Niemann-Pick C1-Like 1 (NPC1L1) mediates intestinal absorption of dietary and biliary
cholesterol.
Ezetimibe, by inhibiting NPC1L1 function, is widely used to treat
hypercholesterolemia in humans. Interestingly,
ezetimibe treatment appears to attenuate hepatic steatosis in rodents and humans without a defined mechanism. Over-consumption of a high-fat diet (HFD) represents a major cause of metabolic disorders including
fatty liver. To determine whether and how NPC1L1 deficiency prevents HFD-induced hepatic steatosis, in this study, we fed NPC1L1 knockout (L1-KO) mice and their wild-type (WT) controls an HFD, and found that 24 weeks of HFD feeding causes no
fatty liver in L1-KO mice. Hepatic
fatty acid synthesis and levels of mRNAs for lipogenic genes are substantially reduced but hepatic
lipoprotein-triglyceride production,
fatty acid oxidation, and
triglyceride hydrolysis remain unaltered in L1-KO versus WT mice. Strikingly, L1-KO mice are completely protected against HFD-induced
hyperinsulinemia under both fed and fasted states and during
glucose challenge. Despite similar
glucose tolerance, L1-KO relative WT mice are more
insulin sensitive and in the overnight-fasted state display significantly lower plasma
glucose concentrations. In conclusion, NPC1L1 deficiency in mice prevents HFD-induced
fatty liver by reducing hepatic lipogenesis, at least in part, through attenuating HFD-induced
insulin resistance, a state known to drive hepatic lipogenesis through elevated circulating
insulin levels.