Tracking the dietary cholesterol molecule

Targeting endogenous cholesterol synthesis has been the focus of many strategies aimed at treating atherosclerosis. With limitations of this approach and the recent discovery of an intestinal cholesterol transporter, Niemann-Pick C1 like 1, and drugs blocking this process such as ezetimibe, the issue of intestinal cholesterol absorption has reached the forefront of lipidology. In addition, two half-transporters (sterolins), encoded by and , have been found to be the molecular reasons behind the human disorder of sitosterolemia. Sterolins seem to play a key role in keeping noncholesterol sterols, such as phytosterols, out of our bodies, and may also be key to cholesterol elimination via biliary secretion in the liver. This review explores the link between dietary cholesterol and atherosclerosis and the rationale behind the current dietary cholesterol recommendations. In addition, potential rate-limiting steps that may control intestinal cholesterol absorption are highlighted with summaries of the molecular insights gained over the past few years.