Ezetimibe impairs uptake of dietary cholesterol oxidation products and reduces alterations in hepatic cholesterol metabolism and antioxidant function in rats

Ezetimibe treatment reduces oxidized low-density lipoprotein in biliary cirrhotic rats

BACKGROUND

In liver cirrhosis, chronic inflammation is associated with an increase in oxidative stress, and subsequently an increase in the concentration of oxidized low-density lipoprotein (ox-LDL). Ezetimibe is a lipid-lowering agent with anti-inflammation and anti-oxidative stress activities. This study aimed to investigate the effect of ezetimibe treatment on ox-LDL in cirrhotic rats.

METHODS

Biliary cirrhosis was induced in Sprague-Dawley rats with common bile duct ligation (BDL). Sham-operated rats served as surgical controls. Ezetimibe (10 mg/kg/d) or vehicle was administered in the sham-operated or BDL rats for 4 weeks, after which hemodynamic parameters, biochemistry data, and oxidative stress were evaluated. Plasma and intrahepatic ox-LDL levels were also examined, and hepatic proteins were analyzed to explore the mechanism of ezetimibe treatment.

RESULTS

The BDL rats had typical features of cirrhosis including jaundice, impaired liver function, hyperlipidemia, and elevated ox-LDL levels compared to the sham-operated rats. Ezetimibe treatment did not affect hemodynamics, liver biochemistry, or plasma lipid levels. However, it significantly reduced oxidative stress, plasma levels of ox-LDL, and tumor necrosis factor α. In addition, ezetimibe upregulated the hepatic protein expression of an ox-LDL scavenger (lectin-like ox-LDL rececptor-1), which resulted in reductions in intrahepatic ox-LDL and fat accumulation in the BDL rats. Nevertheless, ezetimibe treatment did not ameliorate hepatic inflammation or liver fibrosis.

CONCLUSION

Ezetimibe reduced plasma and intrahepatic ox-LDL levels in the cirrhotic rats. Furthermore, it ameliorated intrahepatic fat accumulation and oxidative stress. However, ezetimibe did not alleviate hepatic fibrosis or inflammation in the biliary cirrhotic rats.

Levilactobacillus brevis from carnivores can ameliorate hypercholesterolemia: in vitro and in vivo mechanistic evidence

AIMS

To explore the probiotic and hypocholesterolemic potential of two Levilactobacillus brevis strains of carnivore origin along with selected underlying mechanisms.

METHODS AND RESULTS

L. brevis MT950194 and L. brevis MW365351 were analyzed in vitro for oro-gastro-intestinal stress tolerance, cholesterol reduction, cholesterol adsorption (through scanning electron microscopy) and bile salt hydrolase (BSH) activity. Strains could survive (> 80%) in oro-gastro-intestinal conditions, reduce high amount of cholesterol (35% and 54%) from media containing bile salts (0.3%) as compared with Lactobacillus acidophilus ATCC4356 and presented least pathogenicity towards mammalian cells. Exopolysaccharide production, cell surface cholesterol adherence and BSH activity were witnessed as possible cholesterol lowering mechanisms. In in vivo experiment, the treatments of hypercholesterolemic rats with L. brevis MT950194, L. brevis MW365351 and their mixture led to significant (p < 0.05) reduction in serum and hepatic cholesterol, low density lipids, cholesterol ratio, liver steatosis, and size of adipocytes. It further ameliorated diet induced changes in hepatic enzymes.

CONCLUSIONS

L. brevis MT950194 and L. brevis MW365351 from carnivores have probiotic pharmacological potential and can reduce serum cholesterol through surface adherence and BSH production.

SIGNIFICANCE AND IMPACT OF STUDY

These strains may be utilized in treating hypercholesterolemia and production of low fat functional foods.

Induction of fecal cholesterol excretion is not effective for the treatment of hyperbilirubinemia in Gunn rats

BACKGROUND

Unconjugated hyperbilirubinemia, a feature of neonatal jaundice or Crigler-Najjar syndrome, can lead to neurotoxicity and even death. We previously demonstrated that unconjugated bilirubin (UCB) can be eliminated via transintestinal excretion in Gunn rats, a model of unconjugated hyperbilirubinemia, and that this is stimulated by enhancing fecal fatty acid excretion. Since transintestinal excretion also occurs for cholesterol (TICE), we hypothesized that increasing fecal cholesterol excretion and/or TICE could also enhance fecal UCB disposal and subsequently lower plasma UCB concentrations.

METHODS

To determine whether increasing fecal cholesterol excretion could ameliorate unconjugated hyperbilirubinemia, we treated hyperbilirubinemic Gunn rats with ezetimibe (EZE), an intestinal cholesterol absorption inhibitor, and/or a liver X receptor (LXR) and farnesoid X receptor (FXR) agonist (T0901317 (T09) and obeticholic acid (OCA), respectively), known to stimulate TICE.

RESULTS

We found that EZE treatment alone or in combination with T09 or OCA increased fecal cholesterol disposal but did not lower plasma UCB levels.

CONCLUSIONS

These findings do not support a link between the regulation of transintestinal excretion of cholesterol and bilirubin. Furthermore, induction of fecal cholesterol excretion is not a potential therapy for unconjugated hyperbilirubinemia.

IMPACT

Increasing fecal cholesterol excretion is not effective to treat unconjugated hyperbilirubinemia. This is the first time a potential relation between transintestinal excretion of cholesterol and unconjugated bilirubin is investigated. Transintestinal excretion of cholesterol and unconjugated bilirubin do not seem to be quantitatively linked. Unlike intestinal fatty acids, cholesterol cannot "capture" unconjugated bilirubin to increase its excretion. These results add to our understanding of ways to improve and factors regulating unconjugated bilirubin disposal in hyperbilirubinemic conditions.

Inhibition of Niemann-Pick C1-Like 1 by Ezetimibe Reduces Dietary 5β,6β-Epoxycholesterol Absorption in Rats

PURPOSE

Oxycholesterols (OCs) are produced from cholesterol by oxidation of the steroidal backbone and side-chain. OCs are present in blood and evidence suggests their involvement in disease development and progression. However, limited information is available regarding the absorption mechanisms and relative absorption rates of dietary OCs. Although ezetimibe is known to inhibit intestinal cholesterol absorption via Niemann-Pick C1-Like 1 (NPC1L1), whether it also inhibits dietary OC absorption is unclear.

METHODS

We investigated the effects of ezetimibe on OC absorption in rats fed an OC-rich diet containing 10 different OCs. We collected lymphatic fluid using permanent cannulation of the thoracic duct and quantified OC levels.

RESULTS

Ezetimibe treatment significantly reduced the apparent absorption of 5β,6β-epoxycholesterol (5,6β-epoxy) and its levels in the proximal intestinal mucosa in OC-fed rats. Using in silico analyses, the binding energy of NPC1L1 N-terminal domain (NPC1L1-NTD) and 5,6β-epoxy was found to be similar to that of NPC1L1-NTD and cholesterol, suggesting that polar uncharged amino acids located in the steroidal part of 5,6β-epoxy were involved.

CONCLUSION

Our results indicate that ezetimibe-mediated inhibition of dietary OC absorption varies depending on the specific OC, and only the absorption of 5,6β-epoxy is significantly reduced.

Hypolipidemic, antioxidant and anti-atherosclerogenic effect of aqueous extract leaves of Cassia. occidentalis Linn (Caesalpiniaceae) in diet-induced hypercholesterolemic rats

BACKGROUND

Hyperlipidemia and oxidative stress are major risk factors for atherosclerosis, and all three are among the most important risk factors for cardiovascular diseases. Cassia occidentalis aqueous extract has been used in African traditional medicine for the treatment of hypertension and associated cardiovascular diseases. This study was undertaken to evaluate the hypolipidemic and anti-atherosclerotic properties of the aqueous extract of the leaves of C. occidentalis in rats with hypercholesterolemia (HC). Sixty Normocholesterolemic (NC) male rats were divided into six groups (n = 10) and fed a high-cholesterol (HC) diet for 30 days (5 groups), or normal rat chow (normal control group). The plant extract was administered to animals at the increasing dose of 240, 320 and 400 mg/kg. After 4 weeks of treatment 5 rats out of 10 were sacrificed, blood samples, aorta, liver, and fresh faecal were collected and processed for biochemical tests. The experiments were conducted under the same conditions with a group of rat treated with Atorvastatin (1 mg/kg), used positive control. The effects of C. occidentalis on weight gain, water and food consumptions, levels of serum lipids and lipoprotein lipid oxidation and stress markers in blood and liver were also examined.

RESULTS

A significant body weight gain was observed in general in all the group of animals without any treatment after 4 weeks. During the treatment period, the C. occidentalis extract induced a significant increase (P < 0.01) in water consumption and food intakes. After 4 weeks of treatment with hypercholesterolemia, the body temperature and organ weights including the liver, kidney, heart and the testis did not present any significant change. The administration of C. occidentalis extract significantly (p < 0.05) prevented the elevation in TC, LDL-C, VLDL-C, hepatic and aortic TG and TC. The atherogenic, triglycerides, and lipid peroxidation (TBARS) index were also decreased in the rats treated with the plant extract. C. occidentalis favoured the performance of faecal cholesterol. It also significantly inhibited the changes and the formation of aortic atherosclerotic plaques.

CONCLUSION

This study provides evidence of hypolipidemic and antiatherosclerotic effects of C. occidentalis extract. C. occidenntalis aqueous extract reduced bad cholesterols, triglycerides and increasing good cholesterols in rats subjected to a feeding regime enriched with cholesterol. The results support the traditional use of the extract of this plant in the treatment of hypertension and diabetes.

Ezetimibe reduced hepatic steatosis induced by dietary oxysterols in nonhuman primates

Oxidized cholesterol (oxysterols) plays an important and multifaceted role in lipid metabolism. Here we examined whether dietary oxysterols accelerate hepatic lipid accumulation and inflammation in nonhuman primates. We also examined the effect of the Niemann–Pick C1‐like1 inhibitor, ezetimibe (Ez). Macaca fascicularis (5‐year‐old males) were fed either regular cholesterol + high‐fat diet (control‐HFD) or oxysterols + high‐fat diet (ox‐HFD; with 0.015% of oxysterols cholesterol) for 24 weeks. Compared with control‐HFD, ox‐HFD did not affect plasma lipid levels, but it did affect hepatic lipid levels [total cholesterol, 40.9 mg·g⁻¹ (ox‐HFD) versus 3.2 (control‐HFD) mg·g⁻¹; triglycerides, 28.0 (ox‐HFD) versus 5.7 (control‐HFD) mg·g⁻¹]. Ox‐HFD increased lipid accumulation as well as recruitment of inflammatory cells when compared to control‐HFD. We then examined the effects of Ez, 0.2 mg·kg⁻¹·day⁻¹ for 12 weeks. In addition to a significant reduction in dyslipidemia, Ez alleviated biochemical and pathological aspects of steatosis. Dietary oxysterols aggravate steatosis in nonhuman primates. Treatment with Ez may be a novel therapeutic approach to NAFLD by alleviating dyslipidemia.

Hypolipidemic, antioxidant and anti-atherosclerogenic effects of aqueous extract of Zanthoxylum heitzii stem bark in diet-induced hypercholesterolemic rats

OBJECTIVE

To evaluate anti-dyslipidemic, antioxidant and anti-atherosclerogenic properties of this extract in diet-induced hypercholesterolemic rat, a model of metabolic syndrome-induced atherosclerosis and associated cardiovascular diseases.

METHODS

Normocholesterolemic (NC) male rats were divided into six groups (n=10) and fed a high-cholesterol (HC) diet for 30 days (5 groups), or normal rat chow (normal control group). Rats given a HC diet also received distilled water (disease control), the potent hypocholesterolemic agent with anti-atherosclerotic activity atorvastatin (2 mg/kg, positive control), or one of the three doses of Zanthoxylum heitzii stem bark aqueous extract tested (225, 300 and 375 mg/kg) concomitantly for four months. Signs of general toxicity, body temperature and weight, and water and food intake were monitored in live animals. After sacrifice, lipid profiles and oxidative stress markers were assessed in the blood and liver, aorta, and feces, and histopathological analysis of aorta was performed.

RESULTS

Plant extract prevented the elevation of aortic total cholesterol and triglycerides, and hepatic low density lipoprotein, very low density lipoprotein, and total cholesterol. Lipid peroxidation (TBARS) was decreased and aortic atherosclerotic plaque formation prevented.

CONCLUSIONS

These observations strongly suggest that stem bark aqueous extract of Zanthoxylum heitzii has anti-atherosclerogenic properties, at least partly mediated by antioxidant and hypolipidemic effects.

Plant sterols from foods in inflammation and risk of cardiovascular disease: a real threat?

High dietary intakes of cholesterol together with sedentary habits have been identified as major contributors to atherosclerosis. The latter has long been considered a cholesterol storage disease; however, today atherosclerosis is considered a more complex disease in which both innate and adaptive immune-inflammatory mechanisms as well as bacteria play a major role, in addition to interactions between the arterial wall and blood components. This scenario has promoted nutritional recommendations to enrich different type of foods with plant sterols (PS) because of their cholesterol-lowering effects. In addition to cholesterol, PS can also be oxidized during food processing or storage, and the oxidized derivatives, known as phytosterol oxidation products (POPs), can make an important contribution to the negative effects of both cholesterol and cholesterol oxidation oxides (COPs) in relation to inflammatory disease onset and the development of atherosclerosis. Most current research efforts have focused on COPs, and evaluations of the particular role and physiopathological implications of specific POPs have been only inferential. Appreciation of the inflammatory role described for both COPs and POPs derived from foods also provides additional reasons for safety studies after long-term consumption of PS. The balance and relevance for health of all these effects deserves further studies in humans. This review summarizes current knowledge about the presence of sterol oxidation products (SOPs) in foods and their potential role in inflammatory process and cardiovascular disease.