1. Introduction
Cholesterol is an important factor in the maintenance of cellular homeostasis, and it is synthesized in the liver (about 700–900 mg/day) and ingested through diet (about 300–500 mg/day) [
1]. An excessive consumption of foods rich in saturated and trans fats will increase cholesterol levels and lead to hypercholesterolemia. Hypercholesterolemia is characterized by high levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or triglycerides (TG), as well as a decrease in high-density lipoprotein cholesterol (HDL-C) [
2]. Hypercholesterolemia often leads to atherosclerosis, coronary artery disease, and a range of cardiovascular and cerebrovascular diseases. Statins are commonly used as cholesterol-lowering drugs, but they may cause adverse reactions, such as liver and kidney damage, rhabdomyolysis, elevated blood sugar-induced diabetes, etc., and they are not considered to be an ideal long-term treatment [
3]. Therefore, it is important to find new effective drugs and new treatment strategies for preventing or alleviating hypercholesterolemia.
Systemic cholesterol homeostasis is a strictly regulated process involving de novo biosynthesis, dietary cholesterol absorption, biliary clearance, and excretion, and the liver is the main organ to maintain cholesterol homeostasis [
4]. The metabolism of cholesterol in the body mainly through the following ways: 1. Cholesterol is transformed into cholesterol derivatives with important physiological functions, such as Vitamin D, sex hormones, and adrenocortical hormones; 2. Cell-membrane formation; 3. Esterification; 4. Excretion in feces; 5. Cholesterol is hydroxylated and degraded to produce bile acids (BAs) [
5]. BAs are steroid substances synthesized by the liver from cholesterol. Various bile salts (BS) formed by BAs are the main components of bile, and the conversion of cholesterol into BAs accounts for 80% of total metabolism. There are two main pathways for BA synthesis in hepatocytes: The classical pathway with cholesterol 7α hydroxylase (CYP7A1), and the alternative pathway with sterol 27 hydroxylase (CYP27A1) [
6]. When cholesterol levels are high, cholesterol is broken down into BAs and stored in the gallbladder. They are then released into the duodenum and proximal jejunum after cholecystokinin stimulation. After entering the intestine, a part of the BAs is absorbed by the mucosa and returned to the liver to complete the hepatoenteric circulation. In contrast, the unabsorbed parts are degraded into fecal matter by intestinal microorganisms and expelled [
7]. Promoting the conversion of liver cholesterol to BAs is an important method to reduce cholesterol, which is of great significance for the prevention and treatment of hypercholesterolemia.
Intestinal flora is related to digestion, nutrient metabolism, immune function, etc., and is important in body health and physiological metabolism. Diet is one of the most critical factors in the change of gut microbiota structure, and the functional components in food can regulate the growth and metabolic activities of gut microbiota, thus affecting the microbial composition. Under normal circumstances, the gut flora and the host benefit from a mutual dynamic ecological balance. Once this balance is disrupted, pathogenic bacteria can cause infectious diseases, metabolic syndromes (such as hyperlipidemia and high blood pressure), and certain neurological disorders [
8,
9]. Studies have shown that a high-fat diet disrupts the body’s original microbial balance and induces more conditioned pathogens, such as Betaproteobacteria,
Clostridium_bolteae,
Desulfovibrio, and
Enterobacter_cloacae [
10,
11,
12]. In addition, intestinal flora participates in and regulates host metabolism by producing metabolites and short-chain fatty acids (SCFAs) to alleviate hypercholesterolemia [
13]. SCFAs can stimulate the proliferation and differentiation of intestinal epithelial cells and help maintain the mineral balance of intestinal epithelial cells and the absorption of iron, calcium, and magnesium. Common SCFAs include acetic acid, propionic acid, and butyric acid, while other SCFAs such as isobutyric acid, valeric acid, and isovaleric acid are relatively low in the colon [
14].
Polysaccharides are essential biomacromolecules in living organisms, playing important roles in life activities such as cell–cell connections, signaling pathways, cell adhesion, and immune system molecular recognition. In recent years, more and more studies have reported the isolation and identification of bioactive polysaccharides from natural sources, indicating that polysaccharides have a variety of biological functions, including anti-hypercholesterolemic activity [
15,
16,
17].
Cyclocarya paliurus is a species native only to China, and its leaves are used in medicinal preparations in traditional Chinese medicine, as well as an ingredient in functional foods [
18,
19]. Previous studies have shown that polysaccharides from
Cyclocarya paliurus leaves can regulate lipid metabolism, relieve hyperlipidemia, and relieve diabetes, but its effect on hypercholesterolemia has not been reported [
18,
19,
20]. Therefore, this study attempted to explore the effect of
Cyclocarya paliurus polysaccharides on hypercholesterolemia through in vivo and in vitro experiments to explore the mechanism of action.
4. Discussion
In this study, the cholesterol-lowering activity of CPP20 was investigated in vitro and in vivo. CPP20 used in this experiment was a homogeneous polysaccharide with Mw of 56.282 kDa, obtained by fractional alcohol precipitation. The total carbohydrate content was 67.18 ± 1.22%, the uronic acid content was 25.60 ± 0.37%, and the protein content was 4.21 ± 0.57%. The monosaccharide composed of CPP20 was Glc, Ara, GalA, Gal, Rha, NAG, GlcA, Xyl, GlcN, Fuc, and GlaN, with the molar percentage being 0.296:0.214:0.201:0.170:0.036:0.025:0.020:0.018:0.010:0.008:0.003 mol%.
The BAs are derivatives of cholesterol, and primary BAs exist mainly in the form of BS. It has physiological functions of cholesterol dissolution and fat transfer in the gastrointestinal tract and promotes cholesterol consumption [
25]. Therefore, reducing BS levels not only helps to reduce the accumulation of BAs but also accelerates cholesterol metabolism and reduces cholesterol content. Polysaccharides are reported to reduce the dissolution of cholesterol, inhibit its absorption, and reduce the BAs by binding to cholesterol and BS. At the same time, a decrease in BAs leads to a decrease in micellar solution, which in turn impinges on lipid and cholesterol absorption. Furthermore, BAs that bind to polysaccharides are also excreted from the feces, further lowering cholesterol [
26]. The cholesterol-lowering and other biological activities of polysaccharides are affected by molecular weight, concentration or dose, linkage type, and molecular properties. The functional groups of polysaccharides include -COH, C=O, -O-, -COOH, and -OH, which attract and remove cholesterol and BAs from the gastrointestinal tract [
27]. The results of in vitro experiments showed that CPP20 had the capacity of the cholesterol inhibition rate and the BA binding rate. This may be because the porous structure of CPP20 provides an active site for BA binding, and it has abundant functional groups such as -OH to promote its binding with BAs. On the other hand, the strong BA binding ability of CPP20 may be due to its high uronic acid content and good antioxidant activity. It has been reported that polysaccharide obtained from acid-assisted extraction has the strongest BA binding ability, which may be related to high aldehyde content [
28]. Oxidation will lead to a decline in the ability of β-glucan to restrict the flow of BAs [
29]. The effect of antioxidant capacity on the adsorption of BAs by polysaccharides may be due to the fact that the molecular groups and structures that affect antioxidant activity also affect the binding ability of BAs [
30]. In vitro results of this study are consistent with those previously reported, CPP20 has the best antioxidant capacity, and its ability to absorb BAs is also the strongest. Therefore, CPP20 may exert its cholesterol-lowering activity by forming a network that effectively traps cholesterol and BAs in the aqueous phase, inhibiting cholesterol absorption and increasing BAs excretion [
26,
31].
The liver index reflects liver function and health, and ALT and AST are the most common serum biomarkers for a variety of liver tissue lesions. A high-fat and high-cholesterol diet can increase the production of ROS and MDA by increasing the levels of enzymes such as ALT and AST, ultimately leading to an increase in circulating cholesterol concentration [
32]. In this study, the liver index of CPPM and SIM was higher than that of HFHC, which may be due to the lower body weight of CPPM and SIM, and transaminase levels and H&E results showed significant improvement in CPP20M. Studies have shown that oxidative stress can lead to liver diseases [
33,
34]. ROS is the main cause of oxidative stress and lipid peroxidation, leading to the depletion of antioxidant enzymes, causing cell damage involved in cholesterol metabolic pathways, and ultimately leading to dyslipidemia and related diseases [
34]. It has been reported that polysaccharides inhibit oxidative stress by acting as a natural scrubber of ROS and increasing the levels of antioxidant enzymes (SOD, CAT, GSH-Px), thus producing the potential of lowering blood lipids and cholesterol [
35,
36]. The results of this study are consistent with the results of previous studies, CPP20 increased the levels of SOD, CAT, and GSH-Px, reduced the level of MDA in the liver, and alleviated hypercholesterolemia by enhancing the antioxidant function.
The liver can excrete cholesterol into the plasma circulation in the form of very low-density lipoprotein (VLDL) and/or LDL. At the same time, the liver releases newly synthesized HDL-C, which removes excess cholesterol from the plasma [
37,
38]. LDL is a lipoprotein particle that carries cholesterol into peripheral tissue cells and can be oxidized to Ox-LDL, which is found in high levels in patients with hypercholesterolemia and cardiovascular disease [
39,
40]. LDL-C formed by the LDL and cholesterol is the carrier of TC, and the accumulation of LDL and LDL-C is easy to lead to atherosclerotic plaque lesions. HDL can transport cholesterol from peripheral tissues to the liver for catabolism through the “reverse cholesterol transport” pathway, and high levels of HDL have a protective effect [
33]. After the administration of CPP20, the levels of TC, TG, LDL-C, and TBA in the serum and liver of hypercholesterolemic mice are significantly reduced, and the levels of HDL-C are significantly increased.
The endogenous cholesterol required by the body is mainly synthesized in the liver, and HMGCR is the main rate-limiting enzyme for cholesterol synthesis, which is a well-known target for statins [
41]. Polysaccharides have been reported to competitively inhibit HMGCR and restrict endogenous cholesterol synthesis [
42]. The SREBP-2 transcription factor is related to the overexpression of HMGCR and is involved in the biosynthesis of cholesterol in the liver, and the overexpression of the SREBP-2 transcription factor will lead to elevated cholesterol levels [
43]. The results of this experiment are consistent with previous reports; CPP20 reduced cholesterol levels by inhibiting the expression of SREBP-2 and HMGCR and inhibiting cholesterol synthesis [
44]. The increased synthesis of BAs stimulates the utilization of cholesterol, which is considered to be the main metabolic pathway of cholesterol catabolism. There are two ways to synthesize BAs from cholesterol metabolism in the liver. One is the classical pathway catalyzed by CYP7A1, and the other is the alternative pathway catalyzed by CYP27A1. The classical pathway is the main pathway of BA synthesis in the human body, producing about 75% of BAs, and CYP7A1 activity is negatively regulated by FXR, while FXR is negatively regulated by free BA content [
45]. In this study, CPP20 increased the expression level of CYP7A1, decreased the expression of CYP27A1 and FXR, and lowered cholesterol by promoting the synthesis of BAs (
Figure 11).
Some gut bacteria could produce bile brine hydrolase (BSH) to hydrolyze bound BAs to free BAs, thereby increasing BA excretion and reducing total cholesterol and BA levels [
46]. Glycine and taurine released in the deconjugation reaction become nutrient sources for the gut microbiome, and the optimal pH for this reaction is about 6 [
47]. In this study, the gut microbiota of mice with hypercholesterolemia was significantly different compared to NC. The decrease of α diversity in CPP20, especially in CPP20M, may be related to the bacteriostasis of some BAs (mainly DCA and LCA).
Akkermansia muciniphila, the dominant bacterium in CPP20M, was reported to have a decreased abundance of mice with metabolic disease, and symptoms of the diseased mice improved after supplementation with
Akkermansia muciniphila [
48]. The intragastric administration of
Akkermansia muciniphila can significantly improve intestinal mucosal barrier dysfunction and metabolic disorders in mice with a high-fat diet;
Akkermansia muciniphila can enhance the efficacy of metformin in the treatment of Type 2 diabetes, prevent atherosclerosis, and alleviate metabolic endotoxemia in mice [
49,
50,
51]. The dominant bacteria in HFHC, the members of
Proteobacteria, are often closely related to the occurrence of some diseases. Among them,
Alcaligens_faecalis is extensively resistant, and its infection can cause cystitis, diabetes, and pneumonia, among other diseases [
52].
Bacteroides_acidifaciens, which are positively associated with CPP20M, have been reported to have the potential to treat metabolic diseases such as diabetes and obesity [
53].
Eubacterium is a producer of butyrate and propionate, and it reduces cholesterol levels by converting cholesterol to coprostanol and regulating BA metabolism. Its levels in the gut microbiota are affected by the amount of dietary fiber in the gut, and both high-protein/high-fat diets reduce their levels [
54].
Subdoligranulum is almost absent in people with obesity and diabetes but is systematically present in healthy people [
55]. The
Staphylococcus sciuri species is generally considered harmless, and almost all strains of the
Staphylococcus genus carry BSH, which can promote the production of free BAs [
56,
57].
Desulfovibrio C21-20, which is positively related to HFHC, is often considered a harmful bacterium in the gut and has been linked to inflammatory bowel disease [
58]. Among other bacteria positively related to HFHC,
Clostridium_cocleatum is reported to be enriched in obese mice [
59],
Corynebacterium_stationis and
Psychrobacter_sanguinis are considered as pathogenic bacteria associated with body infection [
59,
60,
61]. In addition, the intake of CPP20 also increased the level of SCFA in the gut. Butyric acid can inhibit the activity of SREBP-2 and the expression of HMGCR, thereby inhibiting cholesterol synthesis and lowering cholesterol levels. Propionic acid can consume plasma cholesterol by reducing HMGCR activity and inhibiting acetyl-Co reductase, which catalyzes acetic acid to synthesize acetyl-CoA [
13,
62]. In addition, acetic acid has been reported to reduce serum total cholesterol and triglyceride levels in rats fed a high-cholesterol diet [
63]. The production of SCFAs also reduces the pH of the large intestine, promotes the unbinding of conjugated BAs, reduces the solubility of BAs, and reduces the conversion of primary BAs into secondary BAs by the bacterial enzyme 7α-dehydroxylase (associated with cholesterol emulsification), which is associated with cholesterol emulsification [
64,
65,
66]. Therefore, changing the composition of intestinal flora and increasing the level of SCFAs are important ways for CPP20 to relieve hypercholesterolemia.
Compared with NC, the function of increased abundance in HFHC is more related to glycolysis. The PWY0-1479 pathway is associated with an increased incidence of Type 2 diabetes [
67]. The function of increased abundance in CPP20M is associated with glycolysis, lipid oxidation, and vitamin production. Among them, PWY-6891 is a synthetic pathway for thiazoles, which are commonly used to treat Type 2 diabetes [
67]. Pyridoxal 5′-phosphate is a chemically active form of Vitamin B6, it is a cofactor in more than 160 enzyme activities, and it is closely related to metabolism [
68]. Sulfate assimilation and fatty-acid β-oxidation (SO4ASSIM-PWY and FAO-PWY) are associated with SCFA production [
69]. Fucose, galactose, uronic acid degradation, and other related pathways (FUCCAT-PWY, GALACTARDEG, and GLUCARGALACTSUPER-PWY) are upregulated, which may be related to the monosaccharide composition of CPP20. CPP20 also facilitated the conversion of pyruvate to butyrate and acidifying fermentation (CENTFERM-PWY and PWY6590). LPS produced by gut microbes has been reported to increase LDL-C and decrease HDL-C, possibly by promoting HMGCA reductase [
70]. CPP20M reduced some of the functional pathways associated with LPS production (PWY6478, PWY7315) and reduced propionic acid degradation (PWY5747, PWY0-42), which may relate to reduced levels of gram-negative bacteria in CPP20M. PWY-6629, and PWY-6165 decreased by CPP20, the metabolites may promote the formation of abdominal aortic aneurysms and are positively correlated with E. coli/Shigella [
71]. PWY-7347 and SUCSYN-PWY metabolic pathways are highly active in chronic endometritis [
72].