Although, studies of lipid metabolism have been focusing on that in the systemic circulation using nonneuronalcells for decades, knowledge regarding cholesterol metabolism in the brain, the most lipid–rich organs, is very limit-ed. The cholesterol metabolism in the brain is supposed to be independently and uniquely regulated, because brainis segregated from the systemic circulation by the blood–brain barrier. Thus, the cholesterol being transported inthe systemic circulation by serum lipoprotein cannot be available to the brain.It has been shown that cholesterolsupplied as a lipoprotein complex, i.e., high–density–lipoprotein (HDL), is critical for the maturation of synapses andthe maintenance of synaptic plasticity.Interestingly, apolipoprotein E (apoE)is the major apolipoprotein generatingHDL in the brain, which is supplied to neurons via apoE receptors. The discovery that possession of apoE alleleε4is a strong risk factor for Alzheimer’s disease (AD)leads us to focus on the role of cholesterol in the pathogenesis ofAD. Accumulating epidemiological and biological evidence suggests the link between the serum cholesterol leveland the development of AD, and the potential therapeutic effectiveness of statins for AD and mild cognitive impair-ment (MCI), whereas other lines of evidence show controversial results. Cholesterol is known to interact with amy-loidβ–protein (Aβ)in a reciprocal manner: cellular cholesterol levels modulate Aβgeneration, while, Aβalters cho-lesterol dynamics in neurons, leading to tauopathy.In this review, the relationship between the cholesterol levels inserum or cerebrospinal fluid (CSF)and the induction of AD is discussed. The mechanism(s), if this is the case, ofhow cholesterol in the central nervous system (CNS)is involved in the induction of pathologies of AD includingAβgeneration and tauopathy, and how statins prevent it are also discussed.
Read full abstract