Regulation of cholesterol homeostasis in health and diseases: from mechanisms to targeted therapeutics
Open accessAbstract
Disturbed cholesterol homeostasis plays critical roles in the development of multiple diseases, such as cardiovascular diseases (CVD), neurodegenerative diseases and cancers, particularly the CVD in which the accumulation of lipids (mainly the cholesteryl esters) within macrophage/foam cells underneath the endothelial layer drives the formation of atherosclerotic lesions eventually. More and more studies have shown that lowering cholesterol level, especially low-density lipoprotein cholesterol level, protects cardiovascular system and prevents cardiovascular events effectively. Maintaining cholesterol homeostasis is determined by cholesterol biosynthesis, uptake, efflux, transport, storage, utilization, and/or excretion. All the processes should be precisely controlled by the multiple regulatory pathways. Based on the regulation of cholesterol homeostasis, many interventions have been developed to lower cholesterol by inhibiting cholesterol biosynthesis and uptake or enhancing cholesterol utilization and excretion. Herein, we summarize the historical review and research events, the current understandings of the molecular pathways playing key roles in regulating cholesterol homeostasis, and the cholesterol-lowering interventions in clinics or in preclinical studies as well as new cholesterol-lowering targets and their clinical advances. More importantly, we review and discuss the benefits of those interventions for the treatment of multiple diseases including atherosclerotic cardiovascular diseases, obesity, diabetes, nonalcoholic fatty liver disease, cancer, neurodegenerative diseases, osteoporosis and virus infection.
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Intracellular cholesterol accumulation provides a potential explanation for the reduced nuclear localization of Srebp2 in Mecp2 KO astrocytes, given negative feedback.
“Notably, the accumulation of intracellular cholesterol provides a potential explanation for the reduced nuclear localization of Srebp2 observed in KO astrocytes, given the negative feedback exerted by intracellular cholesterol on Srebp2 activation (Duan et al., 2022;N.-Q. Wang et al., 2025).”
From Impaired astrocyte-to-neuron cholesterol trafficking drives synaptic dysfunction in Rett syndrome (2026) · cites this paper as Duan et al., 2022
Intracellular cholesterol inhibits Srebp2 activation through a negative feedback mechanism.
“However, intracellular cholesterol is known to inhibit Srebp2 activation through a negative feedback mechanism (Duan et al., 2022;Wang et al., 2025).”
From Impaired astrocyte-to-neuron cholesterol trafficking drives synaptic dysfunction in Rett syndrome (2026) · cites this paper as Duan et al., 2022
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- Authors
- Duan, Y., Gong, K., Xu, S., Zhang, F., Meng, X., & Han, J.
- Affiliations
- University of Science and Technology of China (CN)
- Hefei University of Technology (CN)
- Corresponding author
- Han, Jihong
- Venue
- Signal Transduction and Targeted Therapy
- Published
- 2022-08-02
- Volume
- 7
- Issue
- 1
- Pages
- 265-265
- ISSN
- 2059-3635 (ISSN-L)
- PMC
- PMC9344793
- OpenAlex
- W4289521847
- Cited by
- 538
- References
- 58
- Citations by year
- 2026: 148 · 2025: 193 · 2024: 114 · 2023: 73 · 2022: 9 · 2014: 1
- FWCI
- 23.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Signal Transduction and Targeted Therapy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (82173807, 8 197331 6)
- Nankai University (63211045)
- Tianjin Science and Technology Committee (20JCZDJC00710)
- Fundamental Research Funds for the Central Universities (63211045)
- Topics
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- cholesterol homeostasis, cholesterol biosynthesis, cholesterol absorption, cholesterol efflux, LDL cholesterol, atherosclerosis, cardiovascular disease, statins, HMG-CoA reductase inhibition, foam cells, non-alcoholic fatty liver disease, obesity, diabetes mellitus, cancer, neurodegenerative diseases, osteoporosis, viral infection
- MeSH terms
- Cardiovascular Diseases, Cholesterol, Foam Cells, Homeostasis, Humans, Atherosclerosis
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