Skip to main content
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1998 Aug 1;102(3):625–632. doi: 10.1172/JCI1581

Retinoids increase human apo C-III expression at the transcriptional level via the retinoid X receptor. Contribution to the hypertriglyceridemic action of retinoids.

N Vu-Dac 1, P Gervois 1, I P Torra 1, J C Fruchart 1, V Kosykh 1, T Kooistra 1, H M Princen 1, J Dallongeville 1, B Staels 1
PMCID: PMC508923  PMID: 9691099

Abstract

Hypertriglyceridemia is a metabolic complication of retinoid therapy. In this study, we analyzed whether retinoids increase the expression of apo C-III, an antagonist of plasma triglyceride catabolism. In men, isotretinoin treatment (80 mg/d; 5 d) resulted in elevated plasma apo C-III, but not apo E concentrations. In human hepatoma HepG2 cells, retinoids increased apo C-III mRNA and protein production. Transient transfection experiments indicated that retinoids increase apo C-III expression at the transcriptional level. This increased apo C-III transcription is mediated by the retinoid X receptor (RXR), since LG1069 (4-[1-(5,6,7,8-tetrahydro-3,5,5,8, 8-pentamethyl-2-naphtalenyl)ethenyl]benzoic acid), a RXR-specific agonist, but not TTNPB ((E)- 4-[2-(5,6,7,8-tetrahydro-5,5,8, 8-tetramethyl-2-naphtalenyl)propenyl]benzoic acid), a retinoic acid receptor (RAR)-specific agonist, induced apo C-III mRNA in HepG2 cells and primary human hepatocytes. Mutagenesis experiments localized the retinoid responsiveness to a cis-element consisting of two imperfect AGGTCA sequences spaced by one oligonucleotide (DR-1), within the previously identified C3P footprint site. Cotransfection assays showed that RXR, but not RAR, activates apo C-III transcription through this element either as a homo- or as a heterodimer with the peroxisome proliferator-activated receptor. Thus, apo C-III is a target gene for retinoids acting via RXR. Increased apo C-III expression may contribute to the hypertriglyceridemia and atherogenic lipoprotein profile observed after retinoid therapy.

Full Text

The Full Text of this article is available as a PDF (347.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aalto-Setälä K., Fisher E. A., Chen X., Chajek-Shaul T., Hayek T., Zechner R., Walsh A., Ramakrishnan R., Ginsberg H. N., Breslow J. L. Mechanism of hypertriglyceridemia in human apolipoprotein (apo) CIII transgenic mice. Diminished very low density lipoprotein fractional catabolic rate associated with increased apo CIII and reduced apo E on the particles. J Clin Invest. 1992 Nov;90(5):1889–1900. doi: 10.1172/JCI116066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Aalto-Setälä K., Weinstock P. H., Bisgaier C. L., Wu L., Smith J. D., Breslow J. L. Further characterization of the metabolic properties of triglyceride-rich lipoproteins from human and mouse apoC-III transgenic mice. J Lipid Res. 1996 Aug;37(8):1802–1811. [PubMed] [Google Scholar]
  3. Bershad S., Rubinstein A., Paterniti J. R., Le N. A., Poliak S. C., Heller B., Ginsberg H. N., Fleischmajer R., Brown W. V. Changes in plasma lipids and lipoproteins during isotretinoin therapy for acne. N Engl J Med. 1985 Oct 17;313(16):981–985. doi: 10.1056/NEJM198510173131604. [DOI] [PubMed] [Google Scholar]
  4. Berthou L., Staels B., Saldicco I., Berthelot K., Casey J., Fruchart J. C., Denèfle P., Branellec D. Opposite in vitro and in vivo regulation of hepatic apolipoprotein A-I gene expression by retinoic acid. Absence of effects on apolipoprotein A-II gene expression. Arterioscler Thromb. 1994 Oct;14(10):1657–1664. doi: 10.1161/01.atv.14.10.1657. [DOI] [PubMed] [Google Scholar]
  5. Boehm M. F., Zhang L., Badea B. A., White S. K., Mais D. E., Berger E., Suto C. M., Goldman M. E., Heyman R. A. Synthesis and structure-activity relationships of novel retinoid X receptor-selective retinoids. J Med Chem. 1994 Sep 2;37(18):2930–2941. doi: 10.1021/jm00044a014. [DOI] [PubMed] [Google Scholar]
  6. Clavey V., Lestavel-Delattre S., Copin C., Bard J. M., Fruchart J. C. Modulation of lipoprotein B binding to the LDL receptor by exogenous lipids and apolipoproteins CI, CII, CIII, and E. Arterioscler Thromb Vasc Biol. 1995 Jul;15(7):963–971. doi: 10.1161/01.atv.15.7.963. [DOI] [PubMed] [Google Scholar]
  7. Dammerman M., Sandkuijl L. A., Halaas J. L., Chung W., Breslow J. L. An apolipoprotein CIII haplotype protective against hypertriglyceridemia is specified by promoter and 3' untranslated region polymorphisms. Proc Natl Acad Sci U S A. 1993 May 15;90(10):4562–4566. doi: 10.1073/pnas.90.10.4562. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Devchand P. R., Keller H., Peters J. M., Vazquez M., Gonzalez F. J., Wahli W. The PPARalpha-leukotriene B4 pathway to inflammation control. Nature. 1996 Nov 7;384(6604):39–43. doi: 10.1038/384039a0. [DOI] [PubMed] [Google Scholar]
  9. Ebara T., Ramakrishnan R., Steiner G., Shachter N. S. Chylomicronemia due to apolipoprotein CIII overexpression in apolipoprotein E-null mice. Apolipoprotein CIII-induced hypertriglyceridemia is not mediated by effects on apolipoprotein E. J Clin Invest. 1997 Jun 1;99(11):2672–2681. doi: 10.1172/JCI119456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fraser J. D., Keller D., Martinez V., Santiso-Mere D., Straney R., Briggs M. R. Utilization of recombinant adenovirus and dominant negative mutants to characterize hepatocyte nuclear factor 4-regulated apolipoprotein AI and CIII expression. J Biol Chem. 1997 May 23;272(21):13892–13898. doi: 10.1074/jbc.272.21.13892. [DOI] [PubMed] [Google Scholar]
  11. Gerber L. E., Erdman J. W., Jr Hyperlipidemia in rats fed retinoic acid. Lipids. 1981 Jul;16(7):496–501. doi: 10.1007/BF02535047. [DOI] [PubMed] [Google Scholar]
  12. Giller T., Hennes U., Kempen H. J. Regulation of human apolipoprotein A-I expression in Caco-2 and HepG2 cells by all-trans and 9-cis retinoic acids. J Lipid Res. 1995 May;36(5):1021–1028. [PubMed] [Google Scholar]
  13. Ginsberg H. N., Le N. A., Goldberg I. J., Gibson J. C., Rubinstein A., Wang-Iverson P., Norum R., Brown W. V. Apolipoprotein B metabolism in subjects with deficiency of apolipoproteins CIII and AI. Evidence that apolipoprotein CIII inhibits catabolism of triglyceride-rich lipoproteins by lipoprotein lipase in vivo. J Clin Invest. 1986 Nov;78(5):1287–1295. doi: 10.1172/JCI112713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gollnick H. New indications and new retinoids. Dermatologica. 1987;175 (Suppl 1):182–195. doi: 10.1159/000248882. [DOI] [PubMed] [Google Scholar]
  15. Gustafson S., Vahlquist C., Sjöblom L., Eklund A., Vahlquist A. Metabolism of very low density lipoproteins in rats with isotretinoin (13-cis retinoic acid)-induced hyperlipidemia. J Lipid Res. 1990 Feb;31(2):183–190. [PubMed] [Google Scholar]
  16. Hertz R., Bishara-Shieban J., Bar-Tana J. Mode of action of peroxisome proliferators as hypolipidemic drugs. Suppression of apolipoprotein C-III. J Biol Chem. 1995 Jun 2;270(22):13470–13475. doi: 10.1074/jbc.270.22.13470. [DOI] [PubMed] [Google Scholar]
  17. Ito Y., Azrolan N., O'Connell A., Walsh A., Breslow J. L. Hypertriglyceridemia as a result of human apo CIII gene expression in transgenic mice. Science. 1990 Aug 17;249(4970):790–793. doi: 10.1126/science.2167514. [DOI] [PubMed] [Google Scholar]
  18. Kaptein A., de Wit E. C., Princen H. M. Retinoids stimulate ApoA-I synthesis by induction of gene transcription in primary hepatocyte cultures from cynomolgus monkey (Macaca fascicularis) Arterioscler Thromb. 1993 Oct;13(10):1505–1514. doi: 10.1161/01.atv.13.10.1505. [DOI] [PubMed] [Google Scholar]
  19. Kingston T., Gaskell S., Marks R. The effects of a novel potent oral retinoid (Rol3-6298) in the treatment of multiple solar keratoses and squamous cell epithelioma. Eur J Cancer Clin Oncol. 1983 Sep;19(9):1201–1205. doi: 10.1016/0277-5379(83)90196-7. [DOI] [PubMed] [Google Scholar]
  20. Kurokawa R., DiRenzo J., Boehm M., Sugarman J., Gloss B., Rosenfeld M. G., Heyman R. A., Glass C. K. Regulation of retinoid signalling by receptor polarity and allosteric control of ligand binding. Nature. 1994 Oct 6;371(6497):528–531. doi: 10.1038/371528a0. [DOI] [PubMed] [Google Scholar]
  21. Ladias J. A., Hadzopoulou-Cladaras M., Kardassis D., Cardot P., Cheng J., Zannis V., Cladaras C. Transcriptional regulation of human apolipoprotein genes ApoB, ApoCIII, and ApoAII by members of the steroid hormone receptor superfamily HNF-4, ARP-1, EAR-2, and EAR-3. J Biol Chem. 1992 Aug 5;267(22):15849–15860. [PubMed] [Google Scholar]
  22. Laker M. F., Green C., Bhuiyan A. K., Shuster S. Isotretinoin and serum lipids: studies on fatty acid, apolipoprotein and intermediary metabolism. Br J Dermatol. 1987 Aug;117(2):203–206. doi: 10.1111/j.1365-2133.1987.tb04117.x. [DOI] [PubMed] [Google Scholar]
  23. Le N. A., Gibson J. C., Ginsberg H. N. Independent regulation of plasma apolipoprotein C-II and C-III concentrations in very low density and high density lipoproteins: implications for the regulation of the catabolism of these lipoproteins. J Lipid Res. 1988 May;29(5):669–677. [PubMed] [Google Scholar]
  24. Leff T., Reue K., Melian A., Culver H., Breslow J. L. A regulatory element in the ApoCIII promoter that directs hepatic specific transcription binds to proteins in expressing and nonexpressing cell types. J Biol Chem. 1989 Sep 25;264(27):16132–16137. [PubMed] [Google Scholar]
  25. Leid M., Kastner P., Lyons R., Nakshatri H., Saunders M., Zacharewski T., Chen J. Y., Staub A., Garnier J. M., Mader S. Purification, cloning, and RXR identity of the HeLa cell factor with which RAR or TR heterodimerizes to bind target sequences efficiently. Cell. 1992 Jan 24;68(2):377–395. doi: 10.1016/0092-8674(92)90478-u. [DOI] [PubMed] [Google Scholar]
  26. Leroy A., Vu-dac N., Koffigan M., Clavey V., Fruchart J. C. Characterization of a monoclonal antibody that binds to apolipoprotein E and to lipoprotein of human plasma containing apo E. Applications to ELISA quantification of plasma apo E. J Immunoassay. 1988;9(3-4):309–334. doi: 10.1080/01971528808053219. [DOI] [PubMed] [Google Scholar]
  27. Li W. W., Dammerman M. M., Smith J. D., Metzger S., Breslow J. L., Leff T. Common genetic variation in the promoter of the human apo CIII gene abolishes regulation by insulin and may contribute to hypertriglyceridemia. J Clin Invest. 1995 Dec;96(6):2601–2605. doi: 10.1172/JCI118324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. MacGregor G. R., Caskey C. T. Construction of plasmids that express E. coli beta-galactosidase in mammalian cells. Nucleic Acids Res. 1989 Mar 25;17(6):2365–2365. doi: 10.1093/nar/17.6.2365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Maeda N., Li H., Lee D., Oliver P., Quarfordt S. H., Osada J. Targeted disruption of the apolipoprotein C-III gene in mice results in hypotriglyceridemia and protection from postprandial hypertriglyceridemia. J Biol Chem. 1994 Sep 23;269(38):23610–23616. [PubMed] [Google Scholar]
  30. Malmendier C. L., Lontie J. F., Delcroix C., Dubois D. Y., Magot T., De Roy L. Apolipoproteins C-II and C-III metabolism in hypertriglyceridemic patients. Effect of a drastic triglyceride reduction by combined diet restriction and fenofibrate administration. Atherosclerosis. 1989 Jun;77(2-3):139–149. doi: 10.1016/0021-9150(89)90075-0. [DOI] [PubMed] [Google Scholar]
  31. Mangelsdorf D. J., Evans R. M. The RXR heterodimers and orphan receptors. Cell. 1995 Dec 15;83(6):841–850. doi: 10.1016/0092-8674(95)90200-7. [DOI] [PubMed] [Google Scholar]
  32. Marsh J. L., Erfle M., Wykes E. J. The pIC plasmid and phage vectors with versatile cloning sites for recombinant selection by insertional inactivation. Gene. 1984 Dec;32(3):481–485. doi: 10.1016/0378-1119(84)90022-2. [DOI] [PubMed] [Google Scholar]
  33. Masiakowski P., Breathnach R., Bloch J., Gannon F., Krust A., Chambon P. Cloning of cDNA sequences of hormone-regulated genes from the MCF-7 human breast cancer cell line. Nucleic Acids Res. 1982 Dec 20;10(24):7895–7903. doi: 10.1093/nar/10.24.7895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Masucci-Magoulas L., Goldberg I. J., Bisgaier C. L., Serajuddin H., Francone O. L., Breslow J. L., Tall A. R. A mouse model with features of familial combined hyperlipidemia. Science. 1997 Jan 17;275(5298):391–394. doi: 10.1126/science.275.5298.391. [DOI] [PubMed] [Google Scholar]
  35. Melnik B., Bros U., Plewig G. Characterization of apoprotein metabolism and atherogenic lipoproteins during oral isotretinoin treatment. Dermatologica. 1987;175 (Suppl 1):158–168. doi: 10.1159/000248880. [DOI] [PubMed] [Google Scholar]
  36. Mietus-Snyder M., Sladek F. M., Ginsburg G. S., Kuo C. F., Ladias J. A., Darnell J. E., Jr, Karathanasis S. K. Antagonism between apolipoprotein AI regulatory protein 1, Ear3/COUP-TF, and hepatocyte nuclear factor 4 modulates apolipoprotein CIII gene expression in liver and intestinal cells. Mol Cell Biol. 1992 Apr;12(4):1708–1718. doi: 10.1128/mcb.12.4.1708. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Mérot Y., Camenzind M., Geiger J. M., Saurat J. H. Arotinoid ethyl ester (Ro 13-6298): a long term pilot study in various dermatoses. Acta Derm Venereol. 1987;67(3):237–242. [PubMed] [Google Scholar]
  38. Nagasaki A., Kikuchi T., Kurata K., Masushige S., Hasegawa T., Kato S. Vitamin A regulates the expression of apolipoprotein AI and CIII genes in the rat. Biochem Biophys Res Commun. 1994 Dec 30;205(3):1510–1517. doi: 10.1006/bbrc.1994.2838. [DOI] [PubMed] [Google Scholar]
  39. Nakamaye K. L., Eckstein F. Inhibition of restriction endonuclease Nci I cleavage by phosphorothioate groups and its application to oligonucleotide-directed mutagenesis. Nucleic Acids Res. 1986 Dec 22;14(24):9679–9698. doi: 10.1093/nar/14.24.9679. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. O'Leary T. J., Simo I. E., Kanigsberg N., Walker J., Goodall J. C., Ooi T. C. Changes in serum lipoproteins and high-density lipoprotein composition during isotretinoin therapy. Clin Invest Med. 1987 Jul;10(4):355–360. [PubMed] [Google Scholar]
  41. Ogami K., Hadzopoulou-Cladaras M., Cladaras C., Zannis V. I. Promoter elements and factors required for hepatic and intestinal transcription of the human ApoCIII gene. J Biol Chem. 1990 Jun 15;265(17):9808–9815. [PubMed] [Google Scholar]
  42. Parsy D., Clavey V., Fievet C., Kora I., Duriez P., Fruchart J. C. Quantification of apolipoprotein C-III in serum by a noncompetitive immunoenzymometric assay. Clin Chem. 1985 Oct;31(10):1632–1635. [PubMed] [Google Scholar]
  43. Peters J. M., Hennuyer N., Staels B., Fruchart J. C., Fievet C., Gonzalez F. J., Auwerx J. Alterations in lipoprotein metabolism in peroxisome proliferator-activated receptor alpha-deficient mice. J Biol Chem. 1997 Oct 24;272(43):27307–27312. doi: 10.1074/jbc.272.43.27307. [DOI] [PubMed] [Google Scholar]
  44. Rees A., Shoulders C. C., Stocks J., Galton D. J., Baralle F. E. DNA polymorphism adjacent to human apoprotein A-1 gene: relation to hypertriglyceridaemia. Lancet. 1983 Feb 26;1(8322):444–446. doi: 10.1016/s0140-6736(83)91440-x. [DOI] [PubMed] [Google Scholar]
  45. Rottman J. N., Widom R. L., Nadal-Ginard B., Mahdavi V., Karathanasis S. K. A retinoic acid-responsive element in the apolipoprotein AI gene distinguishes between two different retinoic acid response pathways. Mol Cell Biol. 1991 Jul;11(7):3814–3820. doi: 10.1128/mcb.11.7.3814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Salerno A. J., He Z., Goos-Nilsson A., Ahola H., Mak P. Differential transcriptional regulation of the apoAI gene by retinoic acid receptor homo- and heterodimers in yeast. Nucleic Acids Res. 1996 Feb 15;24(4):566–572. doi: 10.1093/nar/24.4.566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Schonfeld G., George P. K., Miller J., Reilly P., Witztum J. Apolipoprotein C-II and C-III levels in hyperlipoproteinemia. Metabolism. 1979 Oct;28(10):1001–1010. doi: 10.1016/0026-0495(79)90004-0. [DOI] [PubMed] [Google Scholar]
  48. Staels B., Vu-Dac N., Kosykh V. A., Saladin R., Fruchart J. C., Dallongeville J., Auwerx J. Fibrates downregulate apolipoprotein C-III expression independent of induction of peroxisomal acyl coenzyme A oxidase. A potential mechanism for the hypolipidemic action of fibrates. J Clin Invest. 1995 Feb;95(2):705–712. doi: 10.1172/JCI117717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Standeven A. M., Beard R. L., Johnson A. T., Boehm M. F., Escobar M., Heyman R. A., Chandraratna R. A. Retinoid-induced hypertriglyceridemia in rats is mediated by retinoic acid receptors. Fundam Appl Toxicol. 1996 Oct;33(2):264–271. doi: 10.1006/faat.1996.0164. [DOI] [PubMed] [Google Scholar]
  50. Stocks J., Holdsworth G., Galton D. Hypertriglyceridaemia associated with an abnormal triglyceride-rich lipoprotein carrying excess apolipoprotein C-III-2. Lancet. 1979 Sep 29;2(8144):667–671. doi: 10.1016/s0140-6736(79)92068-3. [DOI] [PubMed] [Google Scholar]
  51. Vahlquist C., Michaëlsson G., Vahlquist A., Vessby B. A sequential comparison of etretinate (Tigason) and isotretinoin (Roaccutane) with special regard to their effects on serum lipoproteins. Br J Dermatol. 1985 Jan;112(1):69–76. doi: 10.1111/j.1365-2133.1985.tb02293.x. [DOI] [PubMed] [Google Scholar]
  52. Vahlquist C., Selinus I., Vessby B. Serum lipid changes during acitretin (etretin) treatment of psoriasis and palmo-plantar pustulosis. Acta Derm Venereol. 1988;68(4):300–305. [PubMed] [Google Scholar]
  53. Vu-Dac N., Schoonjans K., Kosykh V., Dallongeville J., Heyman R. A., Staels B., Auwerx J. Retinoids increase human apolipoprotein A-11 expression through activation of the retinoid X receptor but not the retinoic acid receptor. Mol Cell Biol. 1996 Jul;16(7):3350–3360. doi: 10.1128/mcb.16.7.3350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Wallnöfer A. E., van Griensven J. M., Schoemaker H. C., Cohen A. F., Lambert W., Kluft C., Meijer P., Kooistra T. Effect of isotretinoin on endogenous tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) in humans. Thromb Haemost. 1993 Dec 20;70(6):1005–1008. [PubMed] [Google Scholar]
  55. Zolfaghari R., Ross A. C. Effect of vitamin A deficiency and retinoic acid repletion on intestinal and hepatic apolipoprotein A-I mRNA levels of adult rats. J Lipid Res. 1994 Nov;35(11):1985–1992. [PubMed] [Google Scholar]
  56. de Silva H. V., Lauer S. J., Wang J., Simonet W. S., Weisgraber K. H., Mahley R. W., Taylor J. M. Overexpression of human apolipoprotein C-III in transgenic mice results in an accumulation of apolipoprotein B48 remnants that is corrected by excess apolipoprotein E. J Biol Chem. 1994 Jan 21;269(3):2324–2335. [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES