Parasites as host cholesterol consumers: The special case of Toxoplasma gondii

Abstract

Statins have become the most widely used drugs for lowering cholesterol with at least 15% of patients requiring admission to hospital on established statin therapy, and this number is growing each year. However, statins have been postulated to have beneficial effects independent of their lipid lowering including anti-inflammatory and immunomodulatory roles. Evidence is emerging from observational studies and basic science research that HMG Co A Reductase inhibitors (statins) might be associated with a reduced mortality in sepsis. A number of observational studies have suggested that patients on statins for heart disease are less likely to develop infections and that their infections are less likely to be severe or result in death. Not all studies support a benefit associated with statin therapy for patients with sepsis. Other studies have suggested that stopping statins in patients that present with infections (as suggested by current guidelines), may worsen outcomes. The desire to incorporate the ever expanding potential of these agents into routine clinical practice for patients with sepsis must be tempered by the potential for adverse effects. There is a significant body of evidence that the side effects of statins may be more frequent and serious in the critically ill. A variety of less well known toxicities are being reported as these agents gain more widespread use. This is a rapidly growing field of fascinating experimental biology that suggests an urgent need for the investigation of the pharmacology and a reappraisal of the therapeutic indications of these drugs in patients with sepsis. This may provide new insights to the role of lipids and the endothelium in the response to infection. The potential for statins as an adjuvant therapy in sepsis is a simple, inexpensive intervention that warrants further prospective investigation.