High density lipoprotein physiology: Difference between revisions

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===HDL Receptors===
===HDL Receptors===
* [[ABCA1]] transporter: it is expressed in the peripheral tissues, intestine, liver, and macrophage.<ref name="Fitzgerald-2010">{{Cite journal | last1 = Fitzgerald | first1 = ML. | last2 = Mujawar | first2 = Z. | last3 = Tamehiro | first3 = N. | title = ABC transporters, atherosclerosis and inflammation. | journal = Atherosclerosis | volume = 211 | issue = 2 | pages = 361-70 | month = Aug | year = 2010 | doi = 10.1016/j.atherosclerosis.2010.01.011 | PMID = 20138281 }}</ref> An increase in intracellular cholesterol content upregulates ABCA1 transporter which is responsible for cholesterol efflux from the intracellular pool.<ref name="Schwartz-2000">{{Cite journal | last1 = Schwartz | first1 = K. | last2 = Lawn | first2 = RM. | last3 = Wade | first3 = DP. | title = ABC1 gene expression and ApoA-I-mediated cholesterol efflux are regulated by LXR. | journal = Biochem Biophys Res Commun | volume = 274 | issue = 3 | pages = 794-802 | month = Aug | year = 2000 | doi = 10.1006/bbrc.2000.3243 | PMID = 10924356 }}</ref>
* [[ABCA1]] transporter: it is expressed in the peripheral tissues, intestine, liver, and macrophages.<ref name="Fitzgerald-2010">{{Cite journal | last1 = Fitzgerald | first1 = ML. | last2 = Mujawar | first2 = Z. | last3 = Tamehiro | first3 = N. | title = ABC transporters, atherosclerosis and inflammation. | journal = Atherosclerosis | volume = 211 | issue = 2 | pages = 361-70 | month = Aug | year = 2010 | doi = 10.1016/j.atherosclerosis.2010.01.011 | PMID = 20138281 }}</ref> An increase in intracellular cholesterol content upregulates ABCA1 transporter which is responsible for cholesterol efflux from the intracellular pool.<ref name="Schwartz-2000">{{Cite journal | last1 = Schwartz | first1 = K. | last2 = Lawn | first2 = RM. | last3 = Wade | first3 = DP. | title = ABC1 gene expression and ApoA-I-mediated cholesterol efflux are regulated by LXR. | journal = Biochem Biophys Res Commun | volume = 274 | issue = 3 | pages = 794-802 | month = Aug | year = 2000 | doi = 10.1006/bbrc.2000.3243 | PMID = 10924356 }}</ref>


* [[ABCG1]] transporter: it is expressed in intestine and macrophage.<ref name="Fitzgerald-2010">{{Cite journal | last1 = Fitzgerald | first1 = ML. | last2 = Mujawar | first2 = Z. | last3 = Tamehiro | first3 = N. | title = ABC transporters, atherosclerosis and inflammation. | journal = Atherosclerosis | volume = 211 | issue = 2 | pages = 361-70 | month = Aug | year = 2010 | doi = 10.1016/j.atherosclerosis.2010.01.011 | PMID = 20138281 }}</ref> ABCG1 is also responsible for [[cholesterol]] efflux. In addition, ABCG1 may facilitate the oxidation of [[plasma membrane]] cholesterol domains.<ref name="Vaughan-2005">{{Cite journal | last1 = Vaughan | first1 = AM. | last2 = Oram | first2 = JF. | title = ABCG1 redistributes cell cholesterol to domains removable by high density lipoprotein but not by lipid-depleted apolipoproteins. | journal = J Biol Chem | volume = 280 | issue = 34 | pages = 30150-7 | month = Aug | year = 2005 | doi = 10.1074/jbc.M505368200 | PMID = 15994327 }}</ref>
* [[ABCG1]] transporter: it is expressed in the intestine and macrophages.<ref name="Fitzgerald-2010">{{Cite journal | last1 = Fitzgerald | first1 = ML. | last2 = Mujawar | first2 = Z. | last3 = Tamehiro | first3 = N. | title = ABC transporters, atherosclerosis and inflammation. | journal = Atherosclerosis | volume = 211 | issue = 2 | pages = 361-70 | month = Aug | year = 2010 | doi = 10.1016/j.atherosclerosis.2010.01.011 | PMID = 20138281 }}</ref> ABCG1 is also responsible for [[cholesterol]] efflux. In addition, ABCG1 may facilitate the oxidation of [[plasma membrane]] cholesterol domains.<ref name="Vaughan-2005">{{Cite journal | last1 = Vaughan | first1 = AM. | last2 = Oram | first2 = JF. | title = ABCG1 redistributes cell cholesterol to domains removable by high density lipoprotein but not by lipid-depleted apolipoproteins. | journal = J Biol Chem | volume = 280 | issue = 34 | pages = 30150-7 | month = Aug | year = 2005 | doi = 10.1074/jbc.M505368200 | PMID = 15994327 }}</ref>


* [[Scavenger receptor#Scavenger receptor class B|Scavenger receptor class B type I (SR-BI)]]: it is expressed in the liver, endothelial cells, and macrophages.  It participates in reverse cholesterol transport in which extrahepatic cholesterol is delivered to the liver for excretion into the bile.<ref name="Brundert-2005">{{Cite journal | last1 = Brundert | first1 = M. | last2 = Ewert | first2 = A. | last3 = Heeren | first3 = J. | last4 = Behrendt | first4 = B. | last5 = Ramakrishnan | first5 = R. | last6 = Greten | first6 = H. | last7 = Merkel | first7 = M. | last8 = Rinninger | first8 = F. | title = Scavenger receptor class B type I mediates the selective uptake of high-density lipoprotein-associated cholesteryl ester by the liver in mice. | journal = Arterioscler Thromb Vasc Biol | volume = 25 | issue = 1 | pages = 143-8 | month = Jan | year = 2005 | doi = 10.1161/01.ATV.0000149381.16166.c6 | PMID = 15528479 }}</ref><ref name="Out-2004">{{Cite journal | last1 = Out | first1 = R. | last2 = Hoekstra | first2 = M. | last3 = Spijkers | first3 = JA. | last4 = Kruijt | first4 = JK. | last5 = van Eck | first5 = M. | last6 = Bos | first6 = IS. | last7 = Twisk | first7 = J. | last8 = Van Berkel | first8 = TJ. | title = Scavenger receptor class B type I is solely responsible for the selective uptake of cholesteryl esters from HDL by the liver and the adrenals in mice. | journal = J Lipid Res | volume = 45 | issue = 11 | pages = 2088-95 | month = Nov | year = 2004 | doi = 10.1194/jlr.M400191-JLR200 | PMID = 15314100 }}</ref> In macrophages it blunts cytokine production.<ref name="Guo-2009">{{Cite journal | last1 = Guo | first1 = L. | last2 = Song | first2 = Z. | last3 = Li | first3 = M. | last4 = Wu | first4 = Q. | last5 = Wang | first5 = D. | last6 = Feng | first6 = H. | last7 = Bernard | first7 = P. | last8 = Daugherty | first8 = A. | last9 = Huang | first9 = B. | title = Scavenger Receptor BI Protects against Septic Death through Its Role in Modulating Inflammatory Response. | journal = J Biol Chem | volume = 284 | issue = 30 | pages = 19826-34 | month = Jul | year = 2009 | doi = 10.1074/jbc.M109.020933 | PMID = 19491399 }}</ref> In endothelial cells it mediates HDL-induced [[endothelial NOS|endothelial nitric oxide synthase (eNOS)]] activation, proliferation, and migration.<ref name="Besler-2011">{{Cite journal | last1 = Besler | first1 = C. | last2 = Heinrich | first2 = K. | last3 = Rohrer | first3 = L. | last4 = Doerries | first4 = C. | last5 = Riwanto | first5 = M. | last6 = Shih | first6 = DM. | last7 = Chroni | first7 = A. | last8 = Yonekawa | first8 = K. | last9 = Stein | first9 = S. | title = Mechanisms underlying adverse effects of HDL on eNOS-activating pathways in patients with coronary artery disease. | journal = J Clin Invest | volume = 121 | issue = 7 | pages = 2693-708 | month = Jul | year = 2011 | doi = 10.1172/JCI42946 | PMID = 21701070 }}</ref>
* [[Scavenger receptor#Scavenger receptor class B|Scavenger receptor class B type I (SR-BI)]]: it is expressed in the liver, endothelial cells, and macrophages.  It participates in reverse cholesterol transport in which extrahepatic cholesterol is delivered to the liver for excretion into the bile.<ref name="Brundert-2005">{{Cite journal | last1 = Brundert | first1 = M. | last2 = Ewert | first2 = A. | last3 = Heeren | first3 = J. | last4 = Behrendt | first4 = B. | last5 = Ramakrishnan | first5 = R. | last6 = Greten | first6 = H. | last7 = Merkel | first7 = M. | last8 = Rinninger | first8 = F. | title = Scavenger receptor class B type I mediates the selective uptake of high-density lipoprotein-associated cholesteryl ester by the liver in mice. | journal = Arterioscler Thromb Vasc Biol | volume = 25 | issue = 1 | pages = 143-8 | month = Jan | year = 2005 | doi = 10.1161/01.ATV.0000149381.16166.c6 | PMID = 15528479 }}</ref><ref name="Out-2004">{{Cite journal | last1 = Out | first1 = R. | last2 = Hoekstra | first2 = M. | last3 = Spijkers | first3 = JA. | last4 = Kruijt | first4 = JK. | last5 = van Eck | first5 = M. | last6 = Bos | first6 = IS. | last7 = Twisk | first7 = J. | last8 = Van Berkel | first8 = TJ. | title = Scavenger receptor class B type I is solely responsible for the selective uptake of cholesteryl esters from HDL by the liver and the adrenals in mice. | journal = J Lipid Res | volume = 45 | issue = 11 | pages = 2088-95 | month = Nov | year = 2004 | doi = 10.1194/jlr.M400191-JLR200 | PMID = 15314100 }}</ref> In macrophages it blunts cytokine production.<ref name="Guo-2009">{{Cite journal | last1 = Guo | first1 = L. | last2 = Song | first2 = Z. | last3 = Li | first3 = M. | last4 = Wu | first4 = Q. | last5 = Wang | first5 = D. | last6 = Feng | first6 = H. | last7 = Bernard | first7 = P. | last8 = Daugherty | first8 = A. | last9 = Huang | first9 = B. | title = Scavenger Receptor BI Protects against Septic Death through Its Role in Modulating Inflammatory Response. | journal = J Biol Chem | volume = 284 | issue = 30 | pages = 19826-34 | month = Jul | year = 2009 | doi = 10.1074/jbc.M109.020933 | PMID = 19491399 }}</ref> In endothelial cells it mediates HDL-induced [[endothelial NOS|endothelial nitric oxide synthase (eNOS)]] activation, proliferation, and migration.<ref name="Besler-2011">{{Cite journal | last1 = Besler | first1 = C. | last2 = Heinrich | first2 = K. | last3 = Rohrer | first3 = L. | last4 = Doerries | first4 = C. | last5 = Riwanto | first5 = M. | last6 = Shih | first6 = DM. | last7 = Chroni | first7 = A. | last8 = Yonekawa | first8 = K. | last9 = Stein | first9 = S. | title = Mechanisms underlying adverse effects of HDL on eNOS-activating pathways in patients with coronary artery disease. | journal = J Clin Invest | volume = 121 | issue = 7 | pages = 2693-708 | month = Jul | year = 2011 | doi = 10.1172/JCI42946 | PMID = 21701070 }}</ref>
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* Its role in extracellular cholesterol metabolism may facilitate the uptake of cholesterol from peripheral tissues to liver into HDL particles by maintaining a concentration gradient for the efflux of free cholesterol which may play a major role in reverse cholesterol transport (RCT).<ref name="Ohashi-2005">{{Cite journal | last1 = Ohashi | first1 = R. | last2 = Mu | first2 = H. | last3 = Wang | first3 = X. | last4 = Yao | first4 = Q. | last5 = Chen | first5 = C. | title = Reverse cholesterol transport and cholesterol efflux in atherosclerosis. | journal = QJM | volume = 98 | issue = 12 | pages = 845-56 | month = Dec | year = 2005 | doi = 10.1093/qjmed/hci136 | PMID = 16258026 }}</ref>
* Its role in extracellular cholesterol metabolism may facilitate the uptake of cholesterol from peripheral tissues to liver into HDL particles by maintaining a concentration gradient for the efflux of free cholesterol which may play a major role in reverse cholesterol transport (RCT).<ref name="Ohashi-2005">{{Cite journal | last1 = Ohashi | first1 = R. | last2 = Mu | first2 = H. | last3 = Wang | first3 = X. | last4 = Yao | first4 = Q. | last5 = Chen | first5 = C. | title = Reverse cholesterol transport and cholesterol efflux in atherosclerosis. | journal = QJM | volume = 98 | issue = 12 | pages = 845-56 | month = Dec | year = 2005 | doi = 10.1093/qjmed/hci136 | PMID = 16258026 }}</ref>


==HDL Metabolism==
==Reverse Cholesterol Transport==
HDL serves as a mode of transportation for the excess cholesterol from peripheral tissues to the liver.
HDL plays a pivotal role in cholesterol transport from peripheral tissues to the liver for excretion, a process known as reverse cholesterol transport.  HDL’s protective atherosclerotic effect is related to its role in reverse cholesterol transport, where cholesterol efflux from macrophages to HDL is an important initial step.    


Shown below is an image depicting HDL metabolismRefer to the text below for further explanation.
Low concentration of HDL is one of the various risk factors of cardiovascular disease as demonstrated by preclinical and epidemiologic studies.  Increasing HDL concentration by medical therapy, such as niacin and inhibition of cholesteryl ester transfer protein, was evaluated in many clinical trials.  Studies such as [[ILLUMINATE]],<ref name="pmid17984165">{{cite journal| author=Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M et al.| title=Effects of torcetrapib in patients at high risk for coronary events. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 21 | pages= 2109-22 | pmid=17984165 | doi=10.1056/NEJMoa0706628 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17984165  }} </ref> [[dal-OUTCOMES]],<ref name="pmid23126252">{{cite journal| author=Schwartz GG, Olsson AG, Abt M, Ballantyne CM, Barter PJ, Brumm J et al.| title=Effects of dalcetrapib in patients with a recent acute coronary syndrome. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 22 | pages= 2089-99 | pmid=23126252 | doi=10.1056/NEJMoa1206797 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23126252  }} </ref> and [[CHI-SQUARE]], have failed to demonstrate an association between increasing HDL by therapy and improved cardiovascular outcomesHigher cholesterol efflux capacity, however, is associated with a lower rate of cardiovascular disease, independently of HDL cholesterol concentration.<ref name="pmid25404125">{{cite journal| author=Rohatgi A, Khera A, Berry JD, Givens EG, Ayers CR, Wedin KE et al.| title=HDL Cholesterol Efflux Capacity and Incident Cardiovascular Events. | journal=N Engl J Med | year= 2014 | volume=  | issue=  | pages=  | pmid=25404125 | doi=10.1056/NEJMoa1409065 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25404125  }} </ref>  These findings highlight the importance of HDL function in reverse cholesterol transport and cholesterol efflux.


[[Image:HDL-metabolism.gif|500px|center|HDL metabolism]]
[[Image:HDL-metabolism.gif|600px|center]]


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<span style="font-size:85%">
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<ref name="pmid15738977">{{cite journal| author=Linsel-Nitschke P, Tall AR| title=HDL as a target in the treatment of atherosclerotic cardiovascular disease. | journal=Nat Rev Drug Discov | year= 2005 | volume= 4 | issue= 3 | pages= 193-205 | pmid=15738977 | doi=10.1038/nrd1658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15738977  }} </ref></span>
<ref name="pmid15738977">{{cite journal| author=Linsel-Nitschke P, Tall AR| title=HDL as a target in the treatment of atherosclerotic cardiovascular disease. | journal=Nat Rev Drug Discov | year= 2005 | volume= 4 | issue= 3 | pages= 193-205 | pmid=15738977 | doi=10.1038/nrd1658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15738977  }} </ref></span>


==Synthesis and Uptake of Cholesterol==
===Synthesis and Uptake of Cholesterol===
* HDL consists of [[phospholipids]] and [[apolipoproteins]], mainly apo A-I and/or apo A-II.  Both the liver and the small intestine synthesize apo A-I while only the liver synthesizes apo A-II.  
* HDL consists of [[phospholipids]] and [[apolipoproteins]], mainly apo A-I and/or apo A-II.  Both the liver and the small intestine synthesize apo A-I while only the liver synthesizes apo A-II.  
* Free apo A-I is released into the plasma as nascent HDLs.  Nascent HDL readily takes up excess free cholesterol from the periphery such as [[fibroblast]]s, [[macrophage]]s, and arterial wall.  This uptake of cholesterol is mediated by either ATP-binding cassette A1 ([[ABCA1]]), G1/G4, [[Scavenger receptor#Types |scavenger receptor class B type 1 (SR-B1)]], Cyp27A1, caveloin, and [[Passive transport|passive diffusion]], leading to the formation of discoid HDL (a.k.a. pre-βHDL).  
* Free apo A-I is released into the plasma as nascent HDLs.  Nascent HDL readily takes up excess free cholesterol from the periphery such as [[fibroblast]]s, [[macrophage]]s, and arterial wall, a process referred to as cholesterol efflux.  This uptake of cholesterol is mediated by either ATP-binding cassette A1 ([[ABCA1]]), G1/G4, [[Scavenger receptor#Types |scavenger receptor class B type 1 (SR-B1)]], Cyp27A1, caveloin, and [[Passive transport|passive diffusion]], leading to the formation of discoid HDL (a.k.a. pre-βHDL).  
* Apo A-I is a cofactor of [[Lecithin-cholesterol acyltransferase|lecithin-cholesterol acetyltransferase (LCAT)]] which catalyzes the esterification of the free cholesterol bound to the discoid HDL.  The [[apolipoprotein A1]] acts as a signal protein in mobilizing cholesteryl esters from within the cells.
* Apo A-I is a cofactor of [[Lecithin-cholesterol acyltransferase|lecithin-cholesterol acetyltransferase (LCAT)]] which catalyzes the esterification of the free cholesterol bound to the discoid HDL.  The [[apolipoprotein A1]] acts as a signal protein in mobilizing cholesteryl esters from within the cells.


==Maturation and Transfer of Cholesterol==
[[Image:Reverse_cholesterol.jpg|500px|center]]
 
===Maturation and Transfer of Cholesterol===
* The esterified cholesterol moves into the hydrophobic core of the HDL, changing the HDL particle from discoid to spherical (mature HDL).  This process also prevents the re-uptake of cholesterol by cells.  LCAT is responsible for the maturation of HDL particles.
* The esterified cholesterol moves into the hydrophobic core of the HDL, changing the HDL particle from discoid to spherical (mature HDL).  This process also prevents the re-uptake of cholesterol by cells.  LCAT is responsible for the maturation of HDL particles.
*  The esterified cholesterol can be delivered back to the liver through a number of routes:
*  The esterified cholesterol can be delivered back to the liver through a number of routes:
** By the action of [[cholesterylester transfer protein]] (CETP) - CETP, secreted in the liver, transfers cholesterol from HDL to the apo B–containing lipoproteins e.g., very low-density lipoprotein (VLDL) or intermediate-density lipoprotein (IDL) to be taken up by the liver.  Mutations of this transport protein gene causes familial HDL deficiencies and [[Tangier disease]]
** CETP, secreted in the liver, transfers cholesterol from HDL to the apo B–containing lipoproteins e.g., very low-density lipoprotein (VLDL) or intermediate-density lipoprotein (IDL) to be taken up by the liver.  Mutations of this transport protein gene causes familial HDL deficiencies and [[Tangier disease]].
** HDL particles may be taken up directly by the liver
** HDL particles may be taken up directly by the liver.
** Free cholesterol may be taken up directly by the liver
** Free cholesterol may be taken up directly by the liver.
** HDL cholesterol esters may be selectively taken up via the scavenger receptor SR-B1, which is expressed in the liver.
** HDL cholesterol esters may be selectively taken up via the scavenger receptor SR-B1, which is expressed in the liver.


==Catabolism==
===Catabolism===
* Triglyceride lipases degrade these cholesterol-deplete HDL particles into small, dense HDL particles which after dissociation, release apo A-I (nascent HDL).  The apo A-1 either rapidly re-uptakes free cholesterol again by ABCA1 to form discoid HDLs or it is endocytosed in the kidney tubule or cleared via glomerular filtration.
* Triglyceride lipase degrades cholesterol-deplete HDL particles into small, dense HDL particles which release apo A-I (nascent HDL) after dissociation.  The apo A-1 either rapidly re-uptakes free cholesterol again by ABCA1 to form discoid HDLs, or it is endocytosed into the kidney tubule, or cleared via glomerular filtration.


==Functions==
==Role of HDL==
Shown below is an image summarizing the physiologic functions of HDL in an acute and chronic setting.  Please refer to the text below for details about each one of functions of HDL.
Shown below is an image summarizing the physiologic functions of HDL in an acute and chronic setting.  Please refer to the text below for details about each one of functions of HDL.


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===Atheroprotection===
===Atheroprotection===
It has been established that HDL-cholesterol has an inverse correlation with future atherosclerotic cardiovascular complications.  HDL and apo A-I exhibit many atheroprotective functions which primarily aims at removing cholesterol from peripheral tissues and the arterial wall through various efflux mechanisms, mainly the reverse cholesterol transport system.  It is also important in the attenuation of plaque progression and promotion of plaque stabilization.  These functions are exhibited through its anti-oxidative, anti-platelet, anti-apoptotic, and anti-inflammatory properties.  With all these properties in context, HDL will potentially protect against reperfusion ischemic injuries and secondary plaque ruptures frequently observed in post-acute coronary syndrome patients.
It has been established that HDL-cholesterol has an inverse correlation with future atherosclerotic cardiovascular complications.  HDL and apo A-I exhibit many atheroprotective functions which primarily aim at removing cholesterol from peripheral tissues and the arterial wall through various efflux mechanisms, mainly the reverse cholesterol transport system.  HDL also plays a role in the attenuation of plaque progression and promotion of plaque stabilization.  These functions are exhibited through its anti-oxidative, anti-platelet, anti-apoptotic, and anti-inflammatory properties.  With all these properties in context, HDL potentially protects against reperfusion ischemic injuries and secondary plaque rupture observed in post-acute coronary syndrome patients.
* Current data indicate that the plasma HDL associated apolipoprotein M (apoM) levels modulate the ability of plasma to mobilize cellular cholesterol and protects against experimental atherosclerosis.<ref name="pmid24046869">{{cite journal| author=Elsøe S, Christoffersen C, Luchoomun J, Turner S, Nielsen LB| title=Apolipoprotein M promotes mobilization of cellular cholesterol in vivo. | journal=Biochim Biophys Acta | year= 2013 | volume= 1831 | issue= 7 | pages= 1287-92 | pmid=24046869 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24046869  }} </ref>
* Plasma HDL associated apolipoprotein M (apoM) modulates the ability of plasma to mobilize cellular cholesterol and protects against experimental atherosclerosis.<ref name="pmid24046869">{{cite journal| author=Elsøe S, Christoffersen C, Luchoomun J, Turner S, Nielsen LB| title=Apolipoprotein M promotes mobilization of cellular cholesterol in vivo. | journal=Biochim Biophys Acta | year= 2013 | volume= 1831 | issue= 7 | pages= 1287-92 | pmid=24046869 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24046869  }} </ref>
* Animal models have shown that the somatic gene transfer of human apo A-I can prevent the development of atherosclerosis or reverse preexisting atherosclerosis or its role in the anti-endotoxin function of HDL.<ref name="pmid9884386">{{cite journal| author=Benoit P, Emmanuel F, Caillaud JM, Bassinet L, Castro G, Gallix P et al.| title=Somatic gene transfer of human ApoA-I inhibits atherosclerosis progression in mouse models. | journal=Circulation | year= 1999 | volume= 99 | issue= 1 | pages= 105-10 | pmid=9884386 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9884386  }} </ref><ref name="pmid10534470">{{cite journal| author=Tangirala RK, Tsukamoto K, Chun SH, Usher D, Puré E, Rader DJ| title=Regression of atherosclerosis induced by liver-directed gene transfer of apolipoprotein A-I in mice. | journal=Circulation | year= 1999 | volume= 100 | issue= 17 | pages= 1816-22 | pmid=10534470 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10534470  }} </ref><ref name="pmid11804981">{{cite journal| author=Navab M, Anantharamaiah GM, Hama S, Garber DW, Chaddha M, Hough G et al.| title=Oral administration of an Apo A-I mimetic Peptide synthesized from D-amino acids dramatically reduces atherosclerosis in mice independent of plasma cholesterol. | journal=Circulation | year= 2002 | volume= 105 | issue= 3 | pages= 290-2 | pmid=11804981 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11804981  }} </ref><ref name="pmid15188057">{{cite journal| author=Ma J, Liao XL, Lou B, Wu MP| title=Role of apolipoprotein A-I in protecting against endotoxin toxicity. | journal=Acta Biochim Biophys Sin (Shanghai) | year= 2004 | volume= 36 | issue= 6 | pages= 419-24 | pmid=15188057 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15188057  }} </ref>
* Animal models have demonstrated that the somatic gene transfer of human apo A-I can prevent the development of atherosclerosis or reverse preexisting atherosclerosis.<ref name="pmid9884386">{{cite journal| author=Benoit P, Emmanuel F, Caillaud JM, Bassinet L, Castro G, Gallix P et al.| title=Somatic gene transfer of human ApoA-I inhibits atherosclerosis progression in mouse models. | journal=Circulation | year= 1999 | volume= 99 | issue= 1 | pages= 105-10 | pmid=9884386 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9884386  }} </ref><ref name="pmid10534470">{{cite journal| author=Tangirala RK, Tsukamoto K, Chun SH, Usher D, Puré E, Rader DJ| title=Regression of atherosclerosis induced by liver-directed gene transfer of apolipoprotein A-I in mice. | journal=Circulation | year= 1999 | volume= 100 | issue= 17 | pages= 1816-22 | pmid=10534470 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10534470  }} </ref><ref name="pmid11804981">{{cite journal| author=Navab M, Anantharamaiah GM, Hama S, Garber DW, Chaddha M, Hough G et al.| title=Oral administration of an Apo A-I mimetic Peptide synthesized from D-amino acids dramatically reduces atherosclerosis in mice independent of plasma cholesterol. | journal=Circulation | year= 2002 | volume= 105 | issue= 3 | pages= 290-2 | pmid=11804981 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11804981  }} </ref><ref name="pmid15188057">{{cite journal| author=Ma J, Liao XL, Lou B, Wu MP| title=Role of apolipoprotein A-I in protecting against endotoxin toxicity. | journal=Acta Biochim Biophys Sin (Shanghai) | year= 2004 | volume= 36 | issue= 6 | pages= 419-24 | pmid=15188057 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15188057  }} </ref>
* ATP-binding cassette (ABC) transporters ABCA1 and ABCG1 in [[endothelial cells]], and the scavenger receptor B type I mediate multiple intracellular signaling pathways as well as the efflux of cholesterol.<ref name="pmid22488423">{{cite journal| author=Prosser HC, Ng MK, Bursill CA| title=The role of cholesterol efflux in mechanisms of endothelial protection by HDL. | journal=Curr Opin Lipidol | year= 2012 | volume= 23 | issue= 3 | pages= 182-9 | pmid=22488423 | doi=10.1097/MOL.0b013e328352c4dd | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22488423  }} </ref>
* ATP-binding cassette (ABC) transporters ABCA1 and ABCG1 in [[endothelial cells]] and the scavenger receptor B type I mediate multiple intracellular signaling pathways as well as the efflux of cholesterol.<ref name="pmid22488423">{{cite journal| author=Prosser HC, Ng MK, Bursill CA| title=The role of cholesterol efflux in mechanisms of endothelial protection by HDL. | journal=Curr Opin Lipidol | year= 2012 | volume= 23 | issue= 3 | pages= 182-9 | pmid=22488423 | doi=10.1097/MOL.0b013e328352c4dd | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22488423  }} </ref>


===Anti-coagulant Funtions===
===Anti-Coagulation Function===
HDL has the ability to inhibit platelet activation and aggregation by directly inhibiting platelet activation,<ref name="Calkin-2009">{{Cite journal  | last1 = Calkin | first1 = AC. | last2 = Drew | first2 = BG. | last3 = Ono | first3 = A. | last4 = Duffy | first4 = SJ. | last5 = Gordon | first5 = MV. | last6 = Schoenwaelder | first6 = SM. | last7 = Sviridov | first7 = D. | last8 = Cooper | first8 = ME. | last9 = Kingwell | first9 = BA. | title = Reconstituted high-density lipoprotein attenuates platelet function in individuals with type 2 diabetes mellitus by promoting cholesterol efflux. | journal = Circulation | volume = 120 | issue = 21 | pages = 2095-104 | month = Nov | year = 2009 | doi = 10.1161/CIRCULATIONAHA.109.870709 | PMID = 19901191 }}</ref><ref name="Lerch-1998">{{Cite journal  | last1 = Lerch | first1 = PG. | last2 = Spycher | first2 = MO. | last3 = Doran | first3 = JE. | title = Reconstituted high density lipoprotein (rHDL) modulates platelet activity in vitro and ex vivo. | journal = Thromb Haemost | volume = 80 | issue = 2 | pages = 316-20 | month = Aug | year = 1998 |doi =  | PMID = 9716159 }}</ref> downregulating thromboxane A2 synthesis,<ref name="Brill-2011">{{Cite journal  | last1 = Brill | first1 = A. | last2 = Fuchs |first2 = TA. | last3 = Chauhan | first3 = AK. | last4 = Yang | first4 = JJ. | last5 = De Meyer | first5 = SF. | last6 = Köllnberger | first6 = M. | last7 = Wakefield | first7 = TW. | last8 = Lämmle | first8 = B. | last9 = Massberg | first9 = S. | title = von Willebrand factor-mediated platelet adhesion is critical for deep vein thrombosis in mouse models. | journal = Blood | volume = 117 | issue = 4 | pages = 1400-7 | month = Jan | year = 2011 | doi = 10.1182/blood-2010-05-287623 | PMID = 20959603 }}</ref>  increasing the synthesis of prostacyclin,<ref name="Fleisher-1982">{{Cite journal  | last1 = Fleisher | first1 = LN. |last2 = Tall | first2 = AR. | last3 = Witte | first3 = LD. | last4 = Miller | first4 = RW. | last5 = Cannon | first5 = PJ. | title = Stimulation of arterial endothelial cell prostacyclin synthesis by high density lipoproteins. | journal = J Biol Chem | volume = 257 | issue = 12 | pages = 6653-5 | month = Jun | year = 1982 | doi =  | PMID = 7045092 }}</ref> and lowering the expression of the tissue factor which is required in the coagulation process.<ref name="Viswambharan-2004">{{Cite journal  | last1 = Viswambharan | first1 = H. | last2 = Ming | first2 = XF. | last3 = Zhu | first3 = S. | last4 = Hubsch | first4 = A. | last5 = Lerch | first5 = P. | last6 = Vergères | first6 = G. | last7 = Rusconi | first7 = S. | last8 = Yang | first8 = Z. | title = Reconstituted high-density lipoprotein inhibits thrombin-induced endothelial tissue factor expression through inhibition of RhoA and stimulation of phosphatidylinositol 3-kinase but not Akt/endothelial nitric oxide synthase. | journal = Circ Res | volume = 94 | issue = 7 | pages = 918-25 | month = Apr | year = 2004 | doi = 10.1161/01.RES.0000124302.20396.B7 | PMID = 14988229 }}</ref>
HDL has the ability to inhibit platelet activation and aggregation by directly inhibiting platelet activation,<ref name="Calkin-2009">{{Cite journal  | last1 = Calkin | first1 = AC. | last2 = Drew | first2 = BG. | last3 = Ono | first3 = A. | last4 = Duffy | first4 = SJ. | last5 = Gordon | first5 = MV. | last6 = Schoenwaelder | first6 = SM. | last7 = Sviridov | first7 = D. | last8 = Cooper | first8 = ME. | last9 = Kingwell | first9 = BA. | title = Reconstituted high-density lipoprotein attenuates platelet function in individuals with type 2 diabetes mellitus by promoting cholesterol efflux. | journal = Circulation | volume = 120 | issue = 21 | pages = 2095-104 | month = Nov | year = 2009 | doi = 10.1161/CIRCULATIONAHA.109.870709 | PMID = 19901191 }}</ref><ref name="Lerch-1998">{{Cite journal  | last1 = Lerch | first1 = PG. | last2 = Spycher | first2 = MO. | last3 = Doran | first3 = JE. | title = Reconstituted high density lipoprotein (rHDL) modulates platelet activity in vitro and ex vivo. | journal = Thromb Haemost | volume = 80 | issue = 2 | pages = 316-20 | month = Aug | year = 1998 |doi =  | PMID = 9716159 }}</ref> downregulating thromboxane A2 synthesis,<ref name="Brill-2011">{{Cite journal  | last1 = Brill | first1 = A. | last2 = Fuchs |first2 = TA. | last3 = Chauhan | first3 = AK. | last4 = Yang | first4 = JJ. | last5 = De Meyer | first5 = SF. | last6 = Köllnberger | first6 = M. | last7 = Wakefield | first7 = TW. | last8 = Lämmle | first8 = B. | last9 = Massberg | first9 = S. | title = von Willebrand factor-mediated platelet adhesion is critical for deep vein thrombosis in mouse models. | journal = Blood | volume = 117 | issue = 4 | pages = 1400-7 | month = Jan | year = 2011 | doi = 10.1182/blood-2010-05-287623 | PMID = 20959603 }}</ref>  increasing the synthesis of prostacyclin,<ref name="Fleisher-1982">{{Cite journal  | last1 = Fleisher | first1 = LN. |last2 = Tall | first2 = AR. | last3 = Witte | first3 = LD. | last4 = Miller | first4 = RW. | last5 = Cannon | first5 = PJ. | title = Stimulation of arterial endothelial cell prostacyclin synthesis by high density lipoproteins. | journal = J Biol Chem | volume = 257 | issue = 12 | pages = 6653-5 | month = Jun | year = 1982 | doi =  | PMID = 7045092 }}</ref> and lowering the expression of the tissue factor which is required in the coagulation process.<ref name="Viswambharan-2004">{{Cite journal  | last1 = Viswambharan | first1 = H. | last2 = Ming | first2 = XF. | last3 = Zhu | first3 = S. | last4 = Hubsch | first4 = A. | last5 = Lerch | first5 = P. | last6 = Vergères | first6 = G. | last7 = Rusconi | first7 = S. | last8 = Yang | first8 = Z. | title = Reconstituted high-density lipoprotein inhibits thrombin-induced endothelial tissue factor expression through inhibition of RhoA and stimulation of phosphatidylinositol 3-kinase but not Akt/endothelial nitric oxide synthase. | journal = Circ Res | volume = 94 | issue = 7 | pages = 918-25 | month = Apr | year = 2004 | doi = 10.1161/01.RES.0000124302.20396.B7 | PMID = 14988229 }}</ref>


===Anti-oxidant Funtions===
===Anti-Oxidant Function===
The formation of free oxygen radicals contributes to the pathogenesis and progression of atherosclerotic plaques.  Oxidized LDLs gets engulfed by macrophages, which leads to further oxidation and the production of foam cells.  Oxidized LDLs acts as chemotactic agents for circulating monocytes, converts  macrophages into foam cells, induce cytotoxic effects on the endothelium, inhibits motility of tissue macrophages, and stimulates the migration and proliferation of vascular smooth muscle cells.<ref name="pmid11795267">{{cite journal| author=Kita T, Kume N, Minami M, Hayashida K, Murayama T, Sano H et al.| title=Role of oxidized LDL in atherosclerosis. | journal=Ann N Y Acad Sci | year= 2001 | volume= 947 | issue=  | pages= 199-205; discussion 205-6 | pmid=11795267 | doi= |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11795267  }} </ref>  HDL has been shown to inhibit the oxidative modification of oxidized LDLs,<ref name="pmid2344447">{{cite journal| author=Parthasarathy S, Barnett J, Fong LG|title=High-density lipoprotein inhibits the oxidative modification of low-density lipoprotein. | journal=Biochim Biophys Acta | year= 1990 | volume= 1044 |issue= 2 | pages= 275-83 | pmid=2344447 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2344447  }} </ref> as well as preventing their infiltration into the vessel wall.<ref name="Galle-1994">{{Cite journal  | last1 = Galle | first1 = J. | last2 = Ochslen | first2 = M. | last3 = Schollmeyer | first3 = P. | last4 = Wanner | first4 = C. | title = Oxidized lipoproteins inhibit endothelium-dependent vasodilation. Effects of pressure and high-density lipoprotein. | journal = Hypertension |volume = 23 | issue = 5 | pages = 556-64 | month = May | year = 1994 | doi =  | PMID = 8175161 }}</ref>
The formation of free oxygen radicals contributes to the pathogenesis and progression of atherosclerotic plaques.  Oxidized LDL is engulfed by macrophages, which leads to further oxidation and production of foam cells.  Oxidized LDL acts as a chemotactic agent for circulating monocytes, converts  macrophages into foam cells, induces cytotoxic effects on the endothelium, inhibits motility of tissue macrophages, and stimulates the migration and proliferation of vascular smooth muscle cells.<ref name="pmid11795267">{{cite journal| author=Kita T, Kume N, Minami M, Hayashida K, Murayama T, Sano H et al.| title=Role of oxidized LDL in atherosclerosis. | journal=Ann N Y Acad Sci | year= 2001 | volume= 947 | issue=  | pages= 199-205; discussion 205-6 | pmid=11795267 | doi= |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11795267  }} </ref>  HDL also inhibits the oxidative modification of oxidized LDLs,<ref name="pmid2344447">{{cite journal| author=Parthasarathy S, Barnett J, Fong LG|title=High-density lipoprotein inhibits the oxidative modification of low-density lipoprotein. | journal=Biochim Biophys Acta | year= 1990 | volume= 1044 |issue= 2 | pages= 275-83 | pmid=2344447 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2344447  }} </ref> and prevents their infiltration into the vessel wall.<ref name="Galle-1994">{{Cite journal  | last1 = Galle | first1 = J. | last2 = Ochslen | first2 = M. | last3 = Schollmeyer | first3 = P. | last4 = Wanner | first4 = C. | title = Oxidized lipoproteins inhibit endothelium-dependent vasodilation. Effects of pressure and high-density lipoprotein. | journal = Hypertension |volume = 23 | issue = 5 | pages = 556-64 | month = May | year = 1994 | doi =  | PMID = 8175161 }}</ref>


===Anti-inflammatory Functions===
===Anti-Inflammatory Function===
HDL has anti-inflammatory functions in both endothelial cells and leukocytes.  During inflammation, several leukocyte adhesion molecules are activated which promotes the binding of leukocytes and formation of atheroma.  HDL has been shown to inhibit the activation of vascular cell adhesion molecule ([[VCAM-1]],<ref name="Dimayuga-1999">{{Cite journal  | last1 = Dimayuga | first1 = P. | last2 = Zhu | first2 = J. | last3 = Oguchi | first3 = S. | last4 = Chyu | first4 = KY.| last5 = Xu | first5 = XO. | last6 = Yano | first6 = J. | last7 = Shah | first7 = PK. | last8 = Nilsson | first8 = J. | last9 = Cercek | first9 = B. | title = Reconstituted HDL containing human apolipoprotein A-1 reduces VCAM-1 expression and neointima formation following periadventitial cuff-induced carotid injury in apoE null mice. | journal = Biochem Biophys Res Commun | volume = 264 | issue = 2 | pages = 465-8 | month = Oct | year = 1999 | doi = 10.1006/bbrc.1999.1278| PMID = 10529386 }}</ref> interleukin-1-induced expresion of [[E-selectin]],<ref name="Cockerill-2001">{{Cite journal  | last1 = Cockerill | first1 = GW. |last2 = Huehns | first2 = TY. | last3 = Weerasinghe | first3 = A. | last4 = Stocker | first4 = C. | last5 = Lerch | first5 = PG. | last6 = Miller | first6 = NE. | last7 = Haskard | first7 = DO. | title = Elevation of plasma high-density lipoprotein concentration reduces interleukin-1-induced expression of E-selectin in an in vivo model of acute inflammation. | journal = Circulation | volume = 103 | issue = 1 | pages = 108-12 | month = Jan | year = 2001 | doi =  |PMID = 11136694 }}</ref> interleukin-8, intracellular adhesion molecule (ICAM)-1, neutrophils,<ref name="Murphy-2011">{{Cite journal  | last1 = Murphy | first1 = AJ. | last2 = Woollard | first2 = KJ. | last3 = Suhartoyo | first3 = A. | last4 = Stirzaker | first4 = RA. | last5 = Shaw | first5 = J. | last6 = Sviridov |first6 = D. | last7 = Chin-Dusting | first7 = JP. | title = Neutrophil activation is attenuated by high-density lipoprotein and apolipoprotein A-I in in vitro and in vivo models of inflammation. | journal = Arterioscler Thromb Vasc Biol | volume = 31 | issue = 6 | pages = 1333-41 | month = Jun | year = 2011 | doi = 10.1161/ATVBAHA.111.226258 | PMID = 21474825 }}</ref> monocytes,<ref name="Murphy-2008">{{Cite journal  | last1 = Murphy | first1 = AJ. | last2 = Woollard |first2 = KJ. | last3 = Hoang | first3 = A. | last4 = Mukhamedova | first4 = N. | last5 = Stirzaker | first5 = RA. | last6 = McCormick | first6 = SP. | last7 = Remaley | first7 = AT. | last8 = Sviridov | first8 = D. | last9 = Chin-Dusting | first9 = J. | title = High-density lipoprotein reduces the human monocyte inflammatory response. | journal = Arterioscler Thromb Vasc Biol | volume = 28 | issue = 11 | pages = 2071-7 | month = Nov | year = 2008 | doi = 10.1161/ATVBAHA.108.168690 | PMID = 18617650 }}</ref> and also prevents the binding of T-lymphocytes to monocytes thereby preventing the formation of pro-inflammatory cytokines.<ref name="Carpintero-2010">{{Cite journal  | last1 = Carpintero | first1 = R. | last2 = Gruaz | first2 = L. | last3 = Brandt |first3 = KJ. | last4 = Scanu | first4 = A. | last5 = Faille | first5 = D. | last6 = Combes | first6 = V. | last7 = Grau | first7 = GE. | last8 = Burger |first8 = D. | title = HDL interfere with the binding of T cell microparticles to human monocytes to inhibit pro-inflammatory cytokine production. | journal = PLoS One | volume = 5 | issue = 7 | pages = e11869 | month =  | year = 2010 | doi = 10.1371/journal.pone.0011869 | PMID = 20686620 }}</ref>
HDL has anti-inflammatory functions in both endothelial cells and leukocytes.  During inflammation, several leukocyte adhesion molecules are activated, which promotes the binding of leukocytes and formation of atheroma.  HDL inhibits the activation of vascular cell adhesion molecule ([[VCAM-1]]),<ref name="Dimayuga-1999">{{Cite journal  | last1 = Dimayuga | first1 = P. | last2 = Zhu | first2 = J. | last3 = Oguchi | first3 = S. | last4 = Chyu | first4 = KY.| last5 = Xu | first5 = XO. | last6 = Yano | first6 = J. | last7 = Shah | first7 = PK. | last8 = Nilsson | first8 = J. | last9 = Cercek | first9 = B. | title = Reconstituted HDL containing human apolipoprotein A-1 reduces VCAM-1 expression and neointima formation following periadventitial cuff-induced carotid injury in apoE null mice. | journal = Biochem Biophys Res Commun | volume = 264 | issue = 2 | pages = 465-8 | month = Oct | year = 1999 | doi = 10.1006/bbrc.1999.1278| PMID = 10529386 }}</ref> interleukin-1-induced expresion of [[E-selectin]],<ref name="Cockerill-2001">{{Cite journal  | last1 = Cockerill | first1 = GW. |last2 = Huehns | first2 = TY. | last3 = Weerasinghe | first3 = A. | last4 = Stocker | first4 = C. | last5 = Lerch | first5 = PG. | last6 = Miller | first6 = NE. | last7 = Haskard | first7 = DO. | title = Elevation of plasma high-density lipoprotein concentration reduces interleukin-1-induced expression of E-selectin in an in vivo model of acute inflammation. | journal = Circulation | volume = 103 | issue = 1 | pages = 108-12 | month = Jan | year = 2001 | doi =  |PMID = 11136694 }}</ref> interleukin-8, intracellular adhesion molecule (ICAM)-1, neutrophils,<ref name="Murphy-2011">{{Cite journal  | last1 = Murphy | first1 = AJ. | last2 = Woollard | first2 = KJ. | last3 = Suhartoyo | first3 = A. | last4 = Stirzaker | first4 = RA. | last5 = Shaw | first5 = J. | last6 = Sviridov |first6 = D. | last7 = Chin-Dusting | first7 = JP. | title = Neutrophil activation is attenuated by high-density lipoprotein and apolipoprotein A-I in in vitro and in vivo models of inflammation. | journal = Arterioscler Thromb Vasc Biol | volume = 31 | issue = 6 | pages = 1333-41 | month = Jun | year = 2011 | doi = 10.1161/ATVBAHA.111.226258 | PMID = 21474825 }}</ref> monocytes,<ref name="Murphy-2008">{{Cite journal  | last1 = Murphy | first1 = AJ. | last2 = Woollard |first2 = KJ. | last3 = Hoang | first3 = A. | last4 = Mukhamedova | first4 = N. | last5 = Stirzaker | first5 = RA. | last6 = McCormick | first6 = SP. | last7 = Remaley | first7 = AT. | last8 = Sviridov | first8 = D. | last9 = Chin-Dusting | first9 = J. | title = High-density lipoprotein reduces the human monocyte inflammatory response. | journal = Arterioscler Thromb Vasc Biol | volume = 28 | issue = 11 | pages = 2071-7 | month = Nov | year = 2008 | doi = 10.1161/ATVBAHA.108.168690 | PMID = 18617650 }}</ref> and also prevents the binding of T-lymphocytes to monocytes thereby preventing the formation of pro-inflammatory cytokines.<ref name="Carpintero-2010">{{Cite journal  | last1 = Carpintero | first1 = R. | last2 = Gruaz | first2 = L. | last3 = Brandt |first3 = KJ. | last4 = Scanu | first4 = A. | last5 = Faille | first5 = D. | last6 = Combes | first6 = V. | last7 = Grau | first7 = GE. | last8 = Burger |first8 = D. | title = HDL interfere with the binding of T cell microparticles to human monocytes to inhibit pro-inflammatory cytokine production. | journal = PLoS One | volume = 5 | issue = 7 | pages = e11869 | month =  | year = 2010 | doi = 10.1371/journal.pone.0011869 | PMID = 20686620 }}</ref>


===Metabolic Functions===
===Metabolic Function===
In a study to determine the effects and mechanisms of HDL on glucose metabolism, 13 type 2 diabetic patients received intravenous reconstituted HDL.  The result proved a reduction in the plasma glucose of the patients due to an increase in plasma insulin in addition to the activation of AMP-activated protein kinase in skeletal muscle. These findings suggest a role for HDL-raising therapies beyond atherosclerosis to address type 2 diabetes mellitus.<ref name="Drew-2009">{{Cite journal  | last1 = Drew | first1 = BG. | last2 = Duffy | first2 = SJ. | last3 = Formosa | first3 = MF. | last4 = Natoli | first4 = AK. | last5 = Henstridge | first5 = DC. | last6 = Penfold | first6 = SA. | last7 = Thomas | first7 = WG. | last8 = Mukhamedova | first8 = N. | last9 = de Courten | first9 = B. | title = High-density lipoprotein modulates glucose metabolism in patients with type 2 diabetes mellitus. | journal = Circulation | volume = 119 | issue = 15 | pages = 2103-11 | month = Apr | year = 2009 | doi = 10.1161/CIRCULATIONAHA.108.843219 | PMID = 19349317 }}</ref>
In a study on the effects and mechanisms of HDL on glucose metabolism, 13 [[type 2 diabetes]] patients were administered intravenous reconstituted HDL.  There was a reduction in the plasma glucose of the patients due to an increase in plasma insulin in addition to the activation of AMP-activated protein kinase in the skeletal muscle. These findings suggest a role for HDL-raising therapies beyond atherosclerosis to address [[type 2 diabetes mellitus]].<ref name="Drew-2009">{{Cite journal  | last1 = Drew | first1 = BG. | last2 = Duffy | first2 = SJ. | last3 = Formosa | first3 = MF. | last4 = Natoli | first4 = AK. | last5 = Henstridge | first5 = DC. | last6 = Penfold | first6 = SA. | last7 = Thomas | first7 = WG. | last8 = Mukhamedova | first8 = N. | last9 = de Courten | first9 = B. | title = High-density lipoprotein modulates glucose metabolism in patients with type 2 diabetes mellitus. | journal = Circulation | volume = 119 | issue = 15 | pages = 2103-11 | month = Apr | year = 2009 | doi = 10.1161/CIRCULATIONAHA.108.843219 | PMID = 19349317 }}</ref>


=====Glucose Metabolism=====
=====Glucose Metabolism=====
HDL is postulated to modulate [[glucose]] [[homeostasis]] through several mechanisms including stimulating [[insulin]] secretion,<ref name="Brunham-2007">{{Cite journal  | last1 = Brunham | first1 = LR. | last2 = Kruit | first2 = JK. | last3 = Pape | first3 = TD. | last4 = Timmins | first4 = JM. | last5 = Reuwer | first5 = AQ. | last6 = Vasanji | first6 = Z. | last7 = Marsh | first7 = BJ. | last8 = Rodrigues | first8 = B. | last9 = Johnson | first9 = JD. | title = Beta-cell ABCA1 influences insulin secretion, glucose homeostasis and response to thiazolidinedione treatment. | journal = Nat Med | volume = 13 | issue = 3 | pages = 340-7 | month = Mar | year = 2007 | doi = 10.1038/nm1546 | PMID = 17322896 }}</ref><ref name="Abderrahmani-2007">{{Cite journal  | last1 = Abderrahmani | first1 = A. | last2 = Niederhauser | first2 = G. | last3 = Favre | first3 = D. | last4 = Abdelli | first4 = S. | last5 = Ferdaoussi | first5 = M. | last6 = Yang | first6 = JY. | last7 = Regazzi | first7 = R. | last8 = Widmann | first8 = C. | last9 = Waeber | first9 = G. | title = Human high-density lipoprotein particles prevent activation of the JNK pathway induced by human oxidised low-density lipoprotein particles in pancreatic beta cells. | journal = Diabetologia | volume = 50 | issue = 6 | pages = 1304-14 | month = Jun | year = 2007 | doi = 10.1007/s00125-007-0642-z | PMID = 17437081 }}</ref><ref name="Drew-2009">{{Cite journal  | last1 = Drew | first1 = BG. | last2 = Duffy | first2 = SJ. | last3 = Formosa | first3 = MF. | last4 = Natoli | first4 = AK. | last5 = Henstridge | first5 = DC. | last6 = Penfold | first6 = SA. | last7 = Thomas | first7 = WG. | last8 = Mukhamedova | first8 = N. | last9 = de Courten | first9 = B. | title = High-density lipoprotein modulates glucose metabolism in patients with type 2 diabetes mellitus. | journal = Circulation | volume = 119 | issue = 15 | pages = 2103-11 | month = Apr | year = 2009 | doi = 10.1161/CIRCULATIONAHA.108.843219 | PMID = 19349317 }}</ref><ref name="Fryirs-2010">{{Cite journal  | last1 = Fryirs | first1 = MA. | last2 = Barter | first2 = PJ. | last3 = Appavoo | first3 = M. | last4 = Tuch | first4 = BE. | last5 = Tabet | first5 = F. | last6 = Heather | first6 = AK. | last7 = Rye | first7 = KA. | title = Effects of high-density lipoproteins on pancreatic beta-cell insulin secretion. | journal = Arterioscler Thromb Vasc Biol | volume = 30 | issue = 8 | pages = 1642-8 | month = Aug | year = 2010 | doi = 10.1161/ATVBAHA.110.207373 | PMID = 20466975 }}</ref> enhancing [[insulin]] sensitivity, and increasing glucose update by [[skeletal muscle]] via activation of [[AMP-activated protein kinase|AMP-activated protein kinase (AMPK)]] signaling pathway and is being recognized as an active player in the pathophysiology of [[diabetes mellitus]] rather than an onlooker.<ref name="Han-2007">{{Cite journal  | last1 = Han | first1 = R. | last2 = Lai | first2 = R. | last3 = Ding | first3 = Q. | last4 = Wang | first4 = Z. | last5 = Luo | first5 = X. | last6 = Zhang | first6 = Y. | last7 = Cui | first7 = G. | last8 = He | first8 = J. | last9 = Liu | first9 = W. | title = Apolipoprotein A-I stimulates AMP-activated protein kinase and improves glucose metabolism. | journal = Diabetologia | volume = 50 | issue = 9 | pages = 1960-8 | month = Sep | year = 2007 | doi = 10.1007/s00125-007-0752-7 | PMID = 17639303 }}</ref><ref name="Abderrahmani-2007">{{Cite journal  | last1 = Abderrahmani | first1 = A. | last2 = Niederhauser | first2 = G. | last3 = Favre | first3 = D. | last4 = Abdelli | first4 = S. | last5 = Ferdaoussi | first5 = M. | last6 = Yang | first6 = JY. | last7 = Regazzi | first7 = R. | last8 = Widmann | first8 = C. | last9 = Waeber | first9 = G. | title = Human high-density lipoprotein particles prevent activation of the JNK pathway induced by human oxidised low-density lipoprotein particles in pancreatic beta cells. | journal = Diabetologia | volume = 50 | issue = 6 | pages = 1304-14 | month = Jun | year = 2007 | doi = 10.1007/s00125-007-0642-z | PMID = 17437081 }}</ref>  [[Genetic engineering]] studies that manipulate expression of related genes such as [[ABCA1]],<ref name="Vergeer-2010">{{Cite journal  | last1 = Vergeer | first1 = M. | last2 = Brunham | first2 = LR. | last3 = Koetsveld | first3 = J. | last4 = Kruit | first4 = JK. | last5 = Verchere | first5 = CB. | last6 = Kastelein | first6 = JJ. | last7 = Hayden | first7 = MR. | last8 = Stroes | first8 = ES. | title = Carriers of loss-of-function mutations in ABCA1 display pancreatic beta-cell dysfunction. | journal = Diabetes Care | volume = 33 | issue = 4 | pages = 869-74 | month = Apr | year = 2010 | doi = 10.2337/dc09-1562 | PMID = 20067955 }}</ref><ref name="Daimon-2005">{{Cite journal  | last1 = Daimon | first1 = M. | last2 = Kido | first2 = T. | last3 = Baba | first3 = M. | last4 = Oizumi | first4 = T. | last5 = Jimbu | first5 = Y. | last6 = Kameda | first6 = W. | last7 = Yamaguchi | first7 = H. | last8 = Ohnuma | first8 = H. | last9 = Tominaga | first9 = M. | title = Association of the ABCA1 gene polymorphisms with type 2 DM in a Japanese population. | journal = Biochem Biophys Res Commun | volume = 329 | issue = 1 | pages = 205-10 | month = Apr | year = 2005 | doi = 10.1016/j.bbrc.2005.01.119 | PMID = 15721294 }}</ref><ref name="Villarreal-Molina-2008">{{Cite journal  | last1 = Villarreal-Molina | first1 = MT. | last2 = Flores-Dorantes | first2 = MT. | last3 = Arellano-Campos | first3 = O. | last4 = Villalobos-Comparan | first4 = M. | last5 = Rodríguez-Cruz | first5 = M. | last6 = Miliar-García | first6 = A. | last7 = Huertas-Vazquez | first7 = A. | last8 = Menjivar | first8 = M. | last9 = Romero-Hidalgo | first9 = S. | title = Association of the ATP-binding cassette transporter A1 R230C variant with early-onset type 2 diabetes in a Mexican population. | journal = Diabetes | volume = 57 | issue = 2 | pages = 509-13 | month = Feb | year = 2008 | doi = 10.2337/db07-0484 | PMID = 18003760 }}</ref><ref name="Koseki-2009">{{Cite journal  | last1 = Koseki | first1 = M. | last2 = Matsuyama | first2 = A. | last3 = Nakatani | first3 = K. | last4 = Inagaki | first4 = M. | last5 = Nakaoka | first5 = H. | last6 = Kawase | first6 = R. | last7 = Yuasa-Kawase | first7 = M. | last8 = Tsubakio-Yamamoto | first8 = K. | last9 = Masuda | first9 = D. | title = Impaired insulin secretion in four Tangier disease patients with ABCA1 mutations. | journal = J Atheroscler Thromb | volume = 16 | issue = 3 | pages = 292-6 | month = Jun | year = 2009 | doi =  | PMID = 19556721 }}</ref> [[Cholesterylester transfer protein |CETP]],<ref name="López-Ríos-2011">{{Cite journal  | last1 = López-Ríos | first1 = L. | last2 = Pérez-Jiménez | first2 = P. | last3 = Martínez-Quintana | first3 = E. | last4 = Rodriguez González | first4 = G. | last5 = Díaz-Chico | first5 = BN. | last6 = Nóvoa | first6 = FJ. | last7 = Serra-Majem | first7 = L. | last8 = Chirino | first8 = R. | title = Association of Taq 1B CETP polymorphism with insulin and HOMA levels in the population of the Canary Islands. | journal = Nutr Metab Cardiovasc Dis | volume = 21 | issue = 1 | pages = 18-24 | month = Jan | year = 2011 | doi = 10.1016/j.numecd.2009.06.009 | PMID = 19822408 }}</ref><ref name="Zhong-1996">{{Cite journal  | last1 = Zhong | first1 = S. | last2 = Sharp | first2 = DS. | last3 = Grove | first3 = JS. | last4 = Bruce | first4 = C. | last5 = Yano | first5 = K. | last6 = Curb | first6 = JD. | last7 = Tall | first7 = AR. | title = Increased coronary heart disease in Japanese-American men with mutation in the cholesteryl ester transfer protein gene despite increased HDL levels. | journal = J Clin Invest | volume = 97 | issue = 12 | pages = 2917-23 | month = Jun | year = 1996 | doi = 10.1172/JCI118751 | PMID = 8675707 }}</ref> [[ABCG1]],<ref name="Sturek-2010">{{Cite journal  | last1 = Sturek | first1 = JM. | last2 = Castle | first2 = JD. | last3 = Trace | first3 = AP. | last4 = Page | first4 = LC. | last5 = Castle | first5 = AM. | last6 = Evans-Molina | first6 = C. | last7 = Parks | first7 = JS. | last8 = Mirmira | first8 = RG. | last9 = Hedrick | first9 = CC. | title = An intracellular role for ABCG1-mediated cholesterol transport in the regulated secretory pathway of mouse pancreatic beta cells. | journal = J Clin Invest | volume = 120 | issue = 7 | pages = 2575-89 | month = Jul | year = 2010 | doi = 10.1172/JCI41280 | PMID = 20530872 }}</ref> and [[Apolipoprotein A1|apoA-I]]<ref name="Han-2007">{{Cite journal  | last1 = Han | first1 = R. | last2 = Lai | first2 = R. | last3 = Ding | first3 = Q. | last4 = Wang | first4 = Z. | last5 = Luo | first5 = X. | last6 = Zhang | first6 = Y. | last7 = Cui | first7 = G. | last8 = He | first8 = J. | last9 = Liu | first9 = W. | title = Apolipoprotein A-I stimulates AMP-activated protein kinase and improves glucose metabolism. | journal = Diabetologia | volume = 50 | issue = 9 | pages = 1960-8 | month = Sep | year = 2007 | doi = 10.1007/s00125-007-0752-7 | PMID = 17639303 }}</ref> have provided preliminary evidences indicating crude associations between plasma HDL concentrations and [[glycemic control]].  Silencing of [[microRNA]] species has also shown to result in upregulation of these target genes along with elevation of functional [[HDL]] levels,<ref name="Rayner-2010">{{Cite journal  | last1 = Rayner | first1 = KJ. | last2 = Suárez | first2 = Y. | last3 = Dávalos | first3 = A. | last4 = Parathath | first4 = S. | last5 = Fitzgerald | first5 = ML. | last6 = Tamehiro | first6 = N. | last7 = Fisher | first7 = EA. | last8 = Moore | first8 = KJ. | last9 = Fernández-Hernando | first9 = C. | title = MiR-33 contributes to the regulation of cholesterol homeostasis. | journal = Science | volume = 328 | issue = 5985 | pages = 1570-3 | month = Jun | year = 2010 | doi = 10.1126/science.1189862 | PMID = 20466885 }}</ref><ref name="Marquart-2010">{{Cite journal  | last1 = Marquart | first1 = TJ. | last2 = Allen | first2 = RM. | last3 = Ory | first3 = DS. | last4 = Baldán | first4 = A. | title = miR-33 links SREBP-2 induction to repression of sterol transporters. | journal = Proc Natl Acad Sci U S A | volume = 107 | issue = 27 | pages = 12228-32 | month = Jul | year = 2010 | doi = 10.1073/pnas.1005191107 | PMID = 20566875 }}</ref><ref name="Najafi-Shoushtari-2010">{{Cite journal  | last1 = Najafi-Shoushtari | first1 = SH. | last2 = Kristo | first2 = F. | last3 = Li | first3 = Y. | last4 = Shioda | first4 = T. | last5 = Cohen | first5 = DE. | last6 = Gerszten | first6 = RE. | last7 = Näär | first7 = AM. | title = MicroRNA-33 and the SREBP host genes cooperate to control cholesterol homeostasis. | journal = Science | volume = 328 | issue = 5985 | pages = 1566-9 | month = Jun | year = 2010 | doi = 10.1126/science.1189123 | PMID = 20466882 }}</ref><ref name="Wang-2007">{{Cite journal  | last1 = Wang | first1 = MD. | last2 = Franklin | first2 = V. | last3 = Sundaram | first3 = M. | last4 = Kiss | first4 = RS. | last5 = Ho | first5 = K. | last6 = Gallant | first6 = M. | last7 = Marcel | first7 = YL. | title = Differential regulation of ATP binding cassette protein A1 expression and ApoA-I lipidation by Niemann-Pick type C1 in murine hepatocytes and macrophages. | journal = J Biol Chem | volume = 282 | issue = 31 | pages = 22525-33 | month = Aug | year = 2007 | doi = 10.1074/jbc.M700326200 | PMID = 17553802 }}</ref> suggesting an extensively-linked yet fine-tuned state of [[homeostasis]] in energy [[metabolism]].
HDL might modulate [[glucose]] [[homeostasis]] through several mechanisms such as the stimulation of [[insulin]] secretion,<ref name="Brunham-2007">{{Cite journal  | last1 = Brunham | first1 = LR. | last2 = Kruit | first2 = JK. | last3 = Pape | first3 = TD. | last4 = Timmins | first4 = JM. | last5 = Reuwer | first5 = AQ. | last6 = Vasanji | first6 = Z. | last7 = Marsh | first7 = BJ. | last8 = Rodrigues | first8 = B. | last9 = Johnson | first9 = JD. | title = Beta-cell ABCA1 influences insulin secretion, glucose homeostasis and response to thiazolidinedione treatment. | journal = Nat Med | volume = 13 | issue = 3 | pages = 340-7 | month = Mar | year = 2007 | doi = 10.1038/nm1546 | PMID = 17322896 }}</ref><ref name="Abderrahmani-2007">{{Cite journal  | last1 = Abderrahmani | first1 = A. | last2 = Niederhauser | first2 = G. | last3 = Favre | first3 = D. | last4 = Abdelli | first4 = S. | last5 = Ferdaoussi | first5 = M. | last6 = Yang | first6 = JY. | last7 = Regazzi | first7 = R. | last8 = Widmann | first8 = C. | last9 = Waeber | first9 = G. | title = Human high-density lipoprotein particles prevent activation of the JNK pathway induced by human oxidised low-density lipoprotein particles in pancreatic beta cells. | journal = Diabetologia | volume = 50 | issue = 6 | pages = 1304-14 | month = Jun | year = 2007 | doi = 10.1007/s00125-007-0642-z | PMID = 17437081 }}</ref><ref name="Drew-2009">{{Cite journal  | last1 = Drew | first1 = BG. | last2 = Duffy | first2 = SJ. | last3 = Formosa | first3 = MF. | last4 = Natoli | first4 = AK. | last5 = Henstridge | first5 = DC. | last6 = Penfold | first6 = SA. | last7 = Thomas | first7 = WG. | last8 = Mukhamedova | first8 = N. | last9 = de Courten | first9 = B. | title = High-density lipoprotein modulates glucose metabolism in patients with type 2 diabetes mellitus. | journal = Circulation | volume = 119 | issue = 15 | pages = 2103-11 | month = Apr | year = 2009 | doi = 10.1161/CIRCULATIONAHA.108.843219 | PMID = 19349317 }}</ref><ref name="Fryirs-2010">{{Cite journal  | last1 = Fryirs | first1 = MA. | last2 = Barter | first2 = PJ. | last3 = Appavoo | first3 = M. | last4 = Tuch | first4 = BE. | last5 = Tabet | first5 = F. | last6 = Heather | first6 = AK. | last7 = Rye | first7 = KA. | title = Effects of high-density lipoproteins on pancreatic beta-cell insulin secretion. | journal = Arterioscler Thromb Vasc Biol | volume = 30 | issue = 8 | pages = 1642-8 | month = Aug | year = 2010 | doi = 10.1161/ATVBAHA.110.207373 | PMID = 20466975 }}</ref> enhancement of [[insulin]] sensitivity, and increased glucose uptake by [[skeletal muscle]] via activation of [[AMP-activated protein kinase|AMP-activated protein kinase (AMPK)]] signaling pathway.<ref name="Han-2007">{{Cite journal  | last1 = Han | first1 = R. | last2 = Lai | first2 = R. | last3 = Ding | first3 = Q. | last4 = Wang | first4 = Z. | last5 = Luo | first5 = X. | last6 = Zhang | first6 = Y. | last7 = Cui | first7 = G. | last8 = He | first8 = J. | last9 = Liu | first9 = W. | title = Apolipoprotein A-I stimulates AMP-activated protein kinase and improves glucose metabolism. | journal = Diabetologia | volume = 50 | issue = 9 | pages = 1960-8 | month = Sep | year = 2007 | doi = 10.1007/s00125-007-0752-7 | PMID = 17639303 }}</ref><ref name="Abderrahmani-2007">{{Cite journal  | last1 = Abderrahmani | first1 = A. | last2 = Niederhauser | first2 = G. | last3 = Favre | first3 = D. | last4 = Abdelli | first4 = S. | last5 = Ferdaoussi | first5 = M. | last6 = Yang | first6 = JY. | last7 = Regazzi | first7 = R. | last8 = Widmann | first8 = C. | last9 = Waeber | first9 = G. | title = Human high-density lipoprotein particles prevent activation of the JNK pathway induced by human oxidised low-density lipoprotein particles in pancreatic beta cells. | journal = Diabetologia | volume = 50 | issue = 6 | pages = 1304-14 | month = Jun | year = 2007 | doi = 10.1007/s00125-007-0642-z | PMID = 17437081 }}</ref>  Preliminary evidence from [[genetic engineering]] studies that manipulate expression of related genes such as [[ABCA1]],<ref name="Vergeer-2010">{{Cite journal  | last1 = Vergeer | first1 = M. | last2 = Brunham | first2 = LR. | last3 = Koetsveld | first3 = J. | last4 = Kruit | first4 = JK. | last5 = Verchere | first5 = CB. | last6 = Kastelein | first6 = JJ. | last7 = Hayden | first7 = MR. | last8 = Stroes | first8 = ES. | title = Carriers of loss-of-function mutations in ABCA1 display pancreatic beta-cell dysfunction. | journal = Diabetes Care | volume = 33 | issue = 4 | pages = 869-74 | month = Apr | year = 2010 | doi = 10.2337/dc09-1562 | PMID = 20067955 }}</ref><ref name="Daimon-2005">{{Cite journal  | last1 = Daimon | first1 = M. | last2 = Kido | first2 = T. | last3 = Baba | first3 = M. | last4 = Oizumi | first4 = T. | last5 = Jimbu | first5 = Y. | last6 = Kameda | first6 = W. | last7 = Yamaguchi | first7 = H. | last8 = Ohnuma | first8 = H. | last9 = Tominaga | first9 = M. | title = Association of the ABCA1 gene polymorphisms with type 2 DM in a Japanese population. | journal = Biochem Biophys Res Commun | volume = 329 | issue = 1 | pages = 205-10 | month = Apr | year = 2005 | doi = 10.1016/j.bbrc.2005.01.119 | PMID = 15721294 }}</ref><ref name="Villarreal-Molina-2008">{{Cite journal  | last1 = Villarreal-Molina | first1 = MT. | last2 = Flores-Dorantes | first2 = MT. | last3 = Arellano-Campos | first3 = O. | last4 = Villalobos-Comparan | first4 = M. | last5 = Rodríguez-Cruz | first5 = M. | last6 = Miliar-García | first6 = A. | last7 = Huertas-Vazquez | first7 = A. | last8 = Menjivar | first8 = M. | last9 = Romero-Hidalgo | first9 = S. | title = Association of the ATP-binding cassette transporter A1 R230C variant with early-onset type 2 diabetes in a Mexican population. | journal = Diabetes | volume = 57 | issue = 2 | pages = 509-13 | month = Feb | year = 2008 | doi = 10.2337/db07-0484 | PMID = 18003760 }}</ref><ref name="Koseki-2009">{{Cite journal  | last1 = Koseki | first1 = M. | last2 = Matsuyama | first2 = A. | last3 = Nakatani | first3 = K. | last4 = Inagaki | first4 = M. | last5 = Nakaoka | first5 = H. | last6 = Kawase | first6 = R. | last7 = Yuasa-Kawase | first7 = M. | last8 = Tsubakio-Yamamoto | first8 = K. | last9 = Masuda | first9 = D. | title = Impaired insulin secretion in four Tangier disease patients with ABCA1 mutations. | journal = J Atheroscler Thromb | volume = 16 | issue = 3 | pages = 292-6 | month = Jun | year = 2009 | doi =  | PMID = 19556721 }}</ref> [[Cholesterylester transfer protein |CETP]],<ref name="López-Ríos-2011">{{Cite journal  | last1 = López-Ríos | first1 = L. | last2 = Pérez-Jiménez | first2 = P. | last3 = Martínez-Quintana | first3 = E. | last4 = Rodriguez González | first4 = G. | last5 = Díaz-Chico | first5 = BN. | last6 = Nóvoa | first6 = FJ. | last7 = Serra-Majem | first7 = L. | last8 = Chirino | first8 = R. | title = Association of Taq 1B CETP polymorphism with insulin and HOMA levels in the population of the Canary Islands. | journal = Nutr Metab Cardiovasc Dis | volume = 21 | issue = 1 | pages = 18-24 | month = Jan | year = 2011 | doi = 10.1016/j.numecd.2009.06.009 | PMID = 19822408 }}</ref><ref name="Zhong-1996">{{Cite journal  | last1 = Zhong | first1 = S. | last2 = Sharp | first2 = DS. | last3 = Grove | first3 = JS. | last4 = Bruce | first4 = C. | last5 = Yano | first5 = K. | last6 = Curb | first6 = JD. | last7 = Tall | first7 = AR. | title = Increased coronary heart disease in Japanese-American men with mutation in the cholesteryl ester transfer protein gene despite increased HDL levels. | journal = J Clin Invest | volume = 97 | issue = 12 | pages = 2917-23 | month = Jun | year = 1996 | doi = 10.1172/JCI118751 | PMID = 8675707 }}</ref> [[ABCG1]],<ref name="Sturek-2010">{{Cite journal  | last1 = Sturek | first1 = JM. | last2 = Castle | first2 = JD. | last3 = Trace | first3 = AP. | last4 = Page | first4 = LC. | last5 = Castle | first5 = AM. | last6 = Evans-Molina | first6 = C. | last7 = Parks | first7 = JS. | last8 = Mirmira | first8 = RG. | last9 = Hedrick | first9 = CC. | title = An intracellular role for ABCG1-mediated cholesterol transport in the regulated secretory pathway of mouse pancreatic beta cells. | journal = J Clin Invest | volume = 120 | issue = 7 | pages = 2575-89 | month = Jul | year = 2010 | doi = 10.1172/JCI41280 | PMID = 20530872 }}</ref> and [[Apolipoprotein A1|apoA-I]]<ref name="Han-2007">{{Cite journal  | last1 = Han | first1 = R. | last2 = Lai | first2 = R. | last3 = Ding | first3 = Q. | last4 = Wang | first4 = Z. | last5 = Luo | first5 = X. | last6 = Zhang | first6 = Y. | last7 = Cui | first7 = G. | last8 = He | first8 = J. | last9 = Liu | first9 = W. | title = Apolipoprotein A-I stimulates AMP-activated protein kinase and improves glucose metabolism. | journal = Diabetologia | volume = 50 | issue = 9 | pages = 1960-8 | month = Sep | year = 2007 | doi = 10.1007/s00125-007-0752-7 | PMID = 17639303 }}</ref> suggests associations between plasma HDL concentrations and [[glycemic control]].  Silencing of [[microRNA]] species was also been associated with upregulation of these target genes along with elevation of functional [[HDL]] levels,<ref name="Rayner-2010">{{Cite journal  | last1 = Rayner | first1 = KJ. | last2 = Suárez | first2 = Y. | last3 = Dávalos | first3 = A. | last4 = Parathath | first4 = S. | last5 = Fitzgerald | first5 = ML. | last6 = Tamehiro | first6 = N. | last7 = Fisher | first7 = EA. | last8 = Moore | first8 = KJ. | last9 = Fernández-Hernando | first9 = C. | title = MiR-33 contributes to the regulation of cholesterol homeostasis. | journal = Science | volume = 328 | issue = 5985 | pages = 1570-3 | month = Jun | year = 2010 | doi = 10.1126/science.1189862 | PMID = 20466885 }}</ref><ref name="Marquart-2010">{{Cite journal  | last1 = Marquart | first1 = TJ. | last2 = Allen | first2 = RM. | last3 = Ory | first3 = DS. | last4 = Baldán | first4 = A. | title = miR-33 links SREBP-2 induction to repression of sterol transporters. | journal = Proc Natl Acad Sci U S A | volume = 107 | issue = 27 | pages = 12228-32 | month = Jul | year = 2010 | doi = 10.1073/pnas.1005191107 | PMID = 20566875 }}</ref><ref name="Najafi-Shoushtari-2010">{{Cite journal  | last1 = Najafi-Shoushtari | first1 = SH. | last2 = Kristo | first2 = F. | last3 = Li | first3 = Y. | last4 = Shioda | first4 = T. | last5 = Cohen | first5 = DE. | last6 = Gerszten | first6 = RE. | last7 = Näär | first7 = AM. | title = MicroRNA-33 and the SREBP host genes cooperate to control cholesterol homeostasis. | journal = Science | volume = 328 | issue = 5985 | pages = 1566-9 | month = Jun | year = 2010 | doi = 10.1126/science.1189123 | PMID = 20466882 }}</ref><ref name="Wang-2007">{{Cite journal  | last1 = Wang | first1 = MD. | last2 = Franklin | first2 = V. | last3 = Sundaram | first3 = M. | last4 = Kiss | first4 = RS. | last5 = Ho | first5 = K. | last6 = Gallant | first6 = M. | last7 = Marcel | first7 = YL. | title = Differential regulation of ATP binding cassette protein A1 expression and ApoA-I lipidation by Niemann-Pick type C1 in murine hepatocytes and macrophages. | journal = J Biol Chem | volume = 282 | issue = 31 | pages = 22525-33 | month = Aug | year = 2007 | doi = 10.1074/jbc.M700326200 | PMID = 17553802 }}</ref> suggesting an extensively-linked yet fine-tuned state of [[homeostasis]] in energy [[metabolism]].


=====Diabetes Mellitus=====
=====Diabetes Mellitus=====
[[Type 2 diabetes mellitus]] and [[impaired fasting glucose]] are both proved to be associated with decreased levels of [[HDL]].<ref name="Gatti-2009">{{Cite journal  | last1 = Gatti | first1 = A. | last2 = Maranghi | first2 = M. | last3 = Bacci | first3 = S. | last4 = Carallo | first4 = C. | last5 = Gnasso | first5 = A. | last6 = Mandosi | first6 = E. | last7 = Fallarino | first7 = M. | last8 = Morano | first8 = S. | last9 = Trischitta | first9 = V. | title = Poor glycemic control is an independent risk factor for low HDL cholesterol in patients with type 2 diabetes. | journal = Diabetes Care | volume = 32 | issue = 8 | pages = 1550-2 | month = Aug | year = 2009 | doi = 10.2337/dc09-0256 | PMID = 19487641 }}</ref><ref name="Drexel-2005">{{Cite journal  | last1 = Drexel | first1 = H. | last2 = Aczel | first2 = S. | last3 = Marte | first3 = T. | last4 = Benzer | first4 = W. | last5 = Langer | first5 = P. | last6 = Moll | first6 = W. | last7 = Saely | first7 = CH. | title = Is atherosclerosis in diabetes and impaired fasting glucose driven by elevated LDL cholesterol or by decreased HDL cholesterol? | journal = Diabetes Care | volume = 28 | issue = 1 | pages = 101-7 | month = Jan | year = 2005 | doi =  | PMID = 15616241 }}</ref>  In the Framingham Offspring Study, low levels of HDL cholesterol is verified as one of the significant predictors of incident [[type 2 diabetes mellitus]].<ref name="Wilson-2007">{{Cite journal  | last1 = Wilson | first1 = PW. | last2 = Meigs | first2 = JB. | last3 = Sullivan | first3 = L. | last4 = Fox | first4 = CS. | last5 = Nathan | first5 = DM. | last6 = D'Agostino | first6 = RB. | title = Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. | journal = Arch Intern Med | volume = 167 | issue = 10 | pages = 1068-74 | month = May | year = 2007 | doi = 10.1001/archinte.167.10.1068 | PMID = 17533210 }}</ref>
[[Type 2 diabetes mellitus]] and [[impaired fasting glucose]] are both associated with decreased levels of [[HDL]].<ref name="Gatti-2009">{{Cite journal  | last1 = Gatti | first1 = A. | last2 = Maranghi | first2 = M. | last3 = Bacci | first3 = S. | last4 = Carallo | first4 = C. | last5 = Gnasso | first5 = A. | last6 = Mandosi | first6 = E. | last7 = Fallarino | first7 = M. | last8 = Morano | first8 = S. | last9 = Trischitta | first9 = V. | title = Poor glycemic control is an independent risk factor for low HDL cholesterol in patients with type 2 diabetes. | journal = Diabetes Care | volume = 32 | issue = 8 | pages = 1550-2 | month = Aug | year = 2009 | doi = 10.2337/dc09-0256 | PMID = 19487641 }}</ref><ref name="Drexel-2005">{{Cite journal  | last1 = Drexel | first1 = H. | last2 = Aczel | first2 = S. | last3 = Marte | first3 = T. | last4 = Benzer | first4 = W. | last5 = Langer | first5 = P. | last6 = Moll | first6 = W. | last7 = Saely | first7 = CH. | title = Is atherosclerosis in diabetes and impaired fasting glucose driven by elevated LDL cholesterol or by decreased HDL cholesterol? | journal = Diabetes Care | volume = 28 | issue = 1 | pages = 101-7 | month = Jan | year = 2005 | doi =  | PMID = 15616241 }}</ref>  In the Framingham Offspring Study, low levels of HDL cholesterol was reported as a significant predictor of incident [[type 2 diabetes mellitus]].<ref name="Wilson-2007">{{Cite journal  | last1 = Wilson | first1 = PW. | last2 = Meigs | first2 = JB. | last3 = Sullivan | first3 = L. | last4 = Fox | first4 = CS. | last5 = Nathan | first5 = DM. | last6 = D'Agostino | first6 = RB. | title = Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. | journal = Arch Intern Med | volume = 167 | issue = 10 | pages = 1068-74 | month = May | year = 2007 | doi = 10.1001/archinte.167.10.1068 | PMID = 17533210 }}</ref>
 
===Anti-apoptotic Functions===
* Plasma HDLs in-vitro were shown to offer some cytoprotection against oxidized LDL-causing apoptosis and generation of reactive oxygen species.<ref name="de Souza-2010">{{Cite journal  | last1 = de Souza | first1 = JA. | last2 = Vindis | first2 = C. | last3 = Nègre-Salvayre | first3 = A. | last4 = Rye | first4 = KA. | last5 = Couturier | first5 = M. | last6 = Therond | first6 = P. | last7 = Chantepie | first7 = S. | last8 = Salvayre | first8 = R. | last9 = Chapman |first9 = MJ. | title = Small, dense HDL 3 particles attenuate apoptosis in endothelial cells: pivotal role of apolipoprotein A-I. | journal = J Cell Mol Med |volume = 14 | issue = 3 | pages = 608-20 | month = Mar | year = 2010 | doi = 10.1111/j.1582-4934.2009.00713.x | PMID = 19243471 }}</ref>
 
*[[HDL]] also protects endothelial cells from apoptosis and promotes their growth and their migration via SRBI-initiated signaling.<ref name="pmid20089950">{{cite journal| author=Saddar S, Mineo C, Shaul PW| title=Signaling by the high-affinity HDL receptor scavenger receptor B type I. | journal=Arterioscler Thromb Vasc Biol | year= 2010 | volume= 30 | issue= 2 | pages= 144-50 | pmid=20089950 | doi=10.1161/ATVBAHA.109.196170 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20089950  }} </ref>


*It is also proposed that the anti-apoptotic and proliferative effects of apoA-I are mediated through F1-ATPase-catalysed ADP production and subsequent P2Y13 receptor stimulation.<ref name="pmid19372457">{{cite journal| author=Radojkovic C, Genoux A, Pons V, Combes G, de Jonge H, Champagne E et al.| title=Stimulation of cell surface F1-ATPase activity by apolipoprotein A-I inhibits endothelial cell apoptosis and promotes proliferation. | journal=Arterioscler Thromb Vasc Biol | year= 2009 | volume= 29 | issue= 7 | pages= 1125-30 | pmid=19372457 | doi=10.1161/ATVBAHA.109.187997 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19372457  }} </ref>
===Anti-Apoptotic Function===
Plasma HDL offers some cytoprotection against oxidized LDL-mediated apoptosis and generation of reactive oxygen species in-vitro .<ref name="de Souza-2010">{{Cite journal  | last1 = de Souza | first1 = JA. | last2 = Vindis | first2 = C. | last3 = Nègre-Salvayre | first3 = A. | last4 = Rye | first4 = KA. | last5 = Couturier | first5 = M. | last6 = Therond | first6 = P. | last7 = Chantepie | first7 = S. | last8 = Salvayre | first8 = R. | last9 = Chapman |first9 = MJ. | title = Small, dense HDL 3 particles attenuate apoptosis in endothelial cells: pivotal role of apolipoprotein A-I. | journal = J Cell Mol Med |volume = 14 | issue = 3 | pages = 608-20 | month = Mar | year = 2010 | doi = 10.1111/j.1582-4934.2009.00713.x | PMID = 19243471 }}</ref> [[HDL]] also protects endothelial cells from apoptosis and promotes their growth and their migration via SRBI-initiated signaling.<ref name="pmid20089950">{{cite journal| author=Saddar S, Mineo C, Shaul PW| title=Signaling by the high-affinity HDL receptor scavenger receptor B type I. | journal=Arterioscler Thromb Vasc Biol | year= 2010 | volume= 30 | issue= 2 | pages= 144-50 | pmid=20089950 | doi=10.1161/ATVBAHA.109.196170 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20089950  }} </ref>  It is also suggested that the anti-apoptotic and proliferative effects of apoA-I are mediated through F1-ATPase-catalysed ADP production and subsequent P2Y13 receptor stimulation.<ref name="pmid19372457">{{cite journal| author=Radojkovic C, Genoux A, Pons V, Combes G, de Jonge H, Champagne E et al.| title=Stimulation of cell surface F1-ATPase activity by apolipoprotein A-I inhibits endothelial cell apoptosis and promotes proliferation. | journal=Arterioscler Thromb Vasc Biol | year= 2009 | volume= 29 | issue= 7 | pages= 1125-30 | pmid=19372457 | doi=10.1161/ATVBAHA.109.187997 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19372457  }} </ref>


===Vasodilatory Functions===
===Vasodilatory Function===
HDL has been shown to restore endothelial dysfunction which is implicated in the pathogenesis of type 2 diabetes.  In a study, reconstituted HDL was infused in patients with type 2 diabetes and the vascular function (forearm blood flow) was assessed at 4 hours and 7 days post-infusion.  HDL was found to increase the forearm blood flow in diabetic patients as compared to the controlled group, probably due to its effect on increasing nitric oxide bioavailability.<ref name="van Etten-2002">{{Cite journal  | last1 = van Etten | first1 = RW. | last2 = de Koning | first2 = EJ. | last3 = Verhaar | first3 = MC. | last4 = Gaillard | first4 = CA. | last5 = Rabelink | first5 = TJ. | title = Impaired NO-dependent vasodilation in patients with Type II (non-insulin-dependent) diabetes mellitus is restored by acute administration of folate. | journal = Diabetologia | volume = 45 | issue = 7 | pages = 1004-10 | month = Jul | year = 2002 | doi = 10.1007/s00125-002-0862-1 | PMID = 12136399 }}</ref>
HDL might play a role in the restoration of endothelial dysfunction implicated in the pathogenesis of type 2 diabetes.  In one study, reconstituted HDL was infused in patients with type 2 diabetes and the vascular function (forearm blood flow) was assessed at 4 hours and 7 days post-infusion.  HDL infusion was associated with an increase in the forearm blood flow in diabetic patients as compared to the controlled group, probably due to its effect on increasing the bioavailability of nitric oxide.<ref name="van Etten-2002">{{Cite journal  | last1 = van Etten | first1 = RW. | last2 = de Koning | first2 = EJ. | last3 = Verhaar | first3 = MC. | last4 = Gaillard | first4 = CA. | last5 = Rabelink | first5 = TJ. | title = Impaired NO-dependent vasodilation in patients with Type II (non-insulin-dependent) diabetes mellitus is restored by acute administration of folate. | journal = Diabetologia | volume = 45 | issue = 7 | pages = 1004-10 | month = Jul | year = 2002 | doi = 10.1007/s00125-002-0862-1 | PMID = 12136399 }}</ref>


==References==
==References==

Latest revision as of 18:01, 1 July 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

Overview

The physiological role of HDL centers around the reverse cholesterol transport system. Nascent HDL secreted into the plasma by the liver or intestine pick up free cholesterol from peripheral tissues and the arterial wall, an action mediated mainly by the ATP-binding cassette A1 (ABCA1). The enzyme lecithin-cholesteryl acetyltransferase (LCAT) catalyzes the esterification of the free cholesterol, and also converts the nascent HDL into the mature form. The esterified cholesterol is transported to the liver where cholesterylester transfer protein (CETP), an enzyme produced in the liver, acts on it transferring the cholesterol to other apo B containing lipoproteins. The cholesterol-deplete HDL gets broken down by triglyceride lipases releasing apo A-I which either takes up free cholesterol to continue the cycle, or gets eliminated in the kidneys. In addition to its atheroprotective against cardiovascular diseases, HDL also exhibits anti-oxidant, anti-inflammatory, anti-apoptotic, anti-coagulant, vasodilatory, and metabolic properties.

Physiology

Structure

Lipoprotein Density Size % Protein Cholesterol in Plasma Triglyceride in Fasting Plasma Major Apolipoprotein
HDL 1.063 - 1.210 g/mL 6 - 10 mm 40 - 55% 0.9 - 1.6 mmol/L 0.1 - 0.2 mmol/L apoA-I, apoA-II

For more information about the biochemistry of all lipoproteins, click here.

Shown below is a schematic image depicting the structure of the HDL. Note that the inner core is made of triglyceride and cholesterol esters whereas the surface is made of amphiphilic phospholipids along with apolipoproteins.

The structure of the HDL: the inner core is made of triglyceride and cholesterol esters whereas the surface is made of amphiphilic phospholipids along with apolipoproteins.

  • HDL is the smallest of the lipoproteins. It is the densest because it contains the highest proportion of protein. It contains the A class of apolipoproteins. Apolipoprotein A-I is the main protein of HDL that removes excess cell cholesterol and protects against atherosclerosis.[1]
  • The liver synthesizes these lipoproteins as complexes of apolipoproteins and phospholipids, which resemble cholesterol-free flattened spherical lipoprotein particles. They are capable of picking up cholesterol from cells they interact with.
  • A plasma enzyme called lecithin-cholesterol acyltransferase (LCAT) converts the free cholesterol into cholesteryl ester (a more hydrophobic form of cholesterol) which is then sequestered into the core of the lipoprotein particle eventually making the newly synthesized HDL spherical. They increase in size as they circulate through the bloodstream and incorporate more cholesterol molecules into their structure.
  • Thus it is the concentration of large HDL particles which more accurately reflects the HDL protective action, as opposed to the concentration of total HDL particles.[2] This ratio of large HDL to total HDL particles varies widely and is only measured by more sophisticated lipoprotein assays using either electrophoresis, originally developed in the 1970s, or newer nuclear magnetic resonance (NMR) spectroscopy which was developed in the 1990s.
  • HDL particles are not inherently protective. It is only the HDL particles which become the largest (actually picking up and carrying cholesterol) that are protective. There is no reliable relationship between total HDL and large HDL, and more sophisticated analyses which actually measure large HDL, and not just total HDL, correlate much better with clinical outcomes.[3]
  • Many studies have postulated an association between cholesterol efflux from peripheral tissue and Apo A-I HDL particles, whereas the HDL3 containing both Apo A-I and A-II are less effective.[4][5][6]

HDL Receptors

  • ABCA1 transporter: it is expressed in the peripheral tissues, intestine, liver, and macrophages.[7] An increase in intracellular cholesterol content upregulates ABCA1 transporter which is responsible for cholesterol efflux from the intracellular pool.[8]
  • ABCG1 transporter: it is expressed in the intestine and macrophages.[7] ABCG1 is also responsible for cholesterol efflux. In addition, ABCG1 may facilitate the oxidation of plasma membrane cholesterol domains.[9]

Enzymes Associated with HDL

Cholesterol Ester Transfer Protein (CETP)
  • CETP mediates exchange of cholesterol between HDL particles, and triglyceride rich LDL and VLDL in both directions.
  • CETP is normally present in both peripheral tissues and liver and functions to channel cholesterol to the liver for uptake and metabolism.
Lecithin-Cholesterol Acyltransferase (LCAT)
  • LCAT is an enzyme that catalyzes the transfer of fatty acyl chain to free cholesterol which results in cholesteryl ester formation.[14]
  • Its role in extracellular cholesterol metabolism may facilitate the uptake of cholesterol from peripheral tissues to liver into HDL particles by maintaining a concentration gradient for the efflux of free cholesterol which may play a major role in reverse cholesterol transport (RCT).[15]

Reverse Cholesterol Transport

HDL plays a pivotal role in cholesterol transport from peripheral tissues to the liver for excretion, a process known as reverse cholesterol transport. HDL’s protective atherosclerotic effect is related to its role in reverse cholesterol transport, where cholesterol efflux from macrophages to HDL is an important initial step.

Low concentration of HDL is one of the various risk factors of cardiovascular disease as demonstrated by preclinical and epidemiologic studies. Increasing HDL concentration by medical therapy, such as niacin and inhibition of cholesteryl ester transfer protein, was evaluated in many clinical trials. Studies such as ILLUMINATE,[16] dal-OUTCOMES,[17] and CHI-SQUARE, have failed to demonstrate an association between increasing HDL by therapy and improved cardiovascular outcomes. Higher cholesterol efflux capacity, however, is associated with a lower rate of cardiovascular disease, independently of HDL cholesterol concentration.[18] These findings highlight the importance of HDL function in reverse cholesterol transport and cholesterol efflux.

Adapted from Nature Reviews Drug Discovery. ABCA1= ATP-binding cassette transporter A1; ABCG1: ATP-binding cassette transporter G1; ABCG4: ATP-binding cassette transporter G4; ApoA-I= Apolipoprotein A-I; CETP: Cholesteryl transfer protein; LCAT: Lecithin cholesterol acyltransferase; SRBI: Scavenger receptor, class B, type I. [19]

Synthesis and Uptake of Cholesterol

  • HDL consists of phospholipids and apolipoproteins, mainly apo A-I and/or apo A-II. Both the liver and the small intestine synthesize apo A-I while only the liver synthesizes apo A-II.
  • Free apo A-I is released into the plasma as nascent HDLs. Nascent HDL readily takes up excess free cholesterol from the periphery such as fibroblasts, macrophages, and arterial wall, a process referred to as cholesterol efflux. This uptake of cholesterol is mediated by either ATP-binding cassette A1 (ABCA1), G1/G4, scavenger receptor class B type 1 (SR-B1), Cyp27A1, caveloin, and passive diffusion, leading to the formation of discoid HDL (a.k.a. pre-βHDL).
  • Apo A-I is a cofactor of lecithin-cholesterol acetyltransferase (LCAT) which catalyzes the esterification of the free cholesterol bound to the discoid HDL. The apolipoprotein A1 acts as a signal protein in mobilizing cholesteryl esters from within the cells.

Maturation and Transfer of Cholesterol

  • The esterified cholesterol moves into the hydrophobic core of the HDL, changing the HDL particle from discoid to spherical (mature HDL). This process also prevents the re-uptake of cholesterol by cells. LCAT is responsible for the maturation of HDL particles.
  • The esterified cholesterol can be delivered back to the liver through a number of routes:
    • CETP, secreted in the liver, transfers cholesterol from HDL to the apo B–containing lipoproteins e.g., very low-density lipoprotein (VLDL) or intermediate-density lipoprotein (IDL) to be taken up by the liver. Mutations of this transport protein gene causes familial HDL deficiencies and Tangier disease.
    • HDL particles may be taken up directly by the liver.
    • Free cholesterol may be taken up directly by the liver.
    • HDL cholesterol esters may be selectively taken up via the scavenger receptor SR-B1, which is expressed in the liver.

Catabolism

  • Triglyceride lipase degrades cholesterol-deplete HDL particles into small, dense HDL particles which release apo A-I (nascent HDL) after dissociation. The apo A-1 either rapidly re-uptakes free cholesterol again by ABCA1 to form discoid HDLs, or it is endocytosed into the kidney tubule, or cleared via glomerular filtration.

Role of HDL

Shown below is an image summarizing the physiologic functions of HDL in an acute and chronic setting. Please refer to the text below for details about each one of functions of HDL.

The physiologic functions of HDL in an acute and chronic setting
The physiologic functions of HDL in an acute and chronic setting

Atheroprotection

It has been established that HDL-cholesterol has an inverse correlation with future atherosclerotic cardiovascular complications. HDL and apo A-I exhibit many atheroprotective functions which primarily aim at removing cholesterol from peripheral tissues and the arterial wall through various efflux mechanisms, mainly the reverse cholesterol transport system. HDL also plays a role in the attenuation of plaque progression and promotion of plaque stabilization. These functions are exhibited through its anti-oxidative, anti-platelet, anti-apoptotic, and anti-inflammatory properties. With all these properties in context, HDL potentially protects against reperfusion ischemic injuries and secondary plaque rupture observed in post-acute coronary syndrome patients.

  • Plasma HDL associated apolipoprotein M (apoM) modulates the ability of plasma to mobilize cellular cholesterol and protects against experimental atherosclerosis.[20]
  • Animal models have demonstrated that the somatic gene transfer of human apo A-I can prevent the development of atherosclerosis or reverse preexisting atherosclerosis.[21][22][23][24]
  • ATP-binding cassette (ABC) transporters ABCA1 and ABCG1 in endothelial cells and the scavenger receptor B type I mediate multiple intracellular signaling pathways as well as the efflux of cholesterol.[25]

Anti-Coagulation Function

HDL has the ability to inhibit platelet activation and aggregation by directly inhibiting platelet activation,[26][27] downregulating thromboxane A2 synthesis,[28] increasing the synthesis of prostacyclin,[29] and lowering the expression of the tissue factor which is required in the coagulation process.[30]

Anti-Oxidant Function

The formation of free oxygen radicals contributes to the pathogenesis and progression of atherosclerotic plaques. Oxidized LDL is engulfed by macrophages, which leads to further oxidation and production of foam cells. Oxidized LDL acts as a chemotactic agent for circulating monocytes, converts macrophages into foam cells, induces cytotoxic effects on the endothelium, inhibits motility of tissue macrophages, and stimulates the migration and proliferation of vascular smooth muscle cells.[31] HDL also inhibits the oxidative modification of oxidized LDLs,[32] and prevents their infiltration into the vessel wall.[33]

Anti-Inflammatory Function

HDL has anti-inflammatory functions in both endothelial cells and leukocytes. During inflammation, several leukocyte adhesion molecules are activated, which promotes the binding of leukocytes and formation of atheroma. HDL inhibits the activation of vascular cell adhesion molecule (VCAM-1),[34] interleukin-1-induced expresion of E-selectin,[35] interleukin-8, intracellular adhesion molecule (ICAM)-1, neutrophils,[36] monocytes,[37] and also prevents the binding of T-lymphocytes to monocytes thereby preventing the formation of pro-inflammatory cytokines.[38]

Metabolic Function

In a study on the effects and mechanisms of HDL on glucose metabolism, 13 type 2 diabetes patients were administered intravenous reconstituted HDL. There was a reduction in the plasma glucose of the patients due to an increase in plasma insulin in addition to the activation of AMP-activated protein kinase in the skeletal muscle. These findings suggest a role for HDL-raising therapies beyond atherosclerosis to address type 2 diabetes mellitus.[39]

Glucose Metabolism

HDL might modulate glucose homeostasis through several mechanisms such as the stimulation of insulin secretion,[40][41][39][42] enhancement of insulin sensitivity, and increased glucose uptake by skeletal muscle via activation of AMP-activated protein kinase (AMPK) signaling pathway.[43][41] Preliminary evidence from genetic engineering studies that manipulate expression of related genes such as ABCA1,[44][45][46][47] CETP,[48][49] ABCG1,[50] and apoA-I[43] suggests associations between plasma HDL concentrations and glycemic control. Silencing of microRNA species was also been associated with upregulation of these target genes along with elevation of functional HDL levels,[51][52][53][54] suggesting an extensively-linked yet fine-tuned state of homeostasis in energy metabolism.

Diabetes Mellitus

Type 2 diabetes mellitus and impaired fasting glucose are both associated with decreased levels of HDL.[55][56] In the Framingham Offspring Study, low levels of HDL cholesterol was reported as a significant predictor of incident type 2 diabetes mellitus.[57]

Anti-Apoptotic Function

Plasma HDL offers some cytoprotection against oxidized LDL-mediated apoptosis and generation of reactive oxygen species in-vitro .[58] HDL also protects endothelial cells from apoptosis and promotes their growth and their migration via SRBI-initiated signaling.[59] It is also suggested that the anti-apoptotic and proliferative effects of apoA-I are mediated through F1-ATPase-catalysed ADP production and subsequent P2Y13 receptor stimulation.[60]

Vasodilatory Function

HDL might play a role in the restoration of endothelial dysfunction implicated in the pathogenesis of type 2 diabetes. In one study, reconstituted HDL was infused in patients with type 2 diabetes and the vascular function (forearm blood flow) was assessed at 4 hours and 7 days post-infusion. HDL infusion was associated with an increase in the forearm blood flow in diabetic patients as compared to the controlled group, probably due to its effect on increasing the bioavailability of nitric oxide.[61]

References

  1. Mahler, DA.; Shuhart, CR.; Brew, E.; Stukel, TA. (1991). "Ventilatory responses and entrainment of breathing during rowing". Med Sci Sports Exerc. 23 (2): 186–92. PMID 2017014. Unknown parameter |month= ignored (help)
  2. Kwiterovich PO. The Metabolic Pathways of High-Density Lipoprotein, Low-Density Lipoprotein, and Triglycerides: A Current Review. Am J Cardiol 2000;86(suppl):5L.
  3. Tran-Dinh A, Diallo D, Delbosc S; et al. (2013). "HDL and endothelial protection". British Journal of Pharmacology. doi:10.1111/bph.12174. PMID 23488589. Unknown parameter |month= ignored (help)
  4. Yin K, Tang SL, Yu XH; et al. (2013). "Apolipoprotein A-I inhibits LPS-induced atherosclerosis in ApoE-/- mice possibly via activated STAT3-mediated upregulation of tristetraprolin". Acta Pharmacologica Sinica. doi:10.1038/aps.2013.10. PMID 23564081. Unknown parameter |month= ignored (help)
  5. Mazer NA, Giulianini F, Paynter NP, Jordan P, Mora S (2013). "A Comparison of the Theoretical Relationship between HDL Size and the Ratio of HDL Cholesterol to Apolipoprotein A-I with Experimental Results from the Women's Health Study". Clinical Chemistry. doi:10.1373/clinchem.2012.196949. PMID 23426429. Unknown parameter |month= ignored (help)
  6. Kappelle PJ, Gansevoort RT, Hillege HJ, Wolffenbuttel BH, Dullaart RP (2013). "Common variation in cholesteryl ester transfer protein: relationship of first major adverse cardiovascular events with the apolipoprotein B/apolipoprotein A-I ratio and the total cholesterol/high-density lipoprotein cholesterol ratio". Journal of Clinical Lipidology. 7 (1): 56–64. doi:10.1016/j.jacl.2012.05.003. PMID 23351584. Unknown parameter |month= ignored (help)
  7. 7.0 7.1 Fitzgerald, ML.; Mujawar, Z.; Tamehiro, N. (2010). "ABC transporters, atherosclerosis and inflammation". Atherosclerosis. 211 (2): 361–70. doi:10.1016/j.atherosclerosis.2010.01.011. PMID 20138281. Unknown parameter |month= ignored (help)
  8. Schwartz, K.; Lawn, RM.; Wade, DP. (2000). "ABC1 gene expression and ApoA-I-mediated cholesterol efflux are regulated by LXR". Biochem Biophys Res Commun. 274 (3): 794–802. doi:10.1006/bbrc.2000.3243. PMID 10924356. Unknown parameter |month= ignored (help)
  9. Vaughan, AM.; Oram, JF. (2005). "ABCG1 redistributes cell cholesterol to domains removable by high density lipoprotein but not by lipid-depleted apolipoproteins". J Biol Chem. 280 (34): 30150–7. doi:10.1074/jbc.M505368200. PMID 15994327. Unknown parameter |month= ignored (help)
  10. Brundert, M.; Ewert, A.; Heeren, J.; Behrendt, B.; Ramakrishnan, R.; Greten, H.; Merkel, M.; Rinninger, F. (2005). "Scavenger receptor class B type I mediates the selective uptake of high-density lipoprotein-associated cholesteryl ester by the liver in mice". Arterioscler Thromb Vasc Biol. 25 (1): 143–8. doi:10.1161/01.ATV.0000149381.16166.c6. PMID 15528479. Unknown parameter |month= ignored (help)
  11. Out, R.; Hoekstra, M.; Spijkers, JA.; Kruijt, JK.; van Eck, M.; Bos, IS.; Twisk, J.; Van Berkel, TJ. (2004). "Scavenger receptor class B type I is solely responsible for the selective uptake of cholesteryl esters from HDL by the liver and the adrenals in mice". J Lipid Res. 45 (11): 2088–95. doi:10.1194/jlr.M400191-JLR200. PMID 15314100. Unknown parameter |month= ignored (help)
  12. Guo, L.; Song, Z.; Li, M.; Wu, Q.; Wang, D.; Feng, H.; Bernard, P.; Daugherty, A.; Huang, B. (2009). "Scavenger Receptor BI Protects against Septic Death through Its Role in Modulating Inflammatory Response". J Biol Chem. 284 (30): 19826–34. doi:10.1074/jbc.M109.020933. PMID 19491399. Unknown parameter |month= ignored (help)
  13. Besler, C.; Heinrich, K.; Rohrer, L.; Doerries, C.; Riwanto, M.; Shih, DM.; Chroni, A.; Yonekawa, K.; Stein, S. (2011). "Mechanisms underlying adverse effects of HDL on eNOS-activating pathways in patients with coronary artery disease". J Clin Invest. 121 (7): 2693–708. doi:10.1172/JCI42946. PMID 21701070. Unknown parameter |month= ignored (help)
  14. Zechner, R.; Kostner, GM.; Dieplinger, H.; Degovics, G.; Laggner, P. (1984). "In vitro modification of the chemical composition of human plasma low density lipoproteins: effects of morphology and thermal properties". Chem Phys Lipids. 36 (2): 111–9. PMID 6532566. Unknown parameter |month= ignored (help)
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