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Journal of Lipid Research, Vol. 44, 1156-1166, June 2003 Cyclodextrins differentially mobilize free and esterified cholesterol from primary human foam cell macrophages
* Heart Research Institute, Camperdown, Sydney New South Wales, Australia Published, JLR Papers in Press, April 1, 2003. DOI 10.1194/jlr.M200464-JLR200
1 S. M. Liu, A. Cogny, and M. Kockx contributed equally to this work.
2 To whom correspondence should be addressed. e-mail: l.kritharides{at}unsw.edu.au
Human monocyte-derived foam cell macrophages (HMFCs) are resistant to cholesterol efflux mediated by physiological acceptors. The role of the plasma membrane in regulating depletion of free cholesterol (FC) and of cholesteryl ester (CE) was investigated using cyclodextrins (CDs). HMFCs were incubated in media containing CDs (1.0 mg/ml, 0.7 mM) with low [hydroxypropyl-ß-CD (HP-CD)] or high [trimethyl-ß-CD (TM-CD)] affinity for cholesterol in the presence or absence of phospholipid vesicles (PLVs). Low-affinity HP-CD caused minimal cholesterol efflux on its own, but HP-CD+ PLV depleted cell FC and CE to 54.5 ± 6.7% of control by 24 h. TM-CD depleted FC at least as well as HP-CD+PLV but without depleting CE, even when combined with PLV. This was not explained by acceptor saturation, instability of PLV vesicles, de novo cholesterol synthesis, kinetically distinct cholesterol pools, or inhibition of CE hydrolysis. TM-CD did, however, deplete CE when lower concentrations of TM-CD were combined with PLV and when acetyl-CoA cholesteryl acyltransferase was inhibited. TM-CD caused much greater depletion of plasma membrane cholesterol than HP-CD without depleting plasma membrane sphingomyelin. It is concluded that differential depletion of plasma membrane cholesterol pools regulates cholesterol efflux and CE clearance in human macrophages.
Abbreviations: CD, cyclodextrin; CE, cholesteryl ester; FC, free cholesterol; HMFC, human monocyte-derived foam cell macrophage; HP-CD, hydroxypropyl-ß-CD; LPC, lysophosphatidylcholine; PC, phosphatidylcholine; PLV, phospholipid vesicles; SPM, sphingomyelin; TM-CD, trimethyl-ß-CD Supplementary key words cholesterol efflux high density lipoprotein atherosclerosis plasma membrane
Human monocyte-derived foam cell macrophages (HMFCs) containing lipoprotein-derived free cholesterol (FC) and cholesteryl ester (CE) are a hallmark of atherosclerosis. In peripheral cells such as macrophages, excess accumulated cholesterol can be released into aqueous medium after conversion to more polar metabolites (for example, to 27OH-cholesterol) or released to a cholesterol acceptor such as HDL or apolipoprotein A-I (apoA-I) (13). Data from in vitro cell culture systems suggest that sterol release after metabolism is small relative to that released to cholesterol acceptors (4). The eventual delivery of cholesterol from the peripheral tissues to the liver for clearance in the bile is referred to as the reverse cholesterol transport pathway. This is recognized as one likely route by which HDL protects against the development of atherosclerosis. The removal of cholesterol from cells has been broadly categorized as involving several processes: aqueous diffusion, lipid-free apolipoprotein membrane microsolubilization (5), and interaction with proteins ("receptors") located on the cell plasma membrane. As examples of the last of these, clearance of cholesterol from foam cells to HDL and its main protein constituent, apoA-I, have been identified as requiring interactions with the scavenger receptor type I (SR-BI) and the ATP-binding cassette transporter ABCA-1 protein, respectively (610). However, aqueous diffusion and acceptor-cell protein interactions are not mutually exclusive. For example, efflux to phospholipid vesicles (PLVs), which can accept cholesterol after its desorption into the aqueous layer, is enhanced from cells expressing SR-BI (11). Data from several laboratories indicate that human macrophages are resistant to cholesterol efflux, at least in part due to slow mobilization of stored CEs by hydrolysis (1214). In addition, as the flux of cholesterol through all cellular compartments is slow in human THP-1 macrophages (14), factors other than CE hydrolysis may also be limiting. Important earlier studies indicated that variations in rates of cholesterol efflux between different cell types and or different species were largely explained by differences in rates of efflux from the plasma membrane (15, 16). The processes that link the concentration of cholesterol in the plasma membrane with that of intracellular CE are complex (1720), but studies generally indicate a close relationship between the cholesterol concentration of the plasma membrane and the mobilization of intracellular cholesterol. Cyclodextrins (CDs) are cyclical oligomers of six, seven, or eight glucose molecules that can solubilize hydrophobic molecules such as cholesterol by virtue of their hydrophobic interior. Because CDs interact with the cell plasma membrane without internalization and do not disrupt membranes at low concentrations (and are thus unlike detergents) (21), they are useful for elucidating the role of plasma membrane pools of cholesterol in determining net cholesterol efflux and intracellular cholesterol metabolism (22, 23). In ß-CDs, which contain seven glucose molecules and most avidly bind cholesterol, the modification of CD side chains regulates their affinity for cholesterol. This determines the concentration at which CDs can cause effective cholesterol depletion from cells. CDs such as hydroxypropyl-ß-CD (HP-CD) and trimethyl-ß-CD (TM-CD) used at low concentrations mediate the removal of cholesterol and oxysterols from foam cells and from isolated membranes without toxicity and apparently without significant removal of cellular phospholipids or membrane proteins (21, 22, 24, 25). CDs can cause the net removal of cholesterol from cells in one of two ways (26). First, they can accept cholesterol from the plasma membrane and retain it in the extracellular medium, acting as depots or "sinks." Second, at lower concentrations insufficient to alter net equilibrium between cells and medium, they can remove cholesterol from the plasma membrane and deliver it to a second acceptor of larger capacity but slower cholesterol efflux efficiency, such as PLV. In this instance, CDs act as vehicles or "shuttles" between cells and the terminal cholesterol sink (PLV). The latter process has also been identified in the removal of cholesterol by relatively small HDLs to large PLVs (27) and may apply to many other lipoproteins (28). Removal of cellular cholesterol by CDs by either mechanism permits investigation of the role of plasma membrane in net cholesterol efflux. We have investigated cholesterol efflux from HMFC using high-affinity TM-CD ("sink") and low-affinity HP-CD in concert with PLV (HP-CD+PLV "shuttle") and identify the plasma membrane as a major rate-limiting site for cholesterol efflux and net CE clearance from HMFC. Significantly, we identify that depletion of cellular FC and CE are not necessarily linked. High-affinity TM-CD dissociates the clearance of FC and CE, and only HP-CD+PLV consistently depletes intracellular CE.
Materials Egg yolk phosphatidylcholine (PC), penicillin-streptomycin, essentially fatty-acid free BSA, and silica gel on polyester thin-layer chromatography (TLC) plates were from Sigma Aldrich. ß-CDs were from Cyclolabs (Hungary) and Sigma Aldrich. RPMI-1640 medium and glutamine were obtained from Gibco, and tissue culture plates and consumables were purchased from Falcon. [3H]cholesterol (1 mCi/ml, specific activity 44 mCi/µmol) and L-3-phosphatidyl [N-methyl-3H]choline,1,2-dipalmitoyl (1 mCi/ml, specific activity 83.0 mCi/µmol) were purchased from Amersham. Solvents were purchased from EM Science. Sephadex G50 beads were from Amersham. Buffy coats and whole human sera from normal donors were supplied by the Red Cross blood bank of NSW. Acyl-CoA:cholesterol acyltransferase (ACAT) inhibitor Sandoz 58035 (S-58035) was a gift from Drs. Nordmann and Nadelson at Sandoz Pharmaceuticals. Ficoll was supplied by Pharmacia and Nycodenz by Nycomed.
Preparation and modification of lipoproteins
Culture and loading of cells
Metabolic labeling In order to analyze [3H]choline-labeled phospholipids [lysophosphatidylcholine (LPC), PC, and sphingomyelin (SPM)], cholesterol-enriched HMFCs were washed with PBS and incubated in RPMI-1640 containing [3H]choline chloride in ethanol (3 µCi/ml) and 0.1% BSA for 20 h. After incorporation, cells were washed in PBS and equilibrated for 1 h in RPMI containing 0.1% BSA, then washed before undertaking efflux incubations (34).
Cholesterol efflux After loading with AcLDL, HMFCs were washed then incubated in 1 ml of efflux medium at 37°C. Efflux media contained either RPMI-1640 alone (±1.0 mg/ml BSA essentially fatty acid free, Sigma) or RPMI-1640 and PLV, RPMI-1640 and HP-CD ± PLV, or RPMI-1640 and TM-CD ± PLV. These media were incubated with HMFC for up to 24 h, at which time cells and media were extracted. Identical efflux and viability data were obtained with and without BSA in efflux media. To determine mass efflux of cholesterol, both cells and media were extracted at specified times (up to 24 h). Aliquots of media were collected and centrifuged at 16,000 g for 15 min to pellet any cell debris prior to extraction of lipids. Six hundred microliters of the supernatant was extracted with 2.5 ml methanol and 5.0 ml hexane, and the hexane layer analyzed by HPLC as described below (31). HMFC monolayers were washed with PBS and lysed with 600 µl of ice-cold 0.2 M NaOH, and lipids were extracted from 400 µl aliquots of this lysate into methanol and hexane. Mass cholesterol efflux was expressed as nmol cholesterol/culture, nmol/mg cell protein, or percent efflux (medium cholesterol divided by the sum of medium cholesterol and cellular cholesterol and CE in each culture). To quantify progressive efflux of [3H]cholesterol in kinetic studies, aliquots (100 µl) of efflux medium were removed at specified times, centrifuged to remove nonadherent cells and debris, 80 µl aliquots analyzed by scintillation counting, and cumulative efflux expressed as a percentage of total radioactivity present in cells extracted at t0 (14).
Lipid analysis For HMFC radiolabeled with [3H]cholesterol, evaporated hexane extracts were redissolved with acetonitrile-isopropanol-water (44:54:2, v/v/v), and aliquots taken for HPLC analysis, scintillation counting, and TLC separation of [3H]FC and [3H]CE. Total [3H]cholesterol in the cells was determined by scintillation counting of 10 µl of NaOH lysate. Samples and standards were dried and redissolved in chloroform and spotted onto TLC plates, and FC and CE were separated with hexane-ether-glacial acetic acid (46:7:20:1, v/v/v). The proportion of label in [3H]FC and [3H]CE fractions was determined after separation by TLC using standards of FC and CE identified with 10% CuSO4 in H3PO4 at 100°C. Phospholipids were analyzed after Bligh and Dyer extraction (37) of PLV, media, cells, and cell plasma membrane fractions (see below). Phospholipid mass was determined as total phosphorous (38). Total [3H]phospholipids in each sample were determined by scintillation counting and the percentage distribution of phospholipid classes in media or cell plasma membrane fractions determined by TLC using silica-coated glass plates (5, 34). Phospholipid classes (PC, SPM, and LPC) were separated using chloroform-methanol-ammonium hydroxide (75:25:4, v/v/v) using authentic standards of PC, SPM, and LPC. Phospholipid bands were visualized by iodine vapor, scraped, extracted in methanol, and counted by scintillation. The ratio of [3H]PC-[3H]SPM-[3H]LPC on TLC was related to total [3H]phospholipid counts to derive total counts of each phospholipid per milligram of total cell protein or per milligram of plasma membrane protein as indicated.
Subcellular fractionation and isolation of plasma membranes
Protein estimation and cell viability
Data analysis
Side-chain substitutions modulate CD-mediated cholesterol efflux from HMFC TM-CD and HP-CD substitutions of ß-CD were directly compared for ability to induce cholesterol efflux from HMFC at 1.0 mg/ml (i.e., 0.70 mM TM-CD and 0.65 mM HP-CD) and compared with PLV (Fig. 1) . Whereas HP-CD caused only minor cholesterol efflux, both TM-CD and PLV stimulated cholesterol efflux 2- to 3-fold. This differential efflux of cholesterol from HMFC to HP-CD and TM-CD is consistent with their known respective affinities for cholesterol (22), and indicates that at these concentrations TM-CD is superior to HP-CD as a cholesterol sink.
TM-CD achieves less cholesterol efflux than HP-CD when acting as a cholesterol shuttle TM-CD and HP-CD were directly compared for their ability to induce cholesterol efflux in the presence of PLV (Fig. 1). Efflux to HP-CD+PLV was clearly greater than the sum of efflux to HP-CD and PLV added separately. Whereas TM-CD induced more cholesterol efflux than HP-CD in the absence of PLV, TM-CD+PLV induced less efflux than HP-CD+PLV (38.1 ± 4.7% vs. 52.9 ± 5.3%, P < 0.001). TM-CD+PLV induced more cholesterol efflux than either TM-CD or PLV, but the effect was only approximately additive for efflux to TM-CD and PLV, not synergistic. This suggests differences in the mechanisms by which TM-CD and HP-CD interact with macrophages, and indicates that at these concentrations TM-CD is superior as a cholesterol sink, but HP-CD is superior as a cholesterol shuttle.
Efflux of cholesterol is dependent on the concentrations of both HP-CD and PLV
Differential depletion of FC and CE by TM-CD
Kinetic studies of cholesterol efflux to TM-CD and HP-CD+PLV The kinetics of differential depletion of FC and CE by TM-CD were further investigated. The rate of efflux to both TM-CD and HP-CD+PLV was nonlinear, but the rate of efflux declined more gradually with HP-CD+PLV, and much greater overall efflux was achieved by 24 h (Fig. 3) . Some spontaneous loss of cell FC was observed during incubation with RPMI-1640 alone, as previously reported (42); however, TM-CD and HP-CD+PLV induced much greater depletion of FC than did RPMI-1640. The decline in cell FC induced by CDs was rapid (most occurring within 24 h of incubation). Depletion of CE was only detectable between 8 h and 24 h and was only seen with HP-CD+PLV. The time to 50% depletion of CE in the presence of HP-CD+PLV was 26.1 h, which is consistent with that previously described in human macrophages (13, 14). Over a series of experiments, the difference between overall cholesterol efflux to HP-CD+PLV and TM-CD was most marked when HMFC contained relatively large quantities of CE. For example, where the CE pool was large (215.0 ± 35.2 nmol CE/mg cell protein), HP-CD+PLV achieved efflux 3-fold that of TM-CD, and 2-fold that of TM-CD+PLV (24 h efflux of 60.1 ± 1.4%, 16.9 ± 1.2%, and 28.8 ± 2.3% respectively).
Acceptor saturation does not explain restricted efflux to TM-CD The large number of TM-CD molecules required per molecule of cholesterol released [ 1,000:1 (22)] and the inability of PLV to substantially enhance clearance of CE by TM-CD suggested that saturation of TM-CD was not limiting efflux. To further investigate this possibility, we compared the ability of fresh TM-CD±PLV with "cell-conditioned" TM-CD±PLV (previously incubated for 24 h with HMFC) to stimulate efflux from HMFC (Table 1). There was identical depletion of cell lipids by cell-conditioned and fresh media, indicating that acceptor saturation does not limit cholesterol efflux to TM-CD±PLV.
Kinetics of cholesterol efflux to HP-CD+PLV and TM-CD Efflux of plasma membrane cholesterol is kinetically heterogeneous with fast and slow pools, which we hypothesized could be differentially affected by TM-CD and HP-CD. Initial kinetics of cholesterol efflux were therefore determined in cells prelabeled with [3H]FC-enriched AcLDL to investigate if TM-CD more rapidly removed plasma membrane cholesterol than did HP-CD. Under these conditions, all cell [3H]CEs are derived from [3H]FC and are therefore ACAT generated. Thus, these experiments also allowed us to investigate whether TM-CD and HP-CD+PLV differed in their clearance of ACAT-derived CE. There was rapid initial efflux of [3H]cholesterol to both HP-CD+PLV and TM-CD, and at the earliest time point (10 min), HP-CD+PLV removed at least as much cholesterol as did TM-CD (Fig. 4) . Efflux to TM-CD was nonlinear, with a declining rate between 10 min and 2 h, whereas efflux to HP-CD+PLV was almost linear over this period, indicating more limited access of cellular cholesterol to TM-CD even at early time points. At 24 h, HP-CD+PLV and TM-CD had depleted cell [3H]FC to a similar degree, but only HP-CD+PLV depleted cell [3H]CE, indicating that TM-CD failed to clear ACAT-generated CE. The specific activities (dpm/nmol) of FC and CE were unaffected by efflux incubations, which excludes substantial TM-CD-specific de novo synthesis of unlabeled FC or CE. While it remains possible that small amounts of cholesterol synthesis may occur under these conditions, substantial synthesis is unlikely to be a major contributor to preserved CE in HMFC exposed to TM-CD.
The differential effects of TM-CD and HP-CD+PLV on cholesterol clearance were confirmed by comparing the ratios of intracellular [3H]FC and [3H]CE after efflux. The ratio of intracellular [3H]FC-[3H]CE after control medium RPMI-1640 was 0.86 ± 0.12, after TM-CD was 0.31 ± 0.02, and after HP-CD+PLV was 0.98 ± 0.02, indicating preferential clearance of [3H]FC by TM-CD.
The concentration of TM-CD can affect apparent synergistic cholesterol efflux and depletion of cell CE Without PLV, cholesterol efflux to TM-CD was diminished by reducing its concentration (0.0070.7 mM), but TM-CD alone did not decrease CE (unpublished observations). In the presence of PLV, decreasing the concentration of TM-CD promoted depletion of CE but diminished depletion of FC (Fig. 5) . Consequently, overall cholesterol efflux to TM-CD+PLV was similar at low and high concentrations of TM-CD because of greater FC depletion at higher concentrations. These data confirmed that the depletion of FC and CE can be dissociated, and establish that depletion of CE is inhibited by higher concentrations of TM-CD.
Differential CE depletion to TM-CD and HP-CD+PLV is not explained by TM-CD-mediated cytotoxicity A number of experiments demonstrated depletion of over 50% of cellular FC during efflux to TM-CD or HP-CD+PLV from cholesterol-enriched HMFC. Consequently, a number of measures of cell viability were performed. Trypan blue staining, cell morphology, and cell protein all suggested consistent and preserved viability under all conditions (unpublished observations). LDH release (41) indicated a modest time-dependent decline in cell viability indistinguishable among all efflux conditions (viabilities were 75.5 ± 3.2% for RPMI-1640, 76.9 ± 3.1% for TM-CD, 76.2 ± 3.5% for TM-CD+PLV, and 76.4 ± 0.4% for HP-CD+PLV after 24 h). Thus, the poor ability of TM-CD (±PLV) to deplete cell CE was not attributable to cytotoxicity.
Prior exposure to TM-CD does not inhibit efflux to HP-CD+PLV
Liposome stability is not affected by TM-CD The integrity of PLV in the presence of TM-CD under usual and extreme conditions was tested to exclude the possibility that TM-CD destabilized PLV structure and that this limited cholesterol efflux. PLVs prepared using egg PC and [3H]PC were incubated with RPMI, 0.7 mM TM-CD, 70 mM TM-CD, or 1% Triton-X100 (as positive control for PLV destabilization) for 24 h, then subjected to gel filtration (44). Whereas treatment with Triton did cause substantial redistribution of PLV lipids to smaller particles, 0.70 mM TM-CD only slightly (<10%) increased the amount of phospholipid in smaller size particles. PLVs are added at 200 µg/ml, and 100 µg/ml is saturating for cholesterol efflux (unpublished observations); thus loss of 10% of PLV phospholipid is unlikely to inhibit cholesterol efflux by TM-CD+PLV.
Differential CE depletion to TM-CD and HP-CD+PLV requires ongoing cholesterol esterification in the presence of TM-CD
ACAT inhibition did not substantially improve net clearance of total cell cholesterol to TM-CD+PLV because cell FC increased under these conditions. In three separate experiments with ACAT inhibitor, efflux to HP-CD+PLV versus TM-CD+PLV was 57.2 ± 3.7% versus 41.2 ± 2.0%, 62.7 ± 1.0% versus 54.2 ± 1.1%, and 55.3 ± 2.1% versus 48.0 ± 0.6% (P < 0.01 for comparison of HP-CD+PLV vs. TM-CD+PLV in each experiment). These results indicate that impaired clearance of CE is not the only factor limiting efflux to TM-CD (±PLV) relative to HP-CD.
HP-CD acting as a sink achieves depletion of cell CE
TM-CD depletes plasma membrane cholesterol in human macrophages Qualitative differences in the effects of TM-CD and HP-CD on cells could be attributable to differential depletion of plasma membrane cholesterol or phospholipids. Massive depletion of SPM from the plasma membrane by sphingomyelinase has been shown to inhibit cholesterol efflux and to promote cholesterol esterification by ACAT (46), and recently, methyl CDs have been shown to promote phospholipid transfer between phospholipid bilayers (47). We therefore investigated whether TM-CD selectively depleted SPM from the plasma membrane (Table 2) and whether there were differences in cholesterol depletion from the plasma membrane achieved by HP-CD and TM-CD.
Both TM-CD and HP-CD stimulated release of cell phospholipids in the presence of PLV. Efflux media did contain relatively greater proportions of lysoPC than did isolated plasma membranes ( 15% vs. <5% of total phospholipids, respectively), but the proportions of phospholipid subclasses in efflux media and in plasma membranes were not altered by exposure to TM-CD or HP-CD. Importantly, the cholesterol content in isolated plasma membranes was much lower after exposure to TM-CD or TM-CD+PLV than after other conditions (P < 0.01 for HP-CD+PLV vs. TM-CD±PLV). The difference in depletion of plasma membrane cholesterol achieved by TM-CD±PLV relative to HP-CD+PLV was much greater than differences in whole-cell FC depletion (e.g., see Figs. 2, 5). These data indicate that TM-CD depletes pools of plasma membrane FC not depleted by HP-CD, which supports the possibility that certain pools of plasma membrane cholesterol modulate CE clearance in HMFC.
These studies demonstrate that the plasma membrane is a major rate-limiting factor for cholesterol efflux and CE depletion from HMFC, and establish differential CE depletion as an important qualitative difference in the consequences of efflux to CDs with different affinity to cholesterol. This demonstrates for the first time that the properties of an acceptor that are optimal for depletion of FC need not be optimal for depletion of CE and overall cholesterol clearance, and that FC depletion and CE depletion can be dissociated. CDs are sterol-solubilizing agents (21). Their efficient ability to access plasma membrane cholesterol has been attributed to a combination of properties: their small size that increases the frequency of collisions with desorbed cholesterol molecules; their ability to directly access the plasma membrane, evading large surface structures that limit access to comparatively larger PLVs; and their excellent water solubility that facilitates penetration of the extracellular water layer (22, 48). Their interaction with PLVs during the process of shuttling combines efficient CD-mediated solubilization of membrane cholesterol with the greater cholesterol-binding capacity of PLV, and relies upon the relatively low affinity CDs have for cholesterol (Ka). The determination of factors that restrict efflux from primary HMFC has hitherto been indirect. This has substantially underestimated the importance of the plasma membrane because of the relative inability of physiological acceptors to cause significant cholesterol efflux. In our laboratory, saturating concentrations of apoA-I and HDL cause modest depletion of CE from HMFC (<15% per 24 h), but this depletion is commensurate with the limited cholesterol efflux from primary HMFC achieved by these agents (total efflux 1020% at 24 h). In contrast, HP-CD+PLV depleted CE by >50% over 24 h. This effect is consistent with either direct stimulation of CE hydrolysis or CE depletion secondary to efficient removal of plasma membrane cholesterol. Under conditions in which ACAT was inhibited, equal depletion of CE was achieved with HP-CD+PLV and control medium RPMI-1640. This indicates that HP-CD+PLV depletes CE by stimulating cholesterol efflux, not by stimulating CE hydrolysis. The detection of synergy between CD and PLV predictably requires a relatively low level of efflux to individual components; however, previous studies have not described any important qualitative differences in the consequences of efflux to TM-CD acting as a sink and HP-CD+PLV where the CD acts as a shuttle (26, 43). Differences between this study and previous reports may be due to our use of primary HMFCs, which are inherently resistant to cholesterol efflux and may be more sensitive to redistributions of plasma membrane cholesterol, and our deliberate use of net CE clearance as one of the measures of efficacy. The latter is important in HMFCs, given the slow CE hydrolysis in these cells, which cannot be assessed from experiments of <8 h duration. The differences in the effects of low- and high-affinity CDs are also important because of recent application of these agents to study diverse biological phenomena, including the actions of raft-related proteins. A number of studies have manipulated cellular and plasma membrane cholesterol by the use of high concentrations of high-affinity CDs such as methyl CD (49), and high concentrations of HP-CD (50) (10- to 80-fold higher than the present study). Given our observations with nontoxic and low-dose CDs, we anticipate that the use of such high concentrations of high-affinity CDs acting as sinks may dramatically perturb normal cholesterol trafficking pathways and CDs, because a class cannot be assumed to be biologically equivalent. It is most notable in the present studies that TM-CD permits ongoing cholesterol reesterification despite concurrent depletion of FC, as previous studies have shown a very close relationship between plasma membrane cholesterol content and cholesterol esterification in the ER (51). This suggests that TM-CD may remove certain plasma membrane pools of FC that do not affect ACAT activity, or may remove plasma membrane cholesterol from ACAT-inaccessible pools and redeliver it to ACAT-accessible pools while still causing net FC depletion. Previous studies have shown that solutions of CDs that are saturated with respect to cholesterol can deliver cholesterol to macrophages, and that this cholesterol can be esterified by ACAT (14, 43, 52). Net efflux to TM-CD was modestly increased by ACAT inhibition, but greater CE clearance occurred at the expense of diminished FC clearance, suggesting that other unknown properties of TM-CD restrict cholesterol efflux. It is unlikely that TM-CD cannot transfer cholesterol to PLV, as a number of agents with high cholesterol affinity shuttle cholesterol to PLV very effectively (43), and the present study clearly shows synergy between lower concentrations of TM-CD and PLV in stimulating cholesterol efflux and CE depletion. The apparent dissociation of FC and CE depletion with TM-CD may occur via several routes. It is known that plasma membrane pools of cholesterol are structurally and kinetically heterogeneous (53, 54). TM-CD may remove cholesterol from domains within the plasma membrane where it is more strongly bound (e.g., rafts), and subsequently allow cholesterol to reenter the plasma membrane at other sites with greater access to ACAT (54). Our data showing much greater depletion of plasma membrane cholesterol by TM-CD (±PLV) than by HP-CD+PLV support the possibility that TM-CD accesses pools of plasma membrane cholesterol that are not accessed by HP-CD. The removal of selected pools of plasma membrane cholesterol, which may represent only a small proportion of the total, has been shown to affect intracellular protein translocation (55). It is therefore possible that such cholesterol depletion may directly affect the location of ACAT or its regulatory proteins inside the cell. Such depletion may also perturb other cholesterol-regulatory proteins, such as the more recently described ABCA1. Using [3H]cholesterol-labeled cells (Fig. 4), it appears that neither CE mass nor CE specific activity were increased by TM-CD (relative to control incubations), indirectly indicating that ACAT activity is not increased by this agent; however, we have not directly measured changes to ACAT activity induced by CDs. Interpretation of ACAT activity using conventional assays would be complicated by the solubilizing effects of CDs on ACAT substrates (cholesterol and fatty acids) when these are added to culture media, which will indirectly alter apparent ACAT activity. Direct experimental measurement of ACAT activity in whole cells, and investigating if CDs affect cellular fatty acid metabolism and directly regulate ACAT activity, are important future investigations. Selective depletion of SPM from the plasma membrane can potentially perturb the condensing and cholesterol-binding properties of sites preferentially enriched in SPM (such as membrane rafts). By analogy with the effects of sphingomyelinase treatment of cells, this would be expected to increase cholesterol internalization, traffic to the ER, and cytoplasmic esterification (46). We did not identify significant depletion of SPM from the plasma membrane under these experimental conditions. Recent studies show that the rate of cellular SPM synthesis is markedly increased by depletion of cell cholesterol by CDs (56). Consequently, depletion of SPM in cell membranes would require substantial SPM efflux that exceeds the cellular capacity for synthesis and replenishment. In summary, high-affinity CDs appear to dissociate the link between plasma membrane cholesterol concentration, net cholesterol efflux, and intracellular cholesterol esterification. It is likely that plasma membrane cholesterol is an important regulator of net cholesterol efflux and CE metabolism in human macrophages.
This work was supported by the National Health and Medical Research Council (NHMRC project grant 980595) and the Vincent Fairfax Family Trust. W.J. is a Principal Research Fellow of the NHMRC. Tim Sloane is thanked for excellent technical assistance. Manuscript received December 11, 2002 and in revised form March 17, 2003.
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