Imbalance between esterified and free cholesterol in blood plasma in multiple organ dysfunction syndrome

Objective. To evaluate changes in the levels of esterified and free cholesterol in blood plasma in multiple organ dysfunction syndrome (MODS) caused by an abdominal septic process.

Materials and methods. The fractions of esterified and free cholesterol were analyzed in blood samples from 11 patients with abdominal sepsis MODS, as well as in the blood of 9 healthy individuals made up the control group. The total cholesterol content was determined using an automatic biochemical analyzer, while thin-layer chromatography was used to analyze the fractions of free and esterified cholesterol. Statistical analyses were performed using non-parametric statistics; statistical differences were considered significant at p<0.05.

Results. The total plasma cholesterol of patients with sepsis and MODS was characterized by a substantially reduced esterified cholesterol fraction, and correspondingly increased free cholesterol proportion. Upon that the ratio of esterified to free cholesterol was almost four times lower than in the control group. The absolute concentration of esterified cholesterol in blood plasma of these patients was slightly more than half of the minimum normal value, while the concentration of free cholesterol was within the normal range.

Conclusion. The identified changes confirm data on decrease in the activity of lecithin-cholesterol acyltransferase (LCAT) in sepsis and MODS, which is responsible for the formation of the majority of esterified cholesterol in the blood by esterifying its free form. Moreover, it should be taken into account that this process is crucial for reverse cholesterol transport. Obtained results may also represent decreased activity of acyl-CoA cholesterol acyltransferase (ACAT), responsible for intracellular cholesterol esterification. Since the liver plays a leading role not only in cholesterol synthesis but also in LCAT production and ACAT-mediated esterification of cholesterol, the decline in esterified cholesterol levels during MODS likely reflects impaired hepatic metabolic function.

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