Multimodal 3D imaging reveals a central role for lysosomes indissolution of cholesterol crystals by macrophages

Formation of cholesterol crystals (CCs) is a key event during the development of atherosclerosis, but the molecular mechanisms of their degradation within cells are poorly understood. By incorporating the fluorescent cholesterol analogue TopFluor-Cholesterol (TF-Chol) into CCs, we were able to visualize the uptake of CCs in macrophages using correlative fluorescence and soft X-ray microscopy. Using quantitative 3D live-cell imaging, we show that CCs are processed in late endosomes and lysosomes (LE/Lys), resulting in formation of TF-Chol containing lipid droplets (LDs) over time. Inhibition of lysosomal sterol export with U18666A caused accumulation of TF-Chol in LE/Lys, and inhibition of lysosomal acidification with bafilomycin A1 led to reduced dissolution of the CCs. Using a novel assay combined with 3D image processing, we show that large CCs in contact with macrophages are processed via lysosomal exocytosis followed by extracellular and intracellular degradation of CCs. Treating macrophages with a fluorescent version of cyclodextrin (CD) promoted the dissolution of CCs and enhanced the formation of LDs enriched with TF-Chol. The majority of fluorescent CD co-localized with a marker for LE/Lys during this process, suggesting that intracellular delivery to LE/Lys may contribute to the dissolution of CCs. Dehydroergosterol (DHE) is an intrinsically fluorescent sterol closely mimicking the properties and behavior of cholesterol. DHE is known to self-associate into aggregates and crystals, and by using fluorescence spectroscopy and specialized ultraviolet (UV) microscopy, we found that CD enhances the dissolution of DHE crystals in vitro and in cells. Together, our findings highlight the lysosomal pathway as responsible for dissolution of CCs, cholesterol trafficking, and efflux in macrophages.