Cholesterol and Plant Sterol Absorption: Recent Insights
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Intestinal Absorption and Biliary Secretion
The intestinal absorption of plant sterols differs markedly from that of cholesterol.4, 5 On average, campesterol absorption is approximately 3 times lower than that of cholesterol, and sitosterol is 3 times lower than that of campesterol, whether measured by an intestinal perfusion4 or continuous isotope feeding method.4, 5 Plasma sterols are also transported in serum with lipoproteins and excreted into bile. In contrast with cholesterol, plant sterols are not metabolized to bile acids in the
Ezetimibe
The discovery of ezetimibe, which reduces intestinal cholesterol absorption in animals and humans, has provided new insights into the metabolism of plant sterols. Treatment with ezetimibe reduced plant sterols and stanols in patients with mild hypercholesterolemia within 2 weeks of starting treatment (Table 3),14 suggesting that ezetimibe also reduces the absorption of plant sterols. The reduction of plant sterols was significantly more pronounced than the reduction of serum cholesterol.
Conclusion
The discovery of transporters in the intestinal mucosa cells and hepatocytes has given new insights into the regulation of the intestinal absorption and biliary secretion of sterols (Figure 4). Ezetimibe, a potent and selective inhibitor of intestinal absorption of cholesterol and plant sterols, lowers serum cholesterol and plant sterols. The reduction in plant sterols shown in patients with phytosterolemia in a recent study15 suggests that ezetimibe might be of benefit in the long-term
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