Régulation de la lipoprotéine lipase macrophagique et de LOX-1 par des facteurs métaboliques. Implications dans l’athérosclérose associée au diabète de type 2

Atherosclerotic cardiovascular disease is the leading cause of death in western countries and is the major complication of diabetes.  Lipoprotein lipase (LPL) is a key enzyme in lipid metabolism, responsible for the hydrolysis of triglyceride (TG) rich lipoproteins.  Many studies have shown that LPL secreted by macrophages in the arterial wall is proatherogenic. Endothelial dysfunction is a characteristic feature of early-stage atherosclerosis.  The observation that lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), a newly identified receptor for oxidized LDL (oxLDL), is highly expressed in human atherosclerotic lesions and upregulated in the aorta of diabetic rats, suggests a key role for LOX-1 in the pathogenesis of diabetic atherosclerosis. Based on the role of macrophage LPL and LOX-1 in atherosclerosis, we sought to investigate the regulation of these two proatherogenic molecules by metabolic and inflammatory factors dysregulated in diabetes namely leptin, linoleic acid (LA) and C-reactive protein (CRP).  Our results demonstrated that: 1) In human aortic endothelial cells (HAECs), LA increased LOX-1 protein expression in a time- and dose-dependent manner; 2) Pretreatment of HAECs with antioxidants and inhibitors of NADPH oxidase, protein kinase C (PKC), and nuclear factor-kB (NF-kB) inhibited the stimulatory effect of LA on LOX-1 protein expression; 3) Increased expression of classic PKC isoforms was observed in LA-treated HAECs; 4) LA led to a significant increase in LOX-1 gene expression and enhanced the binding of nuclear proteins extracted from HAECs to the NF-kB regulatory element of the LOX-1 gene promoter; 5) LA enhanced, through LOX-1, oxLDL uptake by endothelial cells.  Overall, these results demonstrated that LA enhances endothelial LOX-1 expression in vitro and support a key role for LA in endothelial dysfunction associated with diabetes. Based on our previous studies showing that macrophage LPL expression is increased in patients with type 2 diabetes and that metabolic factors dysregulated in this disease such as glucose, homocysteine (Hcys), fatty acids and advanced glycation end products (AGE), increased macrophage LPL expression, we next determined the effect of two other metabolic and inflammatory factors dysregulated in diabetes, namely leptin and CRP, on macrophage LPL expression in vitro.   Leptin levels are elevated in diabetic patients and are associated with greater cardiovascular risks.  We found that: 1) In human macrophages, leptin increased LPL expression, at both the gene and protein levels; 2) The stimulatory effect of leptin on LPL was abolished by pre-treatment with anti-leptin receptor (Ob-R) antibody, PKC inhibitors and antioxidants; 3) Leptin increased the membrane expression of conventional PKC isoforms and downregulation of endogenous PKC expression abolished the effects of leptin on macrophage LPL expression; 4) In murine macrophages, leptin raised LPL synthetic rate and enhanced the binding of nuclear proteins to the activated protein-1 (AP-1) sequence of the LPL gene promoter.  These observations support the possibility that leptin may represent a macrophage LPL stimulatory factor in diabetes. Finally, we sought to determine the effect of CRP on macrophage LPL expression in vitro.  CRP is an inflammatory molecule and a strong predictor of cardiovascular events and high serum levels of CRP are observed in type 2 diabetic patients.  We found that: 1) In human macrophages, CRP increased LPL expression at the gene and protein levels and CRP binding to CD32 receptors is required for these effects; 2) Preincubation of human macrophages with antioxidants, PKC and mitogen-activated protein kinase (MAPK) inhibitors, prevented the CRP-induced LPL expression; 3) CRP increased LPL activity, intracellular reactive oxygen species (ROS) generation, classic PKC isozymes expression and extracellular signal-regulated protein kinase (ERK) 1/2 phosphorylation; 4) CRP-treated murine macrophages demonstrated increased binding of nuclear proteins to the AP-1 sequence of the LPL gene promoter.  These data suggest that LPL might represent a novel factor underlying the adverse effect of CRP on the diabetic vasculature. Overall, our studies indicate a key role of metabolic and inflammatory factors in the regulation of vascular LPL and LOX-1 in diabetes.  Our data suggest that LPL and LOX-1 are key contributors to the accelerated atherogenesis associated with human diabetes.  Keywords : atherosclerosis, cardiovascular diseases, type 2 diabetes, macrophage, LPL, endothelial cells, LOX-1, oxidative stress, leptin, LA, CRP.

Keyphrases: Macrophage, LPL, LOX-1, Atherosclerosis, Cardiovascular diseases, Type 2 diabetes, Endothelial cells, Oxidative stress, Leptin, LA, CRP