Atherogenic impact of lecithin-cholesterol acyltransferase and its relation to cholesterol esterification rate in HDL (FERHDL) and AIP [log(TG/HDL-C)] biomarkers: the butterfly effect?

摘要

The atherogenic impact and functional capacity of LCAT wasstudied and discussed over a half century. This review aims toclarify the key points that may affect the final decision onwhether LCAT is an anti-atherogenic or atherogenic factor. Thereare three main processes involving the efflux of free cholesterolfrom peripheral cells, LCAT action in intravascular pool wherecholesterol esterification rate is under the control of HDL, LDLand VLDL subpopulations, and finally the destination of newlyproduced cholesteryl esters either to the catabolism in liver or toa futile cycle with apoB lipoproteins. The functionality of LCATsubstantially depends on its mass together with the compositionof the phospholipid bilayer as well as the saturation and thelength of fatty acyls and other effectors about which we know yetnothing. Over the years, LCAT puzzle has been significantlysupplemented but yet not so satisfactory as to enable how tomanipulate LCAT in order to prevent cardiometabolic events. Itreminds the butterfly effect when only a moderate change in theprocess of transformation free cholesterol to cholesteryl estersmay cause a crucial turn in the intended target. On the otherhand, two biomarkers – FERHDL (fractional esterification ratein HDL) and AIP [log(TG/HDL-C)] can offer a benefit to identifythe risk of cardiovascular disease (CVD). They both reflect therate of cholesterol esterification by LCAT and the composition oflipoprotein subpopulations that controls this rate. In clinicalpractice, AIP can be calculated from the routine lipid profile withhelp of AIP calculator www.biomed.cas.cz/fgu/aip/calculator.php.