Abstract
Although the function of liver fatty acid binding protein in hepatic fatty acid metabolism has been extensively studied, its potential role in hepatic cholesterol homeostasis is less clear. Although hepatic cholesterol accumulation was initially reported in L-FABP-null female mice, that study was performed with early N2 backcross generation mice. To resolve whether the hepatic cholesterol phenotype in these L-FABP−/− mice was attributable to genetic inhomogeneity, these L-FABP−/− mice were further backcrossed to C57Bl/6 mice up to the N10 (99.9% homogeneity) generation. Hepatic total cholesterol accumulation was observed in female, but not male, L-FABP−/− mice at all (N2, N4, N6, N10) backcross generations examined. The greater total cholesterol was due to increased hepatic levels of both unesterified (free) cholesterol and esterified cholesterol. Altered hepatic cholesterol accumulation correlated directly with L-FABP's ability to bind cholesterol with high affinity as shown by direct L-FABP binding of fluorescent cholesterol analogs (NBD-cholesterol, dansyl-cholesterol), a photoactivatable cholesterol analog [free cholesterol benzophenone (FCBP)], and free cholesterol (circular dichroism, isothermal titration microcalorimetry). One mole of fluorescent sterol was bound per mole of L-FABP. This was confirmed by photo-cross-linking studies with the photoactivatable cholesterol analog FCBP and by isothermal titration calorimetry with free cholesterol, which showed that L-FABP bound only one sterol molecule per L-FABP molecule. In contrast, the hepatic phenotype of male, but not female, L-FABP−/− mice was characterized by decreased hepatic triacylglycerol levels at all backcross generations examined. Taken together, these data support the hypothesis that L-FABP plays a role in physiological regulation of not only hepatic fatty acid metabolism, but also that of hepatic cholesterol.
Keywords: mouse, gene ablation, triacylglycerol
increased expression of liver fatty acid binding protein (L-FABP) is associated with insulin-dependent diabetes and gestational diabetes in humans, streptozotocin-induced diabetes and obesity in rats, and Type 1 diabetes in mice (23, 46, 51, 63). Human genetic variants in L-FABP exhibit elevated fasting serum cholesterol and triacylglycerol-traits associated with increased risk of cardiovascular disease, Type 2 diabetes, and the metabolic syndrome (14, 28, 86). This phenotype is exacerbated by treatment with fenofibrate, a peroxisome proliferator-activated receptor (PPAR) α ligand (14). L-FABP directly interacts with PPARα to influence transcriptional activity (reviewed in Refs. 37, 95). Genetic variants PPARα L162V and L-FABP T94A together elicit synergistic effects on the basal metabolic index in humans, suggesting that the L-FABP T94A missense mutation, for example, could influence obesity indexes as well as the risk to exhibit residual hypertriglycerolemia following a lipid-lowering therapy with fenofibrate (14). Taken together, these human genetic variants of L-FABP suggest that expression of L-FABP may affect both fatty acid and cholesterol metabolism. This possibility is supported by studies in vitro, with transformed cells overexpressing L-FABP, and in rodents.
With regard to fatty acid metabolism, L-FABP overexpression enhances fatty acid uptake, intracellular transport, esterification, and oxidation in transfected transformed cells (e.g., L-cells, hepatoma cells) (reviewed in Refs. 7, 8, 61, 65, 66, 79). Conversely, studies with L-FABP gene-ablated mice (as well as liver homogenates and primary hepatocytes therefrom) show that loss of L-FABP decreases fatty acid uptake, intracellular transport, esterification, and oxidation (3, 4, 24, 56, 72).
Although L-FABP facilitates cholesterol transport and metabolism in vitro as well as in transformed cells overexpressing L-FABP, studies with gene targeted mice have been more complex. For example, L-FABP facilitates cholesterol transfer from purified plasma membranes to purified endoplasmic reticulum (31, 32, 88) and stimulates microsomal acyl CoA:cholesterol acyl transferase to form cholesterol esters in vitro (reviewed in Refs. 15, 45, 68, 94). Furthermore, L-FABP overexpression enhances cholesterol uptake, redistributes cholesterol from the exofacial to cytofacial leaflet of the plasma membrane, enhances cholesterol transfer and distribution from the plasma membrane to the endoplasmic reticulum for esterification, and increases cholesterol ester mass in L-cell fibroblasts (reviewed in Refs. 44, 45). Interestingly, in polarized cells (liver) upregulation of L-FABP in response to sterol carrier protein (SCP)-x/SCP-2 gene ablation results in decreased hepatic cholesterol ester accumulation due to hypersecretion of cholesterol into bile (33, 97). Although the latter findings suggest a role for L-FABP in hepatic cholesterol accumulation and biliary cholesterol excretion, this phenotype is complicated by the complexity of the SCP-x/SCP-2-null mouse wherein levels of not only L-FABP, but two other proteins (SCP-x, SCP-2) known to be involved in cholesterol metabolism are altered. For example, SCP-x is a peroxisomal ketoacyl CoA thiolase with unique substrate specificity for oxidizing the branched side chain of cholesterol, a key step required for bile acid synthesis and secretion of bile acids and cholesterol into bile (reviewed in Refs. 2, 34). In addition, although itself not an enzyme, SCP-2 enhances the activity of cholesterol-7α-hydroxylase in vitro and SCP-2 overexpression stimulates bile acid synthesis in primary rat hepatocytes (47, 82). Although SCP-2 overexpression enhances hepatic cholesterol accumulation and biliary cholesterol excretion in rodents (1, 105), SCP-2 antisense treatment inhibits biliary cholesterol excretion in mice (1, 80, 105).
To begin to resolve the individual role(s) of L-FABP in hepatic cholesterol metabolism, the L-FABP gene was ablated in mice. On the basis of the above studies with SCP-x/SCP-2-null mice wherein L-FABP was upregulated and hepatic cholesterol ester level decreased (33, 97), it was expected that absence of L-FABP would increase hepatic cholesterol accumulation. Indeed, increased hepatic cholesterol was first reported in early N2 generation L-FABP-null female mice (56). In contrast, N10 backcross generation L-FABP-null mice independently generated by others did not display this phenotype, suggesting that perhaps differences in genotype homogeneity accounted for the apparent contradiction (71). It remains to be shown whether this is the case.
Finally, there is some question as to whether L-FABP may affect cholesterol uptake and metabolism by directly binding cholesterol. X-ray, NMR, and fluorescence studies reveal that L-FABP has a large interior cavity capable of binding two long-chain fatty acids or fatty acyl CoAs with high-affinity (29, 74, 84, 85). Although L-FABP's direct interaction with bile acids (oxidized cholesterol derivatives) indicates that the L-FABP ligand binding cavity is sufficiently large to accommodate the cyclopentanophenanthrene nucleus of cholesterol (101), it remains to be shown whether L-FABP binds cholesterol with high affinity. Unfortunately, the low aqueous solubility of cholesterol and resultant competition between cholesterol micelles (or cholesterol containing membranes) and L-FABP for binding cholesterol has complicated most direct binding measurements such that relatively weak binding affinities have been observed for binding assays utilizing radiolabeled cholesterol (Kd = 0.3–0.7 μM) (87, 90) or weakly fluorescent sterols such as dehydroergosterol and cholestatrienol (Kd = 0.5–0.9 μM) (27, 91). Thus high-affinity cholesterol binding to L-FABP remains to be demonstrated.
These issues were addressed herein by determining 1) the hepatic lipid composition of L-FABP-null mice after backcrossing from the N2 generation up to the N10 (99.9% homogeneity) generation; 2) direct, high-affinity binding of fluorescent cholesterol analogs [22-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-23,24-bisnor-5-cholen-3β-ol (NBD-cholesterol) and dansyl-cholesterol] to L-FABP; 3) binding and cross-linking of a photoactivatable cholesterol analog to L-FABP by mass spectrometry (MS); 4) secondary structure of L-FABP in the presence of cholesterol utilizing circular dichroism spectroscopy; and 5) the thermodynamic binding parameters of cholesterol to L-FABP by isothermal titration calorimetry.
EXPERIMENTAL PROCEDURES
Materials.
Protease activity in liver homogenates was inhibited with a cocktail for mammalian tissues purchased from Sigma-Aldrich (St. Louis, MO). Protein content was determined by use of the Protein Assay Dye Reagent Concentrate from Bio-Rad Laboratories (Richmond, CA). Silica gel G thin-layer chromatography plates were from Analtech (Newark, DE), whereas standards for cholesterol, cholesterol ester, phospholipid, and fatty acids were from Nu-Chek Prep (Elysian, MN) or Sigma Chemical (St. Louis, MO). NBD-cholesterol was obtained from Molecular Probes (Eugene, OR). 6-Dansyl-cholestanol was synthesized as described earlier (Huang H, McIntosh AL, Atshaves BP, Kier AB, Schroeder F, unpublished observations). Free cholesterol benzophenone (FCBP) was generously provided by Dr. Thomas A. Spencer (Department of Chemistry, Dartmouth College, Hanover, NH). Custom synthesis of radiolabeled (3H at position C-3) free cholesterol benzophenone (3H-FCBP) was performed by Moravek Biochemicals (Brea, CA). Cholesterol (> 98% pure) was obtained from Avanti Polar Lipids (Alabaster, AL), and 2-hydroxypropyl-β-cyclodextrin (HPCD) was purchased from Sigma-Aldrich (St. Louis, MO). Rabbit polyclonal antiserum against recombinant rat L-FABP was produced as described (6). All reagents and solvents used were of the highest available grade.
Animals.
The experimental protocols for the use of laboratory animals were approved by the University Lab Animal Care Committee and met American Association for Accreditation of Laboratory Animal Care guidelines. N2 generation L-FABP−/− C57Bl/6 mice, obtained as previously documented (56), were further backcrossed to C57Bl/6 mice from Charles River Laboratories (Wilmington, MA) obtained through the National Cancer Institute (Frederick Cancer Research and Development Center, Frederick, MD) to obtain the N4 (94% homogeneity), N6 (98% homogeneity), and N10 (99.9% homogeneity) backcross generations. Sex- and age- (≥8 mo) matched wild-type littermates of the same generation were used as controls. L-FABP expression was monitored as described earlier (56). Mice were allowed free access to low-fat (5% of calories from fat) standard rodent chow (Teklad Rodent Diet W8604) from Harlan Teklad (Madison, WI). The mice were housed in a temperature-controlled (25°C) facility on a 12-h light-dark cycle. Prior to euthanasia, mice were fasted for 12 h and euthanized by cervical dislocation. The livers were removed, divided into small portions, flash-frozen with dry ice, and stored at −80°C for subsequent analysis.
Lipid analysis.
Mouse liver was homogenized, followed by lipid extraction, resolution into individual lipid classes, and quantification as described earlier (5, 56). Protein was quantified by the Bradford protein assay (Bio-Rad Laboratories) (13). Commercially available kits were used according to the manufacturer's protocols to quantify serum lipids: total cholesterol, Wako no. 439-17501; free cholesterol, Wako no. 435-35801; nonesterified fatty acid, Wako no. 999-34691/991-34891; phospholipid, Wako no. 433-36201; triacylglycerol, Wako no. 461-08992/461-09092 (Wako Diagnostics, Richmond, VA).
Protein purification.
To perform cholesterol-binding assays, recombinant L-FABP and SCP-2 (used as a positive control) were isolated and purified as described earlier (15, 57). Purity of L-FABP and SCP-2 was determined by SDS-PAGE, followed by silver-staining, and correct molecular mass was confirmed by matrix-assisted laser desorption time-of-flight (MALDI-TOF) mass spectrometry and by electrospray ionization (ESI) mass spectrometry (Laboratory for Biological Mass Spectrometry, Department of Chemistry, Texas A&M University) as described (15, 57). The concentration of L-FABP and SCP-2 stock solutions was determined by amino acid analysis (Protein Chemistry Laboratory, Department of Biochemistry and Biophysics, Texas A&M University) as described earlier (29, 57).
NBD-cholesterol and dansyl-cholesterol binding.
The binding constants of NBD-cholesterol to L-FABP and SCP-2 were obtained by titrating a 2-ml sample of L-FABP (50 nM) or SCP-2 (50 nM) in PBS (pH 7.4) with small increments of NBD-cholesterol as described earlier (9, 57, 93, 98). Fluorescence intensities were corrected for signals from NBD-cholesterol and proteins in buffer. The binding curves were constructed by plotting NBD-cholesterol fluorescence intensity increase (F − F0) vs. ligand concentration ([NBD-cholesterol]; brackets denote concentration), with F being fluorescence intensity of NBD-cholesterol in the presence of proteins, and F0 being NBD-cholesterol fluorescence intensity in buffer. Fmax, the maximum fluorescence intensity, was obtained from curve fitting and the dissociation constant Kd was calculated from the slope of double reciprocal plots: 1/(1 − (F − F0)/Fmax) vs. [NBD-cholesterol]/(F − F0)/Fmax, as described previously (9, 57, 93, 98).
Dansyl-cholesterol is highly fluorescent both in buffer and upon binding to proteins; therefore, dansyl-cholesterol binding affinity was examined by using a displacement assay described previously (38, 98) instead of direct binding assay. The displacement of NBD-cholesterol from L-FABP and SCP-2 by dansyl-cholesterol was determined by incubating L-FABP (50 nM in PBS) or SCP-2 (50 nM in PBS) with NBD-cholesterol (30 nM) for 8 min to obtain maximal fluorescence, followed by titration with increasing amounts of dansyl-cholesterol. Fluorescence intensities were corrected for signals from dansyl-cholesterol and proteins in buffer. From the displacement curve, the Ki value was calculated as described (38, 98). NBD-cholesterol fluorescence was recorded by utilizing a Cary Eclipse Fluorescence Spectrophotometer (Varian, Palo Alto, CA) at excitation wavelength = 465 nm and emission wavelength = 535 nm. All experiments were carried out at 24°C by utilizing a circulating water bath.
Binding and cross-linking with a photoactivatable cholesterol.
Cholesterol binding to recombinant L-FABP was determined by covalent attachment (i.e., cross-linking) of a photoactivatable radiolabeled cholesterol derivative (FCBP) basically as described (26, 57). Briefly, 3H-FCBP was cross-linked to L-FABP as detailed earlier for SCP-2 (57). Crosslinked 3H-FCBP/L-FABP unimers were separated from potential higher order multimers by SDS-PAGE, the 3H-FCBP/L-FABP was blotted onto nitrocellulose and probed with a polyclonal anti-L-FABP antibody, and 3H-FCBP/L-FABP was counted for 3H by liquid scintillation counting as described (57).
Mass spectral analysis of L-FABP cross-linked with photactivatable cholesterol.
The nonradioactive photoactivatable cholesterol derivative FCBP was cross-linked to L-FABP followed by mass spectrometric analysis essentially as described earlier for SCP-2 (57). Briefly, an Agilent (Santa Clara, CA) 1200 capillary HPLC system was interfaced to an API QSTAR Pulsar Hybrid QTOF mass spectrometer (Applied Biosystems/MDS Sciex, Framingham, MA) equipped with an ESI source. The L-FABP control and the FCBP-modified L-FABP samples were diluted to 0.05 and 0.1 mg/ml, respectively, in 0.1% formic acid. Liquid chromatography (LC) separation was achieved by using a Phenomenex C4 microbore column (150 mm × 0.50 mm) at flow rate of 10 μl/min. The proteins were eluted by using a gradient of 0.1% formic acid (solution A) vs. 0.1% formic acid in 85% acetonitrile (solution B). The gradient timetable was as follows: 2% (solution B) for 5 min, 2–30% (solution B) for 3 min, 30–60% (solution B) for 44 min, 60–95% (solution B) for 8 min, followed by holding the gradient at 95% (solution B) for 5 min, for a total run time of 65 min. The MS data were acquired in positive ion mode (500–2,000 Da) by using spray voltage of +4,900 V. BioAnalyst software (Applied Biosystems) was used for spectral deconvolution. A mass range of m/z 650–1,400 was used for deconvolution, and the output range was 8,000–30,000 Da by using a step mass of 0.1 Da and signal-to-noise threshold of 5.
Circular dichroism analysis of cholesterol binding to L-FABP.
Protein secondary structure of L-FABP in the presence or absence of cholesterol was determined by circular dichroism (CD) spectropolarimetry utilizing a J-710 spectropolarimeter (JASCO, Easton, MD) as described previously (36, 38, 57, 78) with the following modifications. The samples for CD analysis contained L-FABP at a final concentration of 4 μM in 10 mM potassium phosphate (pH 7.4). Because of its low aqueous solubility a stock solution of 1 mM cholesterol was prepared in 10 mM potassium phosphate (pH 7.4), 20% glycerol, 4.5% (32 mM) HPCD, 1 mM EDTA. For CD analysis of L-FABP in the presence of cholesterol, an aliquot of 1 mM cholesterol in the HPCD buffer was added to L-FABP at a final cholesterol concentration of 50 μM. L-FABP ± cholesterol was placed in the CD cuvette and incubated at 20°C for 10 min, and the sample was scanned from 185 to 260 nm under the following conditions: step resolution 1 nm, bandwidth 2 nm, sensitivity 10 m°, scan rate 50 nm/min, time constant 1 s. For each measurement, 10 scans were averaged, smoothed, background subtracted, and converted to mean residue molar ellipticity, [θ] (°·cm2·dmol−1). Secondary structure analysis and percentage composition of α-helices, β-sheets, turns, and unordered structures for L-FABP ± cholesterol were determined as described (36, 38, 57). The change in percentage secondary structure was determined by subtracting the percentage secondary structure of L-FABP in HPCD buffer only from the percentage secondary structure of L-FABP in HPCD buffer + 50 μM cholesterol.
Isothermal titration calorimetry analysis of cholesterol binding to L-FABP.
Thermodynamic parameters of cholesterol binding to L-FABP or SCP-2 were determined by isothermal titration microcalorimetry utilizing an iTC200 microcalorimeter (MicroCal, Northampton, MA). Cholesterol (300 μM) was prepared in a buffer containing 20 mM Tris·HCl (pH 8.0), 20% glycerol, and 4.5% (32 mM) HPCD as described above. Cholesterol was titrated (2.0 μl/injection) into a solution of protein [20 μM in 20 mM Tris·HCl (pH 8.0)/20% glycerol] at 25°C (298 K), and the amount of heat released or absorbed was measured. Three sets of controls were performed for each experiment: buffer injected into buffer, cholesterol injected into buffer, and buffer injected into protein. Each experiment was repeated five times (n = 5), and the data were analyzed by utilizing MicroCal Origin v7.0383 as supplied with the iTC200 microcalorimeter.
Statistics.
Statistical analysis was performed by ANOVA combined with the Newman-Keuls multiple-comparisons test (GraphPad Prism, San Diego, CA). Data are expressed as means ± SE with n = 5–10 for all analyses, and P is indicated as described in the figure and table legends. Graphical analysis was accomplished by use of SigmaPlot 2000 for Windows version 6.10 (SPSS, Chicago, IL).
RESULTS
Effect of backcrossing on liver total cholesterol in L-FABP-null mice.
Liver total cholesterol mass was significantly increased twofold (P < 0.001) in female N2 generation L-FABP-null mice (Fig. 1). This effect was maintained at higher genetic homogeneity as shown by backcrossing to the N10 generation (99.9% homogeneity) (Fig. 1). In contrast, liver total cholesterol levels were not significantly altered by L-FABP gene ablation in male mice at any backcross generation number examined (Fig. 1). Interestingly, hepatic total cholesterol levels were higher in male than female wild-type L-FABP+/+ mice at all backcross generations (Fig. 1). However, L-FABP gene ablation increased liver total cholesterol in female mice to levels equivalent to or higher than those in male wild-type L-FABP+/+ mice (Fig. 1).
Fig. 1.
Effect of backcrossing on liver total cholesterol mass in liver fatty acid binding protein (L-FABP)−/− mice. Lipid was extracted from liver homogenates of female (F) and male (M) mice as described in experimental procedures. Total cholesterol was determined by resolving and quantifying unesterified (free) cholesterol and esterified cholesterol. Total cholesterol refers to the sum of free and esterified cholesterol. Open bars, wild-type L-FABP+/+; solid bars, L-FABP−/− mice. Data are means ± SE (n = 6–8). ***P < 0.001 for −/− vs. +/+.
Effect of backcrossing on liver unesterified (free) cholesterol in L-FABP-null mice.
To determine whether the increased level of total cholesterol in livers of female L-FABP-null mice was due to increased unesterified (free) cholesterol, the free cholesterol was resolved as described in experimental procedures. The mass of free cholesterol was significantly higher (P < 0.001) in female N2 generation L-FABP-null mice (Fig. 2). This effect did not disappear with higher genetic homogeneity as shown by backcrossing to the N10 generation which exhibits 99.9% homogeneity (Fig. 2). In contrast, hepatic free cholesterol levels were not altered by L-FABP gene ablation in male mice, regardless of L-FABP backcross generation number (Fig. 2). The lack of hepatic free cholesterol phenotype in livers of male L-FABP-null mice correlated with the observation that the hepatic free cholesterol content of liver from male wild-type L-FABP+/+ mice was already higher than that of female wild-type L-FABP+/+. In female L-FABP-null mice the hepatic free cholesterol was only increased to levels similar to those observed in male wild-type L-FABP+/+ and L-FABP−/− mice (Fig. 2).
Fig. 2.
Liver unesterified (free) cholesterol mass in L-FABP−/− mice backcrossed up to the N10 generation. Lipid was extracted from liver homogenates of female and male mice as described in experimental procedures. Unesterified (free) cholesterol was resolved and quantified. Open bars, wild-type L-FABP+/+; solid bars, L-FABP−/− mice. Data are means ± SE (n = 6–8). ***P < 0.001 for −/− vs. +/+.
Effect of backcrossing on liver esterified cholesterol in L-FABP-null mice.
To show whether increased hepatic total cholesterol in female L-FABP-null mice was also associated with increased esterified cholesterol, the esterified cholesterol was resolved as described in experimental procedures. Hepatic cholesteryl ester content was significantly higher (P < 0.001) in female N2 generation L-FABP-null mice, regardless of L-FABP backcross generation number (Fig. 3). In contrast, cholesteryl-ester levels were not increased in male L-FABP-null mice at any backcross generation examined (Fig. 3). In female L-FABP-null mice the level of hepatic cholesteryl esters was increased to levels as high or higher than observed in male wild-type L-FABP+/+ and L-FABP−/− mice (Fig. 3).
Fig. 3.
Liver esterified cholesterol mass in L-FABP−/− mice backcrossed up to the N10 generation. Lipid was extracted from liver homogenates of female (F) and male (M) mice as described in experimental procedures. Esterified cholesterol was resolved and quantified. Open bars, wild-type L-FABP+/+; solid bars, L-FABP−/− mice. Data are means ± SE (n = 6–8). **P < 0.01 for −/− vs. +/+; ***P < 0.001 for −/− vs. +/+.
Effect of backcrossing on liver phospholipid, triacylglycerol, and unesterified fatty acid content in L-FABP-null mice.
To show whether the L-FABP gene ablation-induced increase in all forms of cholesterol in livers of female mice was specific to cholesterol, the hepatic content of phospholipid and triacyglycerol was determined as described in experimental procedures. Phospholipid mass was significantly higher (P < 0.05) in female N2 generation L-FABP-null mice as well as in all subsequent backcross generations examined (Fig. 4A). In contrast, hepatic phospholipid levels of male mice did not display any consistent trend in response to L-FABP gene ablation or backcross generation number (Fig. 4A). Interestingly, L-FABP gene ablation generally increased the hepatic mass of phospholipids in female mice to levels as high as or higher than observed in livers of male wild-type L-FABP+/+ or L-FABP−/− mice (Fig. 4A).
Fig. 4.
Effect of backcrossing on liver phospholipid (A), triacylglycerol (B), and unesterified fatty acid mass (C) in L-FABP−/− vs. wild-type L-FABP+/+ mice. Lipid was extracted from liver homogenates of female and male mice as described in experimental procedures. Phospholipids, triacylglycerols, and unesterified (free) fatty acids were resolved and quantified. Open bars, wild-type L-FABP+/+; solid bars, L-FABP−/− mice. Data are means ± SE (n = 6–8). *P < 0.05 for −/− vs. +/+; **P < 0.01 for −/− vs. +/+; ***P < 0.001 for −/− vs. +/+.
With regard to hepatic triacylglycerol mass, in female mice this level was not significantly increased by L-FABP gene ablation regardless of backcross generation number (Fig. 4B). In contrast, hepatic triacylglycerol mass was markedly decreased in male L-FABP-null mice at all backcross generations examined (Fig. 4B).
Finally, the hepatic mass of unesterified fatty acids did not display any consistent pattern in response to sex, L-FABP gene ablation, or backcross generation number (Fig. 4C).
Effect of backcross generation on serum lipid levels in L-FABP null mice.
Hepatic free cholesterol, cholesteryl ester, and total cholesterol levels were increased in female L-FABP-null mice at all backcross generations examined as described above. To determine whether ablation of the L-FABP gene resulted in changes in serum lipid levels, the serum concentrations of total cholesterol, free cholesterol, cholesteryl ester, phospholipid, triacylglycerol, and nonesterified fatty acid were measured. L-FABP-null male and female mice exhibited no or minor changes in serum levels of total cholesterol (Fig. 5A), free cholesterol (Fig. 5B), cholesteryl ester (Fig. 5C), phospholipid (Fig. 5D), or nonesterified fatty acid (Fig. 5F) at all backcross generations examined. By contrast to the results observed for hepatic triacylglycerol concentrations (Fig. 4B), serum triacylglycerol levels did not change in L-FABP-null male mice; however, L-FABP-null female mice exhibited approximately twofold higher (P < 0.01) triacylglycerol levels than their wild-type counterparts at any backcross generation examined (Fig. 5E).
Fig. 5.
Effect of backcross generation on serum lipid concentrations in L-FABP−/− vs. L-FABP wild-type +/+ mice. A: total cholesterol. B: free cholesterol. C: cholesteryl ester. D: phospholipid. E: triacylglycerol. F: nonesterified fatty acid. Serum lipids were quantified as described in experimental procedures. Open bars, wild-type L-FABP+/+; solid bars, L-FABP−/− mice. Data are means ± SE (n = 6–8). *P < 0.05 for −/− vs. +/+; **P < 0.01 for −/− vs. +/+.
Affinity of L-FABP for cholesterol: direct binding.
Although the above findings confirm that female L-FABP-null mice exhibited elevated hepatic cholesterol levels at all backcross generations examined, as indicated in the introduction, it is also important to demonstrate that L-FABP binds cholesterol with high affinity. However, the poor aqueous solubility of cholesterol and the requirement for separation of L-FABP-bound and unbound radiolabeled cholesterol limit the usefulness of standard radiolabeled cholesterol binding assays. Therefore, determination of L-FABP affinity for cholesterol was addressed by two different approaches that took advantage of the intrinsic fluorescence of fluorescent cholesterol analogs and did not require separation of L-FABP-bound from unbound ligand.
First, L-FABP's binding affinity for NBD-cholesterol was determined by a sensitive direct fluorescence binding assay as described in experimental procedures. NBD-cholesterol is a fluorescent cholesterol analog previously shown to be bound with high affinity by other cholesterol binding proteins (9, 30, 92, 93, 98). Titration of L-FABP with increasing concentration of NBD-cholesterol resulted in a binding curve approaching saturation (Fig. 6A). Further analysis of the binding curves as described in experimental procedures showed that L-FABP bound NBD-cholesterol with high affinity as shown by Kd = 24.5 ± 1.5 nM (mean ± SE, n = 3). As a control, NBD-cholesterol binding to SCP-2, a protein known to bind cholesterol with high affinity (57, 93), was also examined. SCP-2 also exhibited a binding curve approaching saturation (Fig. 6C). SCP-2 bound NBD-cholesterol with high affinity as indicated by Kd = 38.1 ± 4.4 nM (mean ± SE, n = 3). Thus the NBD-cholesterol binding assay showed that L-FABP bound cholesterol with high affinity similar to that observed for SCP-2.
Fig. 6.
22-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-23,24-bisnor-5-cholen-3β-ol (NBD-cholesterol) and dansyl-cholesterol (DChol) binding to L-FABP and sterol carrier protein-2 (SCP-2). Square brackets denote concentration. Left: representative binding curves showing NBD-cholesterol fluorescence increase (F − F0) upon binding to L-FABP (A) and SCP-2 (C) with the double reciprocal plots in the insets. Fluorescence intensities were corrected for signals from NBD-cholesterol and proteins in buffer. Right: representative displacement curves showing NBD-cholesterol fluorescence decrease when increasing concentrations of dansyl-cholesterol were present to displace protein-bound NBD-cholesterol (30 nM) from L-FABP (B) and SCP-2 (D). Fluorescence intensities were corrected for signals from dansyl-cholesterol and proteins in buffer. In all experiments, protein concentrations were 50 nM. NBD-cholesterol fluorescence intensity (mean ± SE, n = 6) was recorded at 465-nm excitation wavelength and 535-nm emission wavelength.
Second, a fluorescent dansyl-cholesterol displacement assay was used to confirm the high affinity of L-FABP for cholesterol. Since dansyl-cholesterol is fluorescent in buffer and when bound to protein, the affinity of L-FABP for dansyl-cholesterol was determined by a ligand-displacement assay as described in experimental procedures. Titration displacement of NBD-cholesterol bound to L-FABP with dansyl-cholesterol resulted in a monophasic decrease in fluorescence intensity (Fig. 6B); analysis of the displacement data yielded a Ki for dansyl-cholesterol/L-FABP of 20.8 ± 3.7 nM (mean ± SE, n = 3). Likewise, dansyl-cholesterol displacement of NBD-cholesterol bound to SCP-2 also resulted in a monophasic decrease in NBD-cholesterol fluorescence intensity (Fig. 6D); analysis of the displacement data yielded a Ki for dansyl-cholesterol/SCP-2 of 60.7 ± 3.0 nM (mean ± SE, n = 3). Thus the dansyl-cholesterol displacement assay confirmed that L-FABP bound cholesterol with high affinity, similar to that observed for SCP-2.
Stoichiometry of L-FABP binding of cholesterol: direct binding and photo-cross-linking.
Since the ligand binding cavity of L-FABP is sufficiently large to accommodate two long-chain fatty acids (29, 74, 84, 85), it was important to determine whether L-FABP bound one or two cholesterol molecules. This issue was addressed by the following two approaches.
First, the NBD-cholesterol binding assay supported the presence of a single cholesterol binding site in L-FABP. A double reciprocal plot of the binding data was linear (Fig. 6A, inset), indicating L-FABP bound NBD-cholesterol at a single binding site. As a control, a double reciprocal plot of NBD-cholesterol binding to SCP-2, known to bind cholesterol at a single binding site (57, 93), was linear (Fig. 6C, inset), consistent with a single cholesterol binding site in SCP-2. Thus both L-FABP and SCP-2 bound NBD-cholesterol at a single binding site.
Second, L-FABP bound a photoactivatable cholesterol derivative (FCBP) at a single site. FCBP binding and covalent cross-linking to L-FABP were shown by mass spectrometry as described in experimental procedures. In the absence of added FCBP, LC-MS analysis of non-cross-linked L-FABP indicated a parent ion of molecular mass = 14,349.7 Da (Fig. 7A). ESI analysis of higher-order ion fragments confirmed the molecular mass of the unreacted L-FABP (Fig. 7B). L-FABP bound 1.0 mol of FCBP per mole of protein such that the molecular mass of the L-FABP/FCBP complex was 14,862.5 Da (Fig. 7C). ESI analysis of the L-FABP complex indicated the presence of both unreacted L-FABP as well higher order ion fragments containing one FCBP per L-FABP molecule (Fig. 7D). Quantification of 3H-FCBP bound to L-FABP confirmed the covalent attachment of one molecule of FCBP per molecule of L-FABP (data not shown).
Fig. 7.
Direct binding of photoactivatable cholesterol to L-FABP. Aliquots of L-FABP and L-FABP photo-cross-linked with free cholesterol benzophenone (FCBP) were examined by mass spectrometry as described in experimental procedures. A: total ion chromatogram for liquid chromatography-mass spectrometry (LC-MS) analysis of unmodified L-FABP. B: electrospray ionization (ESI) mass spectrum of L-FABP. C: total ion chromatogram for LC-MS of the L-FABP/FCBP complex. D: ESI mass spectrum of L-FABP/FCBP complex.
Secondary structure of L-FABP in the presence of cholesterol.
Since we have shown that cholesterol interacts with and binds to L-FABP with high affinity and high specificity, we wanted to examine the effect of cholesterol binding on the secondary structure of L-FABP. Cholesterol binding to L-FABP decreased the percentage of both regular α-helix and distorted α-helix such that there was an overall decrease in α-helix of 4.2 ± 0.3% (P < 0.05) relative to that exhibited by L-FABP in HPCD buffer only (Table 1). Likewise, cholesterol binding to L-FABP caused an 8.2 ± 0.7% decrease (P < 0.001) in regular β-sheet and a 4.7 ± 0.4% decrease (P < 0.05) in total β-sheet (Table 1). Interestingly, cholesterol binding induced a 3.5 ± 0.3% increase (P < 0.05) in distorted β-sheet structure in L-FABP (Table 1). Therefore, the overall effect of cholesterol interaction with L-FABP was to decrease total α-helix and β-sheet while increasing turn and unordered structural elements by 6.7 ± 0.5% (P < 0.01) and 6.6 ± 0.6% (P < 0.01), respectively (Table 1).
Table 1.
Secondary structure analysis of the L-FABP-cholesterol complex
| Secondary Structure | % of Total |
|
|---|---|---|
| Buffer only | Cholesterol | |
| Regular α-helix | 9.0±0.6 | 7.4±0.8 |
| Distorted α-helix | 6.8±0.7 | 4.0±0.5† |
| Total α-helix | 15.2±1.6 | 11.0±0.3* |
| Regular β-sheet | 26.6±1.1 | 18.4±1.1‡ |
| Distorted β-sheet | 11.2±1.0 | 14.7±0.7* |
| Total β-sheet | 37.8±1.9 | 33.1±1.6* |
| Turn | 22.8±1.4 | 29.5±1.7† |
| Unordered | 23.0±1.8 | 29.7±1.0† |
Values are represented as means ± SE (n = 10). Circular dichroism spectra were recorded on samples containing 4 μM liver fatty acid binding protein (L-FABP) in 2-hydroxypropyl-β cyclodextrin buffer with or without 50 μM cholesterol as described in experimental procedures. Secondary structural elements were determined as described in experimental procedures and the data are presented as % of total secondary structure.
P < 0.05 for L-FABP (+ cholesterol) vs. L-FABP (buffer only);
P < 0.01 for L-FABP (+ cholesterol) vs. L-FABP (buffer only);
P < 0.001 for L-FABP (+ cholesterol) vs. L-FABP (buffer only).
Thermodynamic binding parameters of cholesterol with L-FABP or SCP-2.
To further establish that the high binding affinity of L-FABP for fluorescent cholesterol analogs was not simply due to presence of the fluorophore tags, isothermal titration calorimetry was used to directly measure the binding of cholesterol to L-FABP and compared with that of a known cholesterol binding protein, i.e., SCP-2. In addition to resolving binding affinity without the use of a fluorescent or photolabel tag, isothermal titration calorimetry resolved the enthalpic and entropic contributions to ligand binding. Under the conditions used in these experiments, both L-FABP and SCP-2 bound ∼1 mol of cholesterol per mole of protein with high (nM) affinity, 140 ± 10 and 32 ± 8 for L-FABP and SCP-2, respectively (Fig. 8, A and B). Cholesterol binding to both L-FABP and SCP-2 was energetically favorable, as shown by the negative Gibbs free energy changes (Fig. 8E). Cholesterol binding to L-FABP was significantly (P < 0.001) more favorable enthalpically than the binding of cholesterol to SCP-2 (Fig. 8C). However, the binding of cholesterol to SCP-2 was significantly (P < 0.001) more favorable entropically than the binding of cholesterol to L-FABP (Fig. 8D). The net result of these contributions to ligand binding was a more favorable Gibbs free energy change for the cholesterol-SCP-2 interaction than was observed for the cholesterol-L-FABP interaction (Fig. 8E).
Fig. 8.
Thermodynamic parameters of cholesterol binding to L-FABP or SCP-2. Thermodynamic parameters of cholesterol binding to L-FABP or SCP-2 were determined by isothermal titration microcalorimetry utilizing an iTC200 microcalorimeter (MicroCal, Northampton, MA) as described in experimental procedures. Three sets of controls were performed for each experiment: buffer injected into buffer, cholesterol injected into buffer, and buffer injected into protein. Each experiment was repeated 5 times (n = 5), and the data were analyzed utilizing MicroCal Origin v7.0383 as supplied with the iTC200 microcalorimeter. A: equilibrium dissociation constant. B: n, ligand-binding sites. C: ΔH, change in enthalpy. D: −TΔS, (−absolute temperature) × (change in entropy). E: ΔG, change in Gibbs free energy. Hatched bars, L-FABP; solid bars, SCP-2. Values are represented as means ± SE (n = 5). **P < 0.01 for SCP-2 vs. L-FABP; ***P < 0.001 for SCP-2 vs. L-FABP.
DISCUSSION
Despite the fact that the L-FABP is perhaps the single most prevalent lipid binding protein present in the cytoplasm of several metabolically active tissues (liver, intestine, kidney), its physiological function is not completely resolved. L-FABP represents 2–5% of cytosolic protein (100–400 μM) in liver (61). As indicated in the introduction, most attention in the past has focused on L-FABP's role in fatty acid uptake, intracellular trafficking, and metabolism, functions confirmed by studies with L-FABP gene-ablated mice (3, 4, 24, 56, 58, 62, 72). However, two factors suggest that livers of L-FABP-null mice should also exhibit a cholesterol phenotype: 1) early assays indicated that L-FABP may bind cholesterol (27, 87, 90, 91), albeit with up to 100-fold weaker affinity than proteins such as sterol carrier protein-2 (9, 57, 93); and 2) fatty acid and cholesterol metabolism are coordinately linked (50). To begin to address this possibility, the mouse L-FABP was independently ablated by our and another laboratory (56, 72). Interestingly, hepatic cholesterol accumulation was indeed observed with early N2 backcross generation (75% genetic homogeneity) female L-FABP−/− mice generated by our laboratory (56). In contrast, this phenotype was not exhibited by N10 backcross generation (99.9% genetic homogeneity) L-FABP−/− mice created by using a completely different knockout construct strategy (71). To determine whether the discrepancy in observed hepatic cholesterol phenotypes was due to differences in backcross generation number, the L-FABP−/− mice wherein the hepatic cholesterol phenotype was first observed were backcrossed up to the N10 generation and hepatic lipid phenotype was determined. In addition, it was important to revisit the issue of L-FABP affinity for cholesterol by use of improved direct binding assays not requiring separation of L-FABP-bound from free cholesterol, a very poor aqueous soluble ligand. The results yielded the following new insights.
First, the hepatic cholesterol phenotype first reported in L-FABP−/− female mice was shown to be independent of backcross generation number. Hepatic total cholesterol, unesterified cholesterol, and cholesteryl ester mass were all elevated in L-FABP−/− female mice, even at the N10 backcross generation (99.9% homogeneity). Thus differences in backcross generation number did not account for the lack of hepatic cholesterol phenotype observed in female L-FABP−/− mice independently generated by others. The apparent discrepancy in cholesterol phenotype was most likely attributed to significant differences in gene construct strategies. The small L-FABP gene is composed of four exons: exon 1 (encodes aa1–22), exon 2 (aa23–79), exon 3 (aa80–112), and exon 4 (aa 113–126) (60). Since different ablation construct strategies for other proteins involved in lipid metabolism yield mice sharing some but not other aspects of lipid phenotype (25, 59, 100), the L-FABP−/− mice used in the present work were generated with a construct that deleted most of the 5′ noncoding (promoter) region, all four exons of the small L-FABP gene, and part of the 3′ noncoding region to preclude the possibility of expressing L-FABP fragments (56). These L-FABP−/− mice did not contain any detectable L-FABP transcript, L-FABP protein, or L-FABP-derived peptides as determined by mRNA analysis or Western blotting with polyclonal antisera to L-FABP (56). In contrast, another independently generated L-FABP−/− mouse was created by using a construct that left intact the 5′ noncoding region, all of exons 3 and 4, and the 3′ noncoding region (72). However, the presence of potential peptides(s) encoded by exons 3–4 (aa80–126, part of ligand binding domain) was not precluded (17, 72, 101). If such peptides were produced, it is possible that in aqueous buffers they may fold into distinct structures that can mimic those of the native protein, as has been shown for other peptides (22, 64, 83). For example, such a peptide may function analogously to peptides from SCP-2 that do not directly bind/transfer cholesterol but bind to membranes and potentiate SCP-2's sterol transfer activity (39–41). Likewise, peptides derived from another fatty acyl CoA binding protein (i.e., acyl CoA binding protein, ACBP) regulate food intake, steroidogenesis, glucose-stimulated insulin release, and other pathways involved in lipid metabolism (12, 16, 19, 75, 76, 81). In addition, since L-FABP interacts with PPARα, a transcriptional regulator of multiple genes in fatty acid and glucose metabolism, peptides derived from L-FABP may also interact with and influence PPARα activity analogous to the known activity of peptides derived from coactivator or corepressor proteins (95). Thus these subtly different cholesterol phenotypes obtained with different gene ablation strategies may provide new insights regarding potential roles of L-FABP's NH2-terminal α-helical membrane interaction domain, whose full function has yet to be completely determined. Although beyond the scope of the present investigation, it would be fascinating to prepare synthetic peptides based on L-FABP to resolve whether such peptides alone enhance intermembrane sterol transfer or potentiate the sterol transfer activity of cholesterol binding/transfer proteins (e.g., L-FABP, SCP-2) analogous to earlier studies with SCP-2 peptides (39–41). Finally, it is important to note that the L-FABP-null mouse line wherein a cholesterol phenotype was not observed was generated with a green fluorescent protein (GFP) knockin strategy that left intact the entire L-FABP promoter region and resulted in high expression of GFP in all tissues examined (72). High overexpression of GFP alters phenotype in cultured cells (10, 48, 49) and mice (20, 43). Furthermore, studies performed in vitro and in living cells show that GFP is an electron donor to cytochrome c, FAD, FMN, and NAD-cofactors important in lipid metabolism (11).
Second, hepatic cholesterol accumulation was not observed in L-FABP−/− male mice, regardless of the backcross generation number. Lack of hepatic cholesterol accumulation was also observed in male L-FABP−/− mice independently generated by using a different construct strategy (71, 72). The finding that L-FABP gene ablation did not induce hepatic cholesterol accumulation in male mice was consistent with the known sex differences in hepatic cholesterol phenotype of wild-type L-FABP+/+ mice (5, 18, 96, 102): 1) Livers of male mice express higher levels of sterol carrier protein-x, a key peroxisomal enzyme essential for oxidizing cholesterol's branched side chain to form bile acids, the major route of net cholesterol elimination from the body (5). 2) Intestinal cholesterol absorption in male mice is less efficient than that of female mice (102). 3) Male mice, especially L-FABP−/− males, are more resistant than females to hepatic cholesterol accumulation in response to cholesterol-rich diet (52, 53, 102). 4) A sex-related defect in lipid metabolism has also been observed in mice null in PPARα, the nuclear receptor that regulates expression of L-FABP (21).
Third, whereas hepatic cholesterol accumulation was specific to female L-FABP−/− mice, decreased hepatic triacylglycerol phenotype was specific to male L-FABP−/− mice at all backcross generations examined. Lower hepatic triacylglycerol was also observed with independently generated male L-FABP−/− mice obtained with a different construct strategy (71, 72). The lower hepatic triacylglycerol is attributed to decreased fatty acid uptake, since hepatic fatty acid oxidation and VLDL secretion are reduced rather than increased in male L-FABP−/− mice (24, 56, 72).
Fourth, high-affinity cholesterol binding by L-FABP was consistent with a potential direct role for L-FABP in hepatic cholesterol metabolism. High-affinity binding of cholesterol analogs to L-FABP was demonstrated by new fluorescence assays, photoactivatable cholesterol binding assays, CD spectroscopy, and isothermal titration calorimetry not requiring separation of L-FABP bound from free sterol. As indicated in the introduction, early competition binding studies yielded only weak binding affinities for cholesterol to L-FABP (27, 87, 90, 91). In contrast, the binding the data presented herein showed that L-FABP bound NBD-cholesterol with high affinity (Kd = 24.5 ± 1.5 nM) at a single site. Ligand displacement analysis also indicated high-affinity binding of dansyl-cholesterol (Ki = 20.8 ± 3.7 nM) to L-FABP at a single site. Photo-cross-linking studies with FCBP followed by mass spectrometry confirmed the single binding site of this cholesterol derivative with L-FABP. CD measurements and subsequent secondary structure analysis confirmed cholesterol binding to L-FABP and demonstrated significant cholesterol-dependent conformational alterations in L-FABP secondary structure upon cholesterol association with L-FABP. Isothermal titration calorimetry also confirmed the binding of cholesterol to L-FABP at a single, high-affinity binding site. It must be noted, however, that the binding affinity of cholesterol for L-FABP as measured by isothermal titration calorimetry (ITC; 140 ± 10 nM) was ∼7-fold lower than that measured for NBD-cholesterol or for dansyl-cholesterol utilizing fluorescence intensity measurements. One possible explanation for this apparent discrepancy may be found in a recent study that examined the concentration-dependent dimerization of fatty acid binding protein 4 (adipocyte FABP) (35). These authors observed a discrete self-association of FABP4 with a Kd = 120 ± 11 nM. Our fluorescence studies with NBD-cholesterol or with dansyl-cholesterol utilized L-FABP at a protein concentration of 50 nM, whereas the ITC binding studies with free cholesterol utilized L-FABP at a protein concentration of 20 μM. We are currently investigating the possibility of self-association of L-FABP and the potential biological significance of this phenomenon.
The binding affinities of L-FABP for NBD-cholesterol, dansyl-cholesterol, and cholesterol were 10- to 30-fold higher than reported by early assay radioligand and other cholesterol binding assays (Kd values in the 300–900 nM range) (27, 87, 90, 91). More importantly, L-FABP's affinities for NBD-cholesterol, dansyl-cholesterol, and cholesterol overlapped the range exhibited by SCP-2 (Kd values of 32–61 nM) for binding these same ligands under the same binding assay conditions herein. Finally, the importance of an intact ligand binding site is underscored by studies showing that chemically blocking the ligand binding site inhibits L-FABP's ability to facilitate cholesterol transfer between membranes in vitro (103). In addition, L-FABP enhances microsomal cholesterol esterification in vitro (15, 45, 68, 94) and drugs that compete for binding to L-FABP inhibit cholesterol transfer from the plasma membrane to the endoplasmic reticulum for esterification in living cells (45). Finally, hypersecretion of cholesterol into bile concomitant with decreased hepatic cholesterol ester accumulation has been attributed to L-FABP upregulation in gene targeted mice (33, 97). Taken together, these findings suggest that L-FABP may be functionally important in hepatic cholesterol metabolism by binding and transferring cholesterol for secretion into bile.
In summary, the apparent discrepancy in hepatic cholesterol phenotype exhibited by L-FABP−/− mice independently obtained by two different groups (56, 71) was not attributable to differences in genetic homogeneity. Hepatic cholesterol accumulation first noted in N2 backcross generation (75% homogeneity) female L-FABP−/− mice on a control-chow diet (56) was maintained at all subsequent backcross generations examined including the N10 generation (99.9% homogeneity) on a control-chow diet. In contrast, no difference in hepatic cholesterol phenotype was reported in control-chow fed N10 backcross generation (also 99.9% homogeneity) female L-FABP−/− mice independently generated by another laboratory (71). As indicated above, the apparent discrepancy in cholesterol phenotype is most likely attributed to significant differences in gene construct strategies used to generate the L-FABP-null mice. However, it must be considered that other factors (e.g., age, source of control chow diet, length of fasting before euthanasia, or composition of intestinal microbiota) may also contribute to the observed differences in phenotype between the L-FABP−/− mice generated by two independent gene ablation strategies. For example, it is important to note that hepatic cholesterol accumulation was observed only in control-chow fed female L-FABP−/− mice aged >6 mo, but not in younger mice regardless of gender (52–56, 58). Although the lack of hepatic cholesterol phenotype in young mice was also confirmed in mice generated by a different construct strategy, none of the studies with this independently obtained L-FABP-null mouse strain have reported on the hepatic lipid phenotype in control-chow fed mice aged >6 mo, regardless of gender (69–73, 104). Age-dependent differences in lipid phenotype have also been reported in mice null in another fatty acid binding protein, i.e., the adipocyte fatty acid binding protein (A-FABP) (99), and in mice null in PPARα (21). Finally, the direct fluorescence binding assays not requiring separation of L-FABP-bound from free cholesterol indicated that L-FABP exhibits a single, high-affinity binding site for cholesterol and a variety of fluorescent and photoactivatable cholesterol analogs. These affinities were in the same range as for SCP-2, a protein known to interact with caveolin-1 in cholesterol-rich microdomains of the plasma membrane to enhance intermembrane cholesterol transport (reviewed in Refs. 77, 89, 106).
GRANTS
This work was supported in part by the National Institutes of Health DK41402 and GM31651 (F. Schroeder and A. B. Kier) and DK70965 (B. P. Atshaves).
DISCLOSURES
No conflicts of interest are declared by the author(s).
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