Endothelial cannabinoid CB1 receptor deficiency reduces arterial inflammation and lipid uptake in response to atheroprone shear stress

BackgroundPeripherally restricted cannabinoid CB1 receptor antagonists without central side effects hold promise for treating metabolic disorders including diabetes and obesity. In atherosclerosis, the specific effects of peripheral CB1 signaling in vascular endothelial cells (ECs) remain incompletely understood. Methods and resultsEndothelial expression of the CB1 encoding gene CNR1 was detectable in human plaque single-cell RNA sequencing data. In situ hybridization of Cnr1 in murine aortas revealed a significantly increased endothelial expression within atheroprone compared to atheroresistant regions. In vitro, CNR1 was upregulated by oscillatory shear stress (OSS) in human aortic endothelial cells (HAoECs). Endothelial CB1 deficiency (Cnr1EC-KO) in female mice on atherogenic background resulted in pronounced endothelial phenotypic changes, with reduced vascular inflammation and permeability. This resulted in attenuated plaque development with reduced lipid content in female mice, while reduced white and brown adipose tissue mass and liver steatosis were observed in both males and females. Ex vivo imaging of carotid arteries via two-photon microscopy revealed less labeled low density lipoprotein (Dil-LDL) uptake in Cnr1EC-KO. This was accompanied by a significant reduction of aortic endothelial caveolin-1 (CAV1) expression, a key structural protein involved in lipid transcytosis, in female Cnr1EC-KO mice. In vitro, pharmacological blocking with CB1 antagonist AM281 reproduced the inhibition of CAV1 expression and Dil-LDL uptake in response to atheroprone OSS in HAoECs, which was dependent on cAMP-mediated PKA activation. Conversely, the CB1 agonist ACEA increased Dil-LDL uptake and CAV1 expression in HAoECs. Finally, treatment of atherosclerotic mice with the peripheral CB1 antagonist JD-5037 reduced plaque progression, CAV1 and endothelial adhesion molecule expression in female mice. ConclusionsThese results confirm an essential role of endothelial CB1 to the pathogenesis of atherosclerosis. Peripheral CB1 antagonists may hold promise as an effective therapeutic strategy for treating atherosclerosis and related metabolic disorders. NOVELTY AND SIGNIFICANCEWhat is known? O_LIEnhanced endocannabinoid-cannabinoid CB1 receptor signaling has been implicated in metabolic disorders, atherosclerosis, and hypertension, but the cell-specific role of endothelial CB1 in atherosclerosis is not well understood. C_LIO_LIGlobal CB1 antagonists improve metabolic function and inhibit atherosclerotic plaque development in mouse models, but have failed in the clinic due to centrally mediated psychiatric side effects. C_LI What is new? O_LIBased on human single-cell RNA sequencing data, CB1 is expressed in human plaque ECs. C_LIO_LIUsing transgenic mouse models and human primary aortic endothelial cells, we provide evidence for a key role of CB1 in endothelial shear stress response, inflammatory gene expression, and LDL uptake. C_LIO_LIThe underlying signaling pathway of CB1-induced endothelial LDL uptake involves a cAMP-PKA-dependent regulation of caveolin 1 (CAV1) expression, a structural protein of the shear stress sensitive signaling domains of the plasma membrane. C_LIO_LIBy limiting endothelial CAV1 and VCAM1 expression, peripherally restricted CB1 antagonists confer atheroprotection in mice. C_LI Our findings reveal that endothelial CB1 expression is induced by atheroprone shear stress responses and contributes to impaired vascular barrier function, inflammation, and lipid uptake, thereby promoting atherosclerotic lesion formation and progression. By elucidating the transcriptomic pathways regulated by endothelial CB1 and its broad influence on lipid uptake and metabolism in arteries, liver, and brown and white adipose tissue, our study provides insights into novel pathways and potential interventions for the treatment of atherosclerosis and metabolic disorders. The use of peripherally restricted CB1 antagonists that specifically target vascular inflammation and tissue lipid storage could be a complementary and safe therapeutic avenue to treat cardiovascular and metabolic disease comorbidities without altering CB1 signaling in the brain.