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Animal Models |
From the R. W. Johnson Pharmaceutical Research Institute, San Diego, California
| Abstract |
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| Introduction |
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The relationship between Tangier disease (TD), familial HDL deficiency (FHA), and mutation in the human ABCA1 gene has recently been established by positional cloning of hABCA1 from families of TD or FHA patients.11-15 In each case, point mutations, deletions, or frameshifts create a nonfunctional or truncated hABCA1 protein. Individuals suffer from reduced or absent high-density lipoprotein cholesterol (HDL-C) and lower serum cholesterol; accumulate cholesteryl esters in tonsils, spleen, thymus, and liver; and may exhibit corneal clouding and peripheral neuropathy due to deposition of cholesteryl esters.16 Fibroblasts from TD patients have a markedly reduced HDL-mediated efflux of cholesterol.17,18 Enhanced catabolism of HDL and its precursors in vivo has also been reported in TD patients.19 In other cholesterol metabolic diseases such as Apo A-I deficiency, lecithin-cholesterol acyltransferase deficiency, and Fish Eye disease, HDL-C is also reduced, but serum cholesterol levels remain normal.16 Low levels of HDL-C usually indicate a high risk factor for coronary heart disease. Interestingly, the loss of HDL-C in TD patients causes only a minor predisposition to coronary heart disease.20
Tangier disease is exceedingly rare, with only 40 reported families worldwide exhibiting the trait. As such, except for the absence of HDL-C, it is difficult to evaluate which symptoms may be directly attributed to a dysfunctional ABCA1 transporter. Our murine model of Tangier disease, which is described here, confirms the association of ABCA1 with TD and exhibits other phenotypes that have not yet been described in humans.
| Materials and Methods |
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Mouse ABCA1 genomic clones were isolated from a 129/Ola
mouse genomic library. The mouse ABCA1 gene contains 48
exons (GenBank X75926).2
An 8.5-kb mouse DNA fragment
containing exons 1822 of the mouse ABCA1 gene was used to
prepare the knockout construct (Figure 1A)
. A cassette containing a neomycin
resistance gene driven by a strong herpes simplex
virus-thymidine kinase promoter and a polyadenylation signal was
used to replace a 1.9-kb DNA region, which contains exons 19 and 20 and
part of exon 21 of the gene. The neomycin resistance gene cassette
serves as a selectable marker and truncates the transcript of the
targeted gene. The deleted exons encode most of the first ATP binding
cassette of the ABCA1 protein. A herpes simplex virus-thymidine
kinase cassette was placed at the 3' end of the knockout construct. The
DNA construct was introduced into E14 embryonic stem cells by
electroporation. Cells were cultured in the presence of 400 µg/ml
G418 and 0.2 µM gancyclovir. Embryonic stem cells with the disrupted
gene were detected by polymerase chain reaction (PCR) and then
confirmed by Southern hybridization, using a DNA probe flanking the 3'
end of the construct. Chimeric mice were generated from embryos
injected with embryonic stem cells. Germline mice were obtained from
breeding of chimeric male mice with C57BL/6J females.
ABCA1+/- mice were crossbred to obtain mice homozygous for
the disrupted ABCA1 gene, and the lines were maintained with
brother/sister crossings. Mice were maintained with Purina Formulab
5008 chow and water ad libitum.
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Three oligonucleotides were used in PCR amplification to detect both the endogenous and altered ABCA1 genes simultaneously. The sense primers ABC3057 (5'-GAGCACATCTGGTTCTATGC-3'), located in exon 20, and Neo1455 (5'-CGCTTCCTCGTGCTTTACGGTAT-3') are specific for the endogenous and altered ABCA1 genes, respectively. Primer ABC210R (5'-AAGACACGGTGCTGCTACTGTT-3') lies downstream of the knockout region in exon 22. PCR amplification results in a 1.3-kb band from the wild-type gene and a 1.0-kb band from the knockout gene. PCR amplification was carried out as follows: 94°C 1 minute, 54°C 1 minute, 72°C 2 minutes for two cycles; 94°C 15 seconds, 54°C 40 seconds, 72°C 1 minute 30 seconds for 40 cycles followed by a 5-minute elongation period at 72°C. Southern blot analysis was carried out by digestion of genomic DNA with EcoRI. Digested DNA was then run on a 1% agarose gel and vacuum-blotted according to manufacturers instructions (BioRad, Hercules, CA). Southern blots were then hybridized to a probe that lies 3' to the region covered by the knockout construct. The probe hybridizes to a 2.2-kb band from EcoRI-digested ABCA1 gene and to a 2.6-kb band from a knockout ABCA1 gene. Northern Blot analysis was carried out by extracting total RNA from thioglycolate-treated macrophages derived from the peritoneum of wild-type or ABCA1-/- mice. Total RNA was run on a denaturing formaldehyde gel and blotted overnight with standard methods. Northern Blots were then hybridized to a probe named LM243, which covers ABCA1 exons 2631. Total RNA from gestation day 16 placenta derived from wild-type or ABCA1-/- mice was extracted and reverse transcribed to cDNA with standard methods. Primers ABC2370 (5'-CTGTGCGTAGCCTGGCAGGACTAT-3') and ABC2826R (5'-CAACCTTCATGCCATCTCGGTAA-3') or ABC3057 and ABC210R (see above) were used in PCR to amplify exons 1518 (456 bp) and exons 2022 (455 bp), respectively, of the ABCA1 cDNA. PCR amplification was carried out as follows: 94°C 1 minute, 57°C 2 minutes, 72°C 2 minutes for two cycles; 94°C 45 seconds, 62°C 45 seconds, 72°C 2 minutes for 40 cycles followed by a 10-minute elongation period at 72°C.
Lipid and Steroid Hormone Analysis
Cholesterol and HDL-C from six mice of each genotype were directly measured by standard enzymatic means on an Olympus AU5200 multichannel analyzer. Tissues taken for lipid analysis were frozen in OCT, cut, stained with Oil Red O, and counterstained with hematoxylin (San Diego Pathology Laboratory). Tissues taken for birefringence analysis of free cholesterol crystals were frozen in OCT, cut, and immediately viewed at 25°C with a pair of polarizing lenses purchased from Fisher (no. 12-572PA).
Tissues taken for cholesteryl ester staining by the perchloric acid-naphthoquinone (PAN) method were frozen in OCT, freshly cut, and fixed in formol-calcium (3.7% formaldehyde and 1% CaCl2) for 1 minute and allowed to air dry. Slides were treated with 1% FeCl3 for 4 hours, washed with distilled water, then painted with freshly made PAN reagent (1 mg/ml 1:2 naphthoquinone-4-sulfonic acid, 50% ethanol, 15% perchloric acid, 1% formaldehyde), using a camel hair brush. Slides were then heated on a surface at 70°C for 12 minutes until the color developed, with occasional replenishment of the PAN reagent. Tissues were then mounted with a drop of perchloric acid, coverslipped, and immediately photographed.
Tissues taken for free cholesterol staining using the digitonin-PAN method were cut, fixed, and dried as described above. Free cholesterol was precipitated in tissues with 0.5% digitonin in 40% ethanol for 2 hours. Cholesterol esters were then extracted by incubation with acetone for 1 hour at room temperature. Slides were then treated with FeCl3 and PAN as described above.
Progesterone was analyzed by a standard chemiluminescence assay and estrogen by a standard extraction radioimmune assay. All clinical chemistry assays were performed at Quest Diagnostics (San Diego, CA).
Tail-Flick and Hot-Plate Test
Ten ABCA1+/+ and 11 ABCA1-/- mice were tested for peripheral neuropathy by standardized methods.21,22 The tail-flick test consisted of immersion of the tail in a 55°C water bath, and latency to a rapid tail flick was measured. Withdrawal of the tail from the water terminated the test with a maximum cut-off time of 10 seconds. The hot-plate test consisted of placing the mouse on a surface heated to 53°C. Stamping of the hind feet, washing of the front paws, or jumping from the heat source terminated the test with a maximum cut-off time of 30 seconds.
In Situ Hybridization
Placenta from gestation day 14 pregnancies was fixed in buffered formalin and paraffin embedded. In situ hybridization was performed with 35S-riboprobes on this tissue with an adapted protocol.23 The tissue was then put on x-ray film for 6 days, after which the tissue was dipped in NBT2 nuclear emulsion (Kodak) and kept desiccated in the dark at 4°C for 22 days. Slides were developed, stained with hematoxylin and eosin (H&E), and studied under the microscope to observe the distribution of ABCA1 mRNA detected by the LM243 cRNA probe.
RNA Probes
[35S]UTP-labeled antisense and sense probes for LM243 were synthesized after linearization with EcoRI or HindIII, using T7 or T3 RNA polymerase, respectively. The labeled sense strands served as controls and did not show any specific labeling of cellular localization (data not shown). Each slide received 100 µl of hybridization mixture, containing the [35S]UTP-labeled probe (107 cpm/ml). All restriction enzymes and phage RNA polymerases were obtained from Boehringer Mannheim (Indianapolis, IN).
Tissue Fixation and Staining
Tissue was either fixed in buffered formalin, paraffin embedded, and stained with hematoxylin and eosin or quick frozen in OCT and fixed with acetone at -20°C. Frozen tissue sections were processed and stained using VectaStain (catalog no. PK-6100) according to manufacturers instructions (Vector Labs, Burlingame, CA). Rat anti-CD71 (catalog no. 015191D; Pharmingen, San Diego, CA) was used at a concentration of 5 µg/ml, sheep anti-mouse immunoglobulin (catalog no. 1092 618; Boehringer Mannheim) at a concentration of 0.5 µg/ml, and goat anti-mouse C3 (catalog no. 55444; ICN, Aurora, OH) at a dilution of 1:500. Biotinylated rabbit anti-rat IgG (catalog no. BA-4001), biotinylated rabbit anti-sheep IgG (catalog no. BA-6000), and biotinylated rabbit anti-goat IgG (catalog no. BA-5000) were used at a dilution of 1:200 (Vector Labs). Frozen sections were stained with 3-amino-9-ethylcarbazole, counterstained with hematoxylin, and mounted.
| Results |
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Gene targeting technology was used to disrupt the ABCA1
gene. Most of the N-terminal ATP binding cassette of the
ABCA1 gene was replaced with the neomycin resistance gene
cassette (Figure 1A)
. The neomycin resistance cassette harbors stop
codons in all three reading frames at the 5' end, blocking translation
of the ABCA1 protein 3' to the insertion. Two separate lines of mice
capable of germline transmission were generated from two independent
embryonic stem cell clones with the disrupted ABCA1 gene
(55.2 and 64.7). Southern blot and PCR analysis identified the
functional and disrupted ABCA1 alleles, confirming the
mutation (Figure 1, B and C)
. The ABCA1 mRNA 3' to the
disruption is not detectable in ABCA1-/- animals, as
demonstrated in Northern blot analysis of RNA extracted from
ABCA1-/- macrophages (Figure 1D)
.
Using primers either upstream or downstream of the site of disruption,
reverse transcription-PCR was performed to investigate the possibility
of truncated ABCA1 mRNA being expressed in
ABCA1-/- mice. Total RNA was extracted from placenta
derived from either ABCA1-/- or wild-type animals and was
reverse transcribed by standard methods. PCR primers that amplify exons
1518, which are directly upstream of the disrupted region, clearly
indicate that this portion of the ABCA1 transcript is
present in both wild-type and homozygous animals. PCR primers that
amplify exons 2022, however, fail to amplify the ABCA1
transcript in homozygous animals (Figure 1E)
. These results suggest
that RNA transcribed from the disrupted ABCA1 gene is
truncated at the site of the neomycin resistance cassette insertion.
HDL Loss and Lipid Deposition Is the Direct Result of ABCA1 Dysfunction
The primary hallmark of Tangier disease is the lack of HDL-C,
lowered serum cholesterol, and deposition of cholesteryl esters in
various tissues. TD is inherited in an autosomal recessive fashion,
though the HDL-C and cholesterol levels found in heterozygotes are half
the normal values.11,13,14
The more common disease, FHA,
is inherited as an autosomal dominant trait characterized by a low
HDL-C phenotype, but without the clinical manifestation of TD. Four FHA
familial cohorts have been found bearing mutations in the
ABCA1 gene.12,15
As in TD patients, HDL-C
levels in both lines of ABCA1-/- mice are minimal, while
in heterozygous mice HDL-C levels are roughly one-half of the levels
found in normal mice (Table 1
, paired
t-test, P < 0.002). Cholesterol levels are
also significantly reduced in a similar manner (paired
t-test, P < 0.008).
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Another characteristic of Tangier disease is peripheral neuropathy. We used the tail-flick test and hot-plate test to determine whether the peripheral nervous system of ABCA1-/- mice was affected by any lipid deposition that we had failed to observe.21,22 No significant difference was found in the withdrawal of either the tail or paws of ABCA1-/- mice from the heat source when compared to wild-type mice (data not shown). These results suggest that a peripheral sensory neuropathy is not present in our ABCA1-/- model.
Nonproductive Mating and Neonatal Death Are Prevalent in ABCA1-/- Mice
Only 8.4% of the offspring from crosses of ABCA1+/-
mice are ABCA1-/- mice compared to the expected Mendelian
rate of 25% (Table 2
,
2
test, P < 0.0005).
In heterozygote/homozygote crosses, only 28% of the pups are
ABCA1-/- mice, as opposed to the expected Mendelian rate
of 50% (
2
test, P < 0.0005).
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2
test, P < 0.0005). No
fertility problems were observed with male ABCA1-/- mice.
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The marked loss of neonates shortly after birth and the biased
Mendelian ratios led to an examination of fetal development.
ABCA1 mRNA expression in murine placenta was studied using
in situ hybridization. In normal mice, prominent
ABCA1 mRNA expression is clearly seen in the lining of
decidual maternal blood vessels and is present throughout the
labyrinthine trophoblast layer (Figure 4, A and B)
. In contrast, ABCA1 mRNA was observed only in the
deciduae of an ABCA1-/- placenta taken from an
ABCA1+/- female.
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Thus loss of functional ABCA1 consequently results in a severe developmental defect of the placenta, leading to intrauterine growth retardation and neonatal death, and markedly reduces female ability to bear young.
Lipid and Steroid Hormone Levels Are Significantly Altered in ABCA1-/- Mice
The low level of HDL-C and serum cholesterol, combined with
morphological defects in the placenta, led to the speculation that
steroidogenesis was altered in ABCA1-/- mice.
Steroidogenic tissues were examined for the presence of cholesterol,
which is required for the biosynthesis of steroids. The adrenal glands
and ovaries of ABCA1+/+ and ABCA1-/- females
were analyzed for lipid content (including cholesteryl esters) by Oil
Red O staining. Lipid is clearly seen in the adrenal cortex of
ABCA1+/+ females, most particularly in the layers that
synthesize glucocorticoids (Figure 6A)
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In the ovaries, lipid was found in the cells surrounding the developing
follicles and in the corpus luteum of ABCA1+/+ females,
regions in which estrogen and progesterone, respectively, are
synthesized (Figure 6B)
. Lipid is distinctly absent from
ABCA1-/- female adrenal glands and is vastly reduced in
the ovaries, most notably in the corpus luteum. ABCA1+/+ and
ABCA1-/- placentas were also examined with Oil Red O.
Neither the ABCA1+/+ nor the ABCA1-/- placentas
stained for the presence of lipid (data not shown).
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The distinct alterations of lipid content in both adrenal glands and
ovaries in ABCA1-/- females suggest a possible change in
steroidogenesis in ABCA1-/- mice. Progesterone and
estrogen are of particular interest, as both are required and very
tightly regulated during pregnancy.24, 25
Serum was taken
from ABCA1+/+ and ABCA1-/- females at gestation
day 16 for hormonal analysis. Progesterone and estrogen levels are 53%
and 62.8% lower than normal, respectively, in ABCA1-/-
females compared to ABCA1+/+ females (Table 6
, paired t-test,
P < 0.02 and P < 0.01, respectively).
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Loss of ABCA1 Results in Immune Complex Deposition in Kidney Glomeruli and Congestive Heart Failure
ABCA1-/- mice that survive to be weaned appear to
develop normally and mature into apparently healthy adults. Between 4
and 6 months of age the ABCA1-/- mice of both lines begin
to develop respiratory distress and shed granular casts into their
urine. ABCA1+/- females at 1 year of age also exhibit
similar distress. Necropsy examination of all distressed animals
reveals lungs heavily filled with blood and cardiomegaly with dilated
and hypertrophied left and right ventricles. There is occasional
evidence of vasculitis around the cardiac vessels. The kidneys are pale
tan in color. Microscopic examination reveals boxcar nuclei in the
heart consistent with cardiac hypertrophy with frank pulmonary
hemorrhages, as well as severe congestion of the lungs, liver, and
spleen and scarred kidney glomeruli. The glomeruli show evidence of
inflammatory infiltrates, thickened and "split" glomerular basement
membranes, and proliferation of mesangial cells (Figure 7A)
. Immunohistochemistry confirms the
deposition of both immunoglobulin and C3 complement components in the
glomeruli characteristic of membranoproliferative
glomerulonephritis type I (Figure 7B)
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| Conclusion |
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After submission of this manuscript for publication, another murine model of Tangier disease was described by Orso et al.26 Consistent with our model, a marked loss of HDL-C and serum cholesterol was observed. Decreased body weight and platelet aggregation, hemorrhagic diathesis, fat-soluble vitamin deficiency, and an increase in cholesterol birefringence in the adrenal glands were also noted by Orso et al. We have not observed any decrease in body weight or platelet aggregation in our TD model. We have also observed a distinct lack of cholesterol and cholesteryl esters in the adrenal glands of our TD model, in contrast to the model described by Orso et al, and verified our results by Oil Red O staining, birefringence, and the PAN method. The variation between these models may be attributable to the C57BL/6 genetic background of our model versus the DBA/1 genetic background of the model described by Orso et al. Dietary differences may also have contributed to these variations. A comparison between the Formulab 5008 diet used by our facility and the Altromin 1324 standard feed used by Orso et al reveals that the Formulab diet to be richer in fat and protein and supplemented with multiple fat-soluble vitamins, A, D, E, and K1. The richer diet fed to our murine model may have prevented some of the phenotypes noted by Orso et al. Further study directly comparing the two diets may be warranted.
Human TD has not previously been described as causing developmental problems or defective morphogenesis of the placenta. This may be due to differing physiologies because, unlike humans, mice have low LDL and high HDL and apparently have a limited ability to compensate for the loss of HDL.27, 28 High-level expression of ABCA1 mRNA in the placenta has been noted in humans.10 We have shown here for the first time that ABCA1 mRNA expression in placenta is specific to the labyrinthine trophoblast layer. It is not surprising, then, to discover in the murine model of TD that major structural defects exist in the placenta.
Alterations in cholesterol metabolism due to ABCA1 loss may directly affect the normal production of steroids. In the ApoAI knockout mouse, HDL-C levels are extremely low, and staining with Oil Red O demonstrated a distinct lack of lipid in the adrenal glands and ovaries, suggesting reduced cholesteryl ester storage.27, 28 Adrenal stress response was blunted in ApoAI knockout animals as determined by cold water swimming or the administration of ACTH. The SR-BI (scavenger receptor-class BI) knockout mouse also lacks lipid in the adrenal glands and ovaries, as determined by Oil Red O stain.29, 30 The primary pathway by which steroidogenic cells acquire cholesterol is apparently by the uptake of HDL.31, 32 Our analysis of the adrenal glands and ovaries of ABCA1-/- mice indicates a phenotype very similar to that of the ApoAI and SR-BI knockout models and suggests that the marked reduction of pregnancies in ABCA1-/- females may be attributed to altered steroidogenesis. In addition, we have provided evidence demonstrating a distinct reduction of progesterone and estrogen levels in pregnant ABCA1-/- females, supporting the hypothesis that impaired steroidogenesis results in malformation of the placenta.
The overload of the reticuloendothelium system with cholesteryl esters is the basic cause of disease in human TD. Tissues that have a high rate of cell turnover should therefore contain lipid-overloaded macrophages because of an equally high rate of phagocytosis. Hence the phagocytotic cells of the testes and thymus are prime candidates for lipid overload. The lipid-laden Sertoli cells and thymic macrophages of ABCA1-/- mice suggest that this is true in murine TD. Previous research with murine macrophages indicates a possible dysfunction in phagocytosis associated with lack of ABCA1 function.33 We postulate that lipid overload of ABCA1-/- macrophages may prevent normal phagocytosis of immune complexes. Alternatively, evidence exists that the major component of HDL, ApoAI, associates with clusterin, a complement lysis inhibitor.34 The severe alteration of HDL-C in ABCA1-/- mice may in turn affect the normal formation of immune complexes and result in a similar phenotype. Indeed, several complement deficiency diseases eventually manifest with glomerulonephritis.35 Failure to phagocytose immune complexes or to activate complement would result in a build-up of immune complexes in the blood of ABCA1-/- mice. Immune complexes are clearly present in the kidney glomeruli of ABCA1-/- mice, as are inflammatory infiltrates, classic hallmarks of glomerulonephritis. The dilated cardiomyopathy may result from a failure of the normal renal homeostatic mechanisms that control blood pressure due to the heavy scarring of the kidney glomeruli. However, the presence of vasculitis in the vessels of the heart suggests that the loss of ABCA1 function may lead to a general dysregulation of immune complex formation and/or clearance, resulting in immune complex deposition in multiple organs.
The murine model of Tangier disease demonstrates that loss of ABCA1 function may be more detrimental than previously suspected. The marked female inability to bear young, impaired steroidogenesis, and placental malformation may indicate severe developmental consequences in humans if normal ABCA1 function is affected. The renal failure due to immune complex deposition in homozygous animals may also indicate a previously unsuspected risk factor among patients with FHA or TD. Further study of the ABCA1-/- mouse model will allow better dissection of lipid metabolism and its connection with early development and the immune system.
| Acknowledgements |
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| Footnotes |
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Dr. Volands current address: Department of Immunopathology, BD PharMingen, San Diego, CA 92121.
Accepted for publication May 19, 2000.
| References |
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