PPARα is a nuclear receptor that regulates liver and skeletal muscle lipid metabolism as well as glucose homeostasis. Acting as a molecular sensor of endogenous fatty acids (FAs) and their derivatives, this ligand-activated transcription factor regulates the expression of genes encoding enzymes and transport proteins controlling lipid homeostasis, thereby stimulating FA oxidation and improving lipoprotein metabolism. PPARα also exerts pleiotropic antiinflammatory and antiproliferative effects and prevents the proatherogenic effects of cholesterol accumulation in macrophages by stimulating cholesterol efflux. Cellular and animal models of PPARα help explain the clinical actions of fibrates, synthetic PPARα agonists used to treat dyslipidemia and reduce cardiovascular disease and its complications in patients with the metabolic syndrome. Although these preclinical studies cannot predict all of the effects of PPARα in humans, recent findings have revealed potential adverse effects of PPARα action, underlining the need for further study. This Review will focus on the mechanisms of action of PPARα in metabolic diseases and their associated vascular pathologies.
IntroductionNutrient metabolism and energy homeostasis are tightly regulated by endocrine, paracrine, and autocrine signals that control the expression and activity of key metabolic enzymes and transport proteins by transcriptional and posttranscriptional mechanisms. Lipid mediators play a critical role in metabolic control, and the PPARs (NR1Cs), a class of ligand-activated transcription factors, have emerged as master transcriptional regulators of lipid and carbohydrate metabolism. Saturated and unsaturated long-chain fatty acids (FAs) and their eicosanoid derivatives are natural activators of this subclass of nuclear receptors. Increased recognition of a role for PPARs in metabolic regulation came following the discovery that the hypolipidemic fibrates and the insulin sensitizers thiazolidinediones were synthetic ligands for PPARα (NR1C1; refs. 1, 2) and PPARγ (NR1C3; ref. 3), respectively. PPARδ (NR1C3), also known as PPARβ, is the third PPAR isotype.Accumulating evidence supports a link between the 3 PPARs and diabetes, obesity, dyslipidemia, and inflammation. PPARα controls liver and skeletal muscle lipid metabolism, and glucose homeostasis. PPARα influences intracellular lipid and carbohydrate metabolism through direct transcriptional control of genes involved in peroxisomal and mitochondrial β-oxidation pathways, FA uptake, and triglyceride (TG) catabolism. Moreover, preclinical data suggest a role for PPARα in body weight control, supporting the use of PPARα agonists to treat obesity (4). Mice deficient in PPARα exhibit a delayed response to inflammatory stimuli (5). Several clinical trials demonstrate the efficiency of fibrates at decreasing circulatory inflammatory markers and reducing the progression of coronary atherosclerotic lesions. The ability of PPARα to improve