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認識三高疾病系列 – 高血脂
高血壓
高血脂
高血糖
02 認識膽固醇
認識膽固醇
CHOLESTEROL
什麼是膽固醇?
膽固醇有什麼功能作用?
膽固醇從哪裡來?
膽固醇存於人體哪裡?
膽固醇的合成途徑是什麼?
血液中膽固醇來源是什麼?
什麼是膽固醇?
膽固醇是含有 27 個碳原子的分子。
每一條線表示兩個碳原子之間的鍵。
化學式為 C27H46O
膽固醇 (cholesterol) ,
是一種環戊烷多氫菲的衍生物。
環戊烷多氫菲是一種甾核,
很多藥物 ( 比如甾體激素類藥物 ) 的基本結構均具有
環戊烷駢多氫菲母核。
甾「音意同災 (zai) 」有機化合物的一類,
廣泛存在於動植物體內,
膽固醇和多種激素都屬於甾類化合物。
環戊烷駢多氫菲母核
(cyclopentanoperhydrophenanthrene nucleus) 的
17 位上有一個由 8 個碳原子組成的側鏈 ;
在母核上一般有 5 個甲基 , 即 4 位有偕二甲基 ,
10 位和 14 位各有一個甲基 ,
另一個甲基常連接在 13 位或 8 位上。
膽固醇最早於 1769 年,
由一位法國醫生 (François Poulletier de la Salle)
從膽結石中發現並分離出來。
發現這是有酒精成份,凝固成結晶體的化學物質。
1816 年,法國化學家 Michel Eugène Chevreul
將這種具脂類性質的物質命名為膽固醇。
其命名為希臘文中的 chole-( 膽汁 ) 加上  stereos( 固
體 ) ,再加上其化學結構中有羥基,
故再接上 "-ol" 在結尾上。
Cholesterol
中文翻譯便成了「膽固醇」。
膽固醇 (cholesterol) 其溶解性與脂肪類似,
不溶于水,易溶於乙醚、氯仿等溶劑。
膽固醇 (Cholesterol)
膽固醇 (Cholesterol) 別名膽甾醇,
是一種類固醇及甾醇,化學式為 C27H46O 。
膽固醇 (Cholesterol)
固態之下膽固醇是一種無色的結晶。
膽固醇有什麼功能作用?
膽固醇是體內最豐富的固醇類化合物。
組成並穩定細胞膜
合成體內固醇類荷爾蒙的基本原料
糖質新生
膽固醇的轉化: 1. 轉變為膽汁酸 ( 肝臟 )
—— 最主要的去路 (0.4~0.6g/ 天 ) 。
初級膽汁酸的生成:肝細胞以膽固醇為原料,
經多個步驟合成初級膽汁酸,
其中關鍵酶為膽固醇 7α- 羥化酶。
將膽固醇轉化為膽汁酸,
這是肝臟清除膽固醇的主要方式。
膽固醇的轉化: 2. 類固醇激素 ( 腎上腺和性
腺 )
皮質醇。性激素 ( 睾丸酮、雌二醇、孕酮 ) 。
膽固醇的轉化: 3. 轉化為 7- 脫氫膽固醇  
皮膚中膽固醇氧化為 7- 脫氫膽固醇。
7- 脫氫膽固醇經日光照射可以轉變為維生素 D3 。
膽固醇既作為細胞生物膜的構成成分,
又是類固醇類激素、膽汁酸及
維生素 D 的前體物質。
膽汁 (Bile) 是由大多數脊椎動物的
肝細胞分泌出的一種綠黃色、
帶有苦澀味的鹼性液體。
肝臟持續分泌出膽汁,存放於膽囊內,
然後在進食時把膽汁經膽總管
釋放入小腸幫助消化。
膽囊
膽道系統
膽總管
肝臟
膽汁的主要作用是乳化脂質 ( 其中不含酵
素 ) ,
其主要成分包括:膽鹽 ( 鈉甘膽酸鹽、 sodium taurocholate) :
為結合膽汁酸的鈉鹽;膽鹽可以降低脂肪表面張力
,
使脂肪乳化,分散於溶液中,增加胰脂肪酶的作用
面積;膽鹽達到一定濃度,聚合成微膠粒,脂肪酸
、
甘油一脂滲入微膠粒中,促進脂肪酸的吸收。
膽色素:為血紅蛋白的分解產物,由膽紅素、膽綠
素組成;決定著膽汁的顏色,膽色素過多可出現黃
疸。
膽固醇:為膽汁酸的前身;一般膽鹽、膽固醇和卵
磷脂 (Lecithin) 保持適當的比例,膽固醇呈溶解狀態
,
若比例失調,易沉積成膽結石。
膽汁酸 (bile acids , BA) 為膽汁的主要有機成分,
是幾種結構類似的類固醇酸的統稱。
在人類的膽汁中,結合型膽汁酸是主要的存在形式
,
在膽汁 pH 環境下,幾乎均以鈉鹽或鉀鹽的形式存在
,稱為膽汁酸鹽,簡稱膽鹽 (bile salts) 。
肝細胞以膽固醇為原料,
經多個步驟合成初級膽汁酸,
其中關鍵酶為膽固醇 7α- 羥化酶。
Cholesterol 7 alpha-hydroxylase also known as cholesterol 7-alpha-monooxygenase
or cytochrome P450 7A1 (CYP7A1)
將膽固醇轉化為膽汁酸,
這是肝臟清除膽固醇的主要方式。
早期的降膽固醇治療,就是採用口服膽汁酸結合劑,
促進肝細胞合成更多膽汁酸,以消耗膽固醇。
類固醇的功能作用 1/3 :形成膽酸
膽汁產于肝臟而儲存於膽囊內,
經釋放進入小腸與被消化的脂肪混合。
膽汁的功能是將大顆粒的脂肪變成小顆粒,
使其易於與小腸中的酶作用。
在小腸尾部, 85 %~ 95 %的膽汁被重新吸收入血
,
肝臟重新吸收膽酸使之不斷循環,
剩餘的膽汁 (5 %~ 15 % ) 隨糞便排出體外。
肝臟需產生新的膽酸來彌補這 5 %~ 15 %的損失,
此時就需要膽固醇。
類固醇的功能作用 2/3 :構成細胞膜
細胞膜包圍在人體每一細胞外,膽固醇為它的
基本組成成分,占質膜脂類的 20 %以上。
有人曾發現給動物餵食缺乏膽固醇的食物,
結果這些動物的紅細胞脆性增加,容易引起細胞的破
裂。
研究表明:
溫度高時,膽固醇能阻止雙分子層的無序化;
溫度低時又可干擾其有序化,
阻止液晶的形成,保持其流動性。
因此,要是沒有膽固醇,細胞就無法維持
正常的生理功能,生命也將終止。
類固醇的功能作用 3/3 :合成激素
激素是協調多細胞機體中不同細胞代謝作用的
化學信使,參與機體內各種物質的代謝,
包括糖、蛋白質、脂肪、水、電解質和礦物質等代
謝,
對維持人體正常的生理功能十分重要。
人體的腎上腺皮質和性腺所釋放的各種激素,
如皮質醇、醛固酮、睾丸酮、雌二醇以及維生素 D
都
屬於類固醇激素,其前體物質就是膽固醇。
因此對于大多數組織來說,
保證膽固醇的供給,
維持其代謝平衡是十分重要的。
膽固醇有 2 種形式:
酯化膽固醇 (Cholesterol-ester) 及
游離膽固醇 (Free cholesterol )
“ 游離”或“未酯化” (unesterified cholesterol, UC ,
代表未酯化的膽固醇 ) ,這是它活性的形式。
上圖顯示一個游離的膽固醇分子 ( 即, UC) 。
酯化的變體 ( 即 CE) 有一個“附屬物”,箭頭指向的羥基的碳# 3 ,命名為“酯化的地點。”
游離膽固醇 (Free cholesterol )
以它的“酯化”或存儲的形式存在,
我們稱之為膽固醇酯 (cholesterol ester, CE) 。
酯化膽固醇 (Cholesterol-ester)
膽固醇從哪裡來?
膽固醇主要來自人體自身的合成,
食物中的膽固醇是次要補充。
如一個 70kg 體重的成年人:
體內大約有膽固醇 140g ,每日大約更新 1g ,
其中 4/5 在體內代謝產生,只有 1/5 需從食物補充,
每人每日從食物中攝取膽固醇 200mg ,
即可滿足身體需要。
膽固醇的吸收率只有 30% ,
隨著食物膽固醇含量的增加,
吸收率還要下降。
200mg 大約相當於 1 個雞蛋中的膽固醇含量或
3-4 個雞蛋的膽固醇吸收量。
專家建議每天攝入 50mg~300mg 膽固醇為佳。
膽固醇存在於人體哪裡?
人體中膽固醇的總量大約占體重的 0.2 %。
骨質約含 10 毫克,骨骼肌約含 100 毫克,
內臟多在 150-250 毫克之間,
肝臟和皮膚含量稍高,約為 300 毫克。
腦和神經組織中含量最高,
每 100 克組織約含 2 克,
其總量約占全身總量的 l / 4 。
所有的動物細胞都會生產膽固醇為它們的使用,
只是依據不同細胞類型和器官的功能而有不同的生產
率。
約 20-25 %的每日總膽固醇生產發生在肝臟 ;
其他合成速率較高的包括腸、腎上腺和生殖器官。
膽固醇的合成途徑是什麼?
類固醇的合成原料
乙醯輔酶 A (Acetyl coenzyme A or acetyl-CoA) 是
膽固醇合成的直接原料,
它來自葡萄糖、脂肪酸及某些氨基酸的代謝產物。
另外,還需要 ATP 供能和 NADPH 供氫。
合成 1 分子膽固醇需消耗 18 分子乙醯輔酶 A  、
36 分子 ATP 和 16 分子 NADPH 。
甲羥戊酸途徑
( 類固醇的合成途徑 ) 。
膽固醇合成過程比較復雜
,有近 30 步反應。
類固醇的合成途徑,整個過程可分為 3 個階段。
羥甲基戊二酸單醯輔酶 A
(3-hydroxy-3-methylglutaryl-CoA ,
簡稱「 HMG-CoA 」 ) 的生成。
甲羥戊酸 (mevalonic acid , MVA) 的生成。
膽固醇的生成。
甲羥戊酸途徑 (Mevalonate pathway) ,
也被稱為異戊二烯途徑 (Isoprenoid pathway) 或
HMG-CoA 還原酶 (HMG-CoA reductase pathway) 途徑,
是存在於真核生物,古菌和一些細菌中重要的代謝途
徑。
該途徑產生兩種被稱為五碳構件異戊二烯焦磷酸 (IPP)
和二甲基烯丙基焦磷酸 (DMAPP) ,這用來產生異戊
二烯,一個多樣化的類,超過 30,000 的生物分子例如
膽固醇,
血紅素,維生素 K ,輔酶 Q10 ,及所有的類固醇激素。
甲羥戊酸途徑開始於乙醯 -CoA ,
而結束於產生 IPP 和 DMAPP 。
以乙醯輔酶 A 為原料合成 IPP 和 DMAPP 的一條代謝
途徑,存在於所有高等真核生物和很多病毒中。
該途徑的產物可以看作是活化的異戊二烯單位,
是類固醇、類萜等生物分子的合成前體。
乙醯輔酶 A(Acetyl coenzyme A or acetyl-CoA) 是
活化了的乙酸,由乙醯基 (CH3CO-) 與輔酶 A 的
半胱胺酸殘基的 SH- 基團以高能的硫酯鍵相連。
乙醯輔酶 A
乙醯 -CoA 的結構式的概要
乙醯輔酶 A 是脂肪酸的 β- 氧化及糖解作用後
產生的丙酮酸脫羧後的產物。
β- 氧化指的是脂肪酸氧化分解,最終產生乙醯輔酶 A ( Acetyl-CoA )和酮體的過程。
在檸檬酸循環的第一步,乙醯基轉移到草醯乙酸中,
生成檸檬酸,因而得名。
乙醯輔酶 A 是人體內重要的化學物質。
它是脂肪酸合成、膽固醇合成和生酮作用的碳來源。
人體體內合成膽固醇開始於
甲羥戊酸途徑 (mevalonate pathway) :
兩分子的乙醯輔酶 A 先在硫解酶的作用下縮合成為
乙醯乙醯輔酶 A(Acetoacetyl CoA) 。
乙醯乙醯輔酶 A(Acetoacetyl CoA)
硫解酶 ( thiolase) 催化脂肪酸 β 氧化反應中硫解作用的酶。
接著乙醯輔酶 A 再與乙醯乙醯輔酶 A 縮合成羥甲基戊
二酸單醯輔酶 A(3-hydroxy-3-methylglutaryl-CoA ,
簡稱「 HMG-CoA 」 ) 也稱為「 β- 羥基 -β- 甲戊二酸
單醯輔酶 A 」或「 3- 羥基 -3- 甲戊二酸單醯輔酶 A 」。
HMG-CoA
HMGCoA 在 HMG CoA 還原酶 (HMGCoA reductase)
催化下,消耗兩分子 NADPH+H+ 生成甲羥戊酸
(MVA) 。
(mevalonic acid , MVA) 
生產甲羥戊酸在膽固醇合成中是限速和不可逆轉的步
驟。
甲羥戊酸通過兩個步驟的磷酸化和一個步驟的脫羧最
終
轉化成異戊烯基焦磷酸 (isopentenyl pyrophosphate,
IPP) 。
三個分子的異戊烯基焦磷酸通過
香葉基轉移酶 (geranyl transferase) 的作用下縮合成
法尼基焦磷酸 (farnesyl pyrophosphate) 。
兩個分子的法尼基焦磷酸然後在內質網經由
角鯊烯合酶 (squalene synthase) 的作用縮合形成
角鯊烯 (Squalene) 。
角鯊烯經由環氧角鯊烯環化酶 (Oxidosqualene
cyclase) 環化後形成羊毛甾醇 (lanosterol) 。
最後,羊毛甾醇通過一個 19 步驟的過程轉化為膽固
醇。
膽固醇廣泛存在于全身各組織中:
其中約 1/4 分布在腦及神經組織中,
占腦組織總重量的 2% 左右。
肝、腎及腸等內臟以及皮膚、脂肪組織亦含
較多的膽固醇,每 100g 組織中約含 200 至
500mg ,
以肝為最多,而肌肉較少,腎上腺、卵巢等組織
膽固醇含量可高達 1%-5% ,但總量很少。
血液中膽固醇來源是什麼?
血液中膽固醇來源有兩大部分:
1. 身體大部分的細胞自行合成,
稱為內源性 (Endogenous) 膽固醇。
2. 源自飲食,主要取自動物性食物,
尤其是動物的腦、肝、腎及蛋黃等。
稱為外源性 (Exogenous) 膽固醇。
源自飲食的膽固醇占約 25%(300 - 500 mg) ,
身體自行合成的膽固醇占約 75%(800 - 1,200 mg) 。
外源性膽固醇
exogenous
cholesterol
內源性膽固醇
endogenous
cholesterol
全身存儲膽固醇約 30 〜 40 克,
大多數存在於我們的細胞膜內。
在身體每個細胞都可產生膽固醇,
因而很少有細胞實際上需要膽固醇的輸送。
食物中的膽固醇及三酸甘油脂都在小腸被吸收。
小腸黏膜可製造乳糜微粒,
攜帶這些脂肪進入淋巴系統,
再經由胸管進入血液循環。
只有游離或未酯化的膽固醇 (UC)
可通過小腸黏膜細胞被吸收。
換言之,膽固醇酯 (CE) 不能被吸收,
因為它們攜帶笨重的側鏈。
我們從食物中攝取的大部分 (> 50 % ) 是
膽固醇酯 (CE) 。
因此,我們實際上吸收並不多外源性膽固醇
( 即食品中的膽固醇 ) 。
膽固醇酯可以被胰脂肪酶 (pancreatic lipase) 和
酯解酶 (esterase) - 折斷側枝並將 CE 轉回 UC 的酶 -
進行脫酯,所以一些攝入的 CE 可以被轉換為 UC 。
腸道中大部分 ( 約 85 % ) 的未酯化膽固醇 (UC) 實際
上是
內源性來源的 ( 在身體細胞中合成並返回到肝臟 ) 。
其通過膽汁的分泌而到達腸道,
最終由得到由小腸黏膜細胞重新吸收。
肝臟只能外排 ( 經由排出膽汁進入腸道 )UC ,
而不是 CE ,從肝細胞到膽道系統。
肝臟的 CE 無法排泄到膽汁。
因此,如果肝臟是要排泄 CE 到膽汁和最終到腸道,
它需要使用一種酶稱為膽固醇酯解酶來脫脂化,
酯解酶把肝臟的 CE 轉化為 UC 。
肝臟要排出自身的膽固醇最好的方式是
將膽固醇轉化成膽汁酸。
肝細胞以膽固醇為原料,經多個步驟合成初級膽汁酸
,
其中關鍵酶為膽固醇 7α- 羥化酶 (7α-hydroxylase) 。
然後將膽汁酸外排到膽汁
( 通過 ABCB11 轉運器 ) 。
ABCB11 基因編碼產生膽鹽輸出泵 (BSEP),BSEP 是位
於肝細胞毛細膽管面上的重要轉運體 , 將膽鹽從肝細
胞內
轉運到毛細膽管中 , 是形成膽汁流的最主要動力。
然後將膽汁酸經糞便中排泄
( 通常為大多數膽汁酸會在迴腸再吸收 ) 。
植物性食品不含膽固醇,
而含植物固醇如 β 谷固醇、麥角固醇等,
它們不易為人體吸收,
攝入過多還可抑制膽固醇的吸收。
β- 谷固醇 (β-Sitosterol) 麥角固醇 (Ergosterol)
沙拉油所含的植物固醇
可減少膽固醇於小腸的吸收
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Three-Hypers Series - Hyperlipidemia - 02 Introduction to Cholesterol

Editor's Notes

  1. Cholesterol is a 27-carbon molecule shown in the figure below. Each line in this figure represents a bond between two carbon atoms.  膽固醇是含有27個碳原子的分子。每一條線表示兩個碳原子之間的鍵。
  2. 甾「音意同災(zai)」)有机化合物的一类,广泛存在于动植物体内,胆固醇和多种激素都属于甾类化合物。 環戊烷駢多氫菲母核的17位上有一個由8個碳原子組成的側鏈;在母核上一般有5個甲基,即4位有偕二甲基,10位和14位各有一個甲基,另一個甲基常連接在13位或8位上. 環戊烷駢多氫菲母核英文翻譯:cyclopentanoperhydrophenanthrene nucleus
  3. 環戊烷駢多氫菲母核的17位上有一個由8個碳原子組成的側鏈;在母核上一般有5個甲基,即4位有偕二甲基,10位和14位各有一個甲基,另一個甲基常連接在13位或8位上. 環戊烷駢多氫菲母核英文翻譯:cyclopentanoperhydrophenanthrene nucleus
  4. 1769年 François Poulletier de la Salle first identified cholesterol in solid form in gallstones in 1769. However, it was not until 1815 that chemist Michel Eugène Chevreul named the compound "cholesterine". François Poulletier de la Salle (September 30, 1719 in Lyon – March 20, 1788 in Paris) was a French doctor and chemist. In about 1758, he isolated for the first time the crystals from cholesterol. 
  5. 米歇爾-歐仁·謝弗勒爾(法語:Michel-Eugène Chevreul,1786年8月31日-1889年4月9日),法國化學家,對動物脂肪的組成和皂化反應的本質進行了深入研究,從多種脂肪里提純了硬脂酸、油酸和十九酸等脂肪酸。
  6. 當中Chole 是「膽汁」,Stereos是「固體」和硬,ol是酒精的化學名稱「醇」,中文翻譯便成了「膽固醇」。
  7. 糖質新生(gluconeogenesis) 1. 定義:由丙酮酸(pyruvate)合成葡萄糖的過程
  8. 膽固醇廣泛存在於動物體的細胞膜中,同時也是合成幾種重要荷爾蒙及膽酸(膽汁的重要成分)的材料。
  9. 膽固醇廣泛存在於動物體的細胞膜中,同時也是合成幾種重要荷爾蒙及膽酸(膽汁的重要成分)的材料。
  10. Cholesterol, a steroid alcohol, can be “free” or “unesterified” (“UC” as we say, which stands for unesterified cholesterol) which is its active form, or it can exist in its “esterified” or storage form which we call a cholesterol ester (“CE”).  The diagram above shows a free (i.e., UC) molecule of cholesterol.  An esterified variant (i.e., CE) would have an “attachment” where the arrow is pointing to the hydroxyl group on carbon #3, aptly named the “esterification site.” 膽固醇,一種類固醇的醇(酒精) ,可以是“游離”或“酯化”(unesterified cholesterol, UC,代表未酯化的膽固醇),這是它活性的形式;或者它可以在它的“酯化”或存儲的形式存在,我們稱之為膽固醇酯(cholesterol ester, CE)。 上面的圖表顯示一個游離的膽固醇分子(即,UC)。酯化的變體(即CE)有一個“附屬物”,箭頭指向的羥基的碳#3,命名為“酯化的地點。”
  11. Cholesterol, a steroid alcohol, can be “free” or “unesterified” (“UC” as we say, which stands for unesterified cholesterol) which is its active form, or it can exist in its “esterified” or storage form which we call a cholesterol ester (“CE”).  The diagram above shows a free (i.e., UC) molecule of cholesterol.  An esterified variant (i.e., CE) would have an “attachment” where the arrow is pointing to the hydroxyl group on carbon #3, aptly named the “esterification site.” 膽固醇,一種類固醇的醇(酒精) ,可以是“游離”或“酯化”(unesterified cholesterol, UC,代表未酯化的膽固醇),這是它活性的形式;或者它可以在它的“酯化”或存儲的形式存在,我們稱之為膽固醇酯(cholesterol ester, CE)。 上面的圖表顯示一個游離的膽固醇分子(即,UC)。酯化的變體(即CE)有一個“附屬物”,箭頭指向的羥基的碳#3,命名為“酯化的地點。”
  12. Cholesterol, a steroid alcohol, can be “free” or “unesterified” (“UC” as we say, which stands for unesterified cholesterol) which is its active form, or it can exist in its “esterified” or storage form which we call a cholesterol ester (“CE”).  The diagram above shows a free (i.e., UC) molecule of cholesterol.  An esterified variant (i.e., CE) would have an “attachment” where the arrow is pointing to the hydroxyl group on carbon #3, aptly named the “esterification site.” 膽固醇,一種類固醇的醇(酒精) ,可以是“游離”或“酯化”(unesterified cholesterol, UC,代表未酯化的膽固醇),這是它活性的形式;或者它可以在它的“酯化”或存儲的形式存在,我們稱之為膽固醇酯(cholesterol ester, CE)。 上面的圖表顯示一個游離的膽固醇分子(即,UC)。酯化的變體(即CE)有一個“附屬物”,箭頭指向的羥基的碳#3,命名為“酯化的地點。”
  13. All animal cells manufacture cholesterol for their use, with relative production rates varying by cell type and organ function. 所有的動物細胞都會生產膽固醇為它們的使用,只是依據不同的細胞類型和器官的功能而有不同的生產率。 About 20–25% of total daily cholesterol production occurs in the liver; other sites of higher synthesis rates include the intestines, adrenal glands, and reproductive organs. 約20-25%的每日總膽固醇生產發生在肝臟;其他合成速率較高的包括腸,腎上腺和生殖器官。
  14. 乙醯-CoA 乙醯輔酶A(Acetyl coenzyme A or acetyl-CoA ) acetyl [æsitil] n.[化]乙醯基,醋酸基 醯基(「醯」,拼音:xiān,注音:ㄒㄧ;英語:acyl group)是指從含氧酸,包括無機酸中除去一個或多個羥基基團的衍生的官能團。
  15. 羥ㄑ|ㄤˇ :着一種由氫、氧原子組成的原子團。
  16. β-氧化指的是脂肪酸氧化分解,最終產生乙醯輔酶A(Acetyl-CoA)和酮體的過程。
  17. Synthesis within the body starts with the mevalonate pathway where two molecules of acetyl CoA condense to form acetoacetyl-CoA. 在體內合成開始於甲羥戊酸途徑,其中的乙酰輔酶A縮合成兩分子以形成乙酰乙酰CoA。
  18. Synthesis within the body starts with the mevalonate pathway where two molecules of acetyl CoA condense to form acetoacetyl-CoA.
  19. This is followed by a second condensation between acetyl CoA and acetoacetyl-CoA to form 3-hydroxy-3-methylglutaryl CoA (HMG-CoA).[37]  這之後是乙酰CoA和乙酰乙酰CoA之間的第二縮合以形成3-羥基-3-甲基輔酶A(HMG-COA)。[37] ======================================================================================== 羥甲基戊二酸單醯輔酶A(3-hydroxy-3-methylglutaryl-CoA,簡稱「HMG-CoA」)也稱為「β-羥基-β-甲戊二酸單醯輔酶A」或「3-羥基-3-甲戊二酸單醯輔酶A」,是一種重要的脂類代謝中間產物。 合成β-羥-β-甲戊二酸單醯輔酶A需要三分子的乙醯輔酶A,其中兩分子的乙醯輔酶A先在硫解酶的作用下縮合成為乙醯乙醯輔酶A,後者在β-羥-β-甲戊二酸單醯輔酶A合酶的作用下與另一分子的乙醯輔酶A合成出β-羥-β-甲戊二酸單醯輔酶A。 該物質可以走向兩種途徑:在β-羥-β-甲戊二酸單醯輔酶A裂解酶的作用下裂解為乙醯乙酸,繼而生成丙酮和β-D-羥丁酸,這三者被稱為酮體;在β-羥-β-甲戊二酸單醯輔酶A還原酶的作用下還原為甲羥戊酸,繼而參與動植物中萜類、固醇類化合物的合成。 故植物中不少次生代謝產物或激素是由這種化合物衍生而來的,如赤黴素、脫落酸等,動物體內則以此合成膽固醇及各種類固醇激素等。
  20. This molecule is then reduced to mevalonate by the enzyme HMG-CoA reductase. 該分子隨後通過酶HMG-CoA還原酶降低到甲羥戊酸。 Production of mevalonate is the rate-limiting and irreversible step in cholesterol synthesis and is the site of action for statins (a class of cholesterol lowering drugs). 生產甲羥戊酸是在膽固醇合成中限速和不可逆轉的步驟,是作用部位為他汀類藥物(類的降膽固醇的藥物)。
  21. Evaluate is finally converted to isopentenyl pyrophosphate (IPP) through two phosphorylation steps and one decarboxylation step that requires ATP. 甲羥戊酸通過兩個步驟的磷酸化和一個步驟的脫羧最終轉化成異戊烯焦(IPP)。焦磷酸異戊烷
  22. Three molecules of isopentenyl pyrophosphate condense to form farnesyl pyrophosphate through the action of geranyl transferase. 三個分子的異戊烯焦冷凝以形成通過香葉基轉移酶的作用下法尼焦磷酸。 在膽固醇合成中,需要從牻牛兒基(geranyl)和異戊烯焦磷酸生成法呢基(farnesyl)焦磷酸。
  23. Two molecules of farnesyl pyrophosphate then condense to form squalene by the action of squalene synthase in the endoplasmic reticulum.[37]  兩個分子的法尼基焦磷酸然後在內質網經由角鯊烯合酶squalene synthase的作用縮合形成角鯊烯Squalene 內質網(英語:Endoplasmic reticulum, ER)是在真核生物細胞中由膜圍成的隧道系統,為細胞中的重要胞器。 鯊烯(Squalene),又稱角鯊烯,是一種開鏈三萜類化合物。因最初從鯊魚肝油中提取得到,故得名鯊烯。隨後發現鯊魚卵油及其他魚中也含有它,現在發現它的分布比預想的要廣泛許多,真菌及人耳垢中含有少量。鯊烯是膽固醇生物合成中間體之一,是所有類固醇類物質的生物合成前體。
  24. Oxidosqualene cyclase then cyclizes squalene to form lanosterol.環氧角鯊烯環化酶然後環化角鯊烯以形成羊毛甾醇。 羊毛甾醇;羊毛脂醇;異膽甾醇;羊毛脂甾醇
  25. Finally, lanosterol is converted to cholesterol through a 19-step process. 最後,羊毛甾醇是通過一個19步驟的過程轉化為膽固醇。
  26. 膽固醇廣泛存在于全身各組織中,其中約1/4分布在腦及神經組織中,占腦組織總重量的2%左右。肝、腎及腸等內臟以及皮膚、脂肪組織亦含較多的膽固醇,每100g組織中約含200至500mg,以肝為最多,而肌肉較少,腎上腺、卵巢等組織膽固醇含量可高達1%-5%,但總量很少。
  27. 內源性物質,是體內代謝中產生的活性物質及最終產物,比如NH3、胺類、激素、膽色素、神經遞質等都可以稱為內源性物質。 Endogenous substances and processes are those that originate from within an organism, tissue, or cell. The word endogenous /ɛnˈdɒdʒɪnəs/ derives from the Ancient Greek ἐνδο-, "inside" and -γενής, "coming from". Exogenous exogenous /,ɛks'odʒənəs/  (a.)外生的來源
  28.   About 25% of our daily “intake” of cholesterol – roughly 300 to 500 mg — comes from what we eat (called exogenous cholesterol), and the remaining 75% of our “intake” of cholesterol — roughly 800 to 1,200 mg – is made by our body (called endogenous production).   約25%的我們每天膽固醇的“攝入”的 - 大約300至500毫克 - 來自我們吃什麼(稱為外源性膽固醇),和我們的膽固醇“攝入”的其餘75% - 大約800至1200毫克 - 由我們的身體(稱為內源性產生)。
  29. To put these amounts in context, consider that total body stores of cholesterol are about 30 to 40 gm (i.e., 30,000 to 40,000 mg) and most of this resides within our cell membranes.   全身存儲膽固醇約30〜40克(即30,000到40,000毫克),大多數存在於我們的細胞膜內。 Every cell in the body can produce cholesterol and thus very few cells actually require a delivery of cholesterol.  在身體每個細胞都可產生膽固醇,因而很少有細胞實際上需要膽固醇的輸送。
  30. To put these amounts in context, consider that total body stores of cholesterol are about 30 to 40 gm (i.e., 30,000 to 40,000 mg) and most of this resides within our cell membranes.   全身存儲膽固醇約30〜40克(即30,000到40,000毫克),大多數存在於我們的細胞膜內。 Every cell in the body can produce cholesterol and thus very few cells actually require a delivery of cholesterol.  在身體每個細胞都可產生膽固醇,因而很少有細胞實際上需要膽固醇的輸送。
  31. Only free or unesterified cholesterol (UC) can be absorbed through gut enterocytes.  In other words, cholesterol esters (CE) cannot be absorbed because of the bulky side chains they carry. 只有游離或未酯化的膽固醇(UC)可通過腸道腸吸收。換言之,膽固醇酯(CE)不能被吸收,因為它們攜帶笨重的側鏈。 小腸的絨毛細胞 腸上皮細胞(enterocyte) 腸黏膜細胞(enterocyte)
  32. Only free or unesterified cholesterol (UC) can be absorbed through gut enterocytes.  In other words, cholesterol esters (CE) cannot be absorbed because of the bulky side chains they carry. 只有游離或未酯化的膽固醇(UC)可通過腸道腸吸收。換言之,膽固醇酯(CE)不能被吸收,因為它們攜帶笨重的側鏈。 小腸的絨毛細胞 腸上皮細胞(enterocyte) 腸黏膜細胞(enterocyte)
  33. Much (> 50%) of the cholesterol we ingest from food is esterified (CE), hence we don’t actually absorb much, if any, exogenous cholesterol (i.e., cholesterol in food).  大部分(> 50%)我們從食物攝取的是膽固醇酯(CE),因此,我們實際上吸收並不多外源性膽固醇(即,食品中的膽固醇)。
  34. CE can be de-esterified by pancreatic lipases and esterolases – enzymes that break off the side branches and render CE back to UC — so some ingested CE can be converted to UC. 膽固醇酯可以被胰脂肪酶(pancreatic lipases)和酯解酶(esterolases) - 折斷側枝並將CE轉回UC的酶-進行脫酯,所以一些攝入的CE可以被轉換為UC。 ============================================================================ 成人主要是利用胰臟分泌的脂解脢,配合膽汁提供膽鹽幫助,將脂肪分解以供吸收。 酯解酶(esterase)
  35. Furthermore, most of the unesterified cholesterol (UC) in our gut (on the order of about 85%) is actually of endogenous origin (meaning it was synthesized in bodily cells and returned to the liver), which ends up in the gut via biliary secretion and ultimately gets re-absorbed by the gut enterocyte.  •此外,在我們的腸道中大部分(約85%)的未酯化膽固醇(UC)實際上是內源性來源的(意思是它是在身體細胞中合成並返回到肝臟),其通過膽汁的分泌而到達腸道,最終由得到由小腸黏膜細胞重新吸收。
  36. The liver is only able to efflux (send out via bile into the gut) UC, but not CE, from hepatocytes (liver cells) to the biliary system.   Liver CE cannot be excreted into bile. So, if the liver is going to excrete CE into bile and ultimately the gut, it needs to de-esterify it using enzymes called cholesterol esterolases which can convert liver CE to UC. 肝臟是只能外排(經由排出膽汁進入腸道)UC,而不是CE,從肝細胞到膽道系統。肝臟的CE無法排泄到膽汁。因此,如果肝臟是要排泄CE到膽汁和最終到腸道,它需要使用一種酶稱為膽固醇酯解酶來脫脂化,酯解酶把肝臟的CE轉化為UC。
  37. Also realize that the number one way for the liver to rid itself of cholesterol is to convert the cholesterol into a bile acid, efflux that to the bile (via a transporter called ABCB11) and excrete the bile acids in the stool (typically most bile acids are reabsorbed at the ileum). •還認識到,肝臟要擺脫自身的膽固醇最好的方式是將膽固醇轉化成膽汁酸,外排到膽汁(通過稱為ABCB11轉運)並將膽汁酸經糞便中排泄(通常為大多數膽汁酸會在迴腸再吸收)。 ===================================================================================================
  38. Also realize that the number one way for the liver to rid itself of cholesterol is to convert the cholesterol into a bile acid, efflux that to the bile (via a transporter called ABCB11) and excrete the bile acids in the stool (typically most bile acids are reabsorbed at the ileum). •還認識到,肝臟要擺脫自身的膽固醇最好的方式是將膽固醇轉化成膽汁酸,外排到膽汁(通過稱為ABCB11轉運)並將膽汁酸經糞便中排泄(通常為大多數膽汁酸會在迴腸再吸收)。 ===================================================================================================
  39. 膽汁酸鹽輸出泵蛋白(ABCB11) ABCB11基因編碼的膽鹽輸出泵(BSEP)是肝內膽汁酸輸出的主要載體,是膽汁流形成的重要驅動力。 肝細胞轉運蛋白(ABCB)11[即膽鹽輸出泵(BSEP)] 人類ABCB11基因編碼產生膽鹽輸出泵(BSEP),BSEP是位於肝細胞毛細膽管面上的重要轉運體,將膽鹽從肝細胞內轉運到毛細膽管中,是形成膽汁流的最主要動力。 ATP-binding cassette, sub-family B member 11 also known as ABCB11 is a protein which in humans is encoded by the ABCB11 gene.
  40. Also realize that the number one way for the liver to rid itself of cholesterol is to convert the cholesterol into a bile acid, efflux that to the bile (via a transporter called ABCB11) and excrete the bile acids in the stool (typically most bile acids are reabsorbed at the ileum). •還認識到,肝臟要擺脫自身的膽固醇最好的方式是將膽固醇轉化成膽汁酸,外排到膽汁(通過稱為ABCB11轉運)並將膽汁酸經糞便中排泄(通常為大多數膽汁酸會在迴腸再吸收)。 ===================================================================================================
  41. β-Sitosterol