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  Cholesterol, bile acids, and steroid hormones 
 Sterol metabolism 
              In humans cholesterol and cholesterol derivatives (steroid hormones, 
            bile acids) are essential metabolites for the physiological integration 
            of the body of the endocrine system, regulation of cell membrane processes, 
            and adsorption of dietary lipids. Cholesterol 
            (C00187; systematic name Cholest-5-en-3beta-ol) and its fatty acyl 
            esters (C02530) 
            are important structural components of membranes. Cholesterol also 
            serves as precursor for the synthesis of steroid hormones, vitamin 
            D, (C05441; vitamin D2)  and bile salts, which are important 
            in fat absorption from the small intestine into the blood circulatory 
            system and secretion of liver waste products through feces (e.g. bilirubin, 
            the end product of heme degradation which gives feces its dark coloration). 
            As for glucose, the body balance of cholesterol is under control of 
            the liver which regulates the turnover rate of cholesterol levels 
            via lipoprotein particles.
 Cholesterol synthesis 
              (KEGG pathway 
              MAP00100)
 While dietary cholesterol uptake in humans is limited to about 
              0.5g/day or less, all physiological requirments for cholesterol 
              are supplied by the liver through de novo synthesis of cholesterol 
              from acetyl-CoA. Cholesterol, a C27 compound is synthesized in a 
              pathway that can be split in three parts: 
              
              1. Synthesis of mevalonate, a reduced C6 compound from 3 Acetyl-CoA 
                units2. Activation of mevalonate to isopentenyl-PP (isoprene unit), 
                a C5 precursor which is used to elongate a lipid chain to squalene, 
                a C30 intermediate
 3. Cyclycation and demethylation of squalene by monooxygenases 
                to the cyclic C27 cholesterol end product
 The first part of cholesterol synthesis is located in the cytoplasmic 
              compartment in a process reminiscent of ketone body formation in 
              the mitochondrion. Two acetyl-CoA units are combined to acetoacetyl-CoA 
              (C00332) by a thiolase 
              (EC 2.3.1.9; Acetyl-CoA C-acetyltransferase) reaction.  The 
              acetoacetyl-CoA is further combined by hydroxymethylglutaryl-CoA 
              synthase (EC 4.1.3.5) with a third acetyl-CoA unit to form 
              the six carbon (C6) intermediate beta-hydroxy-beta-methylglutaryl-CoA 
              (C))356; HMG-CoA).  HMG-CoA is transported to the endoplasmatic 
              reticulum membrane where it is reduced to mevalonate 
              (C6 compound; C00418) by HMG-CoA 
              reductase (E.C. 1.1.1.34) using 2 molecules of NADPH as 
              reductant. HMG-CoA reductase is an integral membrane protein of 
              the ER membrane. 
             HMG-CoA formation is the key control in sterol synthesis and the 
              synthase is under control of cholesterol levels to adjust cholesterol 
              levels according to serum cholesterol levels (LDL). If cholesterol 
              uptake is low, liver and small intestine will synthesize cholesterol 
              accordingly. If HMG-CoA is not needed because of high levels of 
              dietary cholesterol, it is degraded quickly to acetoacetate 
              (C00164) and acetyl-CoA by HMG-CoA 
              lyase (EC 4.1.3.4) in the mitochondrial matrix compartment 
              contributing to ketone body formation. 
             Mevalonate is the immediate sterol synthesis precursor leading 
              to the formation of the cholesterol ring structure. Mevalonate is 
              decarboxylated to form the C5 intermediate isoprene 
              or isopentenyl diphosphate (C00129). Isoprene is a key intermediate 
              for different pathways including biosynthesis and degradation of 
              glycoproteins (see dolichol-PP; MAP00510), 
              terpenoids (plants; MAP00900), 
              and synthesis of coenzyme Q (ubiquinone), vitamin K, and carotenoids 
              (beta-carotene; 
              retinol biosynthesis MAP00830). 
             Here, isoprene is used to form the C30 compound squalene (from 
              6 isoprene units). In a first isomerization reaction (a) isopentenyl-PP 
              is in equilibrium with dimethyl-PP. One unit each condense (b) to 
              form the C10 compound geranyl-PP. A third C5 unit, isopentenyl-PP 
              is added to form the C15 intermediate farnesyl-PP, two of which 
              condense to form squalene plus pyrophosphate. This reaction is driven 
              by a reducing equivalent NADPH. 
             C5 + C5 = C10 (2x)C10 + C5 = C15 (2x)
 C15 + C15 = C30
 Squalene is cyclized to cholesterol, as is implied by the figure 
              above showing the coiled conformation of this linear aromatic molecule. 
              The cyclization reaction pathway is shown below. In three steps, 
              squalene is reduced in the presence of molecular oxygen and NADPH 
              to squalene epoxide which has a different C=C bond distribution 
              priming the molecule for carbon ring fusion. The latter is the substrate 
              for cyclase forming Lanosterol. Lanosterol is subsequently 
              reduced and three methyl units removed (demethylation) forming the 
              end product cholesterol. Cholesterol is ubiquitous in eukaryotes 
              but absent from most prokaryotes. Sterol metabolism is strictly 
              dependent on molecular oxygen. 
             Regulation of sterol 
              synthesis 
             HMG-CoA reductase is under negative feed back control by the sterol 
              synthesis end products cholesterol and bile salts. The important 
              indicator of HMG-CoA reductase is the blood cholesterol concentration 
              which is mostly determined by the presence of low density lipoprotein 
              particle (LDL).  The reductase is also under hormonal control 
              through a cAMP mediated second messenger pathway. The phosphorylated 
              reductase is inactive. The enzyme is inactivated by hydroxymethylglutaryl-CoA 
              reductase (NADPH)-kinase (EC 2.7.1.109) and reactivated by hydroxymethylglutaryl-CoA 
              reductase (NADPH)-phosphatase (EC 3.1.3.47). 
             Cures for high cholesterol 
              levels?  
             In addition, the reductase is targeted as a control enzyme by cholesterol 
              lowering drugs such as compactin (6-demethyl-mevinolin) which functions 
              as an antagonist, i.e., a competitive inhibitor for the substrate 
              HMG-CoA. Compactin has also been implicated in some forms of anticancer 
              treatments through mechanisms of cell growth inhibition. Another 
              inhibitor is pravastatin 
              (C01844) for treatment of atherosclerosis by lowering blood cholesterol 
              levels. [Note: agood inhibitor of an enzyme is called an antagonist 
              if it binds to the same site on the protein as the substrate (active 
              site). The inhibitor competes for the substrate, but no catalytic 
              reaction will occur. Ideally, the inhibitor will mimic the transition 
              state of the enzyme substrate complex. The side-chain of pravastatin 
              has a structure similar to that of hydroxy-methyl-glutarate on the 
              CoA molecule. Also the double cyclic ring structure of pravastatin 
              is important in its ability to bind to the enzyme active site.] 
             Distribution of cholesterol 
             Cholesterol is an essential component of mammalian cell membranes. 
              It is, however, not evenly distributed. Plasma membranes have a 
              cholesterol content of up to 45% of all lipids found, while ER membranes 
              contain as little as 10%. Inner mitochondrial membranes are almost 
              devoid of cholesterol. Actual cholesterol levels are cell type specific 
              and may vary. As for phospholipids and membrane proteins, cholesterol 
              is transported from its site of synthesis to other membranes by 
              vesicle transport. Cholesterol designated for secretion and transport 
              to other cells in the body  is acylated before incorporated 
              into lipoprotein particles. The low density lipoprotein particle 
              (LDL) is the major particle for cholesterol transport. LDL particles 
              are remnant of VLDL that contain both triglycerides and cholesterol. 
              VLDLs are produced in liver cells - lipids, cholesterol, proteins  
              - and transported from there to target organs to unload triglycerides 
              (to adipocyte, muscle). The remaining cholesterol rich LDLs are 
              recognized by other cell types by cell surface receptor specific 
              for LDLs. They are taken into the cells by endocyteoses and the 
              lysosomal compartment separates the components extracting cholesterol 
              for membrane biosynthesis in ER membranes and recycles the LDL receptor 
              to the cell surface. 
             Steroid hormone synthesis 
              KEGG pathway 
              MAP00140 
              and MAP00150)
 Steroid hormones are cholesterol derivatives in animals that are 
              used for a broad range of signaling mechanisms. Cholesterol is hydroxylated 
              and shortened (removing the the C6 hydrophobic side chain at position 
              C21)  to the C21 intermediates pregnenolone and progestagen. 
              The latter is a hormone secreted in the uterus controlling ovum 
              implantation. It is also the precursor for the male and female sex 
              hormones androgens (C19) and estrogens (C18), respectively. 
              Other hormones for both sexes include the mineralcorticoids 
              (e.g. aldosterone; C21) used to control kidney function (sodium, 
              potassium, proton absorption), and glucocorticoids (e.g. 
              cortisol C21), which are stress activators of gluconeogenesis,  
              glycogen, fat, and protein degradation, similar to the peptide hormone 
              glucagon. 
             One important enzyme type in sterol metabolism are the monooxygenases. 
              They catalyze an oxidation-reduction step in the presence of molecular 
              oxygen. One oxygen atom is used for hydroxyl (or epoxide) formation, 
              while the other is reduced to H2O. Monooxygenases are also known 
              as cytochrome P450 or mixed function oxygenases. 
             Bile acid synthesis 
              (KEGG pathway MAP00120)
 Bile acids are amphipathic derivatives of cholesterol. They 
              are synthesized in the liver and used as detergents in the gastro 
              intestinal tract. They are stored in the gallbladder from where 
              they are released into the small intestine to help solubilize dietary 
              fats. 
             Cholesterol is converted to trihydroxycoprostanoate. This reaction 
              includes the activity of 8 enzymes having either monooxygenase or 
              dehydrogenase activity. This includes EC 1.14.13.1 Cholesterol 
              7alpha-monooxygenase. This P450 heme-thiolate protein is acting 
              on paired donors with incorporation of molecular oxygen using NADH 
              or NADPH as one donor, and incorporation of one atom of oxygen. 
              A second type of oxidation is catalyzed by dehydrogenases like EC 
              1.1.1.181, Cholest-5-ene-3beta,7alpha-diol 3beta-dehydrogenase, 
              acting on the CH-OH group of donors and using NAD+ or NADP+ as acceptor 
              groups. Please note that some of the dehydrogenase and monooxygenases 
              are used in bile acid synthesis as well as steroid hormone synthesis. 
             The hydroxylation renders the sterol ring structure more water 
              soluble. The activated cholyl-CoA then reacts with the amino 
              acids glycine or taurine to form glycocholate or taurocholate, 
              respectively. These final bile acid structures are amphipathic molecules 
              forming small, water soluble micelles. It is the latter micelle 
              activity by which bile acids solubilize dietary lipids. 
             A small difference  
             Looking at the structure of cholesterol derivatives (hormones, 
              bile acids) the hydrogen at position C5 can be in one of two stereo-conformations: 
              alpha- or beta, trans or cis, respectively. The orientation is viewed 
              with respect to the orientation of the methyl groups C19 and C18 
              between rings A-B and C-D. The alpha form is typical for steroid 
              hormones, whereas the beta form is found only in bile acids. Stereo-chemical 
              differences is a major property in sterol metabolism and selectivity 
              of hormones for their receptors. 
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