Exposure to PFAS mixture induces atherosclerosis via modulation of bile acid transport - Per- and polyfluoroalkyl substances (PFAS) are a class of ubiquitous man-made chemicals utilized for their
surfactant properties in industrial and consumer products (cookware, clothing, carpets) as well as in firefighting
foams. PFAS are highly resistant to degradation, leading to their bioaccumulation in the environment and in
humans. Because of this, PFAS are currently circulating in humans at blood concentrations that are
magnitudes higher than other legacy contaminants. Exposure to PFAS have been associated with increased
risk factors for cardiometabolic disease (i.e., increased circulating cholesterol), or major clinical outcomes
related to atherosclerosis that include stroke and heart attack. However, no studies have yet reported on
whether exposure to PFAS can induce the development of atherosclerosis. The overarching objective of this
proposal is to determine if PFAS exposure induces atherosclerosis and to characterize the underlying
mechanisms leading to PFAS-induced development of atherosclerosis risk factors. We have shown in our
preliminary studies that Low Density Lipoprotein Receptor deficient mice (Ldlr -/-) fed an atherogenic diet and
exposed to a simple mixture of 5 environmentally relevant PFAS (PFOS, PFOA, PFNA, PFHxS, and GenX) for
7 weeks resulted in increased circulating cholesterol and bile acids as well as decreased bile acid excretion.
We also observed that PFAS exposure results in induction of ileal bile acid transporters, especially the ileal
reuptake apical sodium dependent bile acid transporter (ASBT). Therefore, the central hypothesis of this
proposal is that PFAS exposure induces atherosclerosis through mechanisms related to ASBT-mediated bile
acid transport and excretion. To test this hypothesis, I will utilize Ldlr -/- mice, which is the gold standard for
mechanistically investigating atherosclerosis because this genetically modified model has cholesterol profiles
that closely mirror those seen in humans and is a model sensitive to dietary manipulation. Experiments
proposed in Aim 1 will investigate the development of atherosclerosis in hyperlipidemic mice by monitoring
lesion development in the aorta and aortic roots, quantifying lipid, sterol, and bile acid levels, and
transcriptomic profiling. Aim 2 will investigate mechanisms underlying the PFAS-mediated increases in
circulating cholesterol and atherosclerosis. Experiments proposed in Aim 2 will explore how ASBT inhibition
modulates circulating cholesterol and bile acids, as well as the development of atherosclerosis. Collectively,
these data will describe new mechanisms linking exposure to PFAS and increased risk of atherosclerosis. This
proposed work will have broad implications for the use of well-tolerated pharmaceuticals as effective
interventions against PFAS-mediated toxicity.