Background: Atherosclerosis is a chronic inflammatory pathology driven by lipid accumulation and immune activation. 25-Hydroxycholesterol (25-HC), an oxysterol synthesized by cholesterol 25-hydroxylase (CH25H) in response to inflammatory stimuli, has emerged as a potent bioactive lipid mediator at the nexus of cholesterol homeostasis and innate immunity.
Objective: Unlike broader reviews on oxysterols, this article synthesizes the multifaceted and context-dependent roles of 25-HC in atherogenesis. We aim to elucidate its specific mechanistic actions across endothelial cells, macrophages, and vascular smooth muscle cells (VSMCs), emphasizing its dual nature and potential as a therapeutic target.
Methods: We conducted a comprehensive review of the literature to integrate mechanistic insights into 25-HC signaling pathways, their regulation by specific transcription factors, and their impact on vascular pathology.
Results: 25-HC exhibits a distinct biphasic dose-response. At physiological concentrations, it maintains lipid homeostasis through suppression of SREBP processing and activation of LXR signaling. However, supraphysiological accumulation induces oxidative stress, mitochondrial dysfunction, and a coordinated activation of apoptosis and autophagy, ultimately precipitating cytotoxicity. Mechanistically, 25-HC disrupts membrane lipid rafts and activates the RIG-I/MAVS axis to drive pro-inflammatory cytokine secretion (e.g., IL-8). Within the plaque microenvironment, it impairs macrophage efferocytosis by downregulating MerTK and promotes VSMC proliferation and migration via PI3K/AKT pathways. Conversely, the transcription factor KLF4 and enzymatic sulfation by SULT2B1b act as critical protective checkpoints against 25-HC-mediated toxicity.
Conclusion: 25-HC is not merely a biochemical byproduct but a functional determinant of plaque instability. Its impact is strictly governed by local concentration gradients and metabolic regulation. Future therapeutic strategies should focus on modulating the CH25H/KLF4 axis and promoting oxysterol sulfation to mitigate vascular inflammation and prevent atherosclerosis progression.
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