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Kuwabara M, Sasaki J, Ouchi Y, Oikawa S, Nakagawa K, Sato M, Koba S, Kono S, Saikawa T, Arai H. Higher Cholesterol Absorption Marker at Baseline Predicts Fewer Cardiovascular Events in Elderly Patients Receiving Hypercholesterolemia Treatment: The KEEP Study. J Am Heart Assoc 2024; 13:e031865. [PMID: 38240241 PMCID: PMC11056156 DOI: 10.1161/jaha.123.031865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Higher cholesterol absorption has been reported to be related to a higher incidence of cardiovascular events (CVEs). The KEEP (Kyushu Elderly Ezetimibe Phytosterol) study, a substudy of the EWTOPIA 75 (Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic Cardiovascular Disease in 75 or Older) study, investigated the relationships of cholesterol absorption and synthesis markers with CVEs in older old individuals with hypercholesterolemia, particularly in relation to ezetimibe treatment. METHODS AND RESULTS Eligible patients were those aged ≥75 years who had low-density lipoprotein cholesterol ≥140 mg/dL, no history of coronary artery disease, and no recent use of lipid-lowering drugs. Participants were randomly assigned into a diet-only or diet-plus-ezetimibe group. Baseline and 24-week follow-up blood samples were analyzed for cholesterol absorption (eg, campesterol) and synthesis markers (eg, lathosterol). Of 1287 patients, 1061 patients with baseline measurement were analyzed. Over a median follow-up of 4.0 years, 64 CVEs occurred. Higher campesterol levels at baseline were significantly associated with a lower risk of CVEs. After adjustment for sex, age, and treatment, the hazard ratios for the lowest to highest quartile categories of baseline campesterol were 1.00 (reference), 0.59 (95% CI, 0.30-1.17), 0.44 (95% CI, 0.21-0.94), and 0.44 (95% CI, 0.21-0.93), respectively (trend P=0.01). This association persisted after further adjustment for hypertension, diabetes, and other cardiovascular risk factors. Neither interactions with ezetimibe treatment nor mediating effects of the changes in cholesterol absorption markers were observed. CONCLUSIONS The KEEP study indicated that higher campesterol levels without lipid-lowering drugs were associated with a lower incidence of CVEs in older old individuals with hypercholesterolemia who were subsequently treated with diet or ezetimibe. REGISTRATION URL: https://www.umin.ac.jp; unique identifier: UMIN000017769.
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Affiliation(s)
| | - Jun Sasaki
- International University of Health and WelfareFukuokaJapan
| | | | | | | | | | | | | | | | - Hidenori Arai
- National Center for Geriatrics and GerontologyAichiJapan
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Mehta P, Tawfeeq S, Padte S, Sunasra R, Desai H, Surani S, Kashyap R. Plant-based diet and its effect on coronary artery disease: A narrative review. World J Clin Cases 2023; 11:4752-4762. [PMID: 37583985 PMCID: PMC10424050 DOI: 10.12998/wjcc.v11.i20.4752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023] Open
Abstract
Coronary artery disease (CAD), a primary component of cardiovascular diseases, is one of the top contributors to mortality rates worldwide. In 2021, dietary risk was estimated to be attributed to 6.58 million cardiovascular deaths. Plant-based diets (PBDs), which encourage higher consumption of plant foods and lower intake of animal-based foods, have been shown to reduce the risk of CAD by up to 29% when compared to non-vegetarian diets in a meta-analysis. This article aims to summarize the array of PBDs and compare them with conventional Western diets that include meat. We review the various proposed mechanisms for how the bioactive nutrients of PBDs aid in preventing atherosclerosis and CAD events, as well as other cardiac diseases. We conducted a detailed search of PubMed using our exclusive search strategy using the keywords plant-based diet, vegan diet, phytosterols, CAD, myocardial ischemia, and atherosclerosis. A total of 162 pertinent articles published within the past decade were identified for qualitative synthesis. To ensure the accuracy and reliability of our review, we included a total of 55 full-text, peer-reviewed articles that demonstrated the effects of plant-based diets on CAD and were written in English. We excluded animal studies, in vitro or molecular studies, and non-original data like editorials, letters, protocols, and conference abstracts. In this article, we emphasize the importance of dietary interventions, such as PBDs, to prevent CAD and their benefits on environmental sustainability. Integrating plant foods and whole grains into one's daily eating habits leads to an increase in the intake of nutrient-rich foods while reducing the consumption of processed food could not only prevent millions of premature deaths but also provide prevention against many chronic gastrointestinal and metabolic diseases.
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Affiliation(s)
- Priyal Mehta
- Department of General Medicine, MWD Hospital, Mumbai 400097, India
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Sawsan Tawfeeq
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Smitesh Padte
- Department of General Medicine, MWD Hospital, Mumbai 400097, India
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Rayyan Sunasra
- Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N Cooper Hospital, Mumbai 400056, India
| | - Heet Desai
- Department of Internal Medicine, CIBNP, Fairfield, CA 94534, United States
| | - Salim Surani
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
- Department of Pulmonary & Critical Care & Pharmacology, Texas A&M University, College Station, TX 77843, United States
| | - Rahul Kashyap
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
- Department of Research, WellSpan Health, York, PA 17403, United States
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Kasprzak M, Rudzińska M, Juzwa W, Olejnik A. Anti-proliferative potential and oxidative reactivity of thermo-oxidative degradation products of stigmasterol and stigmasteryl esters for human intestinal cells. Sci Rep 2023; 13:7093. [PMID: 37127788 PMCID: PMC10151334 DOI: 10.1038/s41598-023-34335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023] Open
Abstract
Stigmasterol in free and esterified form is incorporated in LDL cholesterol-lowering food products, intended for direct consumption and cooking, baking, and frying. Under thermal treatment, stigmasterol compounds may constitute a source of thermo-oxidative degradation products and oxyderivatives with potentially adverse health effects. This study aimed to analyze the anti-proliferative potential and genotoxicity of thermo-oxidatively treated stigmasterol (ST), stigmasteryl linoleate (ST-LA), and oleate (ST-OA). The effects on cell viability and proliferation, cell cycle progression, intracellular reactive oxygen species (ROS) generation, and DNA damage were analyzed in normal human intestinal cells. The mutagenic potential was assessed in a bacterial reverse mutation test using Salmonella enterica serovar Typhimurium strains involving metabolic activation. Stigmasteryl esters showed a significantly lower potential to affect intestinal cell viability and proliferation than non-esterified ST, regardless of heating. Thermo-oxidatively treated ST suppressed intestinal cell proliferation by arresting the cell cycle in the G2/M phase and DNA synthesis inhibition. The enhanced intracellular ROS generation and caspase 3/7 activity suggest targeting intestinal cells to the apoptosis pathway. Also, heated ST-LA intensified ROS production and elicited pro-apoptotic effects. Thermo-oxidative derivatives of ST and ST-LA may evoke harmful gastrointestinal effects due to their high oxidative reactivity towards intestinal cells.
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Affiliation(s)
- Maria Kasprzak
- Department of Biotechnology and Food Microbiology, Poznan University of Life Sciences, 48 Wojska Polskiego St., 60-627, Poznań, Poland
| | - Magdalena Rudzińska
- Institute of Food Technology of Plant Origin, Faculty of Food Science and Nutrition, Poznan University of Life Sciences, 31 Wojska Polskiego St., 60-624, Poznań, Poland
| | - Wojciech Juzwa
- Department of Biotechnology and Food Microbiology, Poznan University of Life Sciences, 48 Wojska Polskiego St., 60-627, Poznań, Poland
| | - Anna Olejnik
- Department of Biotechnology and Food Microbiology, Poznan University of Life Sciences, 48 Wojska Polskiego St., 60-627, Poznań, Poland.
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Rudzińska M, Olejnik A, Grygier A, Kowalska K, Kmiecik D, Grudniewska A, Chojnacka A, Gładkowski W, Maciejewska G, Przybylski R. Thermo-oxidative stability of asymmetric distigmasterol-modified acylglycerols as novel derivatives of plant sterols. Food Chem 2022; 390:133150. [PMID: 35551028 DOI: 10.1016/j.foodchem.2022.133150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 12/23/2022]
Abstract
The study investigated the thermo-oxidative stability of distigmasterol-modified acylglycerols as a new structured acylglycerols. Samples were heated at 60 and 180 °C for 8 h. Their percentage degradation and products formed during heating were compared with free stigmasterol and stigmasteryl esters. The remaining of stigmasterol and fatty acid parts, the formation of stigmasterol oxidation products and the composition of polar and non-polar fractions were analysed using chromatographic methods. The cytotoxicity and genotoxicity were determined with the use of an MTT test and a comet assay, respectively. The highest stability during heating was observed for 2,3-distigmasterylsuccinoyl-1-oleoyl-sn-glycerol (dStigS-OA) and the lowest for 2,3-distigmasterylcarbonoyl-1-oleoyl-sn-glycerol (dStigC-OA). Data showed that the formation of thermo-oxidative degradation products is affected by the temperature and chemical structure of lipids present in the molecule. The dStigMAs bonded by a succinate linker and products formed during their thermo-oxidation showed no cytotoxic or genotoxic activity to normal human cells.
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Affiliation(s)
- M Rudzińska
- Faculty of Food Science and Nutrition, Poznań University of Life Sciences, WojskaPolskiego 28, 60-637 Poznań, Poland.
| | - A Olejnik
- Faculty of Food Science and Nutrition, Poznań University of Life Sciences, WojskaPolskiego 28, 60-637 Poznań, Poland
| | - A Grygier
- Faculty of Food Science and Nutrition, Poznań University of Life Sciences, WojskaPolskiego 28, 60-637 Poznań, Poland
| | - K Kowalska
- Faculty of Food Science and Nutrition, Poznań University of Life Sciences, WojskaPolskiego 28, 60-637 Poznań, Poland
| | - D Kmiecik
- Faculty of Food Science and Nutrition, Poznań University of Life Sciences, WojskaPolskiego 28, 60-637 Poznań, Poland
| | - A Grudniewska
- Department of Chemistry, Wrocław University of Environmental and Life Sciences, Norwida 25, 50-375 Wrocław, Poland
| | - A Chojnacka
- Department of Chemistry, Wrocław University of Environmental and Life Sciences, Norwida 25, 50-375 Wrocław, Poland
| | - W Gładkowski
- Department of Chemistry, Wrocław University of Environmental and Life Sciences, Norwida 25, 50-375 Wrocław, Poland
| | - G Maciejewska
- Faculty of Chemistry, Wrocław University of Science and Technology, WybrzeżeWyspiańskiego 27, 50-370 Wrocław, Poland
| | - R Przybylski
- Department of Chemistry and Biochemistry, University of Lethbridge, 4401 University Drive W, Lethbridge, AB T1K 3M4, Canada
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Oxysterols — how much do we know about food occurrence, dietary intake and absorption? Curr Opin Food Sci 2021. [DOI: 10.1016/j.cofs.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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6
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Ni J, Hong H, Zhang Y, Tang S, Han Y, Fang Z, Zhang Y, Zhou N, Wang Q, Liu Y, Li Z, Wang Y, Dong M. Development of a non-invasive method for skin cholesterol detection: pre-clinical assessment in atherosclerosis screening. Biomed Eng Online 2021; 20:52. [PMID: 34074299 PMCID: PMC8170999 DOI: 10.1186/s12938-021-00889-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background Establishing a high-accuracy and non-invasive method is essential for evaluating cardiovascular disease. Skin cholesterol is a novel marker for assessing the risk of atherosclerosis and can be used as an independent risk factor of early assessment of atherosclerotic risk. Methods We propose a non-invasive skin cholesterol detection method based on absorption spectroscopy. Detection reagents specifically bind to skin cholesterol and react with indicator to produce colored products, the skin cholesterol content can be obtained through absorption spectrum information on colored products detected by non-invasive technology. Gas chromatography is used to measure cholesterol extracted from the skin to verify the accuracy and reliability of the non-invasive test method. A total of 342 subjects were divided into normal group (n = 115), disease group (n = 110) and risk group (n = 117). All subjects underwent non-invasive skin cholesterol test. The diagnostic accuracy of the measured value was analyzed by receiver-operating characteristic (ROC) curve. Results The proposed method is able to identify porcine skin containing gradient concentration of cholesterol. The values measured by non-invasive detection method were significantly correlated with gas chromatography measured results (r = 0.9074, n = 73, p < 0.001). Bland–Altman bias was − 72.78 ± 20.03 with 95% limits of agreement − 112.05 to − 33.51, falling within the prespecified clinically non-significant range. We further evaluated the method of patients with atherosclerosis and risk population as well as normal group, patients and risk atherosclerosis group exhibited higher skin cholesterol content than normal group (all P < 0.001). The area under the ROC curve for distinguishing Normal/Disease group was 0.8642 (95% confidence interval, 0.8138 to 0.9146), meanwhile, the area under the ROC curve for distinguishing Normal/Risk group was 0.8534 (95% confidence interval, 0.8034 to 0.9034). Conclusions The method demonstrated its capability of detecting different concentration of skin cholesterol. This non-invasive skin cholesterol detection system may potentially be used as a risk assessment tool for atherosclerosis screening, especially for a large population. Supplementary Information The online version contains supplementary material available at 10.1186/s12938-021-00889-1.
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Affiliation(s)
- Jingshu Ni
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China.,University of Science and Technology of China, Hefei, 230026, China
| | - Haiou Hong
- Health Management Center, First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Yang Zhang
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China.,University of Science and Technology of China, Hefei, 230026, China
| | - Shiqi Tang
- Health Management Center, Renmin Hospital of WuHan University, Wuhan, 430060, China
| | - Yongsheng Han
- Department of Cardiovascular Medicine, First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, China
| | - Zhaohui Fang
- Department of Endocrinology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230031, China
| | - Yuanzhi Zhang
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China.,Wanjiang Center for Development of Emerging Industrial Technology, Tongling, 244000, China
| | - Nan Zhou
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China.,Wanjiang Center for Development of Emerging Industrial Technology, Tongling, 244000, China
| | - Quanfu Wang
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China.,Wanjiang Center for Development of Emerging Industrial Technology, Tongling, 244000, China
| | - Yong Liu
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China.,University of Science and Technology of China, Hefei, 230026, China.,Wanjiang Center for Development of Emerging Industrial Technology, Tongling, 244000, China
| | - Zhongsheng Li
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China
| | - YiKun Wang
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China. .,University of Science and Technology of China, Hefei, 230026, China.
| | - Meili Dong
- Anhui Provincial Engineering Technology Research Center for Biomedical Optical Instrument, Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science , Chinese Academy of Sciences, Hefei, 230031, China. .,University of Science and Technology of China, Hefei, 230026, China.
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Martianto D, Bararah A, Andarwulan N, Średnicka-Tober D. Cross-Sectional Study of Plant Sterols Intake as a Basis for Designing Appropriate Plant Sterol-Enriched Food in Indonesia. Nutrients 2021; 13:nu13020452. [PMID: 33572980 PMCID: PMC7912629 DOI: 10.3390/nu13020452] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/22/2022] Open
Abstract
Coronary heart disease (CHD) is one of the leading causes of mortality in many low-income and middle-income countries, including Indonesia, with elevated blood cholesterol level being one of significant risk factors for this condition. The problem should be addressed by combining healthy lifestyle and diet, where functional foods having a cholesterol-lowering activity could play a significant role. A group of compounds that had been proven to show cholesterol-lowering ability are plant sterols. To develop more suitable functional foods that could substantially contribute to hypercholesterolemia prevention in Indonesian population, up-to-date data about plant sterols dietary intake are required, and were not available until this research was done. This study aimed to estimate daily plant sterols intake and to determine the consumption pattern of foods containing plant sterols in rural and urban area of Bogor, West Java, Indonesia. The research was conducted with a cross-sectional design, with 200 respondents. The study revealed that the level of plant sterols intake in Bogor reached on average 229.76 mg/day and was not significantly different between urban and rural area. Cereals, vegetables, and fruit products were the main food sources of plant sterols in both areas. In addition, a list of several surveyed food items possible to be enriched with plant sterols was developed within the study. These results provide baseline data to develop functional foods fortified with plant sterols suitable for the Indonesian needs and taste. However, further studies are needed to confirm efficacy and safety of introducing such phytosterol-enriched products into a habitual diet, especially considering possible long-term side effects of plant sterol treatment.
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Affiliation(s)
- Drajat Martianto
- Southeast Asian Food and Agricultural Science and Technology (SEAFAST) Center, IPB Darmaga Campus, IPB University, Bogor 16680, West Java, Indonesia; (D.M.); (N.A.)
- Department of Community Nutrition, Faculty of Human Ecology, IPB Darmaga Campus, IPB University, Bogor 16680, West Java, Indonesia
| | - Atikah Bararah
- Department of Food Science and Technology, Faculty of Agricultural Technology, IPB Darmaga Campus, IPB University, P.O. Box 220, Bogor 16680, West Java, Indonesia;
| | - Nuri Andarwulan
- Southeast Asian Food and Agricultural Science and Technology (SEAFAST) Center, IPB Darmaga Campus, IPB University, Bogor 16680, West Java, Indonesia; (D.M.); (N.A.)
- Department of Food Science and Technology, Faculty of Agricultural Technology, IPB Darmaga Campus, IPB University, P.O. Box 220, Bogor 16680, West Java, Indonesia;
| | - Dominika Średnicka-Tober
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776 Warsaw, Poland
- Correspondence: ; Tel.: +48-225-937-035
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8
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Jie F, Yang X, Wu L, Wang M, Lu B. Linking phytosterols and oxyphytosterols from food to brain health: origins, effects, and underlying mechanisms. Crit Rev Food Sci Nutr 2021; 62:3613-3630. [PMID: 33397124 DOI: 10.1080/10408398.2020.1867819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Phytosterols and their oxidation products, namely oxyphytosterols, are natural compounds present in plant foods. With increased intake of phytosterol-enriched functional food products, the exposure of both phytosterols and oxyphytosterols is rising. Over the past ten years, researches have been focused on their absorption and metabolism in human body, as well as their biological effects. More importantly, recent studies showed that phytosterols and oxyphytosterols can traverse the blood-brain barrier and accumulate in the brain. As brain health problems resulting from ageing being more serious, attenuating central nervous system (CNS) disorders with active compounds in food are becoming a hot topic. Phytosterols and oxyphytosterols have been shown to implicated in cognition altering and the pathologies of several CNS disorders, including Alzheimer's disease and multiple sclerosis. We will overview these findings with a focus on the contents of phytosterols and oxyphytosterols in food and their dietary intake, as well as their origins in the brain, and illustrate molecular pathways through which they affect brain health, in terms of inflammation, cholesterol homeostasis, oxidative stress, and mitochondria function. The existing scientific gaps of phytosterols and oxyphytosterols to brain health in knowledge are also discussed, highlighting research directions in the future.
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Affiliation(s)
- Fan Jie
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Key Laboratory for Agro-Products Nutritional Evaluation of Ministry of Agriculture and Rural Affairs, Key Laboratory of Agro-Products Postharvest Handling of Ministry of Agriculture and Rural Affairs, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang International Scientific and Technological Cooperation Base of Health Food Manufacturing and Quality Control, Zhejiang University, Hangzhou, China.,Fuli Institute of Food Science, Zhejiang University, Hangzhou, China.,Ningbo Research Institute, Zhejiang University, Ningbo, China
| | - Xuan Yang
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Lipeng Wu
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Key Laboratory for Agro-Products Nutritional Evaluation of Ministry of Agriculture and Rural Affairs, Key Laboratory of Agro-Products Postharvest Handling of Ministry of Agriculture and Rural Affairs, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang International Scientific and Technological Cooperation Base of Health Food Manufacturing and Quality Control, Zhejiang University, Hangzhou, China.,Fuli Institute of Food Science, Zhejiang University, Hangzhou, China.,Ningbo Research Institute, Zhejiang University, Ningbo, China
| | - Mengmeng Wang
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Key Laboratory for Agro-Products Nutritional Evaluation of Ministry of Agriculture and Rural Affairs, Key Laboratory of Agro-Products Postharvest Handling of Ministry of Agriculture and Rural Affairs, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang International Scientific and Technological Cooperation Base of Health Food Manufacturing and Quality Control, Zhejiang University, Hangzhou, China.,Fuli Institute of Food Science, Zhejiang University, Hangzhou, China.,Ningbo Research Institute, Zhejiang University, Ningbo, China
| | - Baiyi Lu
- College of Biosystems Engineering and Food Science, National-Local Joint Engineering Laboratory of Intelligent Food Technology and Equipment, Key Laboratory for Agro-Products Nutritional Evaluation of Ministry of Agriculture and Rural Affairs, Key Laboratory of Agro-Products Postharvest Handling of Ministry of Agriculture and Rural Affairs, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang International Scientific and Technological Cooperation Base of Health Food Manufacturing and Quality Control, Zhejiang University, Hangzhou, China.,Fuli Institute of Food Science, Zhejiang University, Hangzhou, China.,Ningbo Research Institute, Zhejiang University, Ningbo, China
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9
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Quintão ECR. Plasma Non-cholesterol Sterols as Markers of Cholesterol Synthesis and Intestinal Absorption: A Critical Review. Curr Pharm Des 2020; 26:5152-5162. [PMID: 32744960 DOI: 10.2174/1381612826666200730220230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022]
Abstract
Plasma concentrations of phytosterols and non-cholesterol sterol precursors of cholesterol synthesis have been used as markers of intestinal cholesterol absorption and synthesis in inherited and secondary dyslipidemias and in population-based investigations to evaluate the risk for cardiovascular disease, respectively. The method aims at replacing initial research procedures such as the use of stable isotopes associated with fecal steroid balance, which are limited by the high cost and tedious procedures. However, we show in this review that numerous results obtained with serum sterol measurements are contradictory. In this regard, the following points are discussed: 1) how phytosterols relate to atherosclerosis considering that defects in biliary output or in the transport of phytosterols from the intestinal mucosa back into the intestinal lumen provide increased content of phytosterols and other sterols in plasma and tissues, thus not allowing to conclude that their presence in arteries and atheromas represents the etiology of atherosclerosis; 2) serum non-cholesterol sterols as markers of cholesterol synthesis and absorption, such as cholestanol, present discrepant results, rendering them often inadequate to identify cases of coronary artery disease as well as alterations in the whole body cholesterol metabolism; 3) such methods of measurement of cholesterol metabolism are confounded by factors like diabetes mellitus, body weight and other pathologies including considerable hereditary hyperlipidemias biological variabilities that influence the efficiency of synthesis and intestinal absorption of cholesterol.
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Martins IR, Onuki J, Miyamoto S, Uemi M. Characterization of oxyphytosterols generated by β-sitosterol ozonization. Arch Biochem Biophys 2020; 689:108472. [DOI: 10.1016/j.abb.2020.108472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
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11
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Feng S, Belwal T, Li L, Limwachiranon J, Liu X, Luo Z. Phytosterols and their derivatives: Potential health‐promoting uses against lipid metabolism and associated diseases, mechanism, and safety issues. Compr Rev Food Sci Food Saf 2020; 19:1243-1267. [DOI: 10.1111/1541-4337.12560] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Simin Feng
- College of Food Science and TechnologyZhejiang University of Technology Hangzhou 310014 People's Republic of China
- College of Biosystems Engineering and Food Science, Key Laboratory of Agro‐Products Postharvest Handling Ministry of Agriculture, Zhejiang Key Laboratory for Agri‐Food Processing, National‐Local Joint Engineering Laboratory of Intelligent Food Technology and EquipmentZhejiang University Hangzhou 310058 People's Republic of China
- Key Laboratory of Food Macromolecular Resources Processing Technology Research, China National Light IndustryZhejiang University of Technology Hangzhou 310014 People's Republic of China
| | - Tarun Belwal
- College of Biosystems Engineering and Food Science, Key Laboratory of Agro‐Products Postharvest Handling Ministry of Agriculture, Zhejiang Key Laboratory for Agri‐Food Processing, National‐Local Joint Engineering Laboratory of Intelligent Food Technology and EquipmentZhejiang University Hangzhou 310058 People's Republic of China
| | - Li Li
- College of Biosystems Engineering and Food Science, Key Laboratory of Agro‐Products Postharvest Handling Ministry of Agriculture, Zhejiang Key Laboratory for Agri‐Food Processing, National‐Local Joint Engineering Laboratory of Intelligent Food Technology and EquipmentZhejiang University Hangzhou 310058 People's Republic of China
| | - Jarukitt Limwachiranon
- College of Biosystems Engineering and Food Science, Key Laboratory of Agro‐Products Postharvest Handling Ministry of Agriculture, Zhejiang Key Laboratory for Agri‐Food Processing, National‐Local Joint Engineering Laboratory of Intelligent Food Technology and EquipmentZhejiang University Hangzhou 310058 People's Republic of China
| | - Xingquan Liu
- School of Agriculture and Food SciencesZhejiang Agriculture and Forestry University Hangzhou 311300 People's Republic of China
| | - Zisheng Luo
- College of Biosystems Engineering and Food Science, Key Laboratory of Agro‐Products Postharvest Handling Ministry of Agriculture, Zhejiang Key Laboratory for Agri‐Food Processing, National‐Local Joint Engineering Laboratory of Intelligent Food Technology and EquipmentZhejiang University Hangzhou 310058 People's Republic of China
- Ningbo Research InstituteZhejiang University Ningbo 315100 People's Republic of China
- Fuli Institute of Food ScienceZhejiang University Hangzhou 310058 People's Republic of China
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12
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Turck D, Castenmiller J, De Henauw S, Hirsch-Ernst KI, Kearney J, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Cubadda F, Frenzel T, Heinonen M, Marchelli R, Neuhäuser-Berthold M, Poulsen M, Schlatter JR, van Loveren H, Gelbmann W, Knutsen HK. Safety of the extension of use of plant sterol esters as a novel food pursuant to Regulation (EU) 2015/2283. EFSA J 2020; 18:e06135. [PMID: 32874320 PMCID: PMC7448038 DOI: 10.2903/j.efsa.2020.6135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the safety of an extension of use of the novel food 'plant sterol esters' when added to vegetable fat spreads and to liquid vegetable fat-based emulsions for cooking and baking purposes pursuant to Regulation (EU) 2015/2283. Member States expressed concerns in relation to plant sterol oxidation products (POP) and consumption by non-target population groups. The median (0.5%) and P90 (2.28%) value of the oxidation rates of plant sterols determined by a wide range of cooking experiments were used together with exposure estimates for plant sterol when added and cooked with vegetable fat spreads and liquids. The no-observed adverse effect level (NOAEL) of a subchronic rat study and an applied default uncertainty factor of 200 served to derive levels (i.e. 0.64 mg POP/kg body weight (bw) per day) considered safe for humans. This safe level of exposure would be exceeded at the P95 by all age groups when considering the P90 oxidation rate and using EFSA's comprehensive food consumption database for assessing the potential exposure. When considering the median oxidation rate, the safe level of 0.64 mg POP/kg bw per day would be exceeded at the highest P95 intake estimates in children below 9 years of age. When considering an intake of the maximum authorised use level of 3 g plant sterols/person per day and oxidation rates of 0.5% and 2.28%, the resulting daily POP intakes per kg bw by an adult weighing 70 kg would be 0.21 and 0.98 mg/kg bw per day, respectively, the latter value exceeding 0.64 mg/kg bw per day. The Panel concludes that the safety of the intended extension of use of plant sterol esters under the proposed conditions of use has not been established.
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13
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Baumgartner S, Ras RT, Trautwein EA, Konings MCJM, Mensink RP, Plat J. Plasma oxyphytosterol concentrations are not associated with CVD status in Framingham Offspring Study participants. J Lipid Res 2019; 60:1905-1911. [PMID: 31455614 DOI: 10.1194/jlr.ra119000274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/16/2019] [Indexed: 12/12/2022] Open
Abstract
Dietary plant sterols, such as campesterol and sitosterol, reduce plasma cholesterol concentrations, but any relationship to plaque development and CVD remains unclear. Some epidemiologic studies have suggested that elevated plasma plant sterol concentrations are atherogenic, including the Framingham Offspring Study that identified a positive association between plant sterol concentrations and CVD status. We hypothesized that this suggested atherogenicity relates to the oxidation status of plant sterols (i.e., concentrations of plasma oxyphytosterols). Therefore, in the Framingham Offspring Study cohort, we measured plasma oxyphytosterol concentrations in 144 patients with documented CVD and/or more than 50% carotid stenosis and 383 matched controls. We analyzed plasma oxyphytosterol concentrations by GC/MS/MS and performed conditional logistic regression analysis to determine associations between plasma plant sterol or oxyphytosterol concentrations and CVD status. We found that higher total cholesterol (TC)-standardized campesterol concentrations [odds ratio (OR): 2.36; 95% CI: 1.60, 3.50] and higher sitosterol concentrations (OR: 1.47; 95% CI: 1.09, 1.97) were significantly associated with increased CVD risk, as in the earlier study. However, the sum of absolute oxyphytosterol concentrations (OR: 0.99; 95% CI: 0.81, 1.21) and the sum of TC-standardized oxyphytosterol concentrations (OR: 0.98; 95% CI: 0.80, 1.19) were not associated with an increased CVD risk. Results were comparable for individual absolute and TC-standardized oxycampesterol and oxysitosterol concentrations. Plasma nonoxidized TC-standardized sitosterol and campesterol concentrations showed weak or no correlations with oxyphytosterol concentrations, while all individual plasma concentrations of oxyphytosterol correlated with each other. In conclusion, circulating plasma oxyphytosterols are not associated with CVD risk in the Framingham Offspring Study.
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Affiliation(s)
- Sabine Baumgartner
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | | | | | - Maurice C J M Konings
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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14
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Dumolt JH, Rideout TC. The Lipid-lowering Effects and Associated Mechanisms of Dietary Phytosterol Supplementation. Curr Pharm Des 2019; 23:5077-5085. [PMID: 28745211 DOI: 10.2174/1381612823666170725142337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/01/2017] [Accepted: 07/21/2017] [Indexed: 12/12/2022]
Abstract
Phytosterols (PS) are plant-based structural analogous of mammalian cholesterol that have been shown to lower blood cholesterol concentrations by ~10%, although inter-individual response to PS supplementation due to subject-specific metabolic and genetic factors is evident. Recent work further suggests that PS may act as effective triglyceride (TG)-lowering agents with maximal TG reductions observed in hypertriglyceridemic subjects. Although PS have been demonstrated to interfere with cholesterol and perhaps TG absorption within the intestine, they also have the capacity to modulate the expression of lipid regulatory genes through liver X receptor (LXR) activation. Identification of single-nucleotide polymorphisms (SNP) in key cholesterol and TG regulating genes, in particular adenosine triphosphate binding cassette G8 (ABCG8) and apolipoprotein E (apoE) have provided insight into the potential of utilizing genomic identifiers as an indicator of PS responsiveness. While PS supplementation is deemed safe, expanding research into the atherogenic potential of oxidized phytosterols (oxyphytosterols) has emerged with their identification in arterial lesions. This review will highlight the lipid-lowering utility and associated mechanisms of PS and discuss novel applications and future research priorities for PS pertaining to in utero PS exposure for long-term cardiovascular disease risk protection and combination therapies with lipidlowering drugs.
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Affiliation(s)
- Jerad H Dumolt
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, United States
| | - Todd C Rideout
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, United States
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15
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Plat J, Baumgartner S, Vanmierlo T, Lütjohann D, Calkins KL, Burrin DG, Guthrie G, Thijs C, Te Velde AA, Vreugdenhil ACE, Sverdlov R, Garssen J, Wouters K, Trautwein EA, Wolfs TG, van Gorp C, Mulder MT, Riksen NP, Groen AK, Mensink RP. Plant-based sterols and stanols in health & disease: "Consequences of human development in a plant-based environment?". Prog Lipid Res 2019; 74:87-102. [PMID: 30822462 DOI: 10.1016/j.plipres.2019.02.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Dietary plant sterols and stanols as present in our diet and in functional foods are well-known for their inhibitory effects on intestinal cholesterol absorption, which translates into lower low-density lipoprotein cholesterol concentrations. However, emerging evidence suggests that plant sterols and stanols have numerous additional health effects, which are largely unnoticed in the current scientific literature. Therefore, in this review we pose the intriguing question "What would have occurred if plant sterols and stanols had been discovered and embraced by disciplines such as immunology, hepatology, pulmonology or gastroenterology before being positioned as cholesterol-lowering molecules?" What would then have been the main benefits and fields of application of plant sterols and stanols today? We here discuss potential effects ranging from its presence and function intrauterine and in breast milk towards a potential role in the development of non-alcoholic steatohepatitis (NASH), cardiovascular disease (CVD), inflammatory bowel diseases (IBD) and allergic asthma. Interestingly, effects clearly depend on the route of entrance as observed in intestinal-failure associated liver disease (IFALD) during parenteral nutrition regimens. It is only until recently that effects beyond lowering of cholesterol concentrations are being explored systematically. Thus, there is a clear need to understand the full health effects of plant sterols and stanols.
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Affiliation(s)
- J Plat
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
| | - S Baumgartner
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - T Vanmierlo
- Department of Immunology and Biochemistry, Biomedical Research Institute (Biomed) Hasselt University, Hasselt, Belgium; Division of Translational Neuroscience, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, the Netherlands
| | - D Lütjohann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - K L Calkins
- David Geffen School of Medicine, University of California Los Angeles, Mattel Children's Hospital at UCLA, Los Angeles, CA; Department of Pediatrics, Division of Neonatology and Developmental Biology, Neonatal Research Center, USA
| | - D G Burrin
- Department of Pediatrics, USDA Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
| | - G Guthrie
- Department of Pediatrics, USDA Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
| | - C Thijs
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - A A Te Velde
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Medical Center, the Netherlands
| | - A C E Vreugdenhil
- Department of Pediatrics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - R Sverdlov
- Department of Molecular Genetics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - J Garssen
- Utrecht University, Division Pharmacology, Utrecht Institute for Pharmaceutical Sciences, the Netherlands
| | - K Wouters
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | | | - T G Wolfs
- Department of Pediatrics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - C van Gorp
- Department of Pediatrics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - M T Mulder
- Department of Internal Medicine, Rotterdam University, Rotterdam, the Netherlands
| | - N P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A K Groen
- Amsterdam Diabetes Center and Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - R P Mensink
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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16
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Nakano T, Inoue I, Murakoshi T. A Newly Integrated Model for Intestinal Cholesterol Absorption and Efflux Reappraises How Plant Sterol Intake Reduces Circulating Cholesterol Levels. Nutrients 2019; 11:nu11020310. [PMID: 30717222 PMCID: PMC6412963 DOI: 10.3390/nu11020310] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/27/2022] Open
Abstract
Cholesterol homeostasis is maintained through a balance of de novo synthesis, intestinal absorption, and excretion from the gut. The small intestine contributes to cholesterol homeostasis by absorbing and excreting it, the latter of which is referred to as trans-intestinal cholesterol efflux (TICE). Because the excretion efficiency of endogenous cholesterol is inversely associated with the development of atherosclerosis, TICE provides an attractive therapeutic target. Thus, elucidation of the mechanism is warranted. We have shown that intestinal cholesterol absorption and TICE are inversely correlated in intestinal perfusion experiments in mice. In this review, we summarized 28 paired data sets for absorption efficiency and fecal neutral sterol excretion, a surrogate marker of TICE, obtained from 13 available publications in a figure, demonstrating the inverse correlation were nearly consistent with the assumption. We then offer a bidirectional flux model that accommodates absorption and TICE occurring in the same segment. In this model, the brush border membrane (BBM) of intestinal epithelial cells stands as the dividing ridge for cholesterol fluxes, making the opposite fluxes competitive and being coordinated by shared BBM-localized transporters, ATP-binding cassette G5/G8 and Niemann-Pick C1-like 1. Furthermore, the idea is applied to address how excess plant sterol/stanol (PS) intake reduces circulating cholesterol level, because the mechanism is still unclear. We propose that unabsorbable PS repeatedly shuttles between the BBM and lumen and promotes concomitant cholesterol efflux. Additionally, PSs, which are chemically analogous to cholesterol, may disturb the trafficking machineries that transport cholesterol to the cell interior.
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Affiliation(s)
- Takanari Nakano
- Department of Biochemistry, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan.
| | - Ikuo Inoue
- Department of Diabetes and Endocrinology, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan.
| | - Takayuki Murakoshi
- Department of Biochemistry, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan.
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17
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Fuhrmann A, Weingärtner O, Meyer S, Cremers B, Seiler-Mußler S, Schött HF, Kerksiek A, Friedrichs S, Ulbricht U, Zawada AM, Laufs U, Scheller B, Fliser D, Schulze PC, Böhm M, Heine GH, Lütjohann D. Plasma levels of the oxyphytosterol 7α-hydroxycampesterol are associated with cardiovascular events. Atherosclerosis 2018; 279:17-22. [PMID: 30366187 DOI: 10.1016/j.atherosclerosis.2018.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/29/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS There are safety issues regarding plant sterol ester-enriched functional food. Oxidized plant sterols, also called oxyphytosterols, are supposed to contribute to plant sterol atherogenicity. This study aimed to analyze associations of plasma oxyphytosterol levels with cardiovascular events. METHODS Plasma cholesterol was measured by gas chromatography-flame ionization detection. Plasma campesterol and sitosterol and their 7-oxygenated metabolites were analyzed by gas chromatography-mass selective detection. RESULTS In 376 patients admitted for elective coronary angiography, who were not on lipid-lowering drugs, 82 cardiovascular events occurred during a follow-up period of 4.2 ± 1.8 years. Patients with cardiovascular events had significantly higher 7α-hydroxycampesterol plasma levels (median, 0.46; [interquartile range (IQR) 0.22-0.81] nmol/L vs. median, 0.25 [IQR, 0.17-0.61] nmol/L; p = 0.003) and 7α-hydroxycampesterol-to-cholesterol ratios (median 0.08 [IQR, 0.04-0.14] nmol/mmol vs. median, 0.05 [IQR 0.03-0.11] nmol/mmol; p = 0.005) than controls without such events. Patients above the median were characterized by higher cumulative event rates in Kaplan-Meier-analysis (Logrank-test p = 0.084 and p = 0.025) for absolute and cholesterol corrected 7α-hydroxycampesterol, respectively. After adjustment for influencing factors and related lipids, the hazard ratios per one standard deviation of the log-transformed variables (HR) were 1.19 [95% confidence interval (CI), 0.95-1.48], p = 0.132 for 7α-hydroxycampesterol and HR, 1.18 [95% CI, 0.94-1.48], p = 0.154 for 7α-hydroxycampesterol-to-cholesterol ratio. None of the other investigated oxyphytosterols showed an association with cardiovascular events. CONCLUSIONS In patients not on lipid-lowering drugs, absolute plasma levels of 7α-hydroxycampesterol and their ratios to cholesterol are associated with cardiovascular events. Further research is required to elucidate the role of OPS in cardiovascular diseases.
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Affiliation(s)
- Arne Fuhrmann
- Institut für Klinische Chemie und Klinische Pharmakologie, Universitätsklinikum Bonn, Germany
| | - Oliver Weingärtner
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Germany; Universitätsklinik für Innere Medizin - Kardiologie, Klinikum Oldenburg, Carl von Ossietzky Universität Oldenburg, Germany, European Medical School Oldenburg-Groningen, Germany
| | - Sven Meyer
- Universitätsklinik für Innere Medizin - Kardiologie, Klinikum Oldenburg, Carl von Ossietzky Universität Oldenburg, Germany, European Medical School Oldenburg-Groningen, Germany
| | - Bodo Cremers
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sarah Seiler-Mußler
- Klinik für Innere Medizin IV, Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Hans-F Schött
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany
| | - Anja Kerksiek
- Institut für Klinische Chemie und Klinische Pharmakologie, Universitätsklinikum Bonn, Germany
| | - Silvia Friedrichs
- Institut für Klinische Chemie und Klinische Pharmakologie, Universitätsklinikum Bonn, Germany
| | - Ursula Ulbricht
- Klinik für Innere Medizin IV, Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Adam M Zawada
- Klinik für Innere Medizin IV, Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Germany
| | - Bruno Scheller
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Danilo Fliser
- Klinik für Innere Medizin IV, Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gunnar H Heine
- Klinik für Innere Medizin IV, Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Medizinische Klinik II, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Dieter Lütjohann
- Institut für Klinische Chemie und Klinische Pharmakologie, Universitätsklinikum Bonn, Germany.
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18
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Oligschlaeger Y, Houben T, Jeurissen MLJ, Bitorina AV, Konings M, Baumgartner S, Plat J, Shiri-Sverdlov R. Exogenously Added Oxyphytosterols Do Not Affect Macrophage-Mediated Inflammatory Responses. Lipids 2018; 53:457-462. [DOI: 10.1002/lipd.12044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Yvonne Oligschlaeger
- Department of Molecular Genetics, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Tom Houben
- Department of Molecular Genetics, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Mike L. J. Jeurissen
- Department of Molecular Genetics, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Albert V. Bitorina
- Department of Molecular Genetics, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Maurice Konings
- Department of Human Biology and Movement Sciences, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Sabine Baumgartner
- Department of Human Biology and Movement Sciences, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Jogchum Plat
- Department of Human Biology and Movement Sciences, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, School of Nutrition & Translational Research Maastricht (NUTRIM); Maastricht University; PO Box 616, 6200 MD, Maastricht The Netherlands
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19
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Kane J, Schaefer E, Malloy M. Xenosterolemia: emerging molecular and clinical insights. Curr Opin Lipidol 2017; 28:518-519. [PMID: 29095365 DOI: 10.1097/mol.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- John Kane
- aCardiovascular Research Institute, UCSF School of Medicine, San Francisco, California bCardiovascular Nutrition Laboratory, Tufts University School of Medicine, Boston, Massachusetts cUCSF School of Medicine, San Francisco, California, USA
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20
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The effects of vitamin E or lipoic acid supplementation on oxyphytosterols in subjects with elevated oxidative stress: a randomized trial. Sci Rep 2017; 7:15288. [PMID: 29127425 PMCID: PMC5681676 DOI: 10.1038/s41598-017-15615-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/27/2017] [Indexed: 12/19/2022] Open
Abstract
Despite increased serum plant sterol concentrations after consumption of plant sterol enriched margarines, plasma oxyphytosterol concentrations were not increased in healthy subjects. Here, we assessed plasma oxyphytosterol concentrations and whether they are affected by antioxidants in subjects with elevated oxidative stress. Twenty subjects with impaired glucose tolerance (IGT) or type 2 diabetes (DM2) consumed for 4 weeks placebo, vitamin E (804 mg/d) or lipoic acid capsules (600 mg/d). Plasma and blood cell oxyphytosterol and oxycholesterol concentrations were determined in butylated hydroxytoluene-enriched EDTA plasma via GC-MS. Also, markers reflecting oxidative stress and antioxidant capacity were measured. Plasma oxycampesterol and oxysitosterol concentrations were 122% and 83% higher in IGT or DM2 subjects than in healthy subjects, as determined in an earlier study. Vitamin E or lipoic acid supplementation did not reduce plasma oxyphytosterol and oxycholesterol concentrations, or other markers reflecting oxidative stress or antioxidative capacity. Concentrations of different oxyphytosterols correlated within plasma, and within red blood cells and platelets. However, plasma and blood cell oxyphytosterol levels did not correlate. Although plasma oxyphytosterol concentrations are higher in IGT or DM2 subjects than in healthy subjects, 4-weeks vitamin E or lipoic acid supplementation does not lower plasma oxycholesterol or oxyphytosterol concentrations.
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21
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Dumolt JH, Radhakrishnan SK, Moghadasian MH, Le K, Patel MS, Browne RW, Rideout TC. Maternal hypercholesterolemia enhances oxysterol concentration in mothers and newly weaned offspring but is attenuated by maternal phytosterol supplementation. J Nutr Biochem 2017; 52:10-17. [PMID: 29107136 DOI: 10.1016/j.jnutbio.2017.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/02/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
In hypercholesterolemic pregnancies, the maternal environment is characterized by excessive levels of atherogenic lipids that may increase cardiovascular disease risk in mothers and their offspring. We examined the influence of maternal hypercholesterolemia and phytosterol (PS) intervention on the concentration and metabolism of oxysterols, bioactive oxygenated cholesterol derivatives that regulate arterial health and lesion progression, in mothers and their newly weaned offspring. Twenty-one female apoE-/- mice were randomly assigned to three different diets throughout gestation and lactation: (1) chow, (2) high cholesterol (CH; 0.15%) and (3) CH with added PS (2%, CH/PS). At the end of the lactation period, mothers and pups were euthanized for serum and hepatic oxysterol analyses, hepatic transcriptional profiling of hepatic sterol regulatory targets and atherosclerosis. Hypercholesterolemic dams and their pups demonstrated increased (P˂.05) serum oxysterols [including 24 hydroxycholesterol (HC), 25HC, 27HC, 7αHC, 7βHC and 7 ketocholesterol)] compared with the chow group that were normalized by maternal PS supplementation. Hepatic oxysterol concentrations followed a similar pattern of response in mothers but were not altered in newly weaned pups. Hepatic mRNA expression suggested a pattern of enhanced abca1/g1 high-density-lipoprotein-mediated efflux but a reduction in biliary abcg5/g8 export in both dams and their pups. Although arterial lesions were not apparent in newly weaned pups, CH dams demonstrated enhanced atherosclerosis that was reduced upon PS intervention. These results demonstrate that offspring from hypercholesterolemic pregnancies have enhanced circulating oxysterol concentrations and highlight the potential utility of PS as a lipid-lowering option during hypercholesterolemic pregnancies for which there are currently limited options.
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Affiliation(s)
- Jerad H Dumolt
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA 14214
| | - Sandhya K Radhakrishnan
- Department of Biotechnical and Clinical Laboratory Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA 14214
| | - Mohammed H Moghadasian
- Department of Human Nutritional Sciences, University of Manitoba, and Canadian Centre for Agri-Food Research in Health and Medicine, St. Boniface Hospital Research Centre, Winnipeg, MB, Canada, RH2 2A6
| | - Khuong Le
- Department of Human Nutritional Sciences, University of Manitoba, and Canadian Centre for Agri-Food Research in Health and Medicine, St. Boniface Hospital Research Centre, Winnipeg, MB, Canada, RH2 2A6
| | - Mulchand S Patel
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA 14214
| | - Richard W Browne
- Department of Biotechnical and Clinical Laboratory Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA 14214
| | - Todd C Rideout
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA 14214.
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22
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Köhler J, Teupser D, Elsässer A, Weingärtner O. Plant sterol enriched functional food and atherosclerosis. Br J Pharmacol 2017; 174:1281-1289. [PMID: 28253422 PMCID: PMC5429322 DOI: 10.1111/bph.13764] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 12/25/2022] Open
Abstract
Hypercholesterolaemia is a major cardiovascular risk factor. A healthy diet and a healthy lifestyle reduces cardiovascular risk. 'Functional foods' supplemented with phytosterols are recommended for the management of hypercholesterolaemia and have become a widely used non-prescription approach to lower plasma cholesterol levels. Two billion euros are spent world-wide each year on various functional foods, which have regulator-approved health claims for the management of elevated cholesterol levels. While international societies, such as the European Atherosclerosis Society or the National Heart Foundation in Australia, still advise phytosterols as an additional dietary option in the management of hypercholesterolaemia, recently released guidelines such as those from the National Institute of Health and Clinical Excellence in the United Kingdom are more critical of food supplementation with phytosterols and draw attention to significant safety issues. This review challenges whether an intervention with phytosterol supplements is beneficial. We summarize the current evidence from genetic diseases, genetic association studies, clinical trial data and data from animal studies. LINKED ARTICLES This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc.
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Affiliation(s)
- Jürgen Köhler
- Clinic for Thorax‐, Vascular and Endovascular Surgery, Pius‐Hospital OldenburgCarl von Ossietzky UniversitätOldenburgGermany
| | - Daniel Teupser
- Institute of Laboratory MedicineLudwig‐Maximilians‐University MunichMunichGermany
| | - Albrecht Elsässer
- Department of Cardiology, Klinikum Oldenburg, European Medical School Oldenburg‐GroningenCarl von Ossietzky UniversityOldenburgGermany
| | - Oliver Weingärtner
- Department of Cardiology, Klinikum Oldenburg, European Medical School Oldenburg‐GroningenCarl von Ossietzky UniversityOldenburgGermany
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23
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Weingärtner O, Bogeski I, Kummerow C, Schirmer SH, Husche C, Vanmierlo T, Wagenpfeil G, Hoth M, Böhm M, Lütjohann D, Laufs U. Plant sterol ester diet supplementation increases serum plant sterols and markers of cholesterol synthesis, but has no effect on total cholesterol levels. J Steroid Biochem Mol Biol 2017; 169:219-225. [PMID: 27473562 DOI: 10.1016/j.jsbmb.2016.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/23/2016] [Accepted: 07/26/2016] [Indexed: 12/17/2022]
Abstract
This double-blind, randomized, placebo-controlled, cross-over intervention-study was conducted in healthy volunteers to evaluate the effects of plant sterol ester supplemented margarine on cholesterol, non-cholesterol sterols and oxidative stress in serum and monocytes. Sixteen volunteers, average age 34 years, with no or mild hypercholesterolemia were subjected to a 4 week period of daily intake of 3g plant sterols per day supplied via a supplemented margarine on top of regular eating habits. After a wash-out period of one week, volunteers switched groups. Compared to placebo, a diet supplementation with plant sterols increased serum levels of plant sterols such as campesterol (+0.16±0.19mg/dL, p=0.005) and sitosterol (+0.27±0.18mg/dL, p<0.001) and increased markers of cholesterol synthesis such as desmosterol (+0.05±0.07mg/dL, p=0.006) as well as lathosterol (+0.11±0.16mg/dL, p=0.012). Cholesterol serum levels, however, were not changed significantly (+18.68±32.6mg/dL, p=0.052). These findings could not be verified in isolated circulating monocytes. Moreover, there was no effect on monocyte activation and no differences with regard to redox state after plant sterol supplemented diet. Therefore, in a population of healthy volunteers with no or mild hypercholesterolemia, consumption of plant sterol ester supplemented margarine results in increased concentrations of plant sterols and cholesterol synthesis markers without affecting total cholesterol in the serum, activation of circulating monocytes or redox state.
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Affiliation(s)
- Oliver Weingärtner
- Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität, Oldenburg, Germany; Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| | - Ivan Bogeski
- Abteilung für Biophysik, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Biophysics Faculty of Medicine CIPMM, Building 48, D-66421 Homburg, Germany
| | - Carsten Kummerow
- Abteilung für Biophysik, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Biophysics Faculty of Medicine CIPMM, Building 48, D-66421 Homburg, Germany
| | - Stephan H Schirmer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Germany
| | - Constanze Husche
- Institut für klinische Chemie und klinische Pharmakologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Tim Vanmierlo
- Institut für klinische Chemie und klinische Pharmakologie, Universitätsklinikum Bonn, Bonn, Germany; Dept. of Immunology and Biochemistry, BIOMED, Hasselt University, Hasselt, Belgium
| | - Gudrun Wagenpfeil
- Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität, Oldenburg, Germany; Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Germany; Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Abteilung für Biophysik, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Institut für klinische Chemie und klinische Pharmakologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Markus Hoth
- Abteilung für Biophysik, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Biophysics Faculty of Medicine CIPMM, Building 48, D-66421 Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Germany
| | - Dieter Lütjohann
- Institut für klinische Chemie und klinische Pharmakologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Ulrich Laufs
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Germany
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24
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Schött HF, Baumgartner S, Husche C, Luister A, Friedrichs S, Miller CM, McCarthy FO, Plat J, Laufs U, Weingärtner O, Lütjohann D. Oxidation of sitosterol and transport of its 7-oxygenated products from different tissues in humans and ApoE knockout mice. J Steroid Biochem Mol Biol 2017; 169:145-151. [PMID: 27132025 DOI: 10.1016/j.jsbmb.2016.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 12/24/2022]
Abstract
The most common phytosterols in the human diet are sitosterol and campesterol, which originate exclusively from plant derived food. These phytosterols are taken up by NPC1L1 transport from the intestine into the enterocytes together with cholesterol and other xenosterols. Phytosterols are selectively pumped back from the enterocytes into the intestinal lumen and on the liver site from hepatocytes into bile by heterodimeric ABCG5/G8 transporters. Like cholesterol, both phytosterols are prone to ring and side chain oxidation. It could be shown that oxyphytosterols, found in atherosclerotic tissue, are most likely of in situ oxidation (Schött et al.; Biochem. Biophys. Res. Commun. 2014 Apr 11;446(3):805-10). However, up to now, the entire mechanism of phytosterol oxidation is not clearly understood. Here, we provide further information about the oxidation of sitosterol and the transport of its oxidation products out of tissue. Our survey includes data of 104 severe aortic stenosis patients that underwent an elective aortic valve cusp replacement. We studied their phytosterol concentrations, as well as absolute and substrate corrected oxyphytosterol levels in plasma and valve cusp tissue. In addition, we also examined phytosterol and oxyphytosterol concentrations in plasma and tissues (from brain and liver) of 10 male ApoE knockout mice. The ratio of 7-oxygenated-sitosterol-to-sitosterol exceeds the ratio for 7-oxygenated-campesterol-to-campesterol in plasma and tissue of both humans and mice. This finding indicates that sitosterol is oxidized to a higher amount than campesterol and that a selective oxidative mechanism might exist which can differentiate between certain phytosterols. Secondly, the concentrations of oxyphytosterols found in plasma and tissue support the idea that oxysitosterols are preferably transported out of individual tissues. Selective oxidation of sitosterol and preferred transport of sitosterol oxidation products out of tissue seem to be a metabolic pathway of forced sitosterol clearance from tissue compartments.
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Affiliation(s)
- Hans-Frieder Schött
- Institute for Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn, Germany; Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Sabine Baumgartner
- Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Constanze Husche
- Institute for Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn, Germany
| | - Alexandra Luister
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Silvia Friedrichs
- Institute for Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn, Germany
| | - Charlotte M Miller
- Department of Chemistry and Analytical and Biological Chemistry Research Facility, University College Cork, Cork, Ireland
| | - Florence O McCarthy
- Department of Chemistry and Analytical and Biological Chemistry Research Facility, University College Cork, Cork, Ireland
| | - Jogchum Plat
- Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Laufs
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Oliver Weingärtner
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Department of Cardiology, Klinikum Oldenburg, Carl von Ossietzky University, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Dieter Lütjohann
- Institute for Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn, Germany.
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