DRUG-CONTROL OF REVERSE CHOLESTEROL TRANSPORT

Reverse cholesterol transport identifies a series of metabolic events resulting in the transport of excess cholesterol from peripheral tissu es to the liver. High-density lipoproteins (HDL) are the vehicle of ch olesterol in this reverse transport, a function believed to explain th e inverse correlation between plasma HDL levels and atherosclerosis. A n attempt to stimulate, by the use of drugs, this transport process ma y hold promise in the prevention and treatment of arterial disease. Am ong the agents affecting lipoprotein metabolism, only probucol exerts significant effects on reverse cholesterol transport, by stimulating t he activity of the cholesteryl ester transfer protein and, consequentl y, altering HDL subfraction composition/distribution. Another approach to the stimulation of reverse cholesterol transport consists of raisi ng plasma HDL levels; studies in animals, either by exogenous suppleme ntation or by endogenous overexpression, have shown a consistent benef it in terms of atherosclerosis regression and/or non-progression. Thus , it is time to consider different future treatments of atherosclerosi s, combining the classical lipid-lowering treatments with innovative m ethods to promote cholesterol removal from the arterial wall.