Vnitr Lek 2011, 57(5):441-450

Disturbance of synthesis of cholesterol and its precursors in clinically serious conditions

P. Vyroubal^1,*, R. Hyšpler¹, A. Tichá¹, J. Samek², J. Cerman³, E. Havel³, J. Bajnárek¹, Z. Zadák¹

¹ Gerontologická a metabolická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Luboš Sobotka, CSc.

² Kardiochirurgická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jan Hamer, CSc.

³ Chirurgická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Alexander Ferko, CSc.

Objective:
The aim of the study was to elucidate the role and importance of hypocholesterolemia in clinically serious conditions. It was a monocentric, prospective clinical study.

Material and Methods:
Two groups of patients were recruited to the study - one group were patients with coronary heart disease (CHD), who underwent miniinvasive cardiosurgical operation without extracorporeal circulatio (n = 17) and one group of patients, who sustain polytrauma (n = 19). Thirty six patients were recruited into the study. We performed the determination of sterols (total cholesterol, HDL-cholesterol, LDL-cholesterol, triacylglycerols), and their precursors (β-sitosterol, campesterol, lathosterol, skvalen), interleukin IL-6 and cortisol in the blood serum. The short version of ACTH stimulation test was performed. The oxidative burst of granulocytes was evaluated. The blood samples were taken on the day of admission, the first, the fourth and the eighth post-operative and post-traumatic day.

Results:
There was a significant decline of total cholesterol (TC) and LDL-cholesterol level with full recovery during observed period. There was a decline of cholesterol synthesis (lathosterol and lathosterol/cholesterol ratio) together with a decline of total cholesterol. There was a significantly negative correlation between IL-6 level and total cholesterol. Despite no confirmation of disturbance of adrenal function, there was a significantly positive correlation between lathosterol/cholesterol ratio (a de novo cholesterol synthesis marker) and cortisol level after the ACTH stimulation test. There was a significant breakdown of bactericidal function of granulocytes along with a decline of cholesterol level.

Conclusion:
There was decline of endogenous cholesterol synthesis in clinically serious conditions. The cholesterol synthesis rate is negatively influenced by IL-6 level. The rate of endogenous cholesterol synthesis positively correlated with cortisol production by the adrenals and with bactericidal function of granulocytes.

Keywords: hypocholesterolemia; hypolipoproteinemia; SIRS; cytokine; cardiosurgery

Received: May 9, 2009; Accepted: December 4, 2010; Published: May 1, 2011  Show citation