Regulation Of Cholesterol Absorption Research Articles

Liver X receptors bridge hepatic lipid metabolism and inflammation

Liver X receptors (LXRs) are members of the superfamily of metabolic nuclear receptors, which play central roles in the regulation of cholesterol absorption, efflux, transportation and excretion and many other processes correlating with lipid metabolism. LXRs can also regulate inflammation in vitro and in vivo. Accumulating evidence demonstrates that LXR are involved in the metabolism and inflammation in human diseases. Nonalcoholic fatty liver disease (NAFLD) is classically associated with lipid metabolic disorders and inflammatory responses, especially in the nonalcoholic steatohepatitis (NASH) phase. The effects of LXRs on cholesterol metabolism and inflammation make them attractive as a potential target for the treatment of NAFLD. Since the ability to synthesize triglycerides may be protective in obesity and fatty liver, the hepatic lipogenesis by LXRs should not rule out the possibility of the use of LXRs in NAFLD.

Regulation of cholesterol absorption by phytosterols

Phytosterols are chemical homologs of cholesterol that are found in most plant foods and are particularly abundant in vegetable oils and whole grains. They interfere with the micellar solubilization of cholesterol in the intestine and reduce the efficiency of cholesterol absorption. The net absorption of phytosterols themselves is very small and most clinical studies suggest that consumption is safe. Phytosterols naturally present in foods appear to be bioactive, but many commercial phytosterol supplements are comprised of purified crystals with limited bioavailability. Proper formulation to improve bioavailability is critical for phytosterol supplements. Phytosterols appear to be quantitatively as important to cholesterol lowering as reducing saturated fat consumption, and they provide an additional tool for regulation of circulating cholesterol through lifestyle changes.

New insights into the role of the adenosine triphosphate–binding cassette transporters in high-density lipoprotein metabolism and reverse cholesterol transport

Four adenosine triphosphate–binding cassette (ABC) transporters—ABCA1, ABCG1, ABCG5, and ABCG8—have been identified and shown to modulate cholesterol and lipoprotein metabolism. Recent analyses of ABCA1 indicate that upregulation of ABCA1 in the liver and macrophages of transgenic mice is associated with increased plasma high-density lipoprotein (HDL) cholesterol levels, increased net flux of cholesterol to the liver, and reduced diet-induced atherosclerosis. In ABCA1 transgenic mice, the enhanced expression of hepatic ABCA1 transporters is associated with increased plasma HDL cholesterol levels, suggesting that the liver plays an important role in the levels of plasma HDL cholesterol. Overexpression of ABCG1 in the liver of mice using recombinant ABCG1 vectors results in decreased plasma HDL levels and indicates that ABCG1 can modulate plasma lipoprotein levels in vivo. The potential importance of ABCG1 in reverse cholesterol transport has not been definitively established. Studies in patients with sitosterolemia have identified 2 major new transporters, ABCG5 and ABCG8, that play a pivotal role in the regulation of intestinal cholesterol, plant, and shellfish absorption. Modulation of the expression of ABCG5 and ABCG8 represents an important new mechanism in the regulation of cholesterol absorption in the intestine. The ABC transporters currently represent excellent targets for the development of new drugs for the treatment of patients with increased risk of premature cardiovascular disease.

Apolipoprotein E competitively inhibits receptor-dependent low density lipoprotein uptake by the liver but has no effect on cholesterol absorption or synthesis in the mouse.

This study examines the question of whether apolipoprotein E (apoE) alters steady-state concentrations of plasma cholesterol carried in low density lipoproteins (LDL-C) by acting as a competitive inhibitor of hepatic LDL uptake or by altering the rate of net cholesterol delivery from the intestinal lumen to the liver. To differentiate between these two possibilities, rates of cholesterol absorption and synthesis and the kinetics of hepatic LDL-C transport were measured in vivo in mice with either normal (apoE+/+) or zero (apoE-/-) levels of circulating apoE. Rates of cholesterol absorption were essentially identical in both genotypes and equaled approximately 44% of the daily dietary load of cholesterol. This finding was consistent with the further observation that the rates of cholesterol synthesis in the liver (approximately 2,000 nmol/h) and extrahepatic tissues (approximately 3,000 nmol/h) were also essentially identical in the two groups of mice. However, the apparent Michaelis constant for receptor-dependent hepatic LDL-C uptake was markedly lower in the apoE-/- mice (44 +/- 4 mg/dl) than in the apoE+/+ animals (329 +/- 77 mg/dl) even though the maximal transport velocity for this uptake process was essentially the same (approximately 400 micrograms/h per g) in the two groups of mice. These studies, therefore, demonstrate that apoE-containing lipoproteins can act as potent competitive inhibitors of hepatic LDL-C transport and so can significantly increase steady-state plasma LDL-C levels. This apolipoprotein plays no role, however, in the regulation of cholesterol absorption, sterol biosynthesis, or hepatic LDL receptor number, at least in the mouse.

Influence of lipid-rich diets on intestinal cholesterol uptake.

The purpose of this work was to determine whether or not cholesterol transport by intestinal brush border is influenced by fat-enriched diets and therefore plays a role in the regulation of cholesterol absorption. This study was carried out on rats divided into three groups according to diet: (1) control with a diet containing 1.2% cholesterol (diet T), (2) diet T plus 28% saturated fat (lard) and (3) diet T plus 28% polyunsaturated fat (corn oil). Uptake of cholesterol and oleic acid from defined mixed micellar solutions was studied on two experimental models: everted sacs and brush border vesicles of the intestinal membrane. In vivo cholesterol absorption was measured by the dual isotope plasma ratio method of Zilversmit. Fat-enriched diets decreased both in vivo cholesterol absorption and in vitro cholesterol uptake without any specific effect of unsaturated fats. This suggests that the mechanisms involved in the transport of cholesterol across the brush border membrane may be rate-limiting for cholesterol absorption. Oleate and butyrate uptakes, in contrast, were unaffected by the fat content of the diet.

Cholesterol absorption in cirrhosis: The role of total and individual bile acid pool size

Dietary cholesterol absorption was studied in patients with either “mild” (n = 23) or “severe” (n = 12) liver cirrhosis in relation to both total and individual bile acid pool size. Cholesterol absorption was significantly reduced in both groups of patients, and it was inversely related (r = −0.68; p < 0.001) to the severity of the disease. Total, cholic acid, and deoxycholic acid pool sizes were significantly reduced in cirrhosis, and a correlation was found between cholesterol absorption and cholic acid pool size (r = 0.78; p < 0.001). In 5 patients, cholesterol absorption and bile acid pool size were estimated both before and after treatment with cholic acid (15 mg/kg/day) plus ampicillin (2 g/day). The treatment was followed by a mean threefold increase of cholic acid pool and by a sharp enhancement of cholesterol absorption in each patient. In conclusion, cholesterol absorption is often impaired in cirrhosis and is related to the severity of the disease. The correlation between cholic acid pool and cholesterol absorption and the constant increase of the absorption values after cholic acid pool expansion suggest that the size of cholic acid pool may be considered as an important factor in the regulation of cholesterol absorption.