Cholesterol excretion

Cholesterol excretion refers to the set of physiological processes by which excess cholesterol is removed from the body. The main routes are conversion into bile acids in the liver followed by biliary secretion into the intestine and subsequent fecal elimination. Another significant route is transintestinal cholesterol excretion (TICE), where enterocytes secrete free cholesterol directly into the gut lumen independently from bile. Reverse cholesterol transport involves high-density lipoproteins collecting peripheral tissue cholesterol and delivering it back to the liver for disposal via these routes. Multiple proteins—including hepatic enzymes like CYP7A1, ATP-binding cassette transporters such as ABCA1/G5/G8—are essential components facilitating these processes[1][3]. Impaired function at any step can contribute to hypercholesterolemia and cardiovascular risk. In summary, "cholesterol excretion" should be considered as a complex biological pathway/process rather than an individual druggable target or receptor[1][3].

Other names

Cholesterol eliminationFecal cholesterol lossBiliary cholesterol secretionTransintestinal cholesterol excretion (TICE)Reverse cholesterol transport (RCT)

Drugs influencing cholesterol excretion act by inhibiting intestinal absorption of dietary/biliary cholesterol (e.g., ezetimibe) or by promoting fecal loss through binding bile acids in the gut (e.g., bile acid sequestrants). These mechanisms modulate steps within the overall cholesterol excretion pathway.