L’hypertriglycéridémie (hyperTG) est une dyslipidémie fréquente, caractérisée par une augmentation de la concentration plasmatique en triglycérides (TG). L’hyperTG est considérée comme un facteur de risque indépendant de la maladie cardiovasculaire, particulièrement de la maladie coronarienne athérosclérotique. Plusieurs facteurs environnementaux et génétiques ont été associés avec l’hyperTG. Cependant, près de 90% des cas d’hyperTG primaire sont encore incomplètement caractérisés au niveau moléculaire. Dernièrement, la protéine GPIHBP1 (glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1), qui a un rôle clef dans le métabolisme des TG, a été associée à l’expression d’hyperTG sévère et rare chez l’humain. Ce mémoire présente les résultats de nos travaux qui ont été effectués afin d’identifier de nouvelles bases moléculaires associées à l’expression de l’hyperTG dans le locus du gène GPIHBP1. Nous avons observé que le polymorphisme GPIHBP1 g.-469G>A (rs72691625), dont la fréquence de l’allèle mineure a été évaluée à 19,6% dans notre échantillon, serait associé à l’expression d’hyperTG (TG ≥ 2mmol/L) dans une population canadienne-française. Ce polymorphisme est associé à un risque 1,67 fois plus grand d’exprimer une triglycéridémie ≥ 2mmol/L chez les porteurs hétérozygotes et 5,7 fois plus grand chez les porteurs homozygotes, comparativement aux non-porteurs. Ce risque d’hyperTG serait exacerbé par la présence concomitante d’une mutation hypertriglycéridémiante dans le gène codant pour la lipoprotéine lipase. La présence de ce polymorphisme serait particulièrement associée à l’expression de la dysbêtalipoprotéinémie familiale et de l’hypertriglycéridémie familiale endogène. GPIHBP1 g.-469G>A est le premier polymorphisme fréquent identifié dans le promoteur du gène à être associé avec l’expression d’hyperTG. GPIHBP1 émerge de plus en plus comme un gène candidat intéressant pour la recherche de nouvelles bases moléculaires pouvant expliquer certaines formes d’hyperTG primaire fréquente. / Hypertriglyceridemia (hyperTG) is a frequent dyslipidemia referring to an increased fasting plasma triglyceride (TG) level ≥ 2 mmol/L. HyperTG is an independent risk factor for cardiovascular disease, such as coronary artery diseases. Several environmental and genetic factors have been associated with hyperTG. Although several gene factors were associated with hyperTG, nearly 90% of cases of primary hyperTG are still incompletely characterized at the molecular level. Recently, few cases of rare and severe hyperTG have been associated with some rare polymorphisms in the gene coding for GPIHBP1 (glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1). This manuscript resumes our research regarding the identification of new molecular bases associated with the expression of frequent hyperTG subtypes in the gene locus GPIHBP1. Our results show that the GPIHBP1 g.-469G>A polymorphism (rs72691625), whose the minor allele frequency was estimated to 19.6% in our sample, was associated with the expression of hyperTG (TG ≥ 2 mmol/L) in a French-Canadian population. Subjects heterozygous and homozygous for this polymorphism respectively had a 1.67-fold and 5.70-fold increased risk to exhibit plasma TG levels ≥ 2mmol/L as compared to non-carriers. This increased risk of hyperTG observed in g.-469A carriers seems to be exacerbated by the concomitant presence of a frequent loss-of-function lipoprotein lipase gene variant. This polymorphism seems also particularly associated with dysbetalipoproteinemia and familial hypertriglyceridemia. The g.-469G>A polymorphism is the first common polymorphism in the GPIHBP1 gene promoter to be associated with the expression of hyperTG. GPIHBP1 emerges as a significant candidate for the molecular based of primary hyperTG.

Dyslipidemia can be a comorbidity of both insulin-resistance and atherosclerosis. Hypertriglyceridemia is common in hyperglycemia and is associated with hypoalphalipoproteinemia (low HDL) and with altered nucleotide or purinergic signaling. We therefore hypothesized that extracellular nucleotides may affect hepatic lipoprotein metabolism. Our studies confirm this view and show that nucleotides regulate cellular proteolytic pathways in liver cells and thereby control lipoprotein secretion and their metabolism by hepatic lipase (HL). Treatment of liver cells with the nucleotide, adenosine diphosphate (ADP), stimulates VLDL-apoB100 and apoE secretion, but blocks HDL-apoA-I and HL secretion. ADP functions like a proteasomal inhibitor to block proteasomal degradation and stimulate apoB100 secretion. Blocking the proteosome is known to activate autophagic pathways. The nucleotide consequently stimulates autophagic degradation in liver cells and increases cellular levels of the autophagic proteins, LC3 and p62. Confocal studies show that ADP increases cellular LC3 levels and promotes co-localization of LC3 and apoA-I in an autophagosomal degradation compartment. ADP acts through the G-protein coupled receptor, P2Y13, to stimulate autophagy and block both HDL and HL secretion. Overexpression of P2Y13 increases cellular LC3 levels and blocks the induction of both HDL and HL secretion, while P2Y13 siRNA reduce LC3 protein levels and cause up to a ten-fold stimulation in HDL and HL secretion. P2Y13 gene expression regulates autophagy through the insulin receptor (IR-β). A reduction in P2Y13 expression increases the phosphorylation of IR-β and protein kinase B (Akt) >3-fold, while increasing P2Y13 expression inhibits the activation of IR-β and Akt. Experiments with epitope-labeled apoA-I and HL show that activation of purinergic pathways has no effect on the internalization and degradation of extracellular apoA-I and HL, which confirms the view that nucleotides primarily impact intracellular protein transport and degradation. In conclusion, elevated blood glucose levels may promote dyslipidemia by stimulating purinergic signaling through P2Y13 and IR-β and perturbing the intracellular degradation and secretion of both HDL and VLDL.

[Truncated abstract] The low density lipoprotein receptor-related protein (LRP), a member of the low-density lipoprotein (LDL) receptor gene family is involved in numerous biological processes including lipoprotein metabolism. This thesis concerns investigations into some aspects of LRP metabolism/regulation and possible roles in coronary artery disease (CAD). Specific aims were: to investigate the association between polymorphisms in the LRP gene and in its associated protein, the lipoprotein receptor-associated protein (RAP), with the risk of CAD; to extensively examine the influence of the LRP exon 22 C200T polymorphism on lipid metabolism; to develop and characterise assays for the mRNA expression of LRP and 2 other genes relevant to lipid metabolism, the LDL receptor (LDLR), and HMG CoA reductase (HMGCR); and finally, to apply the latter techniques to studies on the influence of genetic variation in LRP, and dietary and drug interventions, on LRP, LDLR and HMGCR mRNA expression in nucleated blood cells from healthy human subjects. Six hundred CAD subjects and 700 similarly aged controls were genotyped for 8 LRP gene polymorphisms as well as for the RAP V311M polymorphism. ... In the final phase of my studies, I examined the influence of 4 weeks therapy with a cholesterol lowering drug, an HMGCR inhibitor, atorvastatin (20mg daily), on the mRNA expression of LDLR, LRP and HMGCR in human nucleated blood cells. Twelve normal Caucasian male subjects aged 49 ? 5 (SD) years were studied. Plasma total cholesterol and LDL-C decreased by averages of 29 % and 41 % after the 4 week period. This was accompanied by an elevation in LDLR mRNA expression by approximately 30 35 %. In contrast, there was no significant effect on LRP and HMGCR mRNA expression. In conclusion, the original findings in this thesis included: demonstration of a strong influence of the LRP exon 22 C200T polymorphism on coronary artery disease and LDLR expression, but without a clear effect on fasting or postprandial lipid levels; data on the biological variation in LDLR and LRP gene expression in nucleated blood cells from normal subjects; the influence of an oral fat load on the expression viii of these genes, finding that LDLR was significantly depressed; and finally, the observation that statin therapy upregulated LDLR in nucleated blood cells.

Dyslipidemia can be a comorbidity of both insulin-resistance and atherosclerosis. Hypertriglyceridemia is common in hyperglycemia and is associated with hypoalphalipoproteinemia (low HDL) and with altered nucleotide or purinergic signaling. We therefore hypothesized that extracellular nucleotides may affect hepatic lipoprotein metabolism. Our studies confirm this view and show that nucleotides regulate cellular proteolytic pathways in liver cells and thereby control lipoprotein secretion and their metabolism by hepatic lipase (HL). Treatment of liver cells with the nucleotide, adenosine diphosphate (ADP), stimulates VLDL-apoB100 and apoE secretion, but blocks HDL-apoA-I and HL secretion. ADP functions like a proteasomal inhibitor to block proteasomal degradation and stimulate apoB100 secretion. Blocking the proteosome is known to activate autophagic pathways. The nucleotide consequently stimulates autophagic degradation in liver cells and increases cellular levels of the autophagic proteins, LC3 and p62. Confocal studies show that ADP increases cellular LC3 levels and promotes co-localization of LC3 and apoA-I in an autophagosomal degradation compartment. ADP acts through the G-protein coupled receptor, P2Y13, to stimulate autophagy and block both HDL and HL secretion. Overexpression of P2Y13 increases cellular LC3 levels and blocks the induction of both HDL and HL secretion, while P2Y13 siRNA reduce LC3 protein levels and cause up to a ten-fold stimulation in HDL and HL secretion. P2Y13 gene expression regulates autophagy through the insulin receptor (IR-β). A reduction in P2Y13 expression increases the phosphorylation of IR-β and protein kinase B (Akt) >3-fold, while increasing P2Y13 expression inhibits the activation of IR-β and Akt. Experiments with epitope-labeled apoA-I and HL show that activation of purinergic pathways has no effect on the internalization and degradation of extracellular apoA-I and HL, which confirms the view that nucleotides primarily impact intracellular protein transport and degradation. In conclusion, elevated blood glucose levels may promote dyslipidemia by stimulating purinergic signaling through P2Y13 and IR-β and perturbing the intracellular degradation and secretion of both HDL and VLDL.

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