Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Atherosclerosis. 2010 Mar;209(1):39-41. doi: 10.1016/j.atherosclerosis.2009.09.015. Epub 2009 Sep 16.
Reverse cholesterol transport, although not well understood, is an important mechanism in the pathophysiology of atherosclerosis. Macrophages can eliminate some cholesterol from atherosclerotic lesions by an oxidative mechanism involving sterol 27-hydroxylase. Patients with inherited "cerebrotendinous xanthomatosis" lack sterol 27-hydroxylase (CYP27A1) and develop severe premature atherosclerosis despite normal serum cholesterol concentrations. Thus, it has been speculated that sterol 27-hydroxylase is an anti-atherosclerotic enzyme. Here, we report the case of a 25-year-old patient who presented to our emergency room with an acute non-ST elevation myocardial infarction due to severe coronary heart disease. Lipid analysis revealed dramatically increased 27-hydroxycholesterol and low high-density lipoprotein (HDL)-cholesterol levels. Previous reports suggest that 27-hydroxylase is upregulated to protect peripheral cells from severe cholesterol accumulation, especially in cases of ineffective reverse cholesterol transport due to low HDL-cholesterol levels. Our findings indicate that oxysterols could play an important and so far underestimated role in reverse cholesterol transport.
胆固醇逆向转运虽然尚未完全阐明，但它是动脉粥样硬化病理生理学的一个重要机制。巨噬细胞可通过涉及固醇 27-羟化酶的氧化机制从动脉粥样硬化病变中清除一些胆固醇。患有遗传性“脑腱黄瘤病”的患者缺乏固醇 27-羟化酶（CYP27A1），尽管血清胆固醇浓度正常，但仍会发生严重的早发性动脉粥样硬化。因此，人们推测固醇 27-羟化酶是一种抗动脉粥样硬化酶。在这里，我们报告了一例 25 岁患者的病例，该患者因严重冠心病而在急诊室就诊，患有急性非 ST 段抬高型心肌梗死。脂质分析显示 27-羟胆固醇显著升高，高密度脂蛋白（HDL）-胆固醇水平降低。先前的报告表明，27-羟化酶上调以保护外周细胞免受严重的胆固醇积累，特别是在由于 HDL-胆固醇水平低导致胆固醇逆向转运无效的情况下。我们的研究结果表明，氧化固醇可能在胆固醇逆向转运中发挥重要作用，而这一作用迄今被低估了。
