Regression of inflammation in atherosclerosis by the LXR agonist R211945: A noninvasive assessment and comparison with atorvastatin

Esad Vucic, Claudia Calcagno, Stephen D. Dickson, James H.F. Rudd, Katsumi Hayashi, Jan Bucerius, Erin Moshier, Jessica S. Mounessa, Michelle Roytman, Matthew J. Moon, James Lin, Sarayu Ramachandran, Tatsuo Tanimoto, Karen Brown, Masakatsu Kotsuma, Sotirios Tsimikas, Edward A. Fisher, Klaas Nicolay, Valentin Fuster, Zahi A. Fayad

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


The aim of this study was to noninvasively detect the anti-inflammatory properties of the novel liver X receptor agonist R211945. R211945 induces reversal cholesterol transport and modulates inflammation in atherosclerotic plaques. We aimed to characterize with 18 F-fluorodeoxyglucose (FDG)positron emission tomography (PET)/computed tomography (CT) and dynamic contrast-enhanced cardiac magnetic resonance (DCE-CMR) inflammation and neovascularization, respectively, in atherosclerotic plaques with R211945 treatment compared with atorvastatin treatment and a control. Twenty-one atherosclerotic New Zealand white rabbits were divided into 3 groups (control, R211945 [3 mg/kg orally], and atorvastatin [3 mg/kg orally] groups). All groups underwent 18 F-FDGPET/CT and DCE-CMR at baseline and at 1 and 3 months after treatment initiation. Concomitantly, serum metabolic parameters and histology were assessed. For statistical analysis, continuous DCE-CMR and PET/CT outcomes were modeled as linear functions of time by using a linear mixed model, whereas the histological data, animal characteristics data, and nonlinear regression imaging data were analyzed with a 2-tailed Student t test. 18 F-FDGPET/CT detected a decrease in mean and maximum standard uptake values (SUV) over time in the R211945 group (both p = 0.001), indicating inflammation regression. The atorvastatin group displayed no significant change (p = 0.371 and p = 0.600, respectively), indicating no progression or regression. The control group demonstrated an increase in SUV (p = 0.01 and p = 0.04, respectively), indicating progression. There was a significant interaction between time and group for mean and maximum SUV (p = 0.0003 and p = 0.0016, respectively) . DCE-CMR detected a trend toward difference (p = 0.06) in the area under the curve in the atorvastatin group, suggesting a decrease in neovascularization. There was no significant interaction between time and group (p = 0.6350 and p = 0.8011, respectively). Macrophage and apolipoprotein B immunoreactivity decreased in the R211945 and atorvastatin groups (p < 0.0001 and p = 0.0004, respectively), and R211945 decreased oxidized phospholipid immunoreactivity (p = 0.02). Noninvasive imaging with 18 F-FDGPET/CT and DCE-CMR and histological analysis demonstrated significant anti-inflammatory effects of the LXR agonist R211945 compared with atorvastatin. The results suggest a possible role for LXR agonists in the treatment of atherosclerosis.

Original languageEnglish (US)
Pages (from-to)819-828
Number of pages10
JournalJACC: Cardiovascular Imaging
Issue number8
StatePublished - Aug 2012
Externally publishedYes


  • ABCA1
  • ATP-binding cassette transporter A1
  • AUC
  • CT
  • FDG
  • LXR
  • PET
  • SUV
  • VEGF
  • a.u.
  • arbitrary units
  • area under the curve
  • computed tomography
  • dynamic contrast-enhanced cardiac magnetic resonance
  • fluorodeoxyglucose
  • liver X receptor
  • positron emission tomography
  • standard uptake value
  • vascular endothelial growth factor

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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