LDL Receptor Regulates the Reverse Transport of Macrophage-Derived Unesterified Cholesterol via Concerted Action of the HDL-LDL Axis: Insight From Mouse Models

RATIONALE:The HDL-mediated stimulation of cellular cholesterol efflux initiates the reverse cholesterol pathway from macrophages (m-RCT), which ends in the fecal excretion of macrophage-derived unesterified cholesterol (UC). Early studies established that LDL particles could act as efficient intermediate acceptors of cellular-derived UC, thereby preventing the saturation of HDL particles and facilitating their cholesterol efflux capacity (CEC). However, the capacity of LDL to act as a plasma cholesterol reservoir and its potential impact in supporting the m-RCT pathway in vivo both remain unknown. OBJECTIVE:We investigated LDL contributions to the m-RCT pathway in hypercholesterolemic mice. METHODS AND RESULTS:Macrophage cholesterol efflux induced either in vitro by LDL added to the culture media either alone or together with HDL, or ex vivo by plasma derived from subjects with familial hypercholesterolemia (FH), was assessed. In vivo, m-RCT was evaluated in mouse models of hypercholesterolemia that were naturally deficient in CETP and fed a Western-type diet. LDL induced the efflux of radiolabeled UC from cultured macrophages, and, in the simultaneous presence of HDL, a rapid transfer of the radiolabeled UC from HDL to LDL occurred. However, LDL did not exert a synergistic effect on HDL CEC in the FH plasma. The m-RCT rates of the LDL receptor (LDLr)-KO, LDLr- KO/APOB100, and PCSK9-overexpressing mice were all significantly reduced relative to the wild-type mice. In contrast, m-RCT remained unchanged in human APOB100 transgenic mice with fully functional LDLr, despite increased levels of plasma APOB-containing lipoproteins. CONCLUSIONS:Hepatic LDLr plays a critical role in the flow of macrophage-derived UC to feces, while the plasma increase of APOB-containing lipoproteins is unable to stimulate m-RCT. The results indicate that, besides the major HDL-dependent m-RCT pathway via SR-BI to the liver, a CETP-independent m-RCT path exists, in which LDL mediates the transfer of cholesterol from macrophages to feces.