Cited by 92Lipoproteins and Cardiovascular HealthCancer, Lipids, and MetabolismCholesterol and Lipid Metabolism

ATP-citrate lyase: genetics, molecular biology and therapeutic target for dyslipidemia

Burke, Amy C., Huff, Murray W.·2017·Current Opinion in Lipidology

Abstract

Purpose of review: ATP-citrate lyase (ACLY) has re-emerged as a drug target for LDL cholesterol (LDL-C) lowering. We review ACLY as a therapeutic strategy, its genetics, its molecular and cellular biology, and also its inhibition. Recent findings: ACLY is a critical enzyme linking glucose catabolism to lipogenesis by providing acetyl-CoA from mitochondrial citrate for fatty acid and cholesterol biosynthesis. Human genetic variants have been associated with enhanced growth and survival of several cancers, and with attenuated plasma triglyceride responses to dietary fish oil. In mice, liver-specific Acly deficiency protects from hepatic steatosis and dyslipidemia, whereas adipose tissue-specific Acly deletion has no phenotype, supporting therapeutic inhibition of ACLY. A lipid-regulating compound, bempedoic acid, was discovered to potently inhibit ACLY, and in animal models, it prevents dyslipidemia and attenuates atherosclerosis. Phase 2 clinical trials revealed that bempedoic acid effectively lowers LDL-C as monotherapy, combined with ezetimibe, added to statin therapy and in statin-intolerant hypercholesterolemic patients. Summary: The efficacy of bempedoic acid as an LDL-C-lowering agent has validated ACLY inhibition as a therapeutic strategy. Positive results of phase 3 patient studies, together with long-term cardiovascular disease outcome trials, are required to establish ACLY as a major new target in cardiovascular medicine.

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Crossref · 10.1097/mol.0000000000000390

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Authors
Burke, A. C., & Huff, M. W.
Affiliations
Western University (CA)
Corresponding author
Huff, Murray W.
Venue
Current Opinion in Lipidology
Published
2017-04
Volume
28
Issue
2
Pages
193-200
ISSN
  • 0957-9672 (ISSN-L)
  • 1473-6535
OpenAlex
W2568968070
Cited by
91
References
54
Citations by year
2026: 6 · 2025: 8 · 2024: 9 · 2023: 11 · 2022: 9 · 2021: 7 · 2020: 14 · 2019: 15 · 2018: 8 · 2017: 4
FWCI
2.44
Type
journal article
Language
en
Open access
closed
Locations
  • Current Opinion in Lipidology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
Keywords
ATP citrate lyase, bempedoic acid, LDL cholesterol lowering, dyslipidemia, acetyl-CoA, lipogenesis, hepatic steatosis, atherosclerosis, genetic variants, fish oil, ezetimibe, statin intolerance, hypercholesterolemia, cholesterol biosynthesis, fatty acid synthesis
MeSH terms
Animals, ATP Citrate (pro-S)-Lyase, Dicarboxylic Acids, Enzyme Inhibitors, Fatty Acids, Humans, Dyslipidemias, Molecular Targeted Therapy

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