Klop Boudewijn, Elte Jan Willem F, Cabezas Manuel Castro
Sint Franciscus Gasthuis, afd. Interne Geneeskunde, Rotterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2011;155:A2503.
The intestines have been proposed as the 'new player' in the field of atherosclerosis as a result of recent discoveries on intestinal cholesterol absorption and excretion. 'Niemann-Pick C1-like 1' is one of the most important transport proteins in the process of intestinal and biliary cholesterol absorption. Cholesterol is not only excreted via the hepato-biliary route but is also excreted directly into the intestinal lumen; this transintestinal cholesterol excretion is particularly important in mice. Other cholesterol transporters have also been identified, including the ABC transporters, which have been linked to rare disorders such as sitosterolemia. Inhibition of intestinal cholesterol absorption increases the hepatic synthesis of cholesterol and vis versa; several different genes and hormones play an important role in this process. When the effect of statins is insufficient or they cause too many side-effects, additional inhibition of intestinal cholesterol absorption is indicated.
由于最近在肠道胆固醇吸收和排泄方面的发现，肠道已被视为动脉粥样硬化领域的“新角色”。“尼曼-匹克C1样1蛋白”是肠道和胆汁胆固醇吸收过程中最重要的转运蛋白之一。胆固醇不仅通过肝-胆途径排泄，还直接排入肠腔；这种经肠道胆固醇排泄在小鼠中尤为重要。其他胆固醇转运蛋白也已被识别，包括ABC转运蛋白，它们与诸如谷甾醇血症等罕见疾病有关。抑制肠道胆固醇吸收会增加肝脏胆固醇的合成，反之亦然；几种不同的基因和激素在这一过程中起重要作用。当他汀类药物的效果不足或引起过多副作用时，就需要额外抑制肠道胆固醇吸收。
