Cholesterol and fatty acid homeostasis is maintained by a complex network of regulatory mechanisms that control the biosynthesis and deposition of lipids over diverse physiological conditions. However, these processes can become dysregulated and uncoupled from energy metabolism by metabolic stress such as a hyper-caloric diet and physical inactivity; eventually manifesting as risk factors associated with atherosclerotic cardiovascular disease (ASCVD), Type 2 diabetes (T2D), and/or non-alcoholic fatty liver disease (NAFLD). AMP-activated protein kinase (AMPK) is a sensor of cellular energy status that promotes metabolic homeostasis by mediating effects on multiple cellular processes including cholesterol and fatty acid synthesis biosynthesis. However, the mechanisms linking AMPK to lipid metabolism under normal and pathological conditions, remain undefined. In these studies, we identify a novel nutrient sensing mechanism whereby the coenzyme A (CoA) activated esters of long-chain fatty acids (LCFA-CoA) directly activate AMPK via specific interactions within the β1-regulatory subunit involving a Ser108 residue previously shown only with synthetic activators. We demonstrate the physiological relevance for this mechanism in an acute setting by showing that fatty acid oxidation was attenuated in mice harboring an AMPKβ1-S108A knock-in mutation compared to WT mice. We then demonstrated that β1-selctive AMPK activation is mimicked by the CoA conjugated form of bempedoic acid, a synthetic small molecule lipid synthesis inhibitor in clinical development for lowering elevated levels of low-density lipoprotein cholesterol (LDL-C). The importance of this mechanism was determined by assessing multiple disease outcomes in Ampkβ1-/-/Apoe-/- double knockout (DKO) mice fed a high fat-high cholesterol (HFHC) diet ± bempedoic acid. In these studies, bempedoic acid treatment reduced plasma LDL-C and atherosclerosis in both Apoe-/- and DKO mice, while no differences in disease outcomes was detected between the two genotypes in response to HFHC feeding. Further mechanistic investigations in rodent and primary human hepatocytes, revealed that the CoA conjugate of bempedoic acid suppressed lipid synthesis via competitive inhibition of ATP-citrate lyase (ACL), which promoted LDL receptor upregulation and associated reductions in LDL-C. We then integrate these findings with published literature in a written synthesis aimed to evaluate the role of ACL in metabolism, and its potential utility as a therapeutic target to treat ASCVD and metabolic disorders in humans. Although several questions remain regarding the metabolic role of AMPK activation by LCFA-CoAs, these studies have expanded our understanding of how cells acutely integrate lipid and energy signals to maintain lipid homeostasis, and identified ACL as a promising strategy to treat hypercholesterolemia, ASCVD, and associated metabolic disorders. / Thesis / Doctor of Philosophy (PhD) / The dysregulation of cholesterol and triglyceride metabolism can manifest as risk factors for life-threating diseases such as atherosclerotic cardiovascular diseases (ASCVD), Type-2 diabetes (T2D), and nonalcoholic fatty liver disease (NAFLD). However, the underlying mechanisms controlling lipid homeoastasis in health and disease are not completely understood. ATP-citrate lyase (ACL) and AMP-activated protein kinase (AMPK) are emerging as key nodes in metabolism that integrate lipid metabolism with signals of nutrient availability and cellular energy status, respectively. These strategic positions in metabolism suggest that both these enzymes could play an important role in the underlying pathophysiology of lipid-related diseases, and are therefore, prime candidates for therapeutic intervention. In these studies, we expand our understanding of the role of AMPK in metabolism beyond energy sensing by identifying specific lipid metabolites as direct allosteric activators of kinase activity. We also evaluate the therapeutic utility of targeting both AMPK and ACL in novel models of hypercholesterolemia and metabolic disease, and demonstrate that ACL inhibition offers a promising strategy to address multiple unmet medical needs.

Background: Exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) have been associated with higher circulating concentrations of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C). ApoB is the primary apolipoprotein component of LDL-C, and acts as a ligand for LDL-C receptors in various cells throughout the body. Circulating concentrations of ApoB are considered to be a better indicator of heart disease risk than TC or LDL-C. Objectives: Explore associations of concentrations of PFOA and PFOS with serum ApoB in adults. Methods: We analyzed data from 2744, 20-80 years old participants in the 2005–2006 National Health and Nutrition Examination Survey (NHANES). Linear regression models were used to estimate adjusted predicted means of serum ApoB (in g/L) for quartiles of PFOA and PFOS (in ng/mL) to describe patterns of associations. Results: Adjusted predicted mean concentrations of serum ApoB did not appear to vary meaningfully with increasing concentrations of PFOA (Q1 1.11, Q2 1.02, Q3 1.01, Q4 1.02) or increasing concentrations of PFOS (Q1 1.06, Q2 1.05, Q3 1.07, Q4 0.99) in study participants. Conclusions: Exposure to PFOA or PFOS does not appear to alter Apo B concentrations in adults.

Global obesity is linked to chronic diseases including hypercholesterolemia, a cardiovascular disease risk factor, thus weight reduction in obesity is a key priority for combatting obesity. The cholesterol transporters ABCG5, ABCG8 and NPC1L1 mediate cholesterol trafficking across the intestinal wall, thus are important in regulating cholesterol metabolism and circulating levels. The objective of this study was to examine if single nucleotide polymorphisms (SNP) of cholesterol transporters ABCG5, ABCG8 and NPC1L1 are associated with changes in cholesterol synthesis and absorption and lipid parameters (LP) subsequent to weight loss (WtL) in overweight individuals. Eighty-nine individuals from two WtL trials (Trial A (n = 54) and Trial B (n = 35)) completed a 20-wk WtL period. After 10% WtL, lipid parameters excluding LDL-C were improved in Trial A, while all lipid parameters were ameliorated after 12% of WtL when Trial A and B were combined. Post-WtL, cholesterol synthesis (CS) was reduced; however, cholesterol absorption was not changed in either Trial A or the combined trials. Polymorphisms in ABCG8 V632A were associated with changes in TC and TG levels after WtL in both trial A and the combined data. SNPs in ABCG5 Q604E, ABCG8 T400K, were associated with changes in CS because of WtL in Trial A; however, the association is no longer seen in combined analysis. In conclusion, cardio-protective changes in LP due to weight loss were mediated by reductions in CS. Additionally, polymorphisms in ABCG8 were associated with amelioration in LP after WtL. Thus, the benefits in CVD risk subsequent to weight loss vary across individuals due to genetic factors associated with cholesterol trafficking.

Global obesity is linked to chronic diseases including hypercholesterolemia, a cardiovascular disease risk factor, thus weight reduction in obesity is a key priority for combatting obesity. The cholesterol transporters ABCG5, ABCG8 and NPC1L1 mediate cholesterol trafficking across the intestinal wall, thus are important in regulating cholesterol metabolism and circulating levels. The objective of this study was to examine if single nucleotide polymorphisms (SNP) of cholesterol transporters ABCG5, ABCG8 and NPC1L1 are associated with changes in cholesterol synthesis and absorption and lipid parameters (LP) subsequent to weight loss (WtL) in overweight individuals. Eighty-nine individuals from two WtL trials (Trial A (n = 54) and Trial B (n = 35)) completed a 20-wk WtL period. After 10% WtL, lipid parameters excluding LDL-C were improved in Trial A, while all lipid parameters were ameliorated after 12% of WtL when Trial A and B were combined. Post-WtL, cholesterol synthesis (CS) was reduced; however, cholesterol absorption was not changed in either Trial A or the combined trials. Polymorphisms in ABCG8 V632A were associated with changes in TC and TG levels after WtL in both trial A and the combined data. SNPs in ABCG5 Q604E, ABCG8 T400K, were associated with changes in CS because of WtL in Trial A; however, the association is no longer seen in combined analysis. In conclusion, cardio-protective changes in LP due to weight loss were mediated by reductions in CS. Additionally, polymorphisms in ABCG8 were associated with amelioration in LP after WtL. Thus, the benefits in CVD risk subsequent to weight loss vary across individuals due to genetic factors associated with cholesterol trafficking.

Golgi apparatus protein 1 (GLG1) est une protéine transmembranaire de 160 kDa qui interagit avec l’apolipoprotéine B100 (apoB100), le récepteur des lipoprotéines de basse densité (LDLR) et la proprotein convertase subtilisin/kexin type 9 (PCSK9). Cependant, son mécanisme d’action et sa régulation post-traductionnelle sont inconnus. Des études ont montré que GLG1 subit deux clivages résultant en fragments solubles secrétés de 150 kDa et 55 kDa. Dans cette étude, notre premier objectif est d’identifier les enzymes responsables de la protéolyse de GLG1 ainsi que l’effet du clivage sur sa fonction dans le métabolisme des lipides. De plus, les résultats de nos collaborateurs montrent que les souris adultes déficientes en GLG1 ont un plus grand nombre d’adipocytes mais de taille plus petite que les souris de type sauvage. Notre deuxième objectif est de mesurer la variation de l’expression ainsi qu’identifier l’effet de GLG1 lors de la différentiation des fibroblastes en adipocytes. Pour le premier objectif, les cellules HEK293T surexprimant GLG1 ont été soit transfectées avec des convertases de proprotéines (PCSK) soit incubées avec différents inhibiteurs d’enzymes. Les milieux et les lysats cellulaires ont été analysés par immunobuvardage à la Western. Il n’y a pas eu de nouveaux fragments générés en présence des PCSK. Cependant, en présence d’inhibiteurs des sérines protéases apparentées à la trypsine soit AEBSF et Gabexate mesylate, il y a eu une réduction de la formation du fragment de 55 kDa. Pour identifier la métalloprotéase responsable du clivage de l’ectodomaine générant le fragment de 150 kDa, GLG1 a été transfectée avec les Tissue Inhibitor of Metalloproteinase (TIMP 1-4). Nos résultats ont montré que TIMP3 empêche la relâche de l’ectodomaine de GLG1 dans le milieu de culture. Finalement, nos analyses de plasma de souris par immunobuvardage à la Western ont montré la présence des fragments de 150 kDa et 55 kDa de GLG1 in vivo. Pour le deuxième objectif de l’étude, les fibroblastes préadipocytaires de souris 3T3-L1 ont été différenciés en adipocytes. Des lysats cellulaires et l’isolation d’ARN ont été effectués aux jours 0, 2, 4, 6, 8 et 10 de la différenciation. Des immunobuvardages à la Western ainsi que des RT-qPCR ont été réalisés pour analyser l’expression de GLG1 au cours de la différenciation. Nos résultats ont montré que l’expression de GLG1 augmente durant la différenciation. Bref, nos résultats démontrent que des enzymes trypsin-like clivent GLG1 et génèrent le fragment de 55 kDa. L’inhibition du clivage de l’ectodomaine de GLG1 par TIMP3 suggère que les ADAMs sont impliquées dans la relâche du fragment de 150 kDa. De plus, nous avons montré que l’expression de GLG1 augmente au cours de la différenciation adipocytaire. / Golgi apparatus protein 1 (GLG1) is a 160 kDa transmembrane protein interacting with apolipoprotein B100 (apoB100), low-density lipoprotein receptor (LDLR) and proprotein convertase subtilisin/kexin type 9 (PCSK9). However, the protein’s posttranslational regulation and mechanism of action are poorly understood. Previous studies showed that GLG1 is cleaved resulting in two fragments of 150 kDa and 55 kDa secreted at the cell surface and in the extracellular matrix. The first objective of this study is to identify enzymes responsible for GLG1 proteolysis and the effect of cleavage on its function in lipid metabolism. Furthermore, our collaborators showed that mice with GLG1 knockout have a higher number of adipocytes, but those cells are smaller in size compared to those in wild type mice. Therefore, the second objective of the study is to measure the variation of GLG1 expression during adipocytes differentiation and to identify the effects of GLG1 knockout on adipocytes differentiation. For the first objective, HEK293T cells overexpressing GLG1 were either transfected with basic amino acid-specific proprotein convertases (PCSK) or treated with enzyme inhibitors. Media and cell lysates were analyzed by Western blot. No new fragments were detected in media of PCSK-transfected cells. Cell treatment with trypsin-like serine proteases inhibitors, AEBSF and Gabexate mesylate, reduced the secretion of the 55 kDa fragment. To identify the metalloproteinase responsible for GLG1 shedding, GLG1 was co-transfected with Tissue Inhibitors of Metalloproteinase (TIMP1-4). Our results showed that TIMP3 inhibits shedding of the 150 kDa fragment. Finally, wild-type mouse plasma was analyzed by Western blot and showed the presence of both fragments in vivo. For the second objective of the study, fibroblasts 3T3-L1 cells were differentiated into adipocytes and GLG1 mRNA and protein expression were measured at day 0, 2, 4, 6, 8 and 10 by qPCR and Western Blot. Our results showed that GLG1 expression increased during differentiation and a peak was observed at day 4. To conclude, in the first objective of our study, our results showed that trypsin-like enzymes cleave GLG1 and produce a 55 kDa fragment. Shedding of GLG1 is inhibited by TIMP3, which suggests that ADAM10 or ADAM17 are involved in the release of the 150 kDa fragment. In addition, both 55 kDa and 150 kDa fragments were found in normal mouse plasma supporting the relevance of our findings in vivo. In the second objective of our study, GLG1 expression increased during adipocyte differentiation suggesting a role in adipose tissue development and/or morphology. In conclusion, our study will help elucidate how proteolysis of GLG1 impacts its role in the regulation of apoB and PCSK9 secretion and lipid metabolism and how can GLG1 expression affect adipocytes differentiation.

Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) is the ninth member of the Ca+2-dependent mammalian proprotein convertase super family of serine endoproteases that is structurally related to the bacterial subtilisin and yeast kexin enzymes. It plays a critical role in the regulation of lipid metabolism and cholesterol homeostasis by binding to and degrading low-density lipoprotein-receptor (LDL-R) which is responsible for the clearance of circulatory LDL-cholesterol from the blood. Owing to this functional property, there is plenty of research interest in the development of functional inhibitors of PCSK9 which may find important biochemical applications as therapeutic agents for lowering plasma LDL-cholesterol. The catalytic domain of PCSK9 binds to the EGF-A domain of LDL-R on the cell surface to form a stable complex and re-routes the receptor from its normal endosomal recycling pathway to the lysosomal compartments leading to its degradation. Owing to these findings, we propose that selected peptides from PCSK9 catalytic domain, particularly its disulphide (S-S) bridged loop1 323-358 and loop2 365-385, are likely to exhibit strong affinity towards the EGF-A domain of LDL-R. Several regular peptides along with corresponding all- dextro and retro-inverse peptides as well as the gain-of-function mutant variants were designed and tested for their regulatory effects towards LDL-R expression and PCSK9-binding in human hepatic HepG2 and mouse hepatic Hepa1c1c7 cells. Our data indicated that disulfide bridged loop1-hPCSK9323-358 and its H357 mutant as well as two short loop2-hPCSK9372-380 and its Y374 mutant peptides modestly promote the LDL-R protein levels. Our study concludes that specific peptides from the PCSK9 catalytic domain can regulate LDL-R and may be useful for development of novel class of therapeutic agents for cholesterol regulation.