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Therapy and clinical trials: plant sterols and stanols in management of hypercholesterolemia: where are we now?

The mechanism of cholesterol absorption has remained an enigma until relatively recently. The discovery of ezetimibe as a potent and selective inhibitor of cholesterol absorption has provided new insights in the regulation of cholesterol absorption. It is the protein Niemann-Pick C1 like 1(NPC1L1) in the brush border epithelium of the proximal intestine which is the putative ‘sterol permease’ involved in cholesterol transport [1]. ABCG5 and ABCG8 are two separate ATP-binding cassette proteins involved in plant sterol exportation into the bile and intestinal lumen respectively [2], thus preventing their absorption under normal circumstances. These findings have enhanced our current understanding of cholesterol and related sterol absorption and the effect of dietary and drug intervention in management of hypercholesterolemia.