Liver cholesterol synthesis

HMG-CoA-Reductase Inhibitors. Figure 1 Mechanism of action of statins - cholesterol synthesis pathway. The conversion of acetyl CoA to cholesterol in the liver. The step of cholesterol biosynthesis inhibited by HMG-CoA reductase inhibitors (statins) is shown. 

While an active enzymatic mechanism produces acetoacetate from acetoacetyl-CoA in the liver, acetoacetate once formed cannot be reactivated directly except in the cytosol, where it is used in a much less active pathway as a precursor in cholesterol synthesis. This accounts for the net production of ketone bodies by the liver. 

A little more than half the cholesterol of the body arises by synthesis (about 700 mg/d), and the remainder is provided by the average diet. The liver and intestine account for approximately 10% each of total synthesis in humans. Virtually all tissues containing nucleated cells are capable of cholesterol synthesis, which occurs in the endoplasmic reticulum and the cytosol. 

Starvation elicits mobilization of triglycerides from the adipose tissue and inhibits the endogenic cholesterol synthesis owing to the low activity of hydroxy-methylglutaryl-CoA reductase. The latter process provides the possibility for the active production of ketone bodies in the liver. 

The answer is a. (Hardman, pp 885-887.) Lovastatin decreases cholesterol synthesis in the liver by inhibiting HMG-CoA reductase, the rate-limiting enzyme in the synthetic pathway This results in an increase in LDL receptors in the liver, thus reducing blood levels for cholesterol. The intake of dietary cholesterol must not be increased, as this would allow the liver to use more exogenous cholesterol and def eat the action of lovastatin. 

The true biological function of liver mevaldic reductase is not clear. It is not thought to be involved in cholesterol synthesis, and because of the difference in its stereospecificity for the substrate, it is thought to be only a distant relative of the hydroxymethylglutaryl CoA reductases. But all of these enzymes have the same A stereospecifidty for the pyridine nucleotide. 

Treatment of Hypercholesterolemia Cholestyramine and other drugs that increase elimination of bile salts force the liver to increase their synthesis from cholesterol, thus lowering the internal level of cholesterol in the hepatocytes. Decreased cholesterol within the cell increases LDL receptor expression, allowing the hepatocyte to remove more LDL cholesterol from the blood. HMG-CoA reductase inhibitors such as lovastatin and simvastatin inhibit de novo cholesterol synthesis in the hepatocyte, which subsequently increases LDL receptor expression. 

One role of high density lipoprotein (HDL) is to collect unesterified cholesterol from cells, including endothelial cells of the artery walls, and return it to the liver where it can not only inhibit cholesterol synthesis but also provide the precursor for bile acid formation. The process is known as reverse cholesterol transfer and its overall effect is to lower the amount of cholesterol in cells and in the blood. Even an excessive intracellular level of cholesterol can be lowered by this reverse transfer process (Figure 22.10). Unfortunately, the level of HDL in the subendothelial space of the arteries is very low, so that this safety valve is not available and all the cholesterol in this space is taken up by the macrophage to form cholesteryl ester. This is then locked within the macrophage (i.e. not available to HDL) and causes damage and then death of the cells, as described above. 

Figure 22.10 Reverse cholesterol transfer. High density lipoprotein (HDL) collects cholesterol from cells in various tissues/ organs the complex is then transported in the blood to the liver where it binds to a receptor on the hepatocyte, is internalised and the cholesterolis released into the hepatocyte. This increases the concentration in the liver cells which then decreases the synthesis of cholesterol by inhibition of the rate-limiting enzyme in cholesterol synthesis, HMG-CoA synthase. The cholesterol is also secreted into the bile or converted to bile acids which are also secreted into the bile, some of which is lost in the faeces (Chapter A).

Drugs Drugs that lower the blood levels of cholesterol are frequently used as part of the treatment these include (i) Oral bile acid binding exchange resins. Resins such as cholestyramine are effective because, when taken by mouth, they prevent the reabsorption of bile acids in the lower small intestine, so that they are excreted in the faeces. Since bile acids are formed in the liver from cholesterol, synthesis of more acids requires more cholesterol uptake by the liver from the blood, which occurs via LDL-cholesterol, so that the concentration of the latter is decreased. 

Cholesterol can be derived from two sources—food or endogenous synthesis from ace-tyl-CoA. A substantial percentage of endogenous cholesterol synthesis takes place in the liver. Some cholesterol is required for the synthesis of bile acids (see p. 314). In addition, it serves as a building block for cell membranes (see p. 216), or can be esterified with fatty acids and stored in lipid droplets. The rest is released together into the blood in the form of lipoprotein complexes (VLDLs) and supplies other tissues. The liver also contributes to the cholesterol metabolism by taking up from the blood and breaking down lipoproteins that contain cholesterol and cholesterol esters (HDLs, IDLs, LDLs see p.278). 

These hypolipidemic agents are noncompetitive inhibitors of the enzyme that limit the rate of cholesterol synthesis in the liver at the levalonic acid stage. 

Ezetimibe has a mechanism of action that differs from those of other classes of cholesterol-reducing compounds. Ezetimibe does not inhibit cholesterol synthesis in the liver or increase bile acid excretion. 

The answer is D. This patient s tests indicate that he has severe hypercholesterolemia and high blood pressure in conjunction with atherosclerosis. The deaths of several of his family members due to heart disease before age 60 suggest a genetic component, ie, familial hypercholesterolemia. This disease results from mutations that reduce production or interfere with functions of the LDL receptor, which is responsible for uptake of LDL-cholesterol by liver cells. The LDL receptor binds and internalizes LDL-choles-terol, delivers it to early endosomes and then recycles back to the plasma membrane to pick up more ligand. Reduced synthesis of apoproteins needed for LDL assembly would tend to decrease LDL levels in the bloodstream, as would impairment of HMG CoA reductase levels, the rate-limiting step of cholesterol biosynthesis. Reduced uptake of bile salts will also decrease cholesterol levels in the blood. 

The statin family of six closely related hypocholesterolemic drugs are all potent competitive inhibitors of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG CoA reductase), the rate-limiting enzyme in cholesterol biosynthesis. The liver is their target organ, and decreased hepatic cholesterol synthesis ultimately leads to increased removal of LDL particles from the circulation. As a consequence, all other hypocholesterolemic drugs have been relegated to secondary status. 

Cholesterol metabolism. Hydrogenated oil, administered orally to hamsters at a dose of 20% of diet for 4 weeks, induced hypercholesterolemia. Oil feeding had no effect on cholesterol synthesis but markedly inhibited cholesterol esterification in both the liver and the intestine. The diet-induced hypercholesterolemia was strongly correlated with an increase in acyl-CoA/cholesterol acyltransferase activity. The hypercholesterolemia increased aortic uptake of cholesterol and hence acyl-CoA/cholesterol acyltransferase activity " Coconut fat, administered orally to rabbits with partial ileal bypass, produced a significant increase of serum total cholesterol and phospholipids concentrations. The effect on semm lipids of the type of fat was similar in control and partial ileal bypass rabbits A Coconut—a main source of energy for two... 

Also known as statins. HMG CoA reductase (Hydroxymethyl-Glutaryl Coenzyme A Reductase) inhibitors block the synthesis of cholesterol in liver by competitively inhibiting HMG CoA reductase activity, also cause depletion of critical intracellular pools of sterols and increased transcription of LDL receptors leading to enhanced removal from plasma of LDL cholesterol and LDL precursors. They also reduce hepatic synthesis of VLDL, increase plasma HDL. Reduction of LDL occurs over 4-6 weeks. 

It is a potent HMG CoA reductase inhibitor. This enzyme catalyzes the conversion of HMG CoA to mevalonate in liver which is an important early and rate limiting step in the cholesterol synthesis. It causes marked reduction in LDL cholesterol and also raise HDL level and may lower the triglyceride level. After oral administration it is extensively metabolised in liver and metabolites are excreted in bile. 

Squalene takes part in metabolism as precursor for synthesis of steroids and structurally quite similar to (3-carotene, coenzyme qlO, vitamins Ki, E, and D. The squalene in skin and fat tissue comes from endogenous cholesterol synthesis as well as dietary resources in people who consume high amounts of olive and fish oil especially shark liver (Gershbein and Singh, 1969). Squalene is synthesized by squalene synthase which converts two units of farnesyl pyrophosphate, direct precursor for terpenes and steroids, into squalene. As a secosteroid, vitamin D biosynthesis is also regulated by squalene. Moreover, being precursor for each steroid family makes squalene a crucial component of the body. 

Scientists theorize that, due to its chemical similarity, sitostanol competes with cholesterol to be absorbed into the bloodstream from the intestine. This not only interferes with the uptake of cholesterol from the diet, but it also, more importantly, lowers the amount of cholesterol that wends its way into the blood from cholesterol synthesis in the liver. Cholesterol is an essential biochemical, which the liver can supply, but much of it accesses the bloodstream in an indirect fashion. First it s secreted through bile into the intestine, where it plays a role in fat absorption, and then it is absorbed into the blood. Sitostanol blocks this absorption. 

Much of the cholesterol synthesis in vertebrates takes place in the liver. A small fraction of the cholesterol made there is incorporated into the membranes of he-patocytes, but most of it is exported in one of three forms biliary cholesterol, bile acids, or cholesteryl esters. Bile acids and their salts are relatively hydrophilic cholesterol derivatives that are synthesized in the liver and aid in lipid digestion (see Fig. 17-1). Cholesteryl esters are formed in the liver through the action of acyl-CoA-cholesterol acyl transferase (ACAT). This enzyme catalyzes the transfer of a fatty acid from coenzyme A to the hydroxyl group of cholesterol (Fig. 21-38), converting the cholesterol to a more hydrophobic form. Cholesteryl esters are transported in secreted lipoprotein particles to other tissues that use cholesterol, or they are stored in the liver. 

The first two reactions in the cholesterol synthetic pathway are siri lar to those in the pathway that produces ketone bodies (see Figure 16.22, p. 194). They result in the production of 3-hydroxy-3-methyl-glutaryl CoA (HMG CoA, Figure 18.3). First, two acetyl CtA molecules condense to form acetoacetyl CoA. Next, a third molecule of acetyl CoA is added, producing HMG CoA, a six-carbon compound. [Note Liver parenchymal cells contain two isoenzymes of HMG CoA synthase. The cytosolic enzyme participates in cholesterol synthesis, whereas the mitochondrial enzyme Urc tions in the pathway for ketone body synthesis.]... 

The two-step reduction of HMG-CoA to mevalonate (Fig. 22-1, step a)n 15 is highly controlled, a major factor in regulating cholesterol synthesis in the human liver.121617 The N-terminal portion of the 97-kDa 888-residue mammalian FlMG-CoA reductase is thought to be embedded in membranes of the ER, while the C-terminal portion is exposed in the cytoplasm.16 Tire enzyme is sensitive to feedback inhibition by cholesterol (see Section D, 2). The regulatory mechanisms include a phosphorylation-dephosphorylation cycle and control of both the rates of synthesis and of proteolytic degradation of this key en-... 

Chromium also slimulales fatty acid and cholesterol synthesis from acetate in liver. Thai chromium is an essential cofaclor for the action of insulin on the rat lens was shown by Parkas in 1964. In the absence of the element, no significant insulin effect on glucose utilization of lens can be demonstrated. Chromium supplementation to the donor animals resulls in a significant response of lens tissue to the hormone. Numerous other findings indicate that chromium may play several vital roles in biological systems. 

If a normal person is given an inhibitor for HMG-CoA reductase, cholesterol synthesis is inhibited in the liver. Lower levels of cholesterol then signal the synthesis of increased levels of LDL receptors. This increases the uptake of LDL into the liver and reduces serum LDL. In a patient with FH, this has little effect because there are no LDL receptors. The only effect is that the liver does not make as much cholesterol and does not contribute as much to serum LPT, levels. The new liver will make normal amounts of LDL receptors and have normal uptake of LDL from the blood. This result will dramatically lower serum LDL levels and prevent the new heart from developing coronary artery disease. If the liver transplant had not been done, the heart transplant would have been to no avail. 

An important dmg in the regulation of cholesterol metabolism is lovastatin [75330-75-5] which is an HMG—CoA reductase inhibitor (see Cardiovascularagents). p-Hydroxy-p-methyl glutarate—coenzyme A (HMG—CoA) reductase is the rate-limiting enzyme of cholesterol synthesis. Lovastatin is actually a prodmg, which is eventually hydrolyzed in the liver to its active, p-hydroxylated form (5). 

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