Membrane cholesterol and the formation of cholesterol domains in the pathogenesis of cardiovascular disease

At least three types of cholesterol-rich membrane domains have been described in biological membranes including cholesterol rafts, membrane caveolae and crystalline cholesterol domains,. While clear biological functions have been ascribed to both rafts and caveolae, little attention has been directed to the biological consequences of cholesterol enrichment of cell membranes and the formation of cholesterol domains. Elevated blood cholesterol levels have been shown to result in the enrichment of the cell plasma membrane with cholesterol in arterial smooth muscle cells (SMC), endothelial cells (EC) and cardiac myocytes. In the early period of cholesterol feeding (within days), the cell membrane enriches with cholesterol and membrane viscosity and membrane bilayer width increase. This latter effect severely alters membrane protein function, and recent data indicates that this induces the modulation of vascular cells (SMC and EC) to the atherosclerotic phenotype. In cardiac myocytes these membrane modifications appear to induce alterations in gene expression patterns that lead to the development of a heart failure phenotype. In addition, as the cholesterol content increases, phase separation of cholesterol occurs resulting in the formation of immiscible cholesterol domains within the membrane. These domains likely initiate nucleation of cholesterol crystals which would explain the origin of "cholesterol clefts" in atherosclerotic lesions. Taken together, these membrane alterations secondary to cholesterol enrichment constitute a "membrane lesion" which contribute to the very early pathogenic events underlying major human diseases including coronary artery disease, stroke and heart failure.