Increased apolipoprotein C3 drives cardiovascular risk in type 1 diabetes

• Published in: The Journal of clinical investigation Vol. 129; no. 10; pp. 4165 - 4179
• Main Authors: Kanter, Jenny E., Shao, Baohai, Kramer, Farah, Barnhart, Shelley, Shimizu-Albergine, Masami, Vaisar, Tomas, Graham, Mark J., Crooke, Rosanne M., Manuel, Clarence R., Haeusler, Rebecca A., Mar, Daniel, Bomsztyk, Karol, Hokanson, John E., Kinney, Gregory L., Snell-Bergeon, Janet K., Heinecke, Jay W., Bornfeldt, Karin E.
• Format: Journal Article
• Language: English
• Published: United States American Society for Clinical Investigation 01.10.2019
• Subjects: Animal models; Antisense oligonucleotides; Apolipoproteins; Arteriosclerosis; Atherosclerosis; Biomedical research; Blood lipids; Calcification (ectopic); Calcification (Physiology); Cardiovascular disease; Cardiovascular diseases; Coronary artery; Dapagliflozin; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Health risk assessment; Hyperglycemia; Insulin; Insulin resistance; Lipid metabolism; Lipoproteins; Macrophages; Physiological aspects; Risk factors; Scientific equipment industry; Serum levels; Triglycerides; Type 1 diabetes; United States; Metabolism; Atherosclerosis
• ISSN: 0021-9738; 1558-8238; 1558-8238
• DOI: 10.1172/JCI127308

Type 1 diabetes mellitus (T1DM) increases the risk of atherosclerotic cardiovascular disease (CVD) in humans by poorly understood mechanisms. Using mouse models of T1DM-accelerated atherosclerosis, we found that relative insulin deficiency rather than hyperglycemia elevated levels of apolipoprotein C3 (APOC3), an apolipoprotein that prevents clearance of triglyceride-rich lipoproteins (TRLs) and their remnants. We then showed that serum APOC3 levels predict incident CVD events in subjects with T1DM in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. To explore underlying mechanisms, we investigated the impact of Apoc3 antisense oligonucleotides (ASOs) on lipoprotein metabolism and atherosclerosis in a mouse model of T1DM. Apoc3 ASO treatment abolished the increased hepatic Apoc3 expression in diabetic mice - resulting in lower levels of TRLs - without improving glycemic control. APOC3 suppression also prevented arterial accumulation of APOC3-containing lipoprotein particles, macrophage foam cell formation, and the accelerated atherosclerosis in diabetic mice. Our observations demonstrate that relative insulin deficiency increases APOC3 and that this results in elevated levels of TRLs and accelerated atherosclerosis in a mouse model of T1DM. Because serum levels of APOC3 predicted incident CVD events in the CACTI study, inhibiting APOC3 might reduce CVD risk in T1DM patients.