Published online before print April 14, 2005, doi: 10.1161/01.ATV.0000166548.65753.1e
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© 2005 American Heart Association, Inc.
Brief Reviews |
ACAT2 Is a Target for Treatment of Coronary Heart Disease Associated With Hypercholesterolemia
From the Lipid Sciences Research Program (L.L.R., R.L.), the Departments of Pathology and Biochemistry, Wake Forest University School of Medicine, Winston-Salem, NC; and the Center for Metabolism and Endocrinology (P.P.), Department of Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden.
Correspondence to Lawrence Rudel, Wake Forest University School of Medicine, Department of Pathology (Comparative Medicine), Winston-Salem, NC 27157-1040. E-mail lrudel{at}wfubmc.edu
Series Editor: Daniel J. Rader
Novel Approaches to the Treatment of Dyslipidemia
ATVB in Focus
Previous Brief Reviews in this Series:
•Chen HC, Farese RV Jr. Inhibition of triglyceride synthesis as a treatment strategy for obesity: lessons from DGAT1-deficient mice. 2005;25:482–486.
•Zalewski A, Macphee C. Role of lipoprotein-associated phospholipase A2 in atherosclerosis: biology, epidemiology, and possible therapeutic target. 2005;25:923–931.
The inhibition of intracellular cholesterol esterification as a means to prevent atherosclerosis has been considered to have potential for many years. Two different ACAT enzymes were discovered about 7 years ago, and it has become clear that the two enzymes provide separate physiologic functions. Much has been learned from mice with gene deletions for either ACAT1 or ACAT2. Deletion of ACAT2 has consistently been atheroprotective whereas deletion of ACAT1 has been varyingly problematic. ACAT1 functions in converting cellular cholesterol into cholesteryl ester in response to cholesterol abundance inside the cells. In atherosclerotic lesions, where macrophages ingest excess cholesterol, the ability to esterify the newly-acquired cholesterol seems important for cell survival. Inhibition of ACAT1 may bring undesired consequences with destabilization of cellular membrane function upon cholesterol accumulation leading to macrophage cell death. In contrast, ACAT2 is expressed only in hepatocytes and enterocytes, where ACAT1 is silent, and appears to provide cholesteryl esters for transport in lipoproteins. These two cell types have an abundance of additional mechanisms for disposing of cholesterol so that depletion of ACAT2 does not signal apoptosis. At the present time, the bulk of the available data suggest that the strategy seeming to bear the most potential for treatment of coronary heart disease associated with hypercholesterolemia would be to specifically inhibit ACAT2.
The inhibition of intracellular esterification of cholesterol as a means to prevent the arterial cholesteryl ester accumulation in atherosclerosis has been a strategy considered to have potential throughout the scientific community for many years. Presently, the bulk of the available data suggest that the strategy seeming to bear the most potential for treatment of coronary heart disease associated with hypercholesterolemia would be to specifically inhibit ACAT2.
Key Words: atherosclerosis • cholesterol absorption • cholesteryl ester • hepatocytes • lipoproteins
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