**3. Genetically modified animal models as tools for studying lipoprotein metabolism**

Genetically modified animals for studying lipoprotein metabolism are summarized in Table 1. The list includes genetically modified mice, rats, rabbits, and chicken, but not double- or triple-modified animals. Several double- or triple-modified mice were developed by crossbreeding, for example, the apoE/LDLR-dKO mouse, the apoE/SRBI-dKO mouse, and others. Genetically modified animals can be good tools for clarifying the role of genes in lipoprotein metabolism and atherosclerosis if researchers take into consideration species differences.


**Table 1.** List of genetically modified animals regarding lipoprotein metabolism.

#### **3.1. Cholesterol absorption in the intestine**

538 Lipoproteins – Role in Health and Diseases

apoC-II Shachter, 1994

**Cholesterol absorption in intestine** 

apoC-IV Allan, 1996

tis7 Wang, 2005 **VLDL secretion from liver** 

**Lipolytic enzyme** 

**Lipoprotein metabolism** 

**Reverse cholesterol transport** 

**Apolipoprotein** 

 **Transgenic animals Knockout animals**

apoA-I Walsh, 1989 Swanson, 1992 Duverger, 1996 Plump, 1997 apoA-II Marzal-Casacub, 1996 Koike, 2009 Weng, 1996 apoB100 Farese, 1995 Fan, 1995 Young, 1995 apoC-I Simonet, 1991 Gautier, 2002

apoC-III Aalto-Setala, 1992 Ding, 2011

apo(a) Chiesa, 1992 Rouy, 1998

apoM Christoffersen, 2008 Christoffersen, 2008

apoE Shimano, 1992 Fan, 1998 Piedrahita, 1992

NPC1L1 Altmann, 2004

ACAT1 Buhman, 2000 Apobec 1 Kendrick, 2001 MTP Xie, 2006 PLTP Liu, 2007 SR-BI Mardones, 2001 FABP Newberry, 2009

DGAT2 Liu, 2008 MTP Raabe, 1998 Apobec-1 Morrison, 1996

LPL Shimada, 1993 Fan, 2001 Coleman, 1995

PCSK9 Herbert, 2010 Rashid, 2005 VLDLR Frykman, 1995 SR-type A Suzuki, 1997

ABCA1 Vaisman, 2001 McNeish, 2000 ABCG1 Kennedy, 2005 Kennedy, 2005 SR-BI Wang, 1998 Rigotti, 1997

PLTP Jiang, 1996 Masson, 2011 Jiang, 1999 **Table 1.** List of genetically modified animals regarding lipoprotein metabolism.

LCAT Vaisman, 1995 Hoeg, 1996

CETP Aggellon, 1991 Herrera, 1999

HL Braschi, 1998 Fan, 1994 Gonzalez-Navarro, 2004 EL Ishida, 2003; Ishida, 2003; Ma, 2003

LDLR Hofmann, 1998 Ishibashi, 1993 Asahina, 2012

ABCA1 McNeish, 2003 Mulligan, 2003

mouse rat rabbit mouse rat chick

Recent studies using genetically modified animals have help to clarify the mechanism of cholesterol absorption in the jejunum. Dietary cholesterol forms micelles with bail acids in the lumen of the jejunum, which are then transported through NPC1L1. Thereafter, the free cholesterol is esterified by acyl coenzyme A:cholesterol acyltransferase 2 (ACAT2) and chylomicron particles are formed by the packaging of esterified cholesterol, triglyceride, and apolipoprotein B by MTP (Hussain, 2012). NPC1L1 was found by Altman et al (2002). NPC1L1, highly expressed in the jejunum and located on the surface of absorptive enterocytes, is critical for the intestinal absorption of dietary and biliary cholesterol (Altmann, 2004). NPC1L1 mediates cholesterol uptake through vesicular endocytosis. Davis et al (2004) produced NPC1L1 KO mice, which had substantially reduced intestinal uptake of cholesterol and sitosterol. NPC1L1-deficiency resulted in the up-regulation of intestinal hydroxymethylglutaryl-CoA synthase mRNA expression and an increase in intestinal cholesterol synthesis, the down-regulation of ABCA1 mRNA expression, and no change in ABCG5 and ABCG8 mRNA levels. Therefore, NPC1L1 is required for intestinal uptake of both cholesterol and phytosterols and plays a major role in cholesterol homeostasis. These findings in NPC1L1-KO mice were similar to results obtained with an inhibitor of cholesterol absorption, ezetimibe (Garcia-Calvo, 2005). Phospholipid transfer protein (PLTP) is also involved in cholesterol absorption in the intestine (Liu R, 2007). PLTP-KO mice absorb significantly less cholesterol than wild-type mice. In addition, mRNA levels of NPC1L1 and ABCA1 and MTP activity levels were significantly decreased in the small intestine of PLTP-KO mice. The free cholesterol taken up through NPC1L1 and PLTP is esterified by ACAT2. Experiments with ACAT2-KO mice demonstrated that a deficiency of ACAT2 activity inhibits cholesterol absorption in the intestine (Buhman, 2000). In the intestine, lipids absorbed are packaged with apolipoproteins and form chylomicron particles. The major structural apolipoprotein in chylomicron particles is apoB-48. ApoB-48 is produced by apobec-1, which inserts a stop codon. A deficiency of apobec-1 in the intestine resulted in reduction in the secretion and assembly of chylomicron particles (Kendrick, 2001). These results from apobec-1- KO mice suggested that apoB-48 is involved in the assembly of chylomicron particles (Lo, 2008). Finally, absorbed lipids and synthesized apolipoproteins are assembled by MTP. MTP-KO mice demonstrated a decrease in cholesterol absorption and chylomicron secretion, in addition to manifestations of steatorrhea (Xie, 2006). Although ABC and SR-BI were considered important to cholesterol absorption until the year 2000, SR-BI is not essential for intestinal cholesterol absorption (Mardones, 2001). Cholesterol absorption was independent of ABCA1 in KO mice (McNeish, 2000) and ABCA1-mutant chickens (Mulligan, 2003). Thus, studies with genetically modified animals have verified the mechanisms of dietary lipid absorption revealed by experiments in vitro.

#### **3.2. Formation and secretion of VLDL particles from liver**

The liver is the main organ in lipoprotein metabolism. Endogenous lipoprotein (VLDL) particles are produced in liver. The production and secretion of VLDL consist of the synthesis of cholesterol, triglyceride, phospholipids, and apolipoproteins, and assembly of these components. As described, apobec-1 is expressed in the liver in mice and rats, but not in humans and rabbits. Therefore, apoB-48-containing VLDL particles are secreted from the mouse and rat liver. Compared to those containing apoB-100, VLDL particles containing apoB-48 are rapidly cleared from circulation through apoER expressed on hepatocytes, similar to chylomicron remnants (Fig 2). To better approximate human lipoprotein metabolism, apobec-1-deficient mice were developed by gene targeting (Morrison, 1996). The LDL levels increased and HDL levels decreased in the circulation. However, overexpression of human apoB-100 showed different results between mice and rabbits. Plasma cholesterol levels decreased in apoB-100-overexpresing mice (Farese, 1996), although plasma cholesterol, triglyceride, and LDL levels increased and HDL levels decreased in apoB-100-overexpressing rabbits (Fan, 1995). This difference may be due to differences in CETP activity in the circulation between mice and rabbits. In addition, suppression of acyl-CoA: diacylglycerol acyltransferase 2 (DGAT2) expression by antisense treatment decreased VLDL secretion in mice (Liu, 2008). This suggests that suppression of triglyceride synthesis decreases VLDL secretion. Studies using inhibitors of MTP suggested that MTP plays a key role in the production of VLDL particles and inhibition of MTP activity decreases VLDL secretion in WHHL rabbits (Shiomi, 2001). Indeed, MTP+/- mice fed a high-fat diet demonstrated decreased levels of apoB-containing lipoproteins in plasma (Raabe, 1998). Furthermore, hepatocytes synthesize and/or secrete a lot of apolipoproteins, such as apoA, apoB, apoC, apoE, apoM, and apo(a). The function of these apolipoproteins has been clarified using genetically modified animals. However, influences of the overexpression of apoB, apoE, and apo(a) differ between mice and rabbits. ApoE overexpression resulted in a marked decrease in non-HDL cholesterol in mice (Shimano, 1992), while in rabbits, cholesterol of LDL and HDL increased and the fractional catabolic rate of chylomicron also increased (Fan, 1998). These differences between mice and rabbits may be due to CETP activity and the expression of abobec-1 in mouse liver. Lipoprotein (a), an atherogenic lipoprotein, is formed by the binding of apo(a) to LDL particles and is detected in plasma of only humans and monkeys. In human-apo(a) transgenic mice (Chiesa, 1992), apo(a) does not bind to mouse LDL particles, while human apo(a) binds to rabbit LDL particles and lipoprotein (a) is also atherogenic in rabbits (Rouy, 1998; Fan, 1999). Therefore, the role of endogenous apoB-containing lipoproteins (VLDL, IDL, and LDL) in the regulation of plasma lipid levels differs between genetically modified mice and rabbits or humans.

#### **3.3. Lipolysis of apoB-containing lipoproteins**

Lipoproteins are transporters in circulation that provide cholesterol as a material for steroid hormones and the cytoskeleton, and triglycerides (fatty acids) for energy to peripheral tissue. In the transportation of fatty acids, lipoprotein lipase (LPL), hepatic lipase (HL), and endothelial lipase (EL) function at capillaries and apoC affects lipolytic activities. LPL mediates the lipolysis of VLDL and chylomicrons, and these lipoprotein particles are transformed into IDL and chylomicron remnants, respectively. Although LPL-/- mice die within a day after birth because of dramatic hypertriglyceridemia, impaired fat tolerance, and hypoglycemia (Weinstock, 1995), these LPL-KO mice could be rescued by transient LPL expression induced by adenoviral-mediated gene transfer (Strauss, 2001). Rescued adult LPL-KO mice exhibit severe hypertriglyceridemia as patients with homozygous LPLdeficiency. LPL+/- mice showed increases in plasma triglyceride levels due to increases in the fraction of VLDL and chylomicrons in the circulation. Overexpression of LPL in mice (Shimada, 1993) and rabbits (Fan, 2001) caused decreases in plasma triglyceride, VLDL, and LDL levels, in addition to the suppression of atherosclerotic lesions (Shimada, 1996). ApoC-I modulates this metabolism. Although knockout of apoC-I gene did not affect serum lipid levels, expression of human CETP markedly increased levels of cholesterol ester in plasma, VLDL, and LDL in apoC-I-KO mice (Gautier, 2002). In contrast, in transgenic mice overexpressing human apoC-I, plasma triglyceride and total cholesterol levels were increased compared to those in wild-type mice. In addition, overexpression of apoC-I, apoC-II, apoC-III, and apoC-IV also increased plasma triglyceride and total cholesterol levels, and suppressed LPL activity in mice (Simonet, 1991; Shachter, 1994; Aalto-Setala, 1992; Allan, 1996) and rabbits (Ding, 2011). HL modulates the metabolism of both apoB-containing and apoA-containing lipoproteins. In apoE-KO mice, deficiency of HL showed a decrease in the fractional catabolic rate of apoB-48-containing VLDL, IDL and LDL despite no effects on apoB-100-containing LDL, in addition to increases in total cholesterol and triglyceride levels in apoB-containing and apoA-containing lipoproteins (Mezdour, 1997 & Gonzalez-Navarro H, 2004). However, development of atherosclerotic lesions was reduced in HL-KO mice. In HL-transgenic mice (Brashci, 1998) and rabbits (Fan, 1994), catabolism of both HDL and apoB-48-containing lipoproteins is enhanced, and plasma total cholesterol and triglyceride levels are decreased. Therefore, HL may be associated with catabolism of not only apoBcontaining lipoproteins but HDL. EL is located in arterial endothelial cells and has phospholipase activity against phospholipids in HDL particles (Broedl, 2003; Ishida, 2003). EL hydrolyzes phospholipids on HDL particles and promotes catabolism of HDL. Overexpression of EL decreases in HDL cholesterol and apoA-I levels decreased in mice (Ishida, 2003; Jaye, 1999). By contrast, a deficiency of EL increases HDL levels (Ishida, 2003; Ma, 2003), in addition to atherogenic action (Ishida, 2004) and allergic asthma (Otera, 2009). Another study confirmed the high HDL-C levels in EL-/- mice but did not document an association with atherosclerosis (Ko, 2005). Thus, the role of EL in reverse cholesterol transport and atherosclerosis has not been fully elucidated. Further studies are required to clarify the function of EL in the metabolism of HDL and atherosclerosis. In studies about lipolysis, genetically modified animals have demonstrated no species differences, and are useful in this field.

#### **3.4. Receptor-mediated catabolism of apoB-containing lipoproteins**

#### *3.4.1. LDL receptor*

540 Lipoproteins – Role in Health and Diseases

synthesis of cholesterol, triglyceride, phospholipids, and apolipoproteins, and assembly of these components. As described, apobec-1 is expressed in the liver in mice and rats, but not in humans and rabbits. Therefore, apoB-48-containing VLDL particles are secreted from the mouse and rat liver. Compared to those containing apoB-100, VLDL particles containing apoB-48 are rapidly cleared from circulation through apoER expressed on hepatocytes, similar to chylomicron remnants (Fig 2). To better approximate human lipoprotein metabolism, apobec-1-deficient mice were developed by gene targeting (Morrison, 1996). The LDL levels increased and HDL levels decreased in the circulation. However, overexpression of human apoB-100 showed different results between mice and rabbits. Plasma cholesterol levels decreased in apoB-100-overexpresing mice (Farese, 1996), although plasma cholesterol, triglyceride, and LDL levels increased and HDL levels decreased in apoB-100-overexpressing rabbits (Fan, 1995). This difference may be due to differences in CETP activity in the circulation between mice and rabbits. In addition, suppression of acyl-CoA: diacylglycerol acyltransferase 2 (DGAT2) expression by antisense treatment decreased VLDL secretion in mice (Liu, 2008). This suggests that suppression of triglyceride synthesis decreases VLDL secretion. Studies using inhibitors of MTP suggested that MTP plays a key role in the production of VLDL particles and inhibition of MTP activity decreases VLDL secretion in WHHL rabbits (Shiomi, 2001). Indeed, MTP+/- mice fed a high-fat diet demonstrated decreased levels of apoB-containing lipoproteins in plasma (Raabe, 1998). Furthermore, hepatocytes synthesize and/or secrete a lot of apolipoproteins, such as apoA, apoB, apoC, apoE, apoM, and apo(a). The function of these apolipoproteins has been clarified using genetically modified animals. However, influences of the overexpression of apoB, apoE, and apo(a) differ between mice and rabbits. ApoE overexpression resulted in a marked decrease in non-HDL cholesterol in mice (Shimano, 1992), while in rabbits, cholesterol of LDL and HDL increased and the fractional catabolic rate of chylomicron also increased (Fan, 1998). These differences between mice and rabbits may be due to CETP activity and the expression of abobec-1 in mouse liver. Lipoprotein (a), an atherogenic lipoprotein, is formed by the binding of apo(a) to LDL particles and is detected in plasma of only humans and monkeys. In human-apo(a) transgenic mice (Chiesa, 1992), apo(a) does not bind to mouse LDL particles, while human apo(a) binds to rabbit LDL particles and lipoprotein (a) is also atherogenic in rabbits (Rouy, 1998; Fan, 1999). Therefore, the role of endogenous apoB-containing lipoproteins (VLDL, IDL, and LDL) in the regulation of

plasma lipid levels differs between genetically modified mice and rabbits or humans.

Lipoproteins are transporters in circulation that provide cholesterol as a material for steroid hormones and the cytoskeleton, and triglycerides (fatty acids) for energy to peripheral tissue. In the transportation of fatty acids, lipoprotein lipase (LPL), hepatic lipase (HL), and endothelial lipase (EL) function at capillaries and apoC affects lipolytic activities. LPL mediates the lipolysis of VLDL and chylomicrons, and these lipoprotein particles are transformed into IDL and chylomicron remnants, respectively. Although LPL-/- mice die

**3.3. Lipolysis of apoB-containing lipoproteins** 

Lipoprotein receptors, such as LDLRs, VLDL receptors (VLDLRs), apoE receptors (remnant receptors, apoERs), and scavenger receptors (SRs), take up lipoprotein particles into parenchymal cells and/or phagocytes. LDLRs are expressed on the surface of parenchymal cells and bind to circulating LDL. The ligands are apoB-100 and apoE. A deficiency or the suppression of LDLRs results in the accumulation of LDL in the circulation, a condition known as human familial hypercholesterolemia. Several animal models for LDLR-deficiency have been developed. One of the better known models is the WHHL (Watanabe, 1980) or WHHLMI (Shiomi, 2003; 2009) rabbit. WHHL or WHHLMI rabbits show hypercholesterolemia due to LDLR deficiency even when fed standard chow. However, LDLR-KO mice (Ishibashi, 1993 & 1994) and LDLR-KO rats (Asahina, 2012) showed mildly increased serum cholesterol levels. Sanan et al. (1998) reported that LDLR-KO mice expressing human apoB-100 showed hypercholesterolemia due to the accumulation of LDL in the plasma even in chow feeding. In addition, Teng et al (1997) demonstrated that adenovirus-mediated gene delivery of apobec-1 reduced plasma apoB-100 levels, leading to the almost complete elimination of LDL particles and a reduction in LDL cholesterol in LDLR-KO mice. These studies suggests that the absence of any increase in plasma cholesterol levels in LDLR-KO mice is due to the expression of apobec-1 in the liver and apoB-100-containing LDL is a key player in LDLR deficiency to increased plasma cholesterol levels. Expression of LDLRs on the cell surface is regulated by proprotein convertase subtilisin/kexin type 9 (PCSK9). Recently, Huijgen et al. (2012) reported that plasma levels of PCSK9 were associated with LDL cholesterol levels in patients with familial hypercholesterolemia. In addition, overexpression of PCSK9 induced negative modulation of LDLR expression and decreased plasma LDL clearance, also promoting atherosclerosis (Herbert, 2010). In contrast, knockout of PCSK9 resulted in an increase in the LDL receptor protein (Mbikay, 2010) and a decrease in plasma cholesterol levels (Rashid, 2005). Furthermore, PCSK9 regulates the expression of not only LDLRs but VLDLRs and apoERs (Poirier, 2008). Therefore, PCSK9 can be considered a new target in the treatment of hypercholesterolemia.

#### *3.4.2. VLDL receptor*

VLDL particles are incorporated through VLDLRs. VLDLRs are expressed in heart, muscle, adipose tissues, and macrophages but not in liver in humans and rabbits. In mice, however, VLDLRs are not expressed in macrophages (Takahashi, 2011), suggesting the process of atherogenesis to be somewhat different between mice and humans or rabbits. Knockout of VLDLRs does not affect lipoprotein metabolism but decreases body weight, BMI, and epididymal fat in mice (Frykman, 1995). In addition, LPL activity is decreased by VLDLRdeficiency. These observations suggest VLDLRs to be associated with metabolic syndrome. Furthermore, a recent study suggests that the expression of VLDLRs is affected by PCSK9 (Roubtsova, 2011). Surprisingly, adipose tissues of apoE-KO mice did not express LDLR, VLDLR, and LDLR-related proteins (Huang, 2009), although wild-type mice developed these receptors in adipose tissue. Since the VLDLR has various functions, genetically modified animals may contribute to further studies.

#### *3.4.3. Remnant receptor*

542 Lipoproteins – Role in Health and Diseases

hypercholesterolemia.

*3.4.2. VLDL receptor* 

modified animals may contribute to further studies.

parenchymal cells and/or phagocytes. LDLRs are expressed on the surface of parenchymal cells and bind to circulating LDL. The ligands are apoB-100 and apoE. A deficiency or the suppression of LDLRs results in the accumulation of LDL in the circulation, a condition known as human familial hypercholesterolemia. Several animal models for LDLR-deficiency have been developed. One of the better known models is the WHHL (Watanabe, 1980) or WHHLMI (Shiomi, 2003; 2009) rabbit. WHHL or WHHLMI rabbits show hypercholesterolemia due to LDLR deficiency even when fed standard chow. However, LDLR-KO mice (Ishibashi, 1993 & 1994) and LDLR-KO rats (Asahina, 2012) showed mildly increased serum cholesterol levels. Sanan et al. (1998) reported that LDLR-KO mice expressing human apoB-100 showed hypercholesterolemia due to the accumulation of LDL in the plasma even in chow feeding. In addition, Teng et al (1997) demonstrated that adenovirus-mediated gene delivery of apobec-1 reduced plasma apoB-100 levels, leading to the almost complete elimination of LDL particles and a reduction in LDL cholesterol in LDLR-KO mice. These studies suggests that the absence of any increase in plasma cholesterol levels in LDLR-KO mice is due to the expression of apobec-1 in the liver and apoB-100-containing LDL is a key player in LDLR deficiency to increased plasma cholesterol levels. Expression of LDLRs on the cell surface is regulated by proprotein convertase subtilisin/kexin type 9 (PCSK9). Recently, Huijgen et al. (2012) reported that plasma levels of PCSK9 were associated with LDL cholesterol levels in patients with familial hypercholesterolemia. In addition, overexpression of PCSK9 induced negative modulation of LDLR expression and decreased plasma LDL clearance, also promoting atherosclerosis (Herbert, 2010). In contrast, knockout of PCSK9 resulted in an increase in the LDL receptor protein (Mbikay, 2010) and a decrease in plasma cholesterol levels (Rashid, 2005). Furthermore, PCSK9 regulates the expression of not only LDLRs but VLDLRs and apoERs (Poirier, 2008). Therefore, PCSK9 can be considered a new target in the treatment of

VLDL particles are incorporated through VLDLRs. VLDLRs are expressed in heart, muscle, adipose tissues, and macrophages but not in liver in humans and rabbits. In mice, however, VLDLRs are not expressed in macrophages (Takahashi, 2011), suggesting the process of atherogenesis to be somewhat different between mice and humans or rabbits. Knockout of VLDLRs does not affect lipoprotein metabolism but decreases body weight, BMI, and epididymal fat in mice (Frykman, 1995). In addition, LPL activity is decreased by VLDLRdeficiency. These observations suggest VLDLRs to be associated with metabolic syndrome. Furthermore, a recent study suggests that the expression of VLDLRs is affected by PCSK9 (Roubtsova, 2011). Surprisingly, adipose tissues of apoE-KO mice did not express LDLR, VLDLR, and LDLR-related proteins (Huang, 2009), although wild-type mice developed these receptors in adipose tissue. Since the VLDLR has various functions, genetically Remnant receptors are mainly expressed in liver and contribute to the metabolism of exogenous lipoproteins, which contain apoB-48, in humans and rabbits. Therefore, downregulation of remnant receptor function causes the accumulation of chylomicron remnants in plasma. As their ligand is apolipoprotein E, remnant receptors are also called apoE receptors (apoERs). In mice and rats, VLDL, IDL, and LDL contain apoB-48 due to the expression of apobec-1 in the liver. These apoB-48-containing lipoproteins bind to apoERs through interaction with the apoE ligand and disappear from the circulation rapidly. The fractional catabolic rate for apoB-48-containing VLDL is remarkably high compared to that for apoB-100-containing VLDL (Gonzalez-Navarro, 2004). This is one of the reasons why concentrations of VLDL and LDL are very low in plasma of mice and rats. In contrast, apoE-KO mice have very high VLDL concentration and the VLDL fraction consists of apoB-48 (Gonzalez-Navarro, 2004). Since apoE is a ligand of apoER, lipoproteins containing only apoB-48 cannot bind to apoERs in apoE-KO mice. This is the reason for the hypercholesterolemia in apoE-KO mice. Consequently, the hypercholesterolemia of apoE-KO mice due to the accumulation of apoB-48-containing lipoproteins is different from human hypercholesterolemia due to the accumulation of apoB-100-containing lipoproteins. This difference affects the development of hypocholesterolemic agents.

#### *3.4.4. Scavenger receptor type A*

Scavenger receptor type A (SR-A) is expressed on phagocytes and plays an important role in the removal of modified lipoproteins, such as oxidized-LDL, acetyl-LDL, and glycated-LDL. Therefore, SR-A plays an important role in atherogenesis. Knockout of SR-A decreases the uptake of modified LDL, but does not affect plasma lipid levels (Suzuki, 1997).

#### **3.5. Reverse cholesterol transport**

The plasma concentration of HDL is inversely related to the risk of atherosclerotic vascular diseases. HDL plays a key role in the reverse transport of cholesterol from peripheral tissue to liver. Recent studies suggest that HDL is also associated with anti-inflammation, antithrombosis, anti-oxidation, and the enhancement of endothelial function. Newly synthesized apoA-I binds to ABCs (particularly ABC-A1) or SR-BI of macrophages and takes up free cholesterol from macrophages. The complex of apoA-I and free cholesterol is transformed into discoidal nascent HDL (pre-β HDL). These nascent HDLs become HDL particles (HDL3) after esterification of the free cholesterol by LCAT in plasma. In the process of the transformation from discoidal HDL to HDL3, HDL takes up apoE and free cholesterol from macrophages mainly by ABCG1. Therefore, as the HDL matures, its cholesterol content increases. In humans and rabbits, CETP in plasma exchanges the cholesterol ester of HDL particles with triglyceride in apoB-containing lipoproteins. Therefore, peripheral cholesterol is transported by two pathways; an LDLR pathway mediated by CETP function and a SR-BI pathway. However, mice and rats do not have CETP activity in plasma. Therefore, the pathway of reverse cholesterol transport is markedly different between mice / rats and humans / rabbits.

#### *3.5.1. Apolipoproteins of HDL particles*

HDL particles contain apoA, apoC, apoE, and apoM. ApoA, the main structural apolipoprotein of HDL particles, is mainly classified as apoA-I, apoA-II, and apoA-IV. ApoA and apoE play an important role in the efflux of cholesterol from macrophages to discoidal and small HDL, respectively. Recent studies suggested that apoM is related to the anti-oxidative function of HDL (Elsoe, 2012).

ApoA-I is a major structural apolipoprotein of HDL particles. ApoA is synthesized mainly in the liver and intestine, and from HDL particles hydrolyzed by HL. Humans and mice have two types of HDLs. One contains only apoA-I and the other, both apoA-I and apoA-II. However, rabbit HDLs are apoA-I particles (Chapman, 1980 & Koike, 2009). ApoA-I plays an important role in the reverse transport of cholesterol. Overexpression of apoA-I increases HDL-cholesterol levels in mice (Walsh, 1989), rats (Swanson, 1992), and rabbits (Duverger, 1996). In contrast, knockout of the apoA-I gene in mice decreases cholesterol levels in HDL, VLDL, and whole plasma (Plump, 1997). In addition, apoA-I-deficient HDL is a poor substrate for HL and LCAT. These studies using genetically modified animals indicate that apoA-I plays an important role in cholesterol reverse transport. Another major apolipoprotein of HDL is apoA-II. Overexpression of human apoA-II in mouse liver resulted in a decrease in plasma cholesterol levels due to a decrease in HDL cholesterol but an increase in plasma triglyceride levels (Marzal-Casacub, 1996). In addition, LCAT activity and mouse apoA-II levels in plasma were decreased in human apoA-II transgenic mice. Consequently, the changes in plasma lipid levels in human apoA-II transgenic mice may be due to a reduction in levels of mouse apoA-II. These results suggest species differences in apoA-II. In addition, apoA-II is dimer in human but monomer in mice. Knockout of apoA-II in mice resulted in a decrease in not only HDL-cholesterol but non-HDL cholesterol. In addition, the fractional catabolic rate for apoA-I was increased by a deficiency of apoA-II (Weng, 1996). Furthermore, the deficiency was associated with lower free fatty acid, glucose, and insulin levels, suggesting insulin hypersensitivity, while apoA-II does not relate to insulin sensitivity in humans. Therefore, the function of apoA-II is very confusing in mouse models. Conversely, rabbits overexpressing human apoA-II, which do not have apoA-II, lipid levels in plasma and non-HDL lipoproteins were increased but HDL-cholesterol levels and activities of LPL and HL were decreased (Koike, 2009). Therefore, effects of human apoA-II overexpression may be different between mice and rabbits. To clarify the function of apoA-II, more studies are required.

#### *3.5.2. Transfer of cholesterol from macrophages to HDL*

The start of the reverse cholesterol transport process is the transfer of cholesterol from macrophages to apoA-I, in which ABCs play important roles. Several strains of mice with genetically modified ABCA1 and ABCG1 have been produced. Overexpression of ABCA1 in mice increases cholesterol efflux from macrophages, in addition to increases in levels of cholesterol, apoA-I, and apoA-II in HDL (Vaisman, 2001). In contrast, ABCA1-KO mice showed a marked decrease in HDL-cholesterol, LDL-cholesterol, and plasma apoB levels, and an absence of apoA-I in plasma, but an increase in cholesterol absorption and the accumulation of lipid-laden macrophages (McNeish, 2000). Furthermore, in ABCG1-KO mice, cholesterol efflux from macrophages to HDL is decreased (Kennedy, 2005). After its efflux from macrophages to apoA-I and HDL, free cholesterol is esterified by LCAT in the plasma. Overexpression of LCAT in mice increases levels of cholesterol, apoA-I, apoA-II, and apoE in plasma, in addition to HDL cholesterol (Vaisman, 1995). LCAT-overexpressing rabbits showed an increase in HDL-cholesterol on a chow diet but non-HDL cholesterol was not increased on a cholesterol diet (Hoeg, 1996). Therefore, LCAT plays an important role in the esterification of free cholesterol in HDL. Studies using ABCA1-KO mice, ABCG1-KO mice, and ABCA1/ABCG1-dKO mice (Out, 2008) have elucidated how cholesterol is transported from macrophages to HDL. ApoE also promotes reverse cholesterol transport by enhancing the efflux of free cholesterol from peripheral macrophages to maturing HDL particles (Hayek, 1994). The efflux of free cholesterol to apoE-binding HDL is mediated by ABCG1/4 (Matsuura, 2006). The efflux from macrophages to apoE-containing HDL3 (small HDL particles) depends on apoE. HDL-cholesterol levels are markedly low in apoE-KO mice, despite being high HDL in wild-type mice (Zhang, 1992). Therefore, the low HDLcholesterol levels in apoE-KO mice are due to a decrease in the efflux of cholesterol from macrophages to HDL. By contrast, the overexpression of apoE induced a marked decrease in apoB-containing lipoproteins in mice (Shimano, 1992), but human apoE3 overexpression increased cholesterol levels in not only HDL but LDL in rabbits (Fan, 1998). These differences between mice and rabbits are due to the activity of CETP in plasma, since no CETP activity is detected in mice but strong activity is found in rabbits.

#### *3.5.3. Transfer of lipids from HDL to apoB-containing lipoproteins*

544 Lipoproteins – Role in Health and Diseases

*3.5.1. Apolipoproteins of HDL particles* 

anti-oxidative function of HDL (Elsoe, 2012).

of apoA-II, more studies are required.

*3.5.2. Transfer of cholesterol from macrophages to HDL* 

rats and humans / rabbits.

Therefore, the pathway of reverse cholesterol transport is markedly different between mice /

HDL particles contain apoA, apoC, apoE, and apoM. ApoA, the main structural apolipoprotein of HDL particles, is mainly classified as apoA-I, apoA-II, and apoA-IV. ApoA and apoE play an important role in the efflux of cholesterol from macrophages to discoidal and small HDL, respectively. Recent studies suggested that apoM is related to the

ApoA-I is a major structural apolipoprotein of HDL particles. ApoA is synthesized mainly in the liver and intestine, and from HDL particles hydrolyzed by HL. Humans and mice have two types of HDLs. One contains only apoA-I and the other, both apoA-I and apoA-II. However, rabbit HDLs are apoA-I particles (Chapman, 1980 & Koike, 2009). ApoA-I plays an important role in the reverse transport of cholesterol. Overexpression of apoA-I increases HDL-cholesterol levels in mice (Walsh, 1989), rats (Swanson, 1992), and rabbits (Duverger, 1996). In contrast, knockout of the apoA-I gene in mice decreases cholesterol levels in HDL, VLDL, and whole plasma (Plump, 1997). In addition, apoA-I-deficient HDL is a poor substrate for HL and LCAT. These studies using genetically modified animals indicate that apoA-I plays an important role in cholesterol reverse transport. Another major apolipoprotein of HDL is apoA-II. Overexpression of human apoA-II in mouse liver resulted in a decrease in plasma cholesterol levels due to a decrease in HDL cholesterol but an increase in plasma triglyceride levels (Marzal-Casacub, 1996). In addition, LCAT activity and mouse apoA-II levels in plasma were decreased in human apoA-II transgenic mice. Consequently, the changes in plasma lipid levels in human apoA-II transgenic mice may be due to a reduction in levels of mouse apoA-II. These results suggest species differences in apoA-II. In addition, apoA-II is dimer in human but monomer in mice. Knockout of apoA-II in mice resulted in a decrease in not only HDL-cholesterol but non-HDL cholesterol. In addition, the fractional catabolic rate for apoA-I was increased by a deficiency of apoA-II (Weng, 1996). Furthermore, the deficiency was associated with lower free fatty acid, glucose, and insulin levels, suggesting insulin hypersensitivity, while apoA-II does not relate to insulin sensitivity in humans. Therefore, the function of apoA-II is very confusing in mouse models. Conversely, rabbits overexpressing human apoA-II, which do not have apoA-II, lipid levels in plasma and non-HDL lipoproteins were increased but HDL-cholesterol levels and activities of LPL and HL were decreased (Koike, 2009). Therefore, effects of human apoA-II overexpression may be different between mice and rabbits. To clarify the function

The start of the reverse cholesterol transport process is the transfer of cholesterol from macrophages to apoA-I, in which ABCs play important roles. Several strains of mice with genetically modified ABCA1 and ABCG1 have been produced. Overexpression of ABCA1 in mice increases cholesterol efflux from macrophages, in addition to increases in levels of One of the main courses of reverse cholesterol transport depends on CETP in plasma in human and rabbits (Son, 1986). However, mice and rats do not have CETP activity in plasma (Agellon, 1991). Therefore, in mice, the HDL cholesterol level is high but cholesterol levels of apoB-containing lipoproteins are markedly low. Overexpression of human CETP in mice induces a decrease in HDL-cholesterol but no changes in cholesterol levels in VLDL and LDL (Agellon, 1991). Similar findings were made in Dahl rats (Herrera, 1999). One of the reasons for no changes in cholesterol levels of non-HDL fraction is due to a rapid clearance of apoB-48-containing lipoproteins through apoER. These results suggest that CETP transfers cholesterol ester from HDL to apoB-containing lipoproteins. Furthermore, CETP expression led to atherosclerosis in Dahl rats fed a cholesterol diet. Therefore, CETPoverexpression can cause complex responses depending on diet. PLTP is a plasma protein, which transfers phospholipids from apoB-containing lipoproteins to HDL. Knockout of PLTP resulted in a decrease in cholesterol (Jiang, 1999; 2001). In PLTP transgenic mice, PLTP did not affect lipid levels of apoB-containing lipoproteins but increased phospholipid and cholesterol levels in HDL (Jiang, 1996). However, overexpression of PLTP in rabbits increased cholesterol levels in apoB-containing lipoproteins but had no effect on HDL lipids

in a high-cholesterol deiet feeding (Masson, 2011). These differences in the function of PLTP between mice and rabbits may be due to fundamental differences in lipoprotein metabolism, such as CETP activity in the plasma and apobec-1 expression in the liver. Therefore, one has to be deliberate in interpreting results from gene modification studies.

#### *3.5.4. HDL receptors*

HDL particles are incorporated by SR-BI, a HDL receptor, expressed in liver. In humans and rabbits, cholesterol is transferred from peripheral macrophages to liver through two pathways, via CETP-LDLR and SR-BI, while in mice and rats, cholesterol is transported to liver via SR-BI expressed in liver. Overexpression of SR-BI in mice induces a decrease in plasma lipids and an increase in the fractional catabolic rate for HDL (Wang, 1998). In contrast, SR-BI-KO mice show increases in plasma cholesterol levels, HDL particle size, and levels of apoE and apoA-I in HDL particles (Rigotti, 1997). These results demonstrate the function of SR-BI in reverse cholesterol transport. However, these changes in plasma lipid levels reflect HDL lipid levels, because mice do not have CETP activity in the plasma.
