Cholesterol in cells can be converted into oxysterols, which in turn can potently upregulate ABCA1 expression [
4]. In cell types with relevance to inflammatory lung diseases (including macrophage, epithelial and smooth muscle cells (Table
1) [
4,
35,
40‐
43]), the predominantly reported oxysterol is 25-hydroxycholesterol (25-HC). This naturally occurring stimulus increases the expression of ABCA1 through activation of liver X receptor (LXR) pathway [
44,
45]. LXR forms a heterodimer with retinoid X receptor (RXR), and together they form a transcription factor that binds to the promoter element in the ABCA1 gene to increase expression and ultimately the upregulation of ABCA1 protein expression [
44,
45], amongst other targets. Transcription occurs upon influx of excess intracellular cholesterol, however cholesterol does not directly activate this pathway but is converted to 25-HC [
46]. While oxysterols are the ligands that activate LXR/RXR to increase ABCA1 expression, cholesterol loading triggers the increase in oxysterol production downstream of the mevalonate pathway to initiate increasing transcription of ABCA1 gene [
47,
48]. Specific oxysterols can be produced de novo in the mevalonate pathway, independent of the common cholesterol derived oxysterol [
49]. Cholesterol in humans is predominately synthesized de novo by the liver, initiated by acetyl coenzyme 3-hydroxy-3-methyl-glutaryl-coenzyme [
50]. 24(
S),25-epoxycholesterol (24,25EC) is such an example, where it is produced from acetyl coenzyme during a gap in the mevalonate pathway [
51]. Similar to other oxysterols, 24,25EC has since shown in studies to activate LXR receptors [
52].
Table 1
Currently known effects of clinical and experimental drugs on ABCA1 expression in cells in vitro
Macrophage Cells | Simvastatin Atorvastatin TNF Cholesterol/CD Oxysterol (25 Hydroxyl Cholesterol) Cigarette Smoke Extract | ↓ ↓ ↓/↑ ↑ ↑ ↓ | |
Bronchial Epithelial Cells | Simvastatin Atorvastatin TNF Cholesterol/CD Oxysterol (25 Hydroxyl Cholesterol) | ns ns ↑ ↑ ↑ | |
Airway Smooth Muscle Cells | Cholesterol/CD | ↑ | |
Given the important role played by LXR in this pathway, it follows that a potential therapeutic target to modulate cholesterol homeostasis is by increasing ABCA1 expression through the LXR dependent pathway [
41]. To this end, a series of synthetic LXR agonists have been developed that are able to significantly increase ABCA1 expression [
42]. However LXR agonist treatment outcomes have been varied with reports of adverse off-target effects, including increased fatty acid, triglyceride synthesis and hepatic steatosis [
53‐
55]. Recently, there has been increasing interest in the possibility that LXRα, an isoform of LXR, is the primary cause for adverse effects of conventional LXR ligands [
56]. This has created interest in the development of LXRβ-specific drugs that are thought not to generate such adverse effects.