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Table 1 Etiology of dyslipidemia in patient after allo-HSCT

From: Management of dyslipidemia after allogeneic hematopoietic stem cell transplantation

Causes Mechanism Dyslipidemia profile
IR and diabetes [11, 13, 14] In high glucose internal environment, LDL-C enzyme activity in adipose tissue decreases significantly, TGs metabolism slows down accordingly VLDL, TGs, and TC↑
Immunosuppressants [16,17,18] Glucocorticoids Reduce GLUT2 and glucokinase expression, stimulate B-cell apoptosis, enhance skeletal muscle insulin resistance, and reduce insulin uptake and glycogen storage. Enhance IR. Lead to overproduction of triglycerides and VLDL-C. The clearance of triglyceride rich lipoproteins such as chylomicron and VLDL-C is reduced by corticosteroid induced LPL.enhances esterase activity and decreases LDL receptors.lead to weight gain VLDL, TGs, and TC↑
CNI Inhibit steroid 26 hydroxylase, thereby inhibiting cholesterol conversion into bile acid, blocking LDL receptors, leading to serum LDL elevation, and affecting VLDL and LDL clearance by changing lipase activity. Interfere with the binding of LDL-C to LDL receptors and promote hepatic lipase activity and the decrease of LPL.inhibit insulin secretion of pancreatic B cells by binding to cyclin-D and inducing b cell apoptosis VLDL and LDL↑
mTOR inhibitors Expand the FFA pool and increase hepatic VLDL synthesis. Increase lipolysis via augmentation of hormone-sensitive lipase (increasing circulating FFA), interfering with triglyceride metabolism, decreasing triglyceride storage, and disrupting the insulin-signaling pathway VLDL, TGs↑
GVHD [1, 19, 20] Induce intrahepatic cholestasis and nephrotic syndrome. T cells in the process of GVHD depend on lipid biosynthetic pathways to meet the high metabolic requirement of rapid clonal expansion. Disturbance of intestinal microbiota TC, and TGs↑
Intestinal microflora Gastrointestinal microflora can alter the enzymes that participate in the metabolism of three substances Multiple metabolic disorders
Nutrition intake Excessive high sugar and high fat nutrient intake TC, and TGs↑
Others [21, 22] Hypothyroidism, hyperthyroidism, hypogonadism, and growth hormone deficiency. Most of them are associated with conditioning such as TBI or cytotoxic agents Multiple metabolic disorders
  1. Abbreviations: GLUT2 Glucose transporter 2, IR Insulin resistance, VLDL Very-low-density lipoprotein, LDL Low-density lipoprotein, LPL Lipoprotein lipase, FFA Free fatty acid, TBI Total body irradiation