Abstract 2046: Overexpression Of Endothelial Lipase Enhances The Cellular Uptake Of Low-density Lipoproteins In Cultured Hepatocytes In The Absence Of Low-density Lipoprotein Receptor.

Background: Inhibitors of angiopoietin-like3 (ANGPTL3) reduce low-density lipoprotein (LDL) cholesterol, even in Familial Hypercholesterolemia (FH) patients with a dysfunctional LDL receptor (LDLR). Although the exact mechanism remains elusive, it may depend upon endothelial lipase (EL). Early studies showed that EL mediates the cellular uptake of high-density lipoproteins in hepatocytes; however, whether EL similarly mediates LDL uptake is unknown. Aim: Investigate the role of EL in mediating the cellular uptake of LDL in an LDLR-deficient model. Methods: Cas9-expressing HepG2 cells were transfected with a scrambled or an LDLR -targeting guide RNA to produce control and LDLR -knockout (KO) cells. Control and KO cells were transfected by lipofection with an empty plasmid or a plasmid containing the human LIPG gene (EL). Cellular uptake of fluorescent human LDL was measured by FACS. In addition, we measured the uptake of LDL in cells with and without the pre-incubation with 5 U/ml heparin or a cocktail of heparinases I, II, and II to test the contribution of heparan sulfate proteoglycans (HSPG). Results: LDLR -KO HepG2 cells showed a 20-25% residual uptake of LDL compared to controls (p<0.001) and 10-fold higher levels of EL mRNA. Remarkably, LIPG -transfected LDLR -KO hepatocytes showed a 2-fold increase in LDL uptake compared to LDLR-KO cells non-overexpressing EL (p<0.001). The pre-incubation with either heparinases or heparin completely blocked the uptake of LDL not only in LIPG -transfected LDLR -KO cells but also in those LDLR -KO cells transfected with the empty plasmid, suggesting a crucial role of HSPG in the LDL uptake. Conversely, overexpression of EL decreased LDL uptake in control cells (-11%, p=0.02), while unchanged or slightly increased LDL uptake was observed after incubating with heparinases or heparin. Conclusions: Our findings demonstrate that EL facilitates the uptake of LDL through an LDLR-independent, HSPG-dependent pathway. This pathway may be responsible for the residual uptake of LDL observed in LDLR -KO hepatocytes and may represent a potential druggable target to treat FH. Our data provides an alternative mechanism to explain the reduction of LDL cholesterol induced by ANGPTL3 inhibitors.