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Subclinical atherosclerosis and its progression are modulated by PLIN2 through a feed-forward loop between LXR and autophagy

Journal article
Authors P. Saliba-Gustafsson
M. Pedrelli
K. Gertow
O. Werngren
V. Janas
S. Pourteymour
D. Baldassarre
E. Tremoli
F. Veglia
R. Rauramaa
A. J. Smit
P. Giral
S. Kurl
M. Pirro
U. de Faire
S. E. Humphries
A. Hamsten
I. Goncalves
M. Orho-Melander
A. Franco-Cereceda
Jan Borén
P. Eriksson
J. Magne
P. Parini
E. Ehrenborg
C. R. Sirtori
S. Castelnuovo
M. Amato
B. Frigerio
A. Ravani
D. Sansaro
C. Tedesco
F. Bovis
A. Discacciati
M. Ahl
G. Blomgren
M. J. Eriksson
P. Fahlstadius
M. Heinonen
L. Nilson
J. Cooper
J. Acharya
K. Huttunen
E. Rauramaa
H. Pekkarinen
I. M. Penttila
J. Torronen
A. I. van Gessel
A. M. van Roon
G. C. Teune
W. D. Kuipers
M. Bruin
A. Nicolai
P. Haarsma-Jorritsma
D. J. Mulder
H. J. G. Bilo
G. H. Smeets
J. L. Beaudeux
J. F. Kahn
V. Carreau
A. Kontush
J. Karppi
T. Nurmi
K. Nyyssonen
R. Salonen
T. P. Tuomainen
J. Tuomainen
J. Kauhanen
G. Vaudo
A. Alaeddin
D. Siepi
G. Lupattelli
G. Schillaci
Published in Journal of Internal Medicine
Volume 286
Issue 6
Pages 660-675
ISSN 0954-6820
Publication year 2019
Published at Wallenberg Laboratory
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 660-675
Language en
Keywords 27OH-cholesterol, atherosclerosis, autophagy, liver-X-receptor, PLIN2, reverse cholesterol transport, macrophage foam cells, accumulation, efflux, identification, stimulation, metabolism, receptors, ser251pro, protects, General & Internal Medicine
Subject categories Cardiac and Cardiovascular Systems


Background Hyperlipidaemia is a major risk factor for cardiovascular disease, and atherosclerosis is the underlying cause of both myocardial infarction and stroke. We have previously shown that the Pro251 variant of perilipin-2 reduces plasma triglycerides and may therefore be beneficial to reduce atherosclerosis development. Objective We sought to delineate putative beneficial effects of the Pro251 variant of perlipin-2 on subclinical atherosclerosis and the mechanism by which it acts. Methods A pan-European cohort of high-risk individuals where carotid intima-media thickness has been assessed was adopted. Human primary monocyte-derived macrophages were prepared from whole blood from individuals recruited by perilipin-2 genotype or from buffy coats from the Karolinska University hospital blood central. Results The Pro251 variant of perilipin-2 is associated with decreased intima-media thickness at baseline and over 30 months of follow-up. Using human primary monocyte-derived macrophages from carriers of the beneficial Pro251 variant, we show that this variant increases autophagy activity, cholesterol efflux and a controlled inflammatory response. Through extensive mechanistic studies, we demonstrate that increase in autophagy activity is accompanied with an increase in liver-X-receptor (LXR) activity and that LXR and autophagy reciprocally activate each other in a feed-forward loop, regulated by CYP27A1 and 27OH-cholesterol. Conclusions For the first time, we show that perilipin-2 affects susceptibility to human atherosclerosis through activation of autophagy and stimulation of cholesterol efflux. We demonstrate that perilipin-2 modulates levels of the LXR ligand 27OH-cholesterol and initiates a feed-forward loop where LXR and autophagy reciprocally activate each other; the mechanism by which perilipin-2 exerts its beneficial effects on subclinical atherosclerosis.

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