Reverse cholesterol transport pathway

HDL may be taken up in the liver by receptor-mediated endocytosis, but at least some of the cholesterol in HDL is delivered to other tissues by a novel mechanism. HDL can bind to plasma membrane receptor proteins called SR-BI in hepatic and steroidogenic tissues such as the adrenal gland. These receptors mediate not endocytosis but a partial and selective transfer of cholesterol and other lipids in HDL into the cell. Depleted HDL then dissociates to recirculate in the bloodstream and extract more lipids from chylomicron and VLDL remnants. Depleted HDL can also pick up cholesterol stored in extrahepatic tissues and carry it to the liver, in reverse cholesterol transport pathways (Fig. 21-40). In one reverse transport path, interaction of nascent HDL with SR-BI receptors in cholesterol-rich cells triggers passive movement of cholesterol from the cell surface into HDL, which then carries it back to the liver. In a second pathway, apoA-I in depleted HDL in-... 

Tangier Disease A Disorder in the Reverse Cholesterol Transport Pathway... 

How would you modulate the reverse cholesterol transport pathway to increase cholesterol efflux from cells in normal individuals ... 

G19. Graham, A., Vinogradov, D. V., and Owen, J. S., Effects of peroxynitrite on plasma components of the reverse cholesterol transport pathway. FEBS Lett. 431, 327-332 (1998). 

HDL, like LDL, is a cholesterol-rich particle, and is distinct from the other lipoprotein classes in that it does not contain apoB. HDL levels are inversely correlated with risk for atherosclerosis (Wilson et al., 1988). Nascent HDL particles are produced by direct synthesis (Hamilton, 1984), and excess surface remnants from chylomicrons and VLDL produced during the action of lipoprotein lipase (as noted above) enter the HDL density class. HDL appears to be involved in delivery of cholesterol to steroidogenic tissues as well as the removal of excess cholesterol from peripheral tissues and excretion from the system. This HDL-mediated removal of cholesterol has been termed reverse cholesterol transport (Glomset, 1968). Although apolipoproteins present in HDLs are cleared by the liver, the reverse cholesterol transport pathway has never been directly demonstrated. HDL can remove cholesterol from tissues, a process that may be partially mediated by interaction with a putative HDL receptor, with apoA-I as the ligand for that receptor (Oram el ai, 1983). The existence of an HDL receptor remains controversial saturable HDL binding may not be mediated by a specific apolipoprotein ligand and may not even be required for transfer of cholesterol from cells to... 

Figure 26-21 Reverse cholesterol transport pathway. HDl High-density lipoproteins LDL, low-density lipoproteins tDL, intermediate-density lipoproteins HTL, hepatic lipoprotein lipase LCAT, lecithin cholesterol acyltransferase CETP, cholesteryl ester transfer protein apo E, apoiipoprotein E. Cholesterol is removed from macrophages and other arterial wall cells by an HDL-mediated process. The LCAT esterifies the cholesterol content of HDL to prevent it from reentering the ceils. Cholesterol esters are delivered to the liver by one of three pathways ( ) cholesterol esters are transferred from HDL to LDL by CETP and enter the liver through the specific LDL receptor pathway (2) cholesterol esters are selectively taken from HDL by HDL receptors and HDL particles are returned to circulation for further transport or (3) HDL have accumulated apo E and therefore the particles can enter the liver through remnant receptors, (From Gwynne JT. High density lipoprotein cholesterol levels as a marker of reverse cho/estero/ tronsport./ m j Cardiol I989 64 10G-I7G. Copyright 1989, with permission from Excerpta Medico Inc.)...

HDL is antiatherogenic and removes cholesterol from peripheral cells and tissues for eventual transport to hepatocytes and excretion in the bile directly or after conversion into bile acids. The efflux of cholesterol from peripheral cells is mediated by the ATP-binding cassette (ABC) transporter protein (discussed later). The flux of cholesterol transport from extrahepatic tissues (e.g., blood vessel wall) toward liver for excretion is known as the reverse cholesterol transport pathway. In contrast, the forward cholesterol pathway involves the transport of cholesterol from liver to the peripheral cells and tissues via the VLDL IDL LDL pathway. It should be noted, however, that the liver plays a major role in the removal of these lipoproteins. Thus, the system of reverse cholesterol transport consisting of LCAT, CETP, apo D, and their carrier lipoproteins is critical for maintaining cellular cholesterol homeostasis. The role of CETP is exemplified in clinical studies involving patients with polymorphic... 

PPARs enhance cholesterol efflux and stimulate critical steps of the reverse cholesterol transport pathway (reviewed in ref. 507). PUFA and activating PPAR increase hepatic cholesterol uptake. PPARy induces expression of SR B1 in rat hepatocytes, liver EC, and Kuppfer cells (508). PPARa activation in human macrophages and foam cells results in an enhanced availability of free cholesterol for efflux through the ABCAl pathway by reducing cholesterol esterification rates and ACATl activity (509). 

The pathways of HDL metabolism and reverse cholesterol transport are complex (Fig. 3, [1]). HDL and its major apolipoprotein apoA-I are synthesized by both the intestine and the liver. A second major... 

Whole plasma can also be fractionated into specific lipoprotein size classes to further resolve the underlying biochemistry and metabolism of tissues that deliver these lipids to blood and selectively remove them. Thus, TrueMass analysis can be used to measure the lipid profiles of very-low-density lipoprotein, quantify the lipid pathways responsible for metabolic changes in the liver and measure profiles of high-density lipoprotein to quantify the flux of lipids in reverse cholesterol transport. 

The HDL lipids are removed from the circulation by a selective uptake and by an indirect pathway. The selective uptake of cholesterol esters from HDL into he-patocytes and steroidogenic cells is mediated by the binding of HDL to scavenger receptor B1 (SR-BI). This selective uptake by SR-BI may depend on the presence of cofactors such as HL, which hydrolyses phospholipids on the surface of both HDL and plasma membranes and thereby enables the flux of cholesteryl esters from the lipoprotein core into the plasma membrane [42]. The indirect pathway involves the enzyme CETP, which exchanges cholesteryl esters of a-HDL with triglycerides of chylomicrons, VLDL, IDL, and LDL. The a-HDL derived cholesteryl esters are therefore removed via the LDL-receptor pathway. The removal of excess cholesterol from the periphery and the delivery to the liver for excretion in the bile is termed reverse cholesterol transport. 

Plate 17. Summary of major forward and reverse lipid transport pathways through the extracellular compartment that link the liver and intestine with peripheral tissues. FC, unesterified cholesterol. For other abbreviations see list of abbreviations. (See page 536 in this volume.)... 

As far as HDL levels and metabolism are concerned, one result of the LCAT- and transfer protein-catalyzed reactions is the production of a dynamic spectrum of particles with a wide range of sizes and lipid compositions (Chapter 19). Nascent HDL particles contain mostly apo A1 and phospholipids, and undergo modulation and maturation in the circulation. For instance, the unesterified cholesterol incorporated into plasma HDL is converted to cholesteryl esters by LCAT, creating a concentration gradient of cholesterol between HDL and cell membranes, which is required for efficient cholesterol efflux from cells to HDL. In addition, cholesteryl ester transfer protein transfers a significant amount of HDL cholesteryl ester to VLDL, IDL, and LDL for further transport, primarily to the liver. Thus, a substantial fraction of cell-derived cholesterol is delivered as part of HDL indirectly to the liver via hepatic endocytic receptors for IDL and LDL this process is termed reverse cholesterol transport . However, receptor-mediated delivery of HDL cholesterol to cells is fundamentally different from the classic LDL receptor-mediated endocytic pathway, as described in Section 7.3.2. 

Fig. 6. Major pathways of reverse cholesterol transport. CE = esterified cholesterol HL, hepatic lipase UC, unesterified cholesterol...

The cholesterol-enriched HDL secreted by the cells initially enter the HDL3 fraction of the plasma compartment, where they are metabolized by the action of LCAT and lipoprotein lipase to HDL2. In the first of the four major pathways postulated for reverse cholesterol transport to the liver (Fig. 6), HDL2 are further converted to HDLi which may be taken up by the postulated hepatic E receptor. The second pathway may involve a receptor-mediated mechanism which recognizes Apo A-I-containing HDL taken up by the liver. The third pathway acts via CETP, which is transferred from HDL particles to Apo B-containing hpoproteins and thereby leads cholesterol into the B, E receptor route. The fourth pathway may involve hepatic lipase which interacts with HDL particles and mediates a selective uptake of choles-teryl ester into the liver. 

Reverse cholesterol transport A hypothetical pathway by which cholesterol is transported from extrahepatic-tissues to the Uver via HDL. 

Chylomicron remnants deliver dietary cholesterol to the liver. It is then incorporated into very low-density lipoproteins (VLDL), which are secreted in plasma. The VLDL acquire cholesteryl esters and apolipoprotein E (apo E) from high-density lipoproteins (HDL) to produce intermediate-density lipoproteins (IDL), which are rapidly taken up by the liver or are further catabolized into low-density lipoproteins (LDL). These cholesterol-rich LDL particles are catabolized only slowly in human plasma and are therefore present at relatively high concentrations. Elimination of cholesterol from these extra-hepatic cells is achieved by the delivery of cholesterol from cell membranes to plasma HDL in the first step of a pathway known as reverse cholesterol transport. This process allows for esterification of cholesterol and its delivery back to the liver. 

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