Neutral cholesterol ester hydrolase 1 (NCEH1), also known as KIAA1363 or arylacetamide deacetylase-like 1, is a key enzyme that suppresses lipid droplet formation by removing cholesterol from macrophage foam cells [1, 2]. In contrast, ablation of NCEH1 accelerates atherosclerosis by promoting the formation of macrophage foam cells [3, 4]. In addition to cholesterol uptake, the balance of free cholesterol (FC) and cholesterol ester (CE) is also critical for regulation of intracellular cholesterol content in macrophage foam cells. After internalization, lipoproteins are localized to late endosomes/lysosomes, where CE is hydrolyzed into FC by lysosomal acid lipase. To prevent FC release, FC is re-esterified on the endoplasmic reticulum by acetyl-CoA acetyltransferase 1 and stored in cytoplasmic lipid droplets. If this pathway is persistently activated, excessive CE will accumulate in macrophages, thereby resulting in the formation of foam cells. The resulting CE is hydrolyzed by NCEH1 to release FC for transporter-mediated efflux, which is increasingly recognized as the rate-limiting step in FC outflow [5, 6].
Macrophage-specific overexpression of NCEH1 leads to a significant reduction in atherosclerotic lesions in low-density lipoprotein receptor (LDLR)-/- mice because of enhanced FC efflux and reverse cholesterol transport [3]. NCEH1 is robustly expressed in macrophages and atherosclerotic lesions, and NCEH1 expression has been shown to be regulated by polyunsaturated fatty acids [7], pioglitazone [8], insulin [9], and interleukin (IL)–33 [10]. Moreover, NCEH1 transcripts are downregulated in cortical homogenates from peroxisome proliferator-activated receptor γ coactivator 1-α (PGC–1α)-knockout mice and increased by PGC–1 overexpression [11]. However, the specific mechanisms through which transcriptional regulators modulate NCEH1 expression are still unclear. Notably, two putative response elements for retinoic acid receptor-related orphan receptor α (RORα) are found at –1451/–1440 and 132/–121 regions upstream of the transcription start site (TSS) in the NCEH1 gene.
The RORα gene encodes a ligand-dependent orphan nuclear receptor that acts as a transcriptional regulator and has been identified as a novel anti-atherosclerosis target gene. RORα regulates target gene expression mainly by binding as monomers to promoter response elements, which typically consist of a consensus AGGTCA half-site preceded by an A/T-rich sequence (ROR response elements [ROREs]) [12]. RORα is constitutively active, meaning that the protein remains in an active conformation in the absence of ligand and that ligand binding can actually suppress receptor activity. Although endogenous ligands of RORα have not yet been fully elucidated, recent evidence suggests that oxygenated sterols may function as high-affinity ligands. Indeed, 7-oxygenated sterols (e.g., 7α-OHC, 7β-OHC, and 7-ketocholesterol), 24-hydroxycholesterol (24-OHC), and 25-hydroxycholesterol (25-OHC) function as inverse agonists for RORα [13, 14]. RORα-deficient mice harboring a natural deletion in the ligand-binding domain exhibit cerebellar ataxia, a phenotype also observed in Staggerer (sg/sg) mutant mice [15], which express mutated RORα and present with vascular dysfunction, dyslipidemia, excessive inflammation, immune abnormalities, and diet-induced atherosclerosis [16–18]. Recent studies have demonstrated decreases in serum and liver triglycerides and total and high-density lipoprotein serum cholesterol in sg/sg mice. These mice also exhibit decreased hepatic expression of sterol regulatory element-binding transcription factor 1 (SREBP–1c) and the reverse cholesterol transporters ABCA1 and ABCG1 [19]. Moreover, RORα positively regulates apolipoprotein A (APOA)-I and APOC-III, suggesting a role in lipid metabolism [20, 21]. The transcriptional activator steroid receptor coactivator–2 (SRC–2) functions as a coactivator with RORα to modulate the expression of glucose 6-phosphatase (G6Pase) [22] and phosphoenolpyruvate carboxykinase (PEPCK) [23] as essential gluconeogenesis genes, rate-limiting enzyme that controls glucose release into the plasma. Moreover, RORα deficiency and treatment with RORα inverse agonists inhibit PEPCK expression and glucose production in mice [24, 25]. Additionally, overexpression of Rev-Erbα, the physiological inhibitor of RORα, also suppresses the expression of gluconeogenesis genes in human liver cancer cell lines. Conversely, silencing of Rev-Erbα significantly induces the expression of gluconeogenesis-related genes [26–28].
In brain endothelial cells, claudin domain containing 1 (CLDND1), which is involved in tight junction formation, is regulated at the transcriptional level by RORα and at the post-transcriptional level by miR–124 [29, 30]. Moreover, decreased CLDND1 expression in the adult murine cerebellum results in cerebellar hemorrhage [31].
In macrophages, using the CRISPR-Cas9 system, RORA was deleted in human THP1 monocytic cells, and a dramatic increase was observed in basal expression of a subset of nuclear factor (NF)-κB-regulated anti-inflammatory genes, including tumor necrosis factor, IL–1β, and IL–6, both at the transcriptional and translational levels [32]. RORα is a negative regulator of the inflammatory response, functioning by NF-κB inhibition through IκB activation [33]. Moreover, NF-κB activation requires the removal of IκB from NF-κB by inducible proteolysis, which liberates this transcription factor for migration to the nucleus, where it binds to IκB-regulatory elements and induces transcription [34].
As described above, RORα is involved in many physiological processes, including regulation of metabolism, development, immunity, and the circadian rhythm. The recent characterization of endogenous ligands for these former orphan nuclear receptors has stimulated the development of synthetic ligands and provided insights into targeting these receptors to treat several diseases, including atherosclerosis, diabetes, autoimmunity, and cancer [14, 35, 36]. Nevertheless, the role of RORα in modulating NCEH1 promoter activity is not clear.
Accordingly, in this study, the role of RORα in modulating NCEH1 expression was evaluated. The results suggested that control of NCEH1 expression by synthetic ligands of RORα may facilitate the development of novel anti-arteriosclerosis drugs.