Cannabinoid type 1 receptor inverse agonism attenuates dyslipidemia and atherosclerosis in APOE*3-Leiden.CETP mice

Pharmacological blockade of the cannabinoid type 1 receptor, a G protein-coupled receptor expressed in the central nervous system and various peripheral tissues, reverses diet-induced obesity and dyslipidemia through the reduction of food intake and altered nutrient partitioning. This strategy is being explored for a number of therapeutic applications; however, its potency for the treatment of atherosclerotic cardiovascular disease via improvements in lipid metabolism remains unclear. Therefore, here, we aimed to investigate whether inhibition of the endocannabinoid system can attenuate atherosclerosis development through improvement of dyslipidemia. Lean, dyslipidemic female APOE∗3-Leiden.CETP transgenic mice were fed a Western-type diet supplemented with or without the cannabinoid type 1 receptor inverse agonist rimonabant (20 mg kg body weight 1 day 1) for up to 20 weeks. Plasma lipids and bile acids were determined, and atherosclerotic lesions were scored in the aortic valve region. Rimonabant lowered plasma levels of triglyceride (TG) ( 56%) and non- HDL-C ( 19%) and increased HDL-C ( 57%). These effects were explained by decreased VLDL-TG production ( 52%) and accelerated VLDL-TG turnover accompanied by pronounced browning of white adipose tissue. In addition, rimonabant attenuated reverse cholesterol transport ( 30%), increased plasma bile acid levels ( 160%), and increased hepatic cholesterol accumulation ( 88%). Importantly, rimonabant markedly lowered atherosclerotic lesion size ( 64%), which coincided with decreased lesion severity (28% vs. 56% severe lesions) and which strongly correlated with non-HDLC exposure (R2 0.60). Taken together, inhibition of the endocannabinoid system potently reverses dyslipidemia and prevents atherogenesis, even in the absence of obesity.