Hypocholesterolemic potential of probiotics: Concept and mechanistic insights

ABSTRACT

Cardiovascular diseases (CVDs) have become one of the leading causes of global mortality. The raised serum cholesterol levels and its progressive accumulation in arterial walls results in development of atherosclerosis that leads to most of the heart attacks and strokes. Use of probiotics has been implicated for several health benefits including their cholesterol lowering potential and hence management of CVDs. The current review aims to describe the association of gut microbiota, probiotics and their potential mechanisms responsible for hypocholesterolemic effects. Probiotics execute hypo-cholesterolemic effects through several mechanisms such as bile salt hydrolase activity (BSH), deconjugation of bile salts, cholesterol assimilation, coprecipitation of cholesterol with deconjugated bile salts, removal of cholesterol with cellular surfaces through physical forces, incorporation of cholesterol in the cell membrane of the probiotics, intestinal conversion of cholesterol in coprostanol, and inhibition of Niemann–Pick C1 like 1 (NPC1L1) cholesterol transporter in the enterocytes. However, the health benefits including the hypocholesterolemic effects appear to be a strain specific phenomenon. Further studies are necessary for better understanding of the in-depth molecular mechanisms governing the hypocholesterolemic effects and to establish the probiotics as a potential non-pharmaceutical approach for management of CVDs.