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The Roles of ApoC-III on the Metabolism of Triglyceride-Rich Lipoproteins in Humans
Open accessAbstract
Cardiovascular disease (CVD) is the leading cause of death globally. It is well established based on evidence accrued during the last three decades that high plasma concentrations of cholesterol-rich atherogenic lipoproteins are causatively linked to CVD, and that lowering these reduces atherosclerotic cardiovascular events in humans.1-9 Historically, most attention has been on low-density lipoproteins (LDL) since these are the most abundant atherogenic lipoproteins in the circulation, and thus the main carrier of cholesterol into the artery wall. However, with the rise of obesity and insulin resistance in many populations, there is increasing interest in the role of triglyceride-rich lipoproteins (TRLs) and their metabolic remnants, with accumulating evidence showing they too are causatively linked to CVD. Plasma triglyceride, measured either in the fasting or non-fasting state, is a useful index of the abundance of TRLs and recent research into the biology and genetics of triglyceride heritability has provided new insight into the causal relationship of TRLs with CVD. Of the genetic factors known to influence plasma triglyceride levels variation in APOC3 - the gene for apolipoprotein (apo) C-III - has emerged as being particularly important as a regulator of triglyceride transport and a novel therapeutic target to reduce dyslipidaemia and CVD risk.
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“Moreover, the reduction in apolipoprotein C-III levels by the conventional triglyceride-lowering agents, such as fibrates and omega-3 fatty acids, is modest (10 to 40%)”
From Olezarsen, Acute Pancreatitis, and Familial Chylomicronemia Syndrome (2024) · cites this paper as [34]
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“Elevated apoC-III levels are associated with increased circulating TG, impaired remnant clearance, and a heightened burden of atherogenic lipoproteins.”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [111]
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“beyond its inhibitory action on lipoprotein lipase (LPL), apoC-III also delays hepatic uptake of TRL remnants, contributing to both hypertriglyceridemia and atherosclerotic progression through LPL-independent pathways [111]”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [111]
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“and these agents have not been effective in lowering triglyceride levels in patients with familial chylomicronemia syndrome. 21,34”
From Olezarsen, Acute Pancreatitis, and Familial Chylomicronemia Syndrome (2024) · cites this paper as [34]
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InfluentialProteomic analysis emphasizes the adaptation of energy metabolism in horses during endurance races
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“Similarly, alterations in apoc-iii composition on triglyceride-rich lipoproteins are predictive of hypertriglyceridaemia and atherosclerosis (Borén et al. 2020). in this way, proteomics provides mechanistic information and candidate biomarkers for lipid diseases.”
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“ApoCIII inhibits LPL activity, reduces the hepatic uptake of triglyceride-rich lipoproteins and increases hepatic secretion of triglycerides.([17]) Loss-of-function (LOF) mutations of the gene coding for apoCIII and pharmacologic inhibition of apoCIII lead to reduced plasma triglyceride levels.”
Lipids, Lipoproteins, and Cardiovascular Outcomes
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The evaluation of plozasiran for the treatment of familial chylomicronemia syndrome
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“…been proposed that apo C-III promotes the synthesis and hepatic secretion of TG-rich lipoproteins (TRLs), inhibits LPL-mediated lipolysis, and impairs hepatic clearance of TRL remnants through LPL-independent pathways, potentially by interfering with binding to hepatic receptors (Figure 1) [36].”
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ANGPTL3, Apo CIII, Leptin and Triglycerides Are Elevated in Metastatic Prostate Cancer
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Production and Metabolism of Triglyceride-Rich Lipoproteins: Impact of Diabetes
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“25,26 Insulin resistance is also associated with increased activity of hepatic TG lipase, which enhances the fractional catabolic rate of HDL, hence low serum HDL-C, and facilitates the generation of small dense LDL. 25 The excess intrahepatic lipid accumulation promotes lipid peroxidation and increased oxidative stre…”
Sidorov, V. Y., Sidorova, T. N., Samson, P. C., Reiserer, R. S., Britt, C. M., Neely, M. D., Ess, K. C., & Wikswo, J. P. (2024) · Bioengineering · doi:10.3390/bioengineering11030234 · Cited by 1
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Systemic inflammation is a minor contributor to remnant cholesterol atherogenicityPreprint
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“Indeed, beyond its inhibitory action on lipoprotein lipase (LPL), apoC-III also delays hepatic uptake of TRL remnants, contributing to both hypertriglyceridemia and atherosclerotic progression through LPL-independent pathways [111].”
Björnson, E. (2021) · Gothenburg University Publications Electronic Archive (Gothenburg University)
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de Carvalho, L. S. F., Asari, A. I. A., Teles, B. S. B. D. S., Filho, A. D. B. C., & Yoshinaga, M. Y. (2022) · Biomarkers in disease · doi:10.1007/978-3-031-08014-2_20
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“Since ApoCIII reduces lipoprotein lipase activity and prevents receptor-mediated absorption of TG-rich lipoproteins, TG-rich lipoproteins take longer to be cleared from the body((18)).”
BackgroundFranssen, W. M. A. (2022) · Research Publications (Maastricht University) · doi:10.26481/dis.20221121wf · Cited by 1
Lipoproteins and Diabetic Kidney Disease
Sigfrids, F. J., Elonen, N., & Groop, P. (2023) · Contemporary diabetes · doi:10.1007/978-3-031-26681-2_15
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“This pool of data provides exhaustive evidence of the causal role of LDL in atherogenesis (Borén et al., 2020).”
BackgroundRNA interference-based therapies for atherosclerosis: Recent advances and future prospects
Parsamanesh, N., Poudineh, M., Siami, H., Butler, A. E., Almahmeed, W. A., & Sahebkar, A. (2023) · Progress in molecular biology and translational science · doi:10.1016/bs.pmbts.2023.12.009 · Cited by 1
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“In particular, nutritional intake triggers shifts in circulating lipoprotein profiles, including the modulation of APOC3 38 which are tightly linked to energy states, with fed conditions markedly contrasting the adaptations seen during fasting or energy deprivation.”
Pontali, G., Weichenberger, C. X., Rainer, J., Hantikainen, E. M., Graeve, M. D., Mattivi, F., Kob, M., Ralser, M., Pramstaller, P. P., & Domingues, F. S. (2025) · medRxiv · doi:10.1101/2025.03.10.25323679
“The protein is a therapeutic target of volanesorsen, a drug approved for reduction of triglyceride levels, and is a candidate target for reducing CVD risk [49, 59].”
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Tang, Y., & Lv, D. (2025) · Scientific Reports · doi:10.1038/s41598-025-01677-w
“Up-regulation of ApoC expression has been shown to increase lipoprotein lipase activity and promote the clearance of triglyceride-rich lipoproteins 39 .”
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Jansen, M., Contini, C., Hoffmann, M. M., & Pütz, G. (2025) · Journal of Lipid Research · doi:10.1016/j.jlr.2025.100847
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“[33] Human knock-out studies of ApoC3 have shown that ApoC3 deficiency lowers plasma triglyceride and cholesterol levels and increases HDL-C levels.”
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“This means that even in patients with a defective LPL enzyme, triglycerides can still be metabolized [24,29,30].”
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Pathogenesis of type 2 diabetes
Honka, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00376-9
Liu, Y., Kimita, W., Bharmal, S. H., & Petrov, M. S. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1726174
“By contrast, apo C-III has an inhibitory effect on LPL, leading to reduced lipolysis of TRL particles and reduced clearance of TRL remnants (21).”
Masood, A., Qureshi, A. U. H., Khalid, Z., Shahid, H., Malik, A. R. K., Javed, S., Mandahar, M., Amanullah, A., Siddiqui, Y., Anwar, T., et al. (2026) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2026.3543
Wulff, A. B., Varbo, A., Nordestgaard, A. G., & Nordestgaard, B. G. (2026) · Expert Opinion on Therapeutic Targets · doi:10.1080/14728222.2026.2639678 · Cited by 2
Lee, F., Arvik, T. J., Newman, J. W. I., & Keim, N. L. (2026) · Nutrition Research · doi:10.1016/j.nutres.2026.02.009
Fallatah, T. A., Abdelmigid, H. M., Alyamani, A. A., Morsi, M. M., Ali, M., Lu, J., Zhao, J., & Heikal, Y. M. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1753616
Öörni, K., Äikäs, L., Ruuth, M. K., Tigistu‐Sahle, F., Käkelä, R., Wester, I., Gylling, H., & Simonen, P. P. (2026) · Journal of Internal Medicine · doi:10.1111/joim.70085
“CETP facilitates the exchange of TGs from VLDL to LDL and HDL, effectively enriching these particles with TGs that are subsequently hydrolyzed by hepatic lipase, reducing the size of the LDL and HDL [45].”
Clinical identification of familial chylomicronemia syndrome and novel therapeutic options
Hang, S., & Hegele, R. A. (2026) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2026.2661212
“Apo C-III is a 79–amino acid, helix-forming glycoprotein synthesized predominantly by hepatocytes and enterocytes [51].”
Yang, Y., Zhang, F., Peng, Z., Wu, Y., Li, L., Shen, Z., Ye, Q., Yue, J., & Na, S. (2026) · Acta Pharmaceutica Sinica B · doi:10.1016/j.apsb.2026.06.029
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“Visceral adipose dysfunction impairs insulin sensitivity [26], while dyslipidemia (elevated TG, low HDL) exacerbates β-cell apoptosis [27], explaining the 5-fold higher NIDDM risk in MetS individuals [28].”
Mourre, F., & Béliard, S. (2026) · Cahiers de Nutrition et de Diététique · doi:10.1016/j.cnd.2026.05.002
Clinical Pharmacology of Plozasiran
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“This dual mechanism is why targeting apoC-III can effectively lower triglycerides in patients with FCS, even when LPL is severely impaired or absent [9–11].”
Linking Lipidomics to Vulnerable Coronary Plaques: A PROSPECT II Substudy
Sharma, T., Fall, T., Sayols-Baixeras, S., Maehara, A., Mæng, M., Kjøller‐Hansen, L., Engstrøm, T., Ben‐Yehuda, O., Matsumura, M., Fröbert, O., et al. (2026) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.125.324430
Self-citationApolipoprotein E's impact on metabolic syndrome: A systematic analysis
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Recio-López, P., Rehues, P., Berggren, P., Juntti‐Berggren, L., & Valladolid‐Acebes, I. (2026) · Biomedicines · doi:10.3390/biomedicines14071481
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“…levels by inhibiting lipoprotein lipase activity and interferes with the hepatic clearance of triglyceride-rich lipoproteins and their remnants by disrupting the function of low-density lipoprotein receptors and lipoprotein receptor-related protein 1 (Borén et al. 2020, Hsu et al. 2023).”
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“ApoC-III is a noteworthy apolipoprotein in type 1 diabetes, since its levels are independently influenced by insulin and glucose, and it is an important regulator of triglyceride transport [28, 29].”
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Characterization of metabolically healthy and unhealthy obesity by circulating omics
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Remnant clearance capacity: a new framework for early type 2 diabetes pathogenesis
Nakajima, K., Murakami, M., & Tanaka, A. (2026) · Clinica Chimica Acta · doi:10.1016/j.cca.2026.121345
Yu, H., Zhang, X., Yang, S., Fan, Z., Zhang, D., & Dan, W. A. N. G. (2026) · Lipids · doi:10.1002/lipd.70085
Early Hepatic Transcriptomic Responses to High-Fat Diet in Apolipoprotein A-IV Knockout Mice
Żeber-Lubecka, N., Kulecka, M., Pyśniak, K., Dąbrowska, M., & Hennig, E. E. (2026) · Metabolites · doi:10.3390/metabo16090695
“…that reduced ApoC3 expression would favor triglyceride clearance, ApoA-IV-deficient mice displayed elevated circulating triglyceride levels under HFD, suggesting that ApoA-IV deficiency affects additional pathways involved in triglyceride homeostasis beyond ApoC3-dependent regulation [44].”
Kotlyarov, S. N., Котлярова, А. А., Catanzaro, R., & Marotta, F. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27198614
Olezarsen for the Treatment of Hypertriglyceridemia
Rodriguez, A. S. H., & Yokota, T. (2026) · Methods in molecular biology · doi:10.1007/978-1-0716-5476-7_6
Apolipoprotein CIII as a therapeutic target in obesity-associated metabolic dysfunction
Valladolid‐Acebes, I., Berggren, P., & Juntti‐Berggren, L. (2026) · Advances in Biological Regulation · doi:10.1016/j.jbior.2026.101183
Carrasco, D. G., López, P. J. T., Piña-D’Abreu, M., Cañellas, L. R., López‐González, Á. A., & Ramírez‐Manent, J. I. (2026) · Medical Sciences · doi:10.3390/medsci14060655
“Previous investigations have demonstrated that triglyceride-rich lipoproteins and remnant cholesterol particles contribute significantly to residual cardiovascular risk independently of LDL cholesterol concentrations [71,72].”
Mechanisms of Hepatic Insulin Resistance and Its Contribution to the Pathogenesis of Type 2 Diabetes
Onyango, A. N. (2026) · Comprehensive physiology · doi:10.1002/cph4.70285
“In vitro, ApoC3-enriched VLDL was shown to reduce skeletal muscle glucose uptake by binding to myocyte TLR2, leading to ER stress and AMPK inhibition (Botteri et al. 2017).”
InfluentialPersistent atherogenic lipoprotein changes during lorlatinib therapy
Shibue, K., Kunimasa, K., & Hamasaki, A. (2026) · JCEM Case Reports · doi:10.1210/jcemcr/luag324
“Apolipoprotein C-III is an important regulator of triglyceride-rich lipoprotein metabolism through inhibition of lipoprotein lipase activity and reduced hepatic clearance of triglyceride-rich lipoproteins and their remnants [12].”
Yaoyang, L. I. U., Yang, X., 倪天纯, 宗家录, Qian, C., Wang, X., & Yu, J. (2026) · Microbial Pathogenesis · doi:10.1016/j.micpath.2026.108872
Metadata
- Authors
- Borén, J., Packard, C. J., & Taskinen, M.-R.
- Affiliations
- University of Gothenburg (SE)
- University of Glasgow (GB)
- University of Helsinki (FI)
- Corresponding author
- Borén, Jan
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2020-07-28
- Volume
- 11
- Pages
- 474-474
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC7399058
- OpenAlex
- W3045911834
- Cited by
- 196
- References
- 149
- Citations by year
- 2026: 46 · 2025: 35 · 2024: 30 · 2023: 32 · 2022: 35 · 2021: 17 · 2020: 1
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- Vetenskapsrådet
- Hjärt-Lungfonden
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- apolipoprotein C-III, triglyceride-rich lipoproteins, triglyceride metabolism, cardiovascular disease, dyslipidemia, plasma triglycerides, atherogenic lipoproteins, triglyceride transport, obesity, insulin resistance
- MeSH terms
- Cardiovascular Diseases, Humans, Lipoproteins, Triglycerides, Atherosclerosis, Lipid Metabolism, Apolipoprotein C-III
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