Oxysterols and Alzheimer's disease

There is a clear link between cholesterol turnover and neurodegenerative diseases and hypercholesterolemia is an established risk factor for Alzheimer's disease (AD). The failure to demonstrate a transfer of cholesterol from the circulation into the brain in humans and experimental animals makes it difficult to explain the link between hypercholesterolemia and AD. In contrast to cholesterol itself, side‐chain oxidized cholesterol metabolites such as 24S‐hydroxycholesterol and 27‐hydroxycholesterol are able to pass the blood–brain barrier (BBB). Formation of 24S‐hydroxycholesterol is the quantitatively most important mechanism for elimination of cholesterol from the brain and we recently demonstrated a significant net uptake of 27‐hydroxycholesterol by the brain from the circulation. We have also shown that patients with AD have increased brain levels of 27‐hydroxycholesterol, which may affect the production of β‐amyloid in the brain. The levels of 27‐hydroxycholesterol in the circulation are correlated with the levels of cholesterol and the possibility must be considered that the flux of 27‐hydroxycholesterol into the brain is the missing link between hypercholesterolemia and Alzheimer's disease. Current knowledge about the role of the two oxysterols for cholesterol homeostasis in the brain as well as their diagnostic potential are reviewed.