cell lesion size by about 40% (8). Similarly, apoE-cys142, a rare human apoE variant defective in the binding to HSPG, did not reproduce the beneficial effects of apoE-3 in the vessel wall and actually appeared to increase lesion size (8). These data suggest that the local function of apoE may derive from its physical engagement with membrane receptors, and may be related to its effects on lipoprotein internalization by the macrophage or on cellular cholesterol efflux.
The second set of experiments presented here also supports the idea that macrophage apoE can significantly modulate the biology of arterial lesions in the presence of massive hyperlipidemia. In this study, deletion of apoE exclusively from the macrophages of LDLR-/- mice fed a Western-type diet increased aortic atherosclerosis by approximately 70% without affecting plasma lipids or systemic apoE levels. We previously reported that the removal of macrophage apoE increases lesion size in C57BL/6 mice on a high-fat diet (3), and have recently shown that this intervention is deleterious in both apoA-I-/- and apoA-I over-expressing mice (4, 18). However, in all these models the hyperlipidemia is modest and atherosclerosis is limited to the very early stages of foam cell formation. The present study shows that the atherogenic potential of the lack of apoE in the artery wall is fully measurable in advanced atherosclerosis and in severely hypercholesterolemic LDLR-/- mice. Of note is that the macrophage-rich lesions of apoE-/-/LDLR-/-
apoE+/+/LDLR-/- did not stain for apoE (not shown), confirming our previously reported data in C57BL/6 mice indicating that most of the local apoE in the arterial wall has a macrophage origin (3).
Several recent studies have shed light on potential mechanisms by which macrophage apoE may be protective. Control of macrophage apoE expression appears to be related to cellular cholesterol loading (19), and recently two distal enhancers that specify apoE gene expression from macrophages have been identified (20) and found to contain conserved liver X receptor (LXR) response elements (21). Of interest is the recent observation that macrophage apoE and ABCA1 (both LXR-regulated genes) may have a non-cooperative role in cholesterol homeostasis. Mazzone et al. have shown that the absence of apoE from macrophages is accompanied by increased levels of ABCA1 protein, and that the expression of apoE reduces ABCA1 levels (22). Considering that apoE deficient macrophages have significantly reduced cholesterol efflux (19, 23), these data are compatible with a system where apoE may be the primary motor of cholesterol efflux from the macrophage in a pathway that not only is independent from ABCA1 but cannot be corrected for by the counter-regulatory over-expression of ABCA1. In support of this, Joyce and co-workers found that whereas ABCA1 over-expression was protective against atherosclerotic lesion development in C57Bl/6 mice, the protection was lost in the absence of apoE (24), indicating that apoE is a stronger modulator of atherogenesis and cholesterol efflux than ABCA1 mediated mechanisms. Our own recent observations that the transgenic or retrovirus-based expression of apoA-I from the macrophage corrects the increased atherosclerosis induced by apoE deficiency (4, 18) support the notion that enhanced cholesterol efflux is an important mechanism for the effect of apoE in the arterial wall.
In addition to its effects on cholesterol accumulation in macrophages, apoE can also modulate immune and inflammatory responses and exert anti-oxidant properties. ApoE decreases lymphocyte responses in vitro (25, 26) and apoE-/- mice have higher concentrations of circulating tumor necrosis factor
(TNF
) following challenge with bacterial pathogens (2729). In addition, apoE suppresses microglial cell activation and inflammatory responses, including the secretion of TNF
and nitric oxide (30, 31). Although an antioxidant effect of apoE is certainly visible at higher concentrations (32), we were unable to show a difference in free F2 isoprostanes in apoE-/-/LDLR-/- mice transplanted with apoE+/+/LDLR-/- compared with those transplanted with apoE-/-/LDLR-/- marrow (data not shown). Therefore, oxidative stress is unlikely to represent an important mediator of the vascular effects of apoE.
In conclusion, we have provided definitive evidence that the physiological expression of apoE from macrophages is a powerful regulator of atherogenesis under conditions of extreme hypercholesterolemia, complicated arterial plaques, and absence of the LDLR. The knowledge that apoE gene regulation is within the control of the LXR axis raises the possibility of exploiting macrophage apoE expression through pharmacologic interventions as a means to prevent and cure atherosclerosis.
| ACKNOWLEDGMENTS |
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Manuscript received March 5, 2002 and in revised form June 12, 2002.
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