The primary receptor mediating clearance of apolipoprotein (apo)E-and apoB100-containing lipoproteins from the circulation is the low density lipoprotein (LDL) receptor. Reduced expression of the LDLR is believed to be a precipitating factor in the pathogenesis of type III hyperlipoproteinemia (HLP) in some humans homozygous for the apoE2 allele (APOE*2). To test the effect of genetic changes in LDL receptor expression on the pathogenesis of type III HLP, we have generated a variant allele at the endogenous mouse Ldlr locus that expresses the human LDL receptor transcript. Transcription of the human LDLR minigene is regulated by the endogenous mouse promoter sequence, but a truncation of 3-untranslated region results in increased mRNA stability. Consequently, in liver of heterozygotes, steady state levels of mouse and human LDLR transcripts are 50 and 180% the levels of total transcript in wild type mice, respectively. Overall, the 2.3-fold normal level of LDLR message in heterozygotes completely ameliorates type III HLP caused by the homozygosity for the human APOE*2 allele, normalizing their plasma lipoprotein profile. We conclude that a modest increase in expression of the LDLR through message stabilization is sufficient to prevent precipitation of type III HLP in mice.
Type III hyperlipoproteinemia (type III HLP)1 is a disorder of lipoprotein metabolism that leads to elevated plasma cholesterol and triglyceride concentrations due mainly to an increase of apoB-containing remnant lipoproteins. These particles are the product of lipolytic processing of chylomicrons and very low density lipoproteins (VLDL) derived from the intestine and liver, respectively. Like low density lipoproteins (LDL), these are atherogenic lipoproteins, and subjects with type III hyperlipoproteinemia are predisposed to atherosclerosis and premature death from myocardial infarction (1).Type III HLP is a genetic disease associated with the expression of a metabolically impaired apoE protein (2, 3) or apoE deficiency (4). It is most commonly associated with individuals homozygous for the APOE*2 allele, the product of which has decreased affinity for the LDL receptor compared with other common isoforms. However, homozygosity of APOE*2 is necessary but not sufficient for the common form of type III hyperlipoproteinemia, as only 5-10% of adult homozygotes develop this disorder. In fact, most APOE*2 homozygotes have mild hypocholesterolemia and reduced atherosclerosis risk (5).It has long been appreciated that other genetic and environmental factors besides possession of two APOE*2 alleles are required for development of type III HLP. Type III HLP rarely manifests before adulthood, is more prevalent in men than women, and has an earlier age of onset in men than women (6). Women tend to express type III hyperlipoproteinemia only after menopause. Earlier onset is also associated with obesity, excessive alcohol consumption, diabetes mellitus, and hypothyroidism (1). The mechanism by which these conditions induce type III HLP is unclear. One possi...