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Journal of Lipid Research, Vol. 47, 51-58, January 2006 Reevaluation of the role of the multidrug-resistant P-glycoprotein in cellular cholesterol homeostasis
* Department of Cell Biology NC10, Cleveland Clinic Foundation, Cleveland, OH Published, JLR Papers in Press, October 7, 2005.
1 To whom correspondence should be addressed. e-mail:smithj4{at}.ccf.org
The multidrug resistance P-glycoprotein (P-gp) was recently proposed to redistribute cholesterol in the plasma membrane, suggesting that P-gp could modulate cholesterol efflux to cholesterol acceptors. To address this hypothesis and to reevaluate the role of P-gp in cholesterol homeostasis, we first analyzed the role of P-gp expression on cholesterol efflux in P-gp stably transfected drug-selected LLC-MDR1 cells. Cholesterol efflux to methyl-ß-cyclodextrin (CD) was 4-fold higher in LLC-MDR1 cells compared with control LLC-PK1 cells, indicating that the accessible pool of plasma membrane cholesterol was increased by P-gp expression. However, using the P-gp-inducible cells lines HeLa MDR-Tet and 77.1 MDR-Tet, cholesterol efflux to CD, apolipoprotein A-I, or HDL was not associated with P-gp expression. In addition, we did not observe any effect of P-gp expression on cellular free and esterified cholesterol content, cholesteryl ester uptake from LDL and HDL particles, or acyl-CoA:cholesterol acyltransferase activity. Therefore, we conclude that P-gp expression does not play a major role in cholesterol homeostasis in P-gp-inducible cells and that the effects of P-gp on cholesterol homeostasis previously described in drug-selected cells might result from non-P-gp pathways that were also induced by selection for drug resistance.
Supplementary key words cholesterol efflux ABCA1 cyclodextrin apolipoprotein A-I Abbreviations: apoA-I, apolipoprotein A-I; CD, methyl-ß-cyclodextrin; CE, cholesteryl ester; COE, cholesteryl oleyl ether; DAPI, 4',6-diamidino-2-phenylindole; FC, free cholesterol; MDR, multidrug resistance; P-gp, P-glycoprotein; Rho-123, rhodamine 123
P-glycoprotein (P-gp) is a member of the ATP binding cassette transporter family responsible for the multidrug resistance (MDR) phenotype. P-gp is the protein product of the human MDR1 gene (ABCB1 is the official gene symbol), and P-gp is highly expressed in the intestine, liver, kidney, placenta, and the blood-brain barrier. Plasma membrane P-gp mediates the efflux of numerous neutral and cationic organic compounds and drugs, among them chemotherapeutic drugs, thereby contributing to the MDR phenotype in many cancers. However, information concerning endogenous substrates for P-gp as well as the physiological role of P-gp is still lacking (1). P-gp has been reported to modulate cellular cholesterol homeostasis via several mechanisms. Stable transfection of a rat intestinal cell line with a P-gp expression vector led to a modest increase in the uptake of cholesterol-containing micelles (2). Nonspecific P-gp inhibitors have been reported to inhibit cholesterol biosynthesis in CHO-7 cells (3) and to inhibit cellular cholesterol esterification (4). Transfection of NIH 3T3 cells with a P-gp expression vector followed by selection for drug resistance was associated with increased esterification of plasma membrane cholesterol (5). Mice, unlike humans, have two copies of the gene for P-gp, abcb1a and abcb1b (previously mdr1a and mdr1b). Mice deficient in both of these genes have been constructed, and although intestinal cholesterol absorption and hepatic free cholesterol (FC) and cholesteryl ester (CE) contents were similar to those of wild-type mice, there were subtle differences in the hepatic uptake of plasma FC and the esterification of oral FC that were not observed in other tissues (6). To reevaluate the role of P-gp in cellular cholesterol homeostasis, we used three cell systems with variable P-gp expression. We found that drug-selected LLC-MDR1 cells that overexpress human P-pg, versus control cells, had increased FC efflux to methyl-ß-cyclodextrin (CD), suggesting that P-gp increased FC cholesterol content in the plasma membrane. However, this effect was not observed in two independent P-gp-inducible cell lines. Nor did we observe any effect of P-gp expression on FC efflux to apolipoprotein A-I (apoA-I) or HDL, cellular FC or CE content, uptake of lipoprotein CE, or ACAT activity. Therefore, P-gp expression does not play a major role in cholesterol homeostasis in P-gp-inducible cells, and the effects on cholesterol homeostasis observed in drug-resistant cells may be attributed to factors other than, or in addition to, P-gp expression.
Cell culture The pig kidney polarized epithelial cell lines LLC-PK1 and its MDR1 gene-transfected, vincristine-resistant derivative, LLC-MDR1 (7), were kindly provided by Andrei V. Gudkov (Lerner Research Institute, Cleveland Clinic Foundation). LLC-PK1 and LLC-MDR1 were grown in DMEM supplemented with 10% fetal bovine serum and penicillin/streptomycin. HeLa MDR-Tet and 77.1 MDR-Tet cell lines, derived from human HeLa and mouse embryo fibroblasts from mdr1a/1b knockout mice, respectively, are stably transfected with human MDR1 cDNA under the control of a tetracycline-repressed promoter (8) and were a generous gift from Michael M. Gottesman (National Cancer Institute, National Institutes of Health, Bethesda, MD). HeLa MDR-Tet and 77.1 MDR-Tet cells were cultured in high-glucose DMEM with 10% tetracycline-approved FBS (BD Biosciences), 2 mM L-glutamine, and 20 ng/ml colchicine (Sigma). Tetracycline regulation of P-gp expression was performed by a 4 day incubation with colchicine-free medium in the presence (P-gpOff) or absence (P-gpOn) of 2 µg/ml tetracycline (Sigma), as described previously (8).
P-gp activity and protein assays P-gp protein level was assessed by Western blot analysis. Cells were grown on six-well plates in the presence or absence of 2 µg/ml tetracycline for 4 days. The PBS-washed cell pellet was lysed in 100 µl of lysis buffer (2 mM EDTA, 25 mM Tris-phosphate, pH 7.8, 1% Triton X-100, and 10% protease inhibitor cocktail). After discarding the nuclear pellet, the protein concentration was determined using the micro BCA protein assay (Pierce). Analysis of Pg-p protein content was performed by Western blot using 20 µg of cell protein. Blots were incubated sequentially with 1:200 mouse monoclonal antibody raised against human P-gp (p170; Labvision) and 1:10,000 HRP-conjugated goat anti-mouse secondary antibody. The signal was detected with an enhanced chemi-luminescence substrate (Pierce).
Cholesterol efflux studies
Free and esterified cholesterol mass assay
Cellular uptake of lipoprotein CE
ACAT activity assay
P-gp localization and cellular FC distribution
Statistics
P-gp activity and plasma membrane FC in drug-resistant LLC-MDR1 cells P-gp activity was measured in the pig kidney polarized epithelial cell line LLC-PK1 and in the LLC-MDR1 cell line, which was derived from LLC-PK1 cells by stable transfection with the human MDR1 gene followed by selection for vincristine resistance (7). As shown in Fig. 1A, LLC-MDR1 cells expressed high amounts of human P-gp, whereas no detectable levels were observed in LLC-PK1. P-gp activity was assessed by its ability to pump Rho-123 out of the cells during a 2 h incubation; thus, cellular Rho-123 accumulation is inversely associated with P-gp activity. As shown in Fig. 1B, expression of P-gp in LLC-MDR1 cells significantly decreased cellular Rho-123 accumulation compared with wild-type LLC-PK1 cells (4-fold; P < 0.001). Verapamil (100 µM), a competitive inhibitor of P-gp activity, increased Rho-123 accumulation in LLC-MDR1 cells by 93% compared with nontreated cells (P < 0.01), and similar results were found with 10 µM verapamil (data not shown). However, this increased level of Rho-123 accumulation was still <50% of the level observed in control LLC-PK1 cells (P < 0.001), and, as expected, verapamil had no effect on Rho-123 accumulation in LLC-PK1 cells. Thus, the decreased Rho-123 accumulation in LLC-MDR1 cells confirmed their increased P-gp activity; however, the only partial recovery of Rho-123 accumulation with verapamil treatment implies that other pathways (not sensitive to verapamil inhibition) may differ between LLC-MDR1 cells and the control LLC-PK1 cells.
If P-gp alters the plasma membrane FC pool or its distribution, we would expect this to be reflected in FC release to extracellular acceptors. We analyzed FC efflux from these cell lines to CD during a 10 min incubation. We and others have previously used FC efflux to CD, in moderate doses for short time periods, as an indicator of plasma membrane FC content (10, 14). FC efflux to CD from LLC-MDR1 cells was 4-fold higher than that observed from LLC-PK1 (P < 0.001; Fig. 1C), an increase consistent with the increase of P-gp activity observed in LLC-MDR1 cells (Fig. 1B). Incubation with 100 µM verapamil reduced FC efflux to CD from LLC-MDR1 cells moderately by 17% (P < 0.01), without affecting efflux from LLC-PK1 cells. Together, our experiments in drug-selected LLC-MDR1 cells suggest that expression of human P-gp increases the FC content accessible to CD in plasma membrane, thus supporting a role of P-gp in cellular cholesterol homeostasis. However, these observations must be interpreted with caution, because these experiments were performed with cells that were chronically selected for vincristine resistance; thus, the effects on plasma membrane FC may be mediated by non-P-gp pathways that were also induced by selection for drug resistance.
P-gp activity and plasma membrane FC in cells with P-gp expression driven by a tetracycline-repressible promoter
P-gp activity in both of these cell lines was assessed by Rho-123 accumulation. Congruent with previously published P-gp activity assays for these cell lines (8), expression of human P-gp significantly reduced Rho-123 accumulation in both HeLa MDR-Tet and 77.1 MDR-Tet cells (P < 0.001 and P < 0.05, respectively; Fig. 2B, C). Consistent with the lower P-gp protein levels in 77.1 P-gpOn cells compared with HeLa P-gpOn cells, Rho-123 accumulation was diminished 4-fold in HeLa P-gpOn cells (vs. HeLa P-gpOff) and only 1.3-fold in 77.1 P-gpOn cells (vs. 77.1 P-gpOff), reflecting a higher P-gp activity in HeLa P-gpOn cells than in 77.1 P-gpOn cells. Inhibition of P-gp activity by 10 µM verapamil led to a 124% increase in Rho-123 accumulation in HeLa P-gpOn (P < 0.001), but still did not achieve the level of Rho-123 accumulation in the HeLa P-gpOff cells, and a 19% increase in HeLa P-gpOff cells (P < 0.001). A higher concentration of verapamil (100 µM) only slightly further increased Rho-123 accumulation in HeLa P-gpOn (+46% vs. 10 µM verapamil; P < 0.01), whereas an overnight incubation with 10 µM verapamil had no significant further effect (Fig. 2B). Thus, verapamil had both P-gp-dependent and -independent effects in the HeLa MDR-Tet cell line, and verapamil could not fully inhibit P-gp activity in these cells with very high expression of P-gp. Verapamil led to a 34% increase in Rho-123 accumulation in the 77.1 P-gpOn cells (P < 0.05), restoring the Rho-123 accumulation level to that observed in the 77.1 P-gpOff cells; also, verapamil had no effect on Rho-123 accumulation in these 77.1 P-gpOff cells (Fig. 2C). Thus, verapamil had only P-gp-dependent effects in this cell line, and verapamil could fully inhibit P-gp activity in these cells with very modest expression of P-gp. We analyzed the capacity of HeLa MDR-Tet and 77.1 MDR-Tet cells to mediate FC efflux to CD and to the other exogenous acceptors apoA-I and HDL. The expression versus lack of expression of P-gp had no significant effect on FC efflux to CD, apoA-I, or HDL in both HeLa MDR-Tet and 77.1 MDR-Tet cell lines (Fig. 3A, B). ABCA1 induction via a 16 h incubation with 4 µg/ml 22-hydroxy-cholesterol plus 1 µM 9-cis retinoic acid increased FC efflux to apoA-I from both cell lines, but again, expression of P-gp did not alter this induced efflux within either cell line (data not shown). Time course analysis of FC efflux to CD confirmed the absence of a P-gp effect in both cell lines, even at the earliest time points, indicative that P-gp expression had no effect on FC levels in the plasma membrane (Fig. 3C, D). Thus, these results did not confirm the P-gp association with FC levels in the plasma membrane observed in the drug-selected LLC-MDR1 cells.
Cholesterol metabolism in cells with P-gp expression driven by a tetracycline-repressible promoter We measured total cholesterol, FC, and CE in HeLa MDR-Tet cells maintained in culture medium containing 10% FBS, and we found no effect of P-gp expression on these parameters (data not shown). We repeated this experiment in these cells that had been deprived of FBS for 24 h, and although CE was decreased to barely detectable levels, there was still no effect of P-gp expression on total cholesterol, FC, or CE level (data not shown). Cellular FC, as detected by filipin staining, was distributed in the plasma membrane and in perinuclear vesicles, and this distribution was not qualitatively altered in HeLa cells by the presence or absence of MDR expression in many independent cell preparations (Fig. 4A, C). P-gp staining was observed only in the Tet P-gpOn cells, and it was also distributed in the plasma membrane and in intracellular vesicles (Fig. 4B, D). Although there was partial overlap of MDR and cholesterol in some intracellular vesicles, there were also vesicular regions that were enriched for only cholesterol or MDR (Fig. 4CE). Cholesterol mass assays and filipin staining experiments were also performed in wild-type HeLa cells, and we found no effects of tetracycline treatment on any of these parameters (data not shown). Thus, modulation of P-gp expression did not alter cellular cholesterol levels or FC distribution in HeLa MDR-Tet cells.
The dose-dependent uptake of LDL- and HDL-incorporated COE, a nonmetabolized tracer for CE, was measured during a 5 h incubation at 37°C in HeLa MDR-Tet cells that were preincubated for 16 h in serum-free medium. COE uptake from LDL and HDL was dose-dependent; however, P-gp expression had no effect on COE uptake from either LDL or HDL (data not shown). Similar results were observed in wild-type HeLa cells treated with or without tetracycline (data not shown). Thus, P-gp expression did not affect uptake of the CE tracer from LDL or HDL. Finally, the cellular activity of ACAT to convert FC into CE was estimated in HeLa MDR-Tet cells by incubation with [3H]oleic acid in serum-free medium for 1 and 5 h at 37°C. P-gp expression had no effect on ACAT activity at either time point (data not shown). Similar results were observed in wild-type HeLa cells treated with or without tetracycline (data not shown). Thus, cellular ACAT activity was not altered by the expression of P-gp in HeLa MDR-Tet cells.
Several studies performed in drug-selected cells report that P-gp plays a role in cholesterol homeostasis. Using membrane vesicles prepared from insect cells infected with a P-gp encoding baculovirus leading to a high level of expression, P-gp was reported to increase membrane cholesterol accessibility to cholesterol oxidase (15), which the authors suggest to be the result of P-gp activity as a cholesterol translocase. However, this result might instead be attributable to the overexpression of P-gp, which has been demonstrated to alter liposome lipid packing (16), which could lead to a subsequent effect on cholesterol oxidase accessibility to membrane cholesterol. We first examined the effect of P-gp expression on plasma membrane cholesterol in drug-selected LLC-MDR1, and we found that P-gp expression was associated with an increase in cholesterol efflux to CD, suggesting that P-gp expression increased the accessible pool of plasma membrane cholesterol. However, we then found that P-gp expression did not affect cholesterol efflux to CD in P-gp-inducible cells. We also observed that FC efflux to apoA-I or HDL, and the uptake of CE from HDL or LDL, were not associated with the expression of P-gp in the inducible cell lines. Together, these data suggest that most of the effects on cholesterol homeostasis observed in some drug-resistant cell lines might be attributable to effectors other than P-gp that are altered by the selection for drug-resistant cells. A similar discrepancy in results obtained with drug-selected cells versus P-gp-inducible cells has been reported previously (8). Several drug-selected cells expressing P-gp were found to have increased membrane fluidity and membrane potential, whereas these effects were not observed in the P-gp-inducible HeLa MDR-Tet and 77.1 MDR-Tet cells (8). Thus, it appears that some of the findings made using drug-selected cells may result from drug selection rather than from P-gp expression. Other studies have focused on the role of P-gp in cholesterol transport from the plasma membrane to the endoplasmic reticulum by assaying the esterification of plasma membrane-derived cholesterol by ACAT, which is localized in the endoplasmic reticulum. For example, verapamil, a nonspecific P-gp inhibitor, was found to inhibit cellular cholesterol esterification (4, 5), and P-gp-transfected NIH 3T3 fibroblasts grown under drug selection were also found to have increased cholesterol esterification, without an increase in plasma membrane cholesterol content (5). However, another report, although repeating the verapamil effect, failed to find any effect of a specific P-gp inhibitor, GF120981, on the esterification of lipoprotein-derived cholesterol in HepG2 cells (17). Our study in a P-gp-inducible cell line also failed to find any effect of P-gp expression on cellular cholesterol esterification or on the mass ratio of cellular CE to FC. Finally, data from the mdr1a/1b double knockout mouse show that cholesterol esterification, compared with wild-type mice, is normal in all tissues except for the liver, in which an oral cholesterol bolus is esterified to a greater extent at the 6 h time point (but not at 24 or 72 h), whereas an intravenous cholesterol bolus is esterified to the same extent in the liver of both types of mice (6). Thus, P-gp does not appear to play a role in cholesterol esterification in most tissues, although P-gp may play a minor role in the liver. Previously, cholesterol was also found to play a regulatory role in P-gp expression (18) and activity (15, 16, 19). The current study did not address these issues. However, the observed effects of cholesterol depletion on P-gp ATPase activity in membrane vesicles (15) could also be the result of nonspecific effects on membrane fluidity and lipid packing (16). Finally, P-gp-inducible cells represent a very useful model in which to study the role of P-gp to overcome limitations resulting from the use of drug-selected cells or P-gp inhibitors. Verapamil and cyclosporine A, two molecules known to inhibit P-gp activity, were recently shown to modulate ABCA1 transporter activity (20, 21), a key protein in cholesterol homeostasis. The reevaluation of the role of P-gp in cholesterol homeostasis using P-gp-inducible cells has led us to conclude that P-gp does not play a major role in cholesterol homeostasis.
This work was supported by Grant RO1 HL-66082 from the National Institutes of Health and a Pfizer International HDL Award to J.D.S. The authors thank Andrei V. Gudkov for providing LLC-PK1 and LLC-MDR1 cells. The authors are grateful to Michael M. Gottesman for providing HeLa MDR-Tet and 77.1 MDR-Tet cells. Manuscript received June 17, 2005 and in revised form September 27, 2005.
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