High-density lipoprotein: gene-based approaches to the prevention of atherosclerosis

Although the atheroprotective role of high-density lipoprotein (HDL) has been well documented in epidemiological and animal studies, highly effective therapeutic approaches for the selective increase of plasma HDL levels or function are not yet available. Several mechanisms by which HDL exerts an atheroprotective effect have been proposed on the basis of experiments in vitro and in vivo. These mechanisms include directing excess cellular cholesterol from the peripheral tissues to the liver in 'reverse cholesterol transport', inhibiting oxidative modification or aggregation of LDL, and modulating inflammatory responses to favour vasoprotection. This review gives an overview of the genes regulating these mechanisms, such as those encoding apolipoprotein AT, lecithin:cholesterol acyltransferase (LCAT), scavenger receptor B1 (SR-BI), and the ATP-binding cassette transporter 1 (ABC1), and the potential to exploit them to develop gene-based therapeutic approaches to increase the level or function of HDL.