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Molecular Medicine |
From the Departments of Pathology (K.S., R.L.K.) and Medicine (L.F., S.-H.C., K.H., L.F.H., J.P., J.J., E.R.M., F.A., J.L.W., Y.I.M.), University of California at San Diego, La Jolla; and Department of Molecular Medicine and Pathology (C.H., P.C.), The University of Auckland, New Zealand.
Correspondence to Yury Miller, University of California, San Diego, 1080 Basic Science Building, 9500 Gilman Dr, La Jolla, CA 92093-0682. E-mail yumiller{at}ucsd.edu
| Abstract |
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Key Words: zebrafish atherosclerosis oxidized lipoprotein macrophage
| Introduction |
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Fish are poikilothermic vertebrates that preferentially use lipids rather than carbohydrates as an energy source and would be classified, using standards applied to mammals, as mildly hyperlipidemic and hypercholesterolemic.3 In 1962, Vastesaeger and Delcourt observed the presence of lipid-rich atherosclerosis-like lesions in the aorta of a tuna (Thunnus thynnus).4 More recently, Seierstad et al demonstrated similar lesions in coronary arteries of farmed Atlantic salmon (Salmo salar).5 Lipoproteins have been studied in teleost fish, particularly in rainbow trout (Oncorhynchus mykiss).3 Very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) classes have been identified by analytic ultracentrifugation, with HDL dominating the lipoprotein profile. The nature and the distribution of apolipoproteins in different classes of fish lipoproteins resembles that in mammals, but plasma concentration of apolipoproteins in rainbow trout accounts for 36% of total protein, compared with only 10% in humans. Fish LDL contains more triglycerides and less cholesteryl esters than human LDL. Lipoprotein lipase, hepatic lipase, and lecitin:cholesterol acyltransferase activities have been identified, and there is evidence suggesting the presence of cholesteryl ester transfer protein in rainbow trout plasma.3
During embryonic development of fish, yolk syncytial layer actively synthesizes apolipoprotein (apo)E and other apolipoproteins and forms VLDL from yolk lipids, which then enter the circulatory system and deliver nutrient lipids to the tissues.6,7 As in humans, zebrafish microsomal triglyceride transfer protein is involved in VLDL assembly in the yolk and, later, in intestinal lipoprotein synthesis.8,9 In addition, zebrafish have structural and functional homologs of mammalian apoAI, apoB, and phospholipase A2 (PLA2).10–12 Studies of intestinal lipid metabolism in zebrafish identified annexin2-caveolin1 and fat-free as important factors in intestinal cholesterol absorption and the targets for antihyperlipidemic therapies.13,14 Sequence and expression analyses and studies of OxLDL uptake suggest the presence of SRA, CD36, toll-like receptor (TLR)4, LDL receptor (LDLR), LRP-1, and ABCA1 in fish (described elsewhere15,16; ZFIN Direct Data Submission [http://zfin.org]). Taken together, these data suggest that major elements of lipid metabolism are conserved between teleost fish and mammals.
To explore the potential of zebrafish for atherosclerosis-related studies, we tested lipid and lipoprotein parameters in adult zebrafish fed a high cholesterol diet. These fish were also used for histological analyses. Using confocal microscopy, we detected lipid and leukocyte accumulation in blood vessel walls, endothelial layer disorganization, and vascular PLA2 activity in live zebrafish larvae. To study macrophage lipid accumulation in vivo, in the environment of a fatty streak, we transplanted murine macrophages into zebrafish and measured time courses of macrophage lipid uptake in live animals.
| Materials and Methods |
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Zebrafish
Zebrafish maintenance and procedures were approved by the University of California at San Diego institutional animal care and use committee. A high-cholesterol diet (HCD) for adult zebrafish was made by soaking salmon starter (Aquaneering) in a diethyl ether solution of cholesterol (Sigma) to achieve a content of 4% (wt/wt) cholesterol in the food after ether evaporation. Similarly, larvae were fed artificial artemia (Azoo) that was enriched with 2% to 10% cholesterol using the above procedure. For the purposes of studying vascular lipid accumulation in larvae, both control and HCD food were supplemented with 10 µg/g of a fluorescent cholesteryl ester analog (cholesteryl BODIPY 576/589-C11 from Invitrogen).
Lipid and Lipoprotein Analyses
Two microliters of blood was drawn from the heart of adult fish. Total cholesterol (TC) and triglycerides in plasma were measured using automated enzymatic assays (Roche Diagnostics and Equal Diagnostics). Plasma lipoprotein profiles were analyzed in native agarose gel electrophoresis (Helena Laboratories). Oxidation-specific epitopes were detected in an immunoassay with EO6 monoclonal antibody.17
Histology
Ten-micron thick frozen or paraffin-embedded cross-sections of adult zebrafish (trunk area) were collected. Initial morphological evaluation of nonstained sections was performed using a bright field microscope. Sections containing lesions (intimal thickening) in the dorsal aorta were stained with van Gieson stain, LipidTOX Red (neutral lipid), an antihuman L-plastin antibody (macrophages) or DAPI (nuclei).
In Vivo Microscopy
For in vivo confocal microscopy, anesthetized fish larvae were housed in a sealed, temperature controlled chamber in a small drop of tricaine containing water.2 A Nikon C1-si confocal microscope was used in either regular or spectral acquisition modes. Images were 3D rendered and analyzed using Imaris software (Bitplane). Detailed methods for quantifying vascular lipid and myeloid cell accumulation, apparent thickness and permeability of the endothelial cell (EC) layer, vascular PLA2 activity in larvae, and cell transplant and macrophage lipid accumulation experiments are described in the online data supplement.
Statistics
Data in graphs are presented as means±SE. Statistical differences between experimental groups were evaluated by 1-way ANOVA. Values of P<0.05 were considered statistically significant.
| Results |
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Lipoprotein Oxidation in Adult Zebrafish
Our present understanding of atherogenesis considers that the oxidative modification of LDL is a leading factor in the initiation and progression of the atherosclerotic lesion.20 Our laboratory has developed monoclonal antibodies that can be used in immunoassays to detect oxidation-specific epitopes on lipoproteins in plasma of different animal species and humans.17 Monoclonal antibody EO6 is used to measure the amount of oxidized phospholipids bound per apoB or apoAI lipoproteins. In human epidemiological studies, a 3- to 5-fold increase in the EO6/apoB plasma levels multiplies the risk of coronary artery disease 3-fold among patients <60 years of age and when combined with hypercholesterolemia, up to 17-fold.17
Thus, given high TC levels and evidence for elevated VLDL and LDL lipoproteins, we measured the EO6/apoB levels in zebrafish plasma. We found that a polyclonal antibody against human apoB recognized proteins in zebrafish plasma corresponding to human apoB (Online Figure II), which agrees with a similar cross-reactivity of a different antihuman apoB antibody with trout apoB.3 Remarkably, the EO6 reactivity in apoB lipoproteins was as much as 20 to 30 times higher in HCD-fed zebrafish plasma than in control plasma samples (Figure 1F). Using an anti-human apoAI antibody (Online Figure II) to trap HDL particles from plasma revealed the equally remarkable finding that EO6 immunoreactivity on apoAI particles was also 20- to 30-fold higher in the HCD plasma (Figure 1G).
Vascular Lesions in Adult Zebrafish
Next, we examined HCD-fed and control zebrafish frozen and paraffin-embedded sections stained with van Gieson stain, LipidTOX (a fluorescent stain for neutral lipids), and DAPI (a nuclear stain). In sections of partially perfused dorsal aorta, we found vascular lesions of enlarged intima that extended into the lumen of the dorsal aorta and were characterized by accumulation of lipid and cell infiltration (Figure 2, Online Figure III, and Online Table I). Such lesions are classified as fatty streaks, early lesions of developing atherosclerosis in mouse models and in humans. From a total of 9 HCD-fed fish (both males and females), 7 had lesions of 100 to 500 µm in length in a 5-mm long segment of the dorsal aorta, whereas only 1 of 9 control fish had 1 small lesion (Online Table I). The lesions were mostly found at the sites of intersegmental arteries bifurcation, where turbulent flow can be expected (Figure 2A). To detect macrophages in zebrafish vascular lesions, we used a polyclonal antibody against human L-plastin. Zebrafish and human L-plastin are 82% identical and 90% homologous, and in western blots the antibody stained bands of the same molecular mass in zebrafish larvae lysates and in the lysates of murine macrophages (Online Figure IV). It also stained cells in murine atherosclerotic lesions (Online Figure IV; note similar patterns of L-plastin and Mac3 stainings) and in zebrafish vascular lesions (Figure 2E), suggesting macrophage infiltration.
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Vascular Lipid and Myeloid Cell Accumulation in Zebrafish Larvae
The zebrafish body is transparent during approximately 30 dpf, which would allow for a dynamic study of the processes of vascular lipid accumulation and inflammation. Thus, we explored whether HCD leads to vascular lipid accumulation in larvae. On the fifth dpf, when zebrafish larvae begin free feeding, we started the HCD, supplemented with a red fluorescent cholesteryl ester analog, and continued it for 10 days. The control diet with normal cholesterol content was also supplemented with the fluorescent cholesteryl ester analog. These 2 diets were fed to 2 groups of fli1:EGFP zebrafish, constitutively expressing GFP in ECs,1 which enables visualization of the vasculature. Live anesthetized zebrafish larvae were imaged using a Nikon C1-si confocal microscope. We observed that vasculature of the control and HCD larvae were stained diffusely red, consistent with circulating fluorescent lipid (Figure 3A). Remarkably, only in HCD-fed larvae there were many focal areas of bright red fluorescence in blood vessels, which we interpreted as lipid accumulation in the vessel wall (either cholesteryl ester or its hydrolyzed fatty acid chain present as a free fatty acid or reesterified into triglycerides, phospholipids, or cholesteryl esters). To further confirm that the accumulation of fluorescent lipid is indeed a consequence of HCD feeding, we fed wild-type AB larvae diets with a varying concentration of cholesterol (2% to 10%). There was a dose-dependent increase in vascular accumulation of fluorescent lipid, with most reproducible results achieved at 4% cholesterol (Figure 3B). Using a 4% cholesterol diet with fli1:EGFP larvae, we observed even higher levels of fluorescent lipid accumulation than in AB larvae, on average a 5-fold increase (Figure 3C). Three-dimensional rendering demonstrated that these lipid deposits were subendothelial (Figure 3D), which would correspond to intimal lipid accumulation in mice and humans, although lipid accumulation in adventitia cannot be excluded. Although the majority of lipid deposits were observed in the caudal vein, some deposits were found in the dorsal aorta and at sites of blood vessel bifurcation as well (Figure 3E and Online Movie 1). The presence of the lipid deposits in veins can be explained by the specifics of the zebrafish circulatory system at this stage of development, when large arteries and veins connect directly rather than via a capillary network. In adult zebrafish, lesions were found only in the dorsal aorta but not in the caudal vein.
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Feeding HCD to lyz:DsRed2 larvae, in which DsRed2 is expressed in monocyte/macrophages and granulocytes,21 resulted in the recruitment of red fluorescent myeloid cells to the caudal vein, within a 2-cell distance from the lumen (Figure 4), suggesting accumulation of macrophages and/or neutrophils in the vascular wall. In mammalian atherosclerosis, neutrophils are notably excluded from vascular lesions,20 and the absolute majority of myeloid cells are macrophages.
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Endothelial Layer Disorganization and Permeability in HCD-Fed Larvae
Under laminar flow in noninflamed mammalian blood vessels, ECs form a regular layer with the cells oriented along the flow. At sites of turbulent flow and when the lipid deposition in the intima causes EC activation, an apparent thickness of the EC layer increases because of the loss of EC alignment, formation of large vacuole-like EC boundaries, and infiltration of macrophages, as observed in early lesions in hypercholesterolemic mice.22 In HCD-fed larvae, we observed irregularity in endothelial layer morphology of the caudal vein (Figure 5A) and apparent thickening of the EC layer in central and peripheral blood vessels (Figure 5A through 5C). Ezetimibe, an inhibitor of intestinal cholesterol absorption, added to the fish tank water during the HCD feeding period, reduced lipid deposition in the intestine and peritoneal cavity of HCD-fed zebrafish (Figure 5B, top images), which agrees with an earlier report.13 Remarkably, the ezetimibe treatment attenuated HCD-induced EC disorganization in peripheral vasculature (Figure 5B, bottom images) and reduced an apparent thickness of the EC layer in the caudal vein (Figure 5C), which likely reflects attenuated vascular inflammation.
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To test whether the observed EC layer disorganization resulted in the loss of its barrier function as found in mammalian atherosclerotic lesions, we injected intravenously a fluorescent dextran and observed its leakage outside the caudal vein (Figure 6 and Online Figure V). The intensity of dextran fluorescence at 5 µm from the lumen margin was 2.5-fold higher in HCD-fed larvae compared to the control. The ezetimibe treatment prevented dextran leaking from the blood vessels.
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Vascular PLA2 Activity in Zebrafish Larvae
Imaging of live zebrafish permits not only morphological but also functional studies. Farber et al developed a fluorescent reporter for PLA2 activity, PED6, and used it in the study of intestinal lipid metabolism in zebrafish.23 We found that in addition to intestinal and gall bladder fluorescence of PLA2-hydrolyzed PED6, a bright emission was detected from zebrafish blood vessels following 10 days of HCD but was almost absent in the vasculature of control zebrafish (Figure 7A, top images, and 7B). To demonstrate that there was equal penetration of the fluorogenic substrate into vasculature of control and HCD-fed zebrafish, we used a phospholipid in which the fluorophore is unquenched and, thus, its fluorescence intensity is independent of being cleaved by PLA2. There were no differences in the intensities of the control phospholipid fluorescence in the control and HCD-fed larvae (Figure 7A, bottom images, and 7B). These results suggest that fluorescent reporters can be used to study activities of enzymes involved in vascular inflammation in live zebrafish.
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TLR4-Dependent Macrophage Lipid Uptake in Zebrafish Larvae
Studies of atherosclerosis in mouse models are facilitated by the availability of knockout mouse strains and engineered cell lines, but the technology for generating knockout zebrafish is not yet well established, and morpholino antisense techniques provide the gene knockdown only for first 3 to 5 dpf, before we initiate high-cholesterol feeding. To circumvent this problem, we transplanted genetically manipulated murine macrophages into the larvae that were fed HCD for 10 days before the transplantation. Because adaptive immunity in 15 to 20 dpf larvae is undeveloped, this technique allows for monitoring the function of mammalian macrophages in the environment of a zebrafish fatty streak. We applied this technique to investigate the function of TLR4 in atherogenesis.
We have previously reported that minimally oxidized LDL (mmLDL) activates macrophages in a TLR4-dependent manner.24,25 We noticed that in cell culture, mmLDL stimulated TLR4-competent J774 macrophages to accumulate lipid and that this effect was inhibited in TLR4-knockdown cells expressing TLR4-specific short hairpin (sh)RNA (Figure 8A). Remarkably, when transplanted into HCD-fed zebrafish larvae, TLR4-competent macrophages, repeatedly imaged in areas of vascular lipid deposition, accumulated fluorescent lipid at a significantly higher rate than TLR4-deficient macrophages (Figure 8B and 8C). At 24 hours after injection, close to 30% of TLR4-competent macrophages accumulated lipid, compared to less than 10% of TLR4-deficient macrophages (Figure 8D). To confirm these results with primary cells, we used peritoneal macrophages and circulating mononuclear cells isolated from C3H mice; the C3H/HeJ mice carry the lps-d mutation in the TLR4 gene that makes the receptor nonfunctional, whereas the C3H/HeOuJ mice have normal functional TLR4.26 In a cell culture experiment, wild-type, but not TLR4 mutant macrophages, stimulated with mmLDL, spread (as we reported earlier24,25) and accumulated lipid (Figure 8E). Following transplantation into HCD-fed larvae, more than 40% of wild-type macrophages accumulated endogenous (dietary) lipid, compared to only
15% of TLR4 mutant cells (Figure 8F). Among the transplanted cells that have accumulated lipid, the relative amount of intracellular lipid was 3-fold lower in TLR4 mutant cells compared to wild-type macrophages (Figure 8G). These in vivo experiments suggest a novel function for TLR4 in mediating lipoprotein uptake by macrophages.
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| Discussion |
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Lipoprotein oxidation is a major pathogenic factor that accelerates atherogenesis.17,20 A dramatic increase in the plasma levels of the EO6-reactive oxidation-specific epitopes that we observed in HCD-fed zebrafish (Figure 1F and 1G) is very unusual for human samples or for any mammalian model of atherosclerosis. In particular, we have never observed such high levels of HDL-associated EO6 reactivity in any species. One possible explanation for these findings is that a poikilothermic fish in water at ambient temperature and at lower oxygen concentration than in the open air has developed less sophisticated antioxidative systems.28 Thus, the HCD challenge results in a higher rate of oxidation, and hence a greater accumulation of such products as oxidized phospholipids, as measured by the EO6 immunoassay. Increased PLA2 activity (Figure 7) might be a response to the elevated levels of oxidized phospholipids found in the plasma lipoproteins (Figure 1F and 1G) because such enzymes have the ability to degrade oxidized phospholipids. These data in zebrafish correlate with recent human studies showing that increasing lipoprotein-associated PLA2 activity further amplifies the risk of cardiovascular disease mediated by oxidized phospholipids,29 although we do not know yet which PLA2 isoform in zebrafish was involved.
Studies with atherosclerosis-prone apoE–/– mice in which either TLR4 or MyD88 (a critical downstream molecule in TLRs signaling) was knocked out, demonstrated reduced atherosclerosis in the animals fed a high fat diet.30,31 Although these studies suggested a role for TLR4 in atherogenesis, the mechanisms remain obscure. Earlier, we observed that a putative endogenous ligand for TLR4, mmLDL, induced extensive membrane ruffling in macrophages and cell spreading, associated with intracellular vacuolization.24,32,33 Based on these findings, we hypothesized that the TLR4-mediated cytoskeletal rearrangements and liquid phase uptake may quantitatively increase the rate of lipoprotein uptake by macrophages and thus accelerate foam cell formation. We tested this hypothesis using the zebrafish model. Because lipoprotein oxidation occurs in vivo in HCD-fed zebrafish (Figure 1F and 1G), we expected that an in vivo generated zebrafish analog of mmLDL may induce TLR4-dependent lipid uptake. Indeed, we observed that murine macrophages transplanted into zebrafish that were fed HCD before transplantation, accumulated endogenous (dietary) lipid, and that this effect was significantly attenuated in TLR4-deficient macrophages (Figure 8). Moreover, we were able, for the first time, to monitor time-dependent macrophage lipid uptake in a fatty streak in live animals. This technique will be useful in calculating rates of in vivo lipid uptake by genetically modified macrophages and, thus, quantitatively comparing different mechanisms of foam cell formation.
Based on these results, we propose that HCD-fed larvae and adult zebrafish make a useful and highly informative experimental model of certain aspects of vascular inflammation and atherosclerosis, which can be further developed using the knowledge of zebrafish intestinal lipid metabolism, angiogenesis and innate immunity.9,13,14,23,34 The optical transparency of zebrafish larvae provides the opportunity to observe specific processes in the vascular wall repeatedly over time in a live animal. Adult zebrafish can be used to study in vivo lipoprotein oxidation and its attendant biological responses. Economic colony maintenance, ease of genetic manipulation, fast maturation, short feeding periods, and a simple method of drug administration make the zebrafish model particularly attractive for studies of vascular lipid accumulation and inflammation.
| Acknowledgments |
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This study was supported by the NIH grants R01HL081862 (to Y.I.M.) and P01HL088093 (to J.L.W. and Y.I.M.) and a grant from the Leducq Fondation (to J.L.W.).
Disclosures
None.
| Footnotes |
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Original received October 24, 2008; revision received February 23, 2009; accepted February 24, 2009.
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