A feline model of human LDLR-related atherosclerosis

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Background: Atherosclerosis, a chronic inflammatory vascular disease driven by the accumulation of LDL-derived cholesterol on arterial walls, is the leading cause of mortality worldwide but is rare in animals. We recently identified spontaneous atherosclerosis in the Korat cat breed, characterized by severe hypercholesterolemia and clinical signs of congestive heart failure, ultimately leading to death. Histopathological examination revealed lesions similar to those observed in human atherosclerosis. Given the close genetic relationship among affected cats, we hypothesized a genetic basis for the condition. Methods: We expanded our sample recruitment and employed whole genome sequencing to identify genetic variants associated with the condition. Results: We identified a homozygous XM_003981898.6:c.2406G>A variant specific to the cases in the LDLR gene. This variant is predicted to result in a premature stop codon, XP_003981947.3:p.Trp758*, leading to a truncated LDLR protein that lacks the last 108 amino acids, including the transmembrane and intracellular C-terminal domains. Genotyping this LDLR variant in an additional cohort of 309 Korat cats confirmed its segregation and revealed new affected cats for clinical follow-up. In silico analyses demonstrated that the identified variant appears optimal for gene-editing-based therapeutics. Conclusions: This is the first report of a spontaneous atherosclerosis animal model with an LDLR variant, the most common gene associated with familial hypercholesterolemia in humans. Given that PCSK9, another known hypercholesterolemia gene, has been lost in many mammalian genomes, including cats, our study provides an exciting double knockout model for human atherosclerosis. The affected Korats may also serve as a valuable model for DNA base editing therapeutics.

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