[Transfer of plasma cholesterol and atherosclerosis]

Transfer processes in plasma are determinant in cholesterol metabolism. In many species, including man, there is an alternative route for the disposal of cholesteryl esters (CE) in HDL via transfer to VLDL in exchange for triglycerides (TG), a process dependent on a hydrophobic 74 kDa glycoprotein called cholesteryl ester transfer protein (CETP). In vivo, cholesteryl esters transferred from HDL will contribute to LDL, to which VLDL is converted. Although the prevention of CE accumulation in HDL may enhance the ability of HDL to take up more cholesterol from tissues, high rates of transfer may also increase the risk for atheroma by increasing formation of atherogenic lipoproteins. Conversely, CE retained within HDL, if returned directly to the liver, would be expected to be beneficial. Moreover, in most conditions predisposing to atheroma, CETP activity is raised; whereas species with low or absent CETP activity are at low risk for atherosclerosis.