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Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets

Critical illness is characterized by a hypercatabolic response encompassing endocrine and metabolic alterations. Not only the uptake, synthesis and metabolism of glucose and amino acids is majorly affected, but also the homeostasis of lipids and cholesterol is altered during acute and prolonged crit...

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Autores principales: Lauwers, Caroline, De Bruyn, Lauren, Langouche, Lies
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10684846/
https://www.ncbi.nlm.nih.gov/pubmed/38015312
http://dx.doi.org/10.1186/s40635-023-00570-y
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author Lauwers, Caroline
De Bruyn, Lauren
Langouche, Lies
author_facet Lauwers, Caroline
De Bruyn, Lauren
Langouche, Lies
author_sort Lauwers, Caroline
collection PubMed
description Critical illness is characterized by a hypercatabolic response encompassing endocrine and metabolic alterations. Not only the uptake, synthesis and metabolism of glucose and amino acids is majorly affected, but also the homeostasis of lipids and cholesterol is altered during acute and prolonged critical illness. Patients who suffer from critically ill conditions such as sepsis, major trauma, surgery or burn wounds display an immediate and sustained reduction in low plasma LDL-, HDL- and total cholesterol concentrations, together with a, less pronounced, increase in plasma free fatty acids. The severity of these alterations is associated with severity of illness, but the underlying pathophysiological mechanisms are multifactorial and only partly clarified. This narrative review aims to provide an overview of the current knowledge of how lipid and cholesterol uptake, synthesis and metabolism is affected during critical illness. Reduced nutritional uptake, increased scavenging of lipoproteins as well as an increased conversion to cortisol or other cholesterol-derived metabolites might all play a role in the decrease in plasma cholesterol. The acute stress response to critical illness creates a lipolytic cocktail, which might explain the increase in plasma free fatty acids, although reduced uptake and oxidation, but also increased lipogenesis, especially in prolonged critical illness, will also affect the circulating levels. Whether a disturbed lipid homeostasis warrants intervention or should primarily be interpreted as a signal of severity of illness requires further research.
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spelling pubmed-106848462023-11-30 Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets Lauwers, Caroline De Bruyn, Lauren Langouche, Lies Intensive Care Med Exp Reviews Critical illness is characterized by a hypercatabolic response encompassing endocrine and metabolic alterations. Not only the uptake, synthesis and metabolism of glucose and amino acids is majorly affected, but also the homeostasis of lipids and cholesterol is altered during acute and prolonged critical illness. Patients who suffer from critically ill conditions such as sepsis, major trauma, surgery or burn wounds display an immediate and sustained reduction in low plasma LDL-, HDL- and total cholesterol concentrations, together with a, less pronounced, increase in plasma free fatty acids. The severity of these alterations is associated with severity of illness, but the underlying pathophysiological mechanisms are multifactorial and only partly clarified. This narrative review aims to provide an overview of the current knowledge of how lipid and cholesterol uptake, synthesis and metabolism is affected during critical illness. Reduced nutritional uptake, increased scavenging of lipoproteins as well as an increased conversion to cortisol or other cholesterol-derived metabolites might all play a role in the decrease in plasma cholesterol. The acute stress response to critical illness creates a lipolytic cocktail, which might explain the increase in plasma free fatty acids, although reduced uptake and oxidation, but also increased lipogenesis, especially in prolonged critical illness, will also affect the circulating levels. Whether a disturbed lipid homeostasis warrants intervention or should primarily be interpreted as a signal of severity of illness requires further research. Springer International Publishing 2023-11-28 /pmc/articles/PMC10684846/ /pubmed/38015312 http://dx.doi.org/10.1186/s40635-023-00570-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Reviews
Lauwers, Caroline
De Bruyn, Lauren
Langouche, Lies
Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
title Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
title_full Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
title_fullStr Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
title_full_unstemmed Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
title_short Impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
title_sort impact of critical illness on cholesterol and fatty acids: insights into pathophysiology and therapeutic targets
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10684846/
https://www.ncbi.nlm.nih.gov/pubmed/38015312
http://dx.doi.org/10.1186/s40635-023-00570-y
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