HDL infusion for the management of atherosclerosis: current developments and new directions

Because human genetic studies and large clinical trials have demonstrated that HDL-cholesterol levels are not causally related to cardiovascular disease risk, attention has shifted toward the functional properties of HDL. Infusion of HDL mimetics containing apolipoprotein A-I remains a potential strategy to exploit the atheroprotective effects of HDL.

Three HDL mimetic drugs are under development and currently being evaluated in clinical trials. Upon infusion, these drugs increase cholesterol efflux capacity. Although proof-of-concept studies are promising, large outcome studies are awaited. Alternatively, HDL particles may be used for targeted drug delivery in a nanomedicine approach. Finally, links between cholesterol efflux and myelopoeisis may prove to be a target for HDL infusion in the future.

Clinical studies are currently ongoing to evaluate the potential of several HDL mimetic drugs. Novel nanomedicinal approaches and emerging pathophysiological insights may further expand the relevance of HDL infusion.