Ezetimibe improves hepatic steatosis in relation to autophagy in obese and diabetic rats

World J Gastroenterol. 2015 Jul 7;21(25):7754-63. doi: 10.3748/wjg.v21.i25.7754.


Aim: To investigate whether ezetimibe ameliorates hepatic steatosis and induces autophagy in a rat model of obesity and type 2 diabetes.

Methods: Male age-matched lean control LETO and obese and diabetic OLETF rats were administered either PBS or ezetimibe (10 mg/kg per day) via stomach gavage for 20 wk. Changes in weight gain and energy intake were regularly monitored. Blood and liver tissue were harvested after overnight fasting at the end of study. Histological assessment was performed in liver tissue. The concentrations of glucose, insulin, triglycerides (TG), free fatty acids (FFA), and total cholesterol (TC) in blood and TG, FFA, and TG in liver tissue were measured. mRNA and protein abundance involved in autophagy was analyzed in the liver. To investigate the effect of ezetimibe on autophagy and reduction in hepatic fat accumulation, human Huh7 hepatocytes were incubated with ezetimibe (10 μmol/L) together with or without palmitic acid (PA, 0.5 mmol/L, 24 h). Transmission electron microscopy (TEM) was employed to demonstrate effect of ezetimibe on autophagy formation. Autophagic flux was measured with bafilomycin A1, an inhibitor of autophagy and following immunoblotting for autophagy-related protein expression.

Results: In the OLETF rats that received ezetimibe (10 mg/kg per day), liver weight were significantly decreased by 20% compared to OLETF control rats without changes in food intake and body weight (P < 0.05). Lipid parameters including TG, FFA, and TC in liver tissue of ezetimibe-administrated OLETF rats were dramatically decreased at least by 30% compared to OLETF controls (P < 0.01). The serum glucose, insulin, HOMA-IR, and lipid profiles were also improved by ezetimibe (P < 0.05). In addition, autophagy-related mRNA expression including ATG5, ATG6, and ATG7 and the protein level of microtubule-associated protein light chain 3 (LC3) were significantly increased in the liver in rats that received ezetimibe (P < 0.05). Likewise, for hepatocytes cultured in vitro, ezetimibe treatment significantly decreased PA-induced fat accumulation and increased PA-reduced mRNA and protein expression involved in autophagy (P < 0.05). Ezetimibe-increased autophagosomes was observed in TEM analysis. Immunoblotting analysis of autophagy formation with an inhibitor of autophagy demonstrated that ezetimibe-increased autophagy resulted from increased autophagic flux.

Conclusion: The present study demonstrates that ezetimibe-mediated improvement in hepatic steatosis might involve the induction of autophagy.

Keywords: Autophagy; Ezetimibe; Hepatic steatosis; Nonalcoholic fatty liver disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anticholesteremic Agents / pharmacology*
  • Autophagy / drug effects*
  • Autophagy / genetics
  • Biomarkers / blood
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism
  • Cells, Cultured
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / genetics
  • Disease Models, Animal
  • Ezetimibe / pharmacology*
  • Fatty Liver / blood
  • Fatty Liver / etiology
  • Fatty Liver / pathology
  • Fatty Liver / prevention & control*
  • Gene Expression Regulation
  • Hepatocytes / drug effects*
  • Hepatocytes / metabolism
  • Hepatocytes / ultrastructure
  • Lipids / blood
  • Liver / drug effects*
  • Liver / metabolism
  • Liver / ultrastructure
  • Macrolides / pharmacology
  • Male
  • Obesity / blood
  • Obesity / complications
  • Obesity / drug therapy*
  • Obesity / genetics
  • Palmitic Acid / pharmacology
  • RNA, Messenger / metabolism
  • Rats, Inbred OLETF


  • Anticholesteremic Agents
  • Biomarkers
  • Blood Glucose
  • Lipids
  • Macrolides
  • RNA, Messenger
  • Palmitic Acid
  • bafilomycin A1
  • Ezetimibe