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most likely reflecting increased macrophage content [49]. These results suggest increased inflammation in SR-BI KO mice at least when fed a high fat, atherogenic diet.
Elimination of SR-BI expression in the context of inactivating mutations in the genes encoding either LDL receptor or apoE has more profound effects on atherosclerosis [39, 46, 59]. Elimination of SR-BI in LDL receptor-deficient mice resulted in substantially increased Western diet-induced atherosclerosis relative to LDL receptor KO controls [39]. Elimination of SR-BI in normal chow-fed apoE KO mice resulted in increased aortic sinus atherosclerosis at an age (5–7 weeks) when apoE KO mice show no signs of atherosclerotic plaque [46]. Both Western diet fed SR-BI/LDL receptor and normal chow-fed SR-BI/apoE double KO mice exhibited decreased levels of plasma apoB containing lipoproteins relative to corresponding SR-BI-expressing controls. Cholesterol associated with HDL-like particles (increased in size relative to normal HDL) was increased relative to that in SR-BI-expressing mice. Thus the increased atherosclerosis in these mice appeared to be accompanied by impaired hepatic HDL cholesterol clearance [46].
In addition to increased aortic atherosclerosis, SR-BI/apoE double KO mice also exhibited occlusive coronary artery disease, myocardial infarction, and death between 5 and 8 weeks of age [46, 60]. These mice exhibit impaired heart functional and conductance properties [47, 60] and represent a unique mouse model of coronary heart disease. The antioxidant drug, probucol, has been shown to be effective in overcoming the effects of a lack of SR-BI expression on both plasma lipoprotein structure and composition and delays the onset of coronary heart disease in SR-BI/apoE double KO mice [47]. Exactly how probucol works is still not clear. Whether probucol enhances selective HDL cholesteryl ester clearance in an SR-BI-independent manner in SR-BI- deficient mice remains to be determined [61, 62]. A low level of apoE expression is sufficient to prevent the development of coronary heart disease, at least in chow-fed mice, since elimination of SR-BI in mice homozygous for a hypomorphic apoE allele (express very low levels of apoE) did not induce atherosclerosis or coronary heart disease [63]. When these mice were switched to a high-fat diet, however, atherosclerosis and occlusive coronary artery disease were induced [63]. These lead to myocardial infarction, reduced heart function and conductance abnormalities, and death with similar kinetics to those seen in SR-BI/apoE double KO mice [63]. These studies suggest that SR-BI and apoE may be involved in parallel lipoprotein metabolic pathways that normally prevent occlusive coronary artery atherosclerosis.
Role of Hepatic SR-BI in Protection against Atherosclerosis
As discussed above, in vitro studies in cells and analyses of SR-BI KO mice suggest that SR-BI plays an important role in hepatic selective HDL cholesterol uptake and reverse cholesterol transport. Confirmation of this has come
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from studies in which hepatic SR-BI levels have been either overexpressed or suppressed in a tissue-specific manner. Hepatic overexpression of SR-BI in either transgenic mice or using adenovirus-mediated gene transfer reduced plasma HDL cholesterol levels, increased biliary cholesterol levels, and reduced atherosclerosis in susceptible strains ([64–67] and references cited therein). Decreased atherosclerosis was associated with decreased HDL cholesterol levels in LDL receptor-deficient mice overexpressing adenovirusdelivered SR-BI in a liver-specific manner, suggesting that decreased atherosclerosis resulted from increased clearance of HDL cholesterol and increased HDL-dependent reverse cholesterol transport [64, 66]. Alternatively, in another study, liver-specific transgenic SR-BI overexpression in LDL receptor +/− mice reduced atherosclerosis in a manner that was correlated with decreased plasma LDL cholesterol, suggesting that overexpression of SR-BI increased LDL cholesterol clearance [65]. In vitro studies suggest that SR-BI mediates selective uptake of LDL cholesterol by hepatocytes and in vivo studies in SR-BI KO mice indicate that SR-BI participates in LDL cholesterol clearance from plasma [54, 68, 69], supporting this possibility. In another study of different lines of SR-BI transgenic mice (driven by an apoA1 promoter), only moderate (twofold) increased levels of hepatic SR-BI overexpression reduced diet-induced atherosclerosis in apoB transgenic mice [67, 70]. In contrast, high levels (tenfold) of SR-BI overexpression did not reduce diet-induced atherosclerosis in apoB transgenic mice relative to controls even though the level of reduction of HDL cholesterol was dependent on the level of SR-BI overexpression [67]. In this case, the increased atherosclerosis in high-SR-BI-expressing relative to low-SR-BI-expressing transgenic mice may have been related to reduced levels of plasma HDL and altered HDL particle composition [67].
Mice with liver-restricted reduction in SR-BI gene expression have been generated by the insertion of a neomycin gene cassette into the promoter region of the mouse Scarb1 gene [71]. Mice with both alleles containing the insertion (called SR-BI attenuated or SR-BIatt mice) express ~50% of normal levels of SR-BI in liver and normal levels of SR-BI in other tissues examined (e.g., adrenal gland) [71]. SR-BIatt mice exhibit slightly increased levels of plasma HDL cholesterol, reduced clearance of HDL cholesterol from blood, and reduced hepatic selective uptake of HDL cholesterol [71]. These studies, together with those of SR-BI KO mice discussed above, suggest that hepatic SR-BI is solely responsible for hepatic selective HDL cholesteryl ester uptake in mice, and plays a major role in hepatic reverse cholesterol transport. LDL receptor KO mice that carry two copies of the SR-BIatt insertion (SR-BIatt/LDL receptor KO mice) have also been generated and exhibit increased levels of LDL cholesterol, supporting the idea that normal levels of hepatic SR-BI expression are required for normal clearance of LDL cholesterol [59]. SR-BIatt/LDL receptor KO mice also develop increased diet-induced atherosclerosis relative to LDL receptor KO mice with normal Scarb1 alleles, consistent with hepatic SR-BI protecting against atherosclerosis [59].
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Regulation of Hepatic SR-BI Protein Expression
A distinct mouse model of tissue-restricted SR-BI suppression has been generated. These mice contain a targeted mutation in the gene encoding an adaptor protein called PDZK1, which contains multiple postsynaptic density protein-95/Drosophila discs-large/ZO1 (PDZ) protein–protein interaction domains (reviewed in [72, 73]). PDZK1 (also called CLAMP) was identified as a protein that interacted with the C-terminal three amino acids (AKL) of SR-BI via one of its four PDZ protein–protein interaction domains. SR-BI homologs from all mammalian species identified to date contain a potential PDZ target sequence (see Fig. 4.2 and [93]) though PDZK1 interaction has been verified only for mouse SR-BI [74–77]. An intact PDZK1 interaction domain has been demonstrated to be essential for the proper trafficking of SR-BI to the cell surface in hepatocytes but not in other cells examined (such as Chinese hamster ovary cells) [72, 74, 75]. Similarly, expression of PDZK1 is required for trafficking of SR-BI to the cell surface in hepatocytes [77, 78]. In the absence of PDZK1, SR-BI in hepatocytes is degraded resulting in a substantial decrease in SR-BI expression at the protein level [77, 78]. SR-BI is also moderately reduced in the small intestine but not in steroidogenic tissues including the adrenal gland, testes, and ovary [77]. PDZK1 KO mice exhibit altered plasma HDL cholesterol levels and enlarged HDL particles of altered composition, similar to those found in SR-BI KO mice ([77], reviewed in [73]). Treatment of mice with fibrates has also been shown to result in decreased expression of both SR-BI and PDZK1 protein, although the mechanisms involved remain uncertain [78, 79]. Mice fed diets supplemented with fibrates exhibit alterations in plasma HDL cholesterol levels and HDL structure similar to those seen in SR-BI KO mice [79].
A PDZK1-interacting protein, called small PDZK1-associated protein (SPAP) [76] has been identified by virtue of coimmunoprecipitation with PDZK1 from mouse liver and kidney extracts. Transgenic mice overexpressing SPAP in a liver-specific manner exhibit drastically reduced levels of hepatic PDZK1 and SR-BI protein [76]. These mice also exhibit increased levels of plasma cholesterol associated with large HDL particles reminiscent
FIGURE 4.2. Comparison of SR-BI C-terminal sequences from different species. Shown are the sequences of the last ten amino acids of SR-BI from different species. The PDZ recognition sequence identified in mouse SR-BI is indicated with a box. CHO is Chinese hamster ovary. Amino acid sequences are based on cDNA sequences [24, 87–92].
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of those seen in SR-BI KO mice [76]. Overexpression of SPAP in cultured hepatocytes increases PDZK1 protein-degradation via an as yet uncharacterized proteasome-independent pathway [76]. It is not yet clear if SPAP at physiological levels of expression are involved in the regulation of PDZK1 and SR-BI.
Hepatocytes are polarized cells, with distinct basolateral and apical membranes. PDZK1 appears to be required for regulation of SR-BI cell surface expression only in polarized hepatocytes [75]. When hepatocytes are cultured under conditions in which they are not polarized, SR-BI expression is no longer dependent on the presence of PDZK1 [75]. SR-BI is expressed basolaterally and continuously internalized and recycled in polarized hepatocytes and other polarized cells, such as Madin–Darby canine kidney (MDCK) cells [75, 80]. It is not known whether SR-BI stability and trafficking to the cell surface are dependent on PDZK1 in other polarized cells. SR-BI’s polarized distribution in MDCK cells is disrupted by overexpression, depletion of cellular cholesterol, or activation of protein kinase A (PKA) [80]. It is not known if the distribution of SR-BI in polarized hepatocytes is also subjected to similar regulation, or if PDZK1 is involved in these processes.
Role of SR-BI in Cells in the Vascular Wall
SR-BI is expressed in both macrophages and vascular endothelial cells [29–32], and therefore can have local effects on the development of atherosclerosis. As discussed above, SR-BI in endothelial cells can mediate the HDL-stimulated activation of eNOS. This appears to be important physiologically since HDL is able to stimulate the relaxation of arteries from SR- BI-expressing mice, whereas HDL-stimulated relaxation was impaired if arteries were from SR-BI KO mice [14]. Normal levels of eNOS activity have been proposed to protect against the development of atherosclerosis [81–85]. Alterations in eNOS expression clearly affect atherogenesis in mouse models, however, contrary to expectation, inactivation of eNOS reduced atherosclerosis and overexpression of eNOS increased atherosclerosis in apoE KO mice [81, 84, 85]. This may have been due to an imbalance between eNOS activity and the amount of tetrahydrobiopterin, an eNOS cofactor required for its proper function (NO production) and without which, eNOS is dysfunctional leading to the production of superoxide radical [81]. In fact increased endothelial tetrahydrobiopterin production in transgenic mice overexpressing GTP-cyclohydrolase I, an enzyme required for its synthesis, results in reduced atherosclerosis in apoE KO mice [82]. This suggests that increased functional eNOS may protect against atherosclerosis. Therefore, a lack of SR-BI-dependent HDL stimulation of eNOS in SR-BI KO mice could contribute to the development of atherosclerosis through reduced functional eNOS. Confirmation of this awaits the generation of mice with endothelial cell-specific alterations in SR-BI expression.
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In atherosclerotic plaques, SR-BI appears most abundant in macrophages [31, 32]. As indicated above, SR-BI overexpression in transfected cells has been shown to confer increased cholesterol efflux to HDL and other cholesterol acceptors [33, 34, 37]. In contrast, cholesterol efflux to HDL and other acceptors does not appear to be substantially affected in macrophages from SR-BI KO mice compared to those from SR-BI-expressing controls [39–41]. This suggests that SR-BI may not be required for cholesterol efflux from macrophages in atherosclerotic plaque. To test whether SR-BI in macrophages and other leukocytes affect the development of atherosclerosis, bone marrow transplantation has been used to generate chimeric mice with impaired SR-BI expression in bone marrow-derived cells (including monocyte-derived macrophages and other leukocytes) but normal SR-BI expression in nonhematopoietic cells [39–41]. These mice developed increased atherosclerosis relative to controls receiving bone marrow from SR-BI-expressing mice [39–41]. These studies demonstrated that leukocyte SR-BI is normally required for protection against atherosclerosis at least in advanced stages. Curiously, the sizes of small lesions at early stages of atherosclerosis appeared to be decreased in mice with leukocyte-specific SR-BI gene inactivation, suggesting that leukocyte SR-BI might promote early steps in plaque formation but prevent later steps [41].
Conclusion
SR-BI plays an important role in HDL metabolism, HDL cholesterol transport, and noncholesterol transport properties of HDL. Its activity in both liver and cells in the vascular wall affects the development and progression of atherosclerosis in mouse models. Several studies have identified sequence variations and single nucleotide polymorphisms in the human gene encoding SR-BI. Associations of these sequence variants with a variety of parameters including HDL and LDL cholesterol, postprandial triglyceride, body mass index, and incidence of coronary artery disease (reviewed in [86]) suggests that variations in SR-BI function/levels may contribute to variations in lipoprotein metabolism and heart disease in the general population. Research in mouse models of atherosclerosis will continue to provide insights into the role of SR-BI in this disease process and will complement our understanding of its involvement in human disease.
Acknowledgements: Research in the Trigatti lab is supported by grants from the Canadian Institutes of Health Research, The Heart and Stroke Foundation of Ontario, and the Natural Sciences and Engineering Research Council of Canada. B.T. is a Heart and Stroke Foundation of Canada New Investigator.
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