apoB-100, apolipoprotein B-100; ANOVA, analysis of variance; ASGPR1, asialoglycoprotein receptor; CAD, coronary artery disease; FH, familial hypercholesterolemia; FL-LDL, fluorescently labeled LDL; GWAS, genome-wide association studies; hESC, human embryonic stem cell; hiPSC, human induced pluripotent stem cell; HMG-CoA, 3-hydroxy-3-methyl-glutaryl-coenzyme A; HNF4a, hepatocyte nuclear factor 4a; iPSC, induced pluripotent stem cell; LDL-C, low-density lipoprotein cholesterol; LY294002 mRNA, messenger RNA; qRT-PCR, quantitative reverse-transcription polymerase chain reaction; SREBP, sterol regulatory element binding protein; VLDL, very low-density lipoprotein. A detailed description

of the Materials and Methods is provided in the Supporting Information. Procedures used for the generation of iPSCs and differentiation of pluripotent stem cells to hepatocytes have been described.4, 9 All culture of human embryonic stem cells (hESCs) and generation of iPSCs was approved by the MCW Human Stem Cell

Research Oversight Committee (hSCRO approval #09-005), and all animal procedures were approved by the Medical College of Wisconsin’s Institutional Animal Care and Use Committee. FH is an autosomal dominant dyslipidemia caused by mutations in the LDLR gene that result in severely elevated plasma LDL-C levels and premature cardiovascular disease.10 The liver is central to the pathogenesis of FH, and homozygous FH patients are selleck products successfully treated with liver transplantation. Although

hepatocytes are the key cells that control cholesterol flux, LDLR mutations have primarily been studied using fibroblasts.10 Such studies Orotidine 5′-phosphate decarboxylase revealed that LDLR-deficient fibroblasts had an impaired capacity to internalize LDL, which gave rise to the paradigm that the level of LDL-C in serum is determined by the rate of LDL clearance.11 However, modifications to this model have recently been proposed based on evidence suggesting that FH patients often possess profoundly elevated hepatic very low-density lipoprotein (VLDL) production.12 Given the extensive understanding of FH and the fact that single nucleotide polymorphisms have been identified in the vicinity of the LDLR gene, we felt that hepatocytes derived from FH hiPSCs would offer an ideal model to define the feasibility of using iPSCs to study genetic variations that could affect complex hepatic metabolism. The generation of iPSCs from a patient with early onset atherosclerotic disease with hypercholesterolemia has been described7; however, the genetic lesion was undefined. In addition, this study by Rashid et al. was designed only to test whether cells derived from LDLR-deficient iPSCs could internalize LDL. However, LDLR-mediated uptake of LDL is not a hepatocyte-specific process, and most cells use this pathway to internalize cholesterol.