Lancet, — Commonly, drug treatment for cholesterol includes: 1 HMG-CoA reductase inhibitors such as statins, 2 bile acid sequestrants such as resins, 3 lipoprotein lipase activators such as fibric acid derivatives, 4 lipolysis and triglyceride inhibitor such as nicotinic acid derivative, and 5 cholesterol absorption inhibitor such as ezetimibe.

However, some adverse effects of a statin such as headache, bowel indigestion, vomiting, nausea, and hepatotoxicity [ [6]Jisha V, Sruthy SA, Neethu J, Nithin MR and Babitha MSR Hypercholesterolemia. Circulation, 50— Therefore, other treatments with low side effects should be overlooked as an alternative to prevent and cure hypercholesterolemia.

Diet modification is one of the safest alternatives to maintain cholesterol levels in the body. This diet modification includes consuming hypocholesterolemic food, such as probiotic products. Many studies reported the promising effect of probiotic consumption on cholesterol status.

Probiotics are beneficial live microorganisms because they provide health benefits to the host after being consumed in sufficient quantities, primarily by increasing the proliferation of native digestive microflora. These properties have been found in various microorganisms, especially lactic acid bacteria LAB.

LAB is a group of bacteria that produce lactic acid as the main metabolic end product during carbohydrate fermentation.

LAB is grouped into several generas, including Lactobacillus, Enterococcus, Streptococcus, Lactococcus, Leuconostoc , and Pediococcus. Generally, probiotic bacteria are non-pathogenic bacteria that are usually found in the human gastrointestinal tract, and provide protection to the intestines from pathogenic bacteria.

Probiotics are generally used as food adjuvants, and several compounds resulting from the metabolism of probiotic bacteria provide health benefits, including:. dan Ind. Pangan, 22 1 : 11— b Prevention of constipation by lowering the pH in the large intestine through formation of short-chain fatty acids such as butyric acid, propionic acid, and lactic acid.

Low pH can increase peristalsis in the large intestine and decrease colonic transit time [ [9]Astawan M and Wresdiyati T Production of synbiotic Yogurt-Like using indigenous lactic acid bacteria as functional food.

Media Peternakan, 35 1 : 9— c Stimulation of immune system through 3 three mechanisms, firstly by direct contact with gastrointestinal epithelial cells IEC , which secrete various cytokines such as Interleukin-6 IL-6 and initiate communication with other cells—surrounding immune cells.

Secondly is through specialized epithelial cells namely M cells MC which are present throughout the digestive tract. Macrophages MQ or dendritic cells DC are the first cells under M cells to directly come into contact with probiotics or their antigen fragments and produce cytokines.

And the last mechanism is that DCs in the lamina propria of the GI tract may elongate their dendrites between the IECs and may be able to directly uptake and process probiotics in the lumen of the GI tract [ [10]Jankovic I, Sybesma W, Phothirath P, Ananta E and Mercenier A Application of probiotics in food products—challenges and new approaches.

d Reduce lactose intolerance by production of galactosidase enzymes which hydrolize lactose [ [11]Bhatia A, Sharma A, Sood A and Singla R Hypoglycemic effect of encapsulated CLA producing probiotic isolate: An in vivo study J.

e Prevention of the risk of colon cancer by preventing changes in the intestinal microflora, inactivating carcinogenic compounds, competing with pathogenic bacteria, increasing the host immune response, providing anti-proliferative effects through regulation of apoptosis and cell differentiation, fermenting undigested food, inhibiting tyrosine kinase signaling pathways [ [12]Hovhannisyan G, Aroutiounian R and Glei M Butyrate reduces the frequency of micronuclei in human colon carcinoma cells in vitro.

f Reduce allergy symptoms, by acting as potent activators for the innate immune system [ [13]Vrese M and Offick B Probiotics and Prebiotics: Effects on Diarrhea. In: Bioactive Foods in Promoting Health Watson RR and Preedy VR ed. g Facilitates mineral absorption by increasing mineral solubility due to increased production of antibacterial compounds in short-chain fatty acids [ [14]Danneskiold-samsøe NB, Dias H, Queiroz DF, Santos R, Bicas JL, Baú C, Cazarin B, Madsen L, Kristiansen K, Pastore GM, Brix S, Roberto M and Junior M Interplay between food and gut microbiota in health and disease.

Food Res. h Lowering cholesterol levels [ [15]Toole PWO and Cooney JC Probiotic bacteria influence the composition and function of the intestinal microbiota. LAB that have potential as probiotic agents are Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus acidophilus, and Streptococcus thermophilus [ [16]Reddy G, Altaf M, Naveena BJ, Venkateshwar M and Kumar EV Amylolytic bacterial lactic acid fermentation -a review.

CRC Press Taylor and Francis Group, Florida. LWT-Food Sci. Czech J. Food Sci. Dairy Sci. Cholesterol is a major essential component for membrane cells in the human body. It is also used for synthesis of bile acids, vitamin D, and sex hormones such as testosterone, progesterone, androsterone, and estradiol.

It is also essential to maintain nerve cells [ [4]Wang HH, Garruti G, Liu M, Portincasa P and Wang DQ Cholesterol and lipoprotein metabolism and atherosclerosis: Recent advances in reverse cholesterol transport. De novo synthesis of cholesterol is a complex and complicated biochemical process.

It is composed of 30 cellular reactions involving more than 15 different enzymes through human cellular tissues [ [23]Jones PJH and Kubow S Lipids, sterols and their metabolites.

In: Modern Nutrition In Health and Disease 9 th , ed. Our diet contributes to the absorption of — mg of cholesterol daily. The absorption occurs mainly on the duodenum and proximal jejunum [ [25]Alphonse PA and Jones PJ Revisiting human cholesterol synthesis and absorption: The reciprocity paradigm and its key regulators.

Lipids, — Wang et al. Cell Metab. As cholesterol is a hydrophobic molecule and insoluble in the water, it needs a carrier to be transported into various human body tissues. Therefore, cholesterol is packaged as water-soluble lipoproteins in the bloodstream and lymphatic vessels.

The lipoprotein structure consists of the core and the shell. The center is filled with hydrophobic lipids such as cholesterol esters. This core is surrounded by a body of polar lipids the phospholipids.

The surface of the lipoprotein also contains a wide variety of apoproteins that increase molecular stability and enhance solubility. Furthermore, apoprotein also has other functions, such as activating specific enzymes for metabolism and acting as ligands that target specific receptors for certain functions.

Based on the density, the lipoproteins can be classified into four major classes, which are: 1 chylomicrons, 2 very low-density lipoprotein VLDL , 3 low-density lipoprotein LDL , and 4 high-density lipoprotein HDL.

The first three classes play a role in lipid delivery from the liver into the tissues. Precisely, LDL delivers cholesterol to cells. Meanwhile, HDL reverses cholesterol transport, collecting excess cholesterol from various tissues into the liver. Hypercholesterolemia is a condition in which serum level concentration is elevated significantly.

This hypercholesterolemia is characterized by high plasma levels of LDL and low plasma concentration of HDL [ [4]Wang HH, Garruti G, Liu M, Portincasa P and Wang DQ Cholesterol and lipoprotein metabolism and atherosclerosis: Recent advances in reverse cholesterol transport.

Several theories of how probiotics remove host cholesterol have been put forward. They are mainly: 1 the ability of probiotics to convert cholesterol into coprostanol, 2 the deconjugation of cholesterol by probiotics enzyme, which leads to cholesterol precipitation and assimilation, 3 the probiotics regulation of protein expression related to cholesterol metabolism, and 4 the production of SCFA by probiotics that can increase apolipoprotein expression responsible for reverse cholesterol transport [ [30]Sekimoto H, Shimada O, Makanishi M, Nakano T and Katayama O Interrelationship between serum and fecal sterols.

Japan J. Microorganisms, 9: — Catalysts, 9: — Three pathways are proposed regarding the conversion of cholesterol to coprostanol by probiotics [ [33]Kriaa A, Bourgin M, Mkaouar H, Jablaoui A, Akermi N, Soussou S, Maguin E and Rhimi M Microbial reduction of cholesterol to coprostanol: An old concept and new insights.

Figure 1: The mechanism of the cholesterol conversion pathway to coprostanol by probiotic activity a Direct pathway, b Isomerization pathway, c Indirect pathway.

The indirect pathway of cholesterol to coprostanone consists of three steps Figure 1: The mechanism of the cholesterol conversion pathway to coprostanol by probiotic activity a Direct pathway, b Isomerization pathway, c Indirect pathway.

Although the multi-omics study shows that there are frequent and abundant microbiome resources in human biota that can produce 3-beta-hydroxysteroid dehydrogenase enzyme, only a few active strains exhibit the ability to convert cholesterol into coprostanone has been isolated.

It indicates that the conversion process is carried out by several microbiomes that require the challenging task of isolation [ [31]Juste C and Philippe G Cholesterol-to-coprostanol conversion by the gut microbiota: What we know, suspect, and ignore.

Sekimoto et al. Bile salt hydrolase BSH is an enzyme expressed mainly through intestinal bacteria living in the bile environment, such as Bifidobacterium spp. acidophilus, L. plantarum , and so on. However, it is not found in strains that live in non-bile environments, such as S.

thermophilus and L. delbruecki [ [34]Usman AH Bile tolerance, taurocholate deconjugation, and binding of cholesterol by lactobacillus gasseri strains. The coprecipitation of deconjugated bile salt occurs at low pH. Initially, the pH of the intestine is neutral to slightly alkaline, which is unsuitable for coprecipitation reaction.

However, dietary fibre fermentation by intestinal microbe produces short-chain fatty acids. Thus, the pH becomes acidic and suitable for coprecipitation reaction [ [36]Begley M, Hill C and Grahan CG Bile salt hydrolase activity in probiotics.

Figure 2: Mechanism of cholesterol deconjugation process with BSH enzyme by probiotics and the assimilation of cholesterol in the body. Some probiotics living in the bile environment such as Bifidobacterium spp, L. acidophilus, and L. plantarum expressed BSH enzyme which plays a role in deconjugation process of bile salt.

Probiotics promote deconjugation process of bile salt through formation of SCFA which create acidic condition in the intestine. Deconjugated bile salt was removed from enterohepatic circulation and excreted in faeces, which further will lower the absorption of cholesterol.

This condition promoting formation of new bile salt by using cholesterol storage. Meanwhile, increased BSH activity reduces FXR activity which promotes decreasement of SHP.

This, in turn, will activate the LXR and promoting reserved cholesterol transportation into bile. Finally, bile salt is synthesized which further will lower the cholesterol concentration in the body. Furthermore, bile salts are needed as the prerequisite for assimilation reaction, mainly through the modification of membrane lipid composition [ [35]Li G Intestinal probiotics: Interactions with Bile salts and reduction of cholesterol.

This assimilation reaction is not pH-dependent and generally occurs at a higher reaction rate in the growth phase of cells. Cells within the resting phase show no significant cholesterol assimilation activity.

Moreover, Jarocki et al. PLoS One, 9: 1— Probiotics have several pathways of protein expression regulation related to cholesterol metabolism as seen in Figure 3: Pathways of protein synthesis regulation related to cholesterol metabolism by probiotics.

No spam, just science. Your gut bacteria's interaction with bile might also influence your cholesterol levels.

Bile helps break down fats in your diet. Without it, most fats would pass right through and come out in your poop. Your liver continuously produces bile, and this is stored in a pouch-like organ called the gallbladder.

You make around milliliters 2. In the gallbladder, bile becomes more concentrated before getting released into your intestines when a fat-containing meal arrives. Gut bacteria break down bile acids into so-called secondary bile acids.

And these compounds there are more than 20 appear to have a wide range of activities. Some bile acids send signals to the liver, telling it to reduce bile synthesis.

Secondary bile acids seem less likely to reduce bile synthesis, so having more of them around is likely to improve your cholesterol levels. But it seems likely that ratios of bile acids to secondary bile acids have some sway on your blood cholesterol levels.

Overall, researchers are still working out the details. But coprostanol, entrapment, and secondary bile acids all seem to alter our cholesterol levels. This leads us to ask:. Probiotics are live microorganisms that, when consumed in large enough amounts, provide health benefits.

Probiotics exist in a range of fermented foods , like natural yogurt, some cheeses, kimchi, and sauerkraut. So, if gut bacteria can influence cholesterol levels, could probiotics help manage these levels?

Over the past decade or so, some scientists have investigated. Several animal studies have hinted that some probiotic strains might help manage cholesterol levels. And a smaller number of human trials have also provided a glimmer of hope.

For instance, one study included participants with high cholesterol. Twice a day for 6 weeks, the researchers gave participants either "placebo" yogurt or yogurt containing a species of Lactobacillus bacteria.

A review from looked at 32 relevant randomized controlled trials that together included almost 2, participants. Overall, the researchers concluded that probiotics could reduce total blood cholesterol levels.

They also found that probiotics were most effective for people who had higher cholesterol levels at the start of the study. But they found that not all probiotics seem to work. And this includes maintaining blood cholesterol levels. By producing coprostanol, trapping cholesterol, and breaking down bile acids into secondary bile acids, gut bacteria seem likely to influence these levels.

ZOE co-founder Prof. Tim Spector recommends having small portions of fermented foods every day. Or you might prefer plain yogurt with live cultures and smelly cheeses. If you're worried about your cholesterol levels, make sure you speak with a doctor.

A mini-review of human studies on cholesterol-lowering properties of probiotics. Scientica Pharmaceutica. Cardiovascular disease. Cholesterol-lowering efficacy of a microencapsulated bile salt hydrolase-active Lactobacillus reuteri NCIMB yoghurt formulation in hypercholesterolaemic adults.

The British Journal of Nutrition. Cholesterol-to-coprostanol conversion by the gut microbiota: What we know, suspect, and ignore.

Climate impacts on human settlement and agricultural activities in northern Norway revealed through sediment biogeochemistry. Correlation between faecal microbial community structure and cholesterol-to-coprostanol conversion in the human gut. FEMS Microbiology Letters.

Does cholesterol play a role in the bacterial selectivity of antimicrobial peptides? Frontiers in Immunology. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70— years: A contemporary primary prevention cohort.

The Lancet. Faecal bacterial and short-chain fatty acids signature in hypercholesterolemia. Scientific Reports. Gut microbiota and cardiovascular disease: Opportunities and challenges.

HDL and cardiovascular disease. Health survey for England Incorporation of cholesterol into the cellular membrane of Lactobacillus acidophilus ATCC Journal of Dairy Science. Interrelationship between serum and fecal sterols. Japanese Journal of Medicine. Mechanisms of cholesterol removal by Lactobacilli under conditions that mimic the human gastrointestinal tract.

International Dairy Journal. Metabolism of cholesterol and bile acids by the gut microbiota. Microbial impact on cholesterol and bile acid metabolism: Current status and future prospects. Journal of Lipid Research.

Ultimately, probiotics could be worth a try. However, the effects will likely vary according to the probiotic strains used, whether you take the probiotic each day as indicated, as well as your health status and your diet.

Red yeast rice is another non-fiber supplement that has gained attention for lowering cholesterol. It is often used in Asia and some European countries as a complementary therapy. It comes in capsule form and is thought to mimic the role of the cholesterol-lowering medications known as statins.

A systematic review analyzed data from 15 randomized controlled trials. It found taking red yeast rice supplements ,mg a day was more effective for lowering blood fats known as triglycerides but less effective at lowering total cholesterol compared with statins.

However, these trials don't tell us if red yeast rice works and is safe in the long term. The authors also said only one study in the review was registered in a major database of clinical trials. So we don't know if the evidence base was complete or biased to only publish studies with positive results.

Always speak to your GP and dietitian about your plan to take supplements to lower your cholesterol. But remember, dietary changes alone — with or without supplements — might not be enough to lower your cholesterol levels sufficiently.

You still need to quit smoking, reduce stress, exercise regularly and get enough sleep. Genetics can also play a role.

Even then, depending on your cholesterol levels and other risk factors, you may still be recommended cholesterol-lowering medications, such as statins. Your GP will discuss your options at your six-month review.

This article is republished from The Conversation under a Creative Commons license. Read the original article. Sticky Header Night Mode. Subscribe Help keep Salon independent. Sekimoto et al. Bile salt hydrolase BSH is an enzyme expressed mainly through intestinal bacteria living in the bile environment, such as Bifidobacterium spp.

acidophilus, L. plantarum , and so on. However, it is not found in strains that live in non-bile environments, such as S. thermophilus and L. delbruecki [ [34]Usman AH Bile tolerance, taurocholate deconjugation, and binding of cholesterol by lactobacillus gasseri strains. The coprecipitation of deconjugated bile salt occurs at low pH.

Initially, the pH of the intestine is neutral to slightly alkaline, which is unsuitable for coprecipitation reaction. However, dietary fibre fermentation by intestinal microbe produces short-chain fatty acids. Thus, the pH becomes acidic and suitable for coprecipitation reaction [ [36]Begley M, Hill C and Grahan CG Bile salt hydrolase activity in probiotics.

Figure 2: Mechanism of cholesterol deconjugation process with BSH enzyme by probiotics and the assimilation of cholesterol in the body. Some probiotics living in the bile environment such as Bifidobacterium spp, L. acidophilus, and L. plantarum expressed BSH enzyme which plays a role in deconjugation process of bile salt.

Probiotics promote deconjugation process of bile salt through formation of SCFA which create acidic condition in the intestine.

Deconjugated bile salt was removed from enterohepatic circulation and excreted in faeces, which further will lower the absorption of cholesterol.

This condition promoting formation of new bile salt by using cholesterol storage. Meanwhile, increased BSH activity reduces FXR activity which promotes decreasement of SHP. This, in turn, will activate the LXR and promoting reserved cholesterol transportation into bile.

Finally, bile salt is synthesized which further will lower the cholesterol concentration in the body. Furthermore, bile salts are needed as the prerequisite for assimilation reaction, mainly through the modification of membrane lipid composition [ [35]Li G Intestinal probiotics: Interactions with Bile salts and reduction of cholesterol.

This assimilation reaction is not pH-dependent and generally occurs at a higher reaction rate in the growth phase of cells. Cells within the resting phase show no significant cholesterol assimilation activity. Moreover, Jarocki et al. PLoS One, 9: 1— Probiotics have several pathways of protein expression regulation related to cholesterol metabolism as seen in Figure 3: Pathways of protein synthesis regulation related to cholesterol metabolism by probiotics.

a In human liver HepG2 cell, live LAB or its part could reduce the expression of HMGCR through NF-κB binding site at nt bp. Two main NF-κB pp65 and pp50 downregulate HMGCR expression which in turn lowers biosynthesis of cholesterol.

Meanwhile, part of Lactobacillus plantarum DR7 increase phosphorylation of AMPK which further downregulate expression of HMGCR. Downregulation of HMGCR causes reduction in cholesterol synthesis.

plantarum NS5 and L. delbrueckii subsp. bulgaricus NS12, has a significant effect on reducing serum cholesterol in male SD rats given a high cholesterol diet through three mechanisms: first, by decreasing expression of Acyl-CoA: cholesterol acyltransferase ACAT , which is the enzyme responsible for esterification of cholesterol, and reduces cholesterol stored in the body in the form of cholesterol esters; second, by increasing expression of Cholesterol 7α-hydroxylase CYP7A1 , which is an enzyme that plays a role in the synthesis of bile acids from cholesterol; and the third, by increasing the expression of FXR production which increased RCT.

Cell Res. Cold Spring Harb Perspect Biol. Trends Immunol. Lipid Res. Chen et al. Korean J. Lactobacillus strains have been shown to regulate the mRNA expression levels of liver enzymes related to cholesterol metabolism, including the down-regulation of acyl-CoA: cholesterol acyltransferase ACAT and the upregulation of cholesterol 7α-hydroxylase also known as cytochrome P 7A1 or CYP7A1 [ [51]Hu X, Wang T, Li W, Jin F and Wang L Effects of NS lactobacillus strains on lipid metabolism of rats fed a high-cholesterol diet.

Lipids Health Dis. ameliorate non-alcoholic fatty liver. PLoS One, e Liver Res. Hepatology, — Cell, — Figure 3: Pathways of protein synthesis regulation related to cholesterol metabolism by probiotics. SCFAs are fatty acid hydrocarbon groups comprising C1 until C6 hydrocarbon bones.

The members of this group are formic acid C1 , acetic acid C2 , propionic acid C3 , butyric acid C4 , valeric acid C5 , and hexanoic acid C6 [ [62]Popeijus HE, Zwaan W, Tayyeb JZ and Plat J Potential contribution of short chain fatty acids to hepatic apolipoprotein A-I production.

Nutrients, 7: — The absorbed SCFAs are then metabolized in three sites: colonocytes, hepatocytes, and muscle cells. Butyrate is utilized as the primary energy source of colonocytes.

Butyrate, along with propionate, is also metabolized by hepatocytes. Administration of SCFA increases HDL-C, meanwhile SCFA such as butyric acid C4 enhanced secretion of ApoA-1 which plays an important role in RCT process as the acceptor of cholesterol.

On the other hand, SCFAs downregulate the KEAP-1 and activate PCarliPARα. Downregulation of KEAP-1 will inhibit BET and increasing ApoA-1 expression. Meanwhile, the activation of PPARα also increases the expression of ApoA SCFAs such as propionate C3 , butyrate C4 and valerate C5 have been known to inhibit IL-8, a cytokine which activates neutrophils on inflammation reaction.

While, amoxycillin has been found to suppress the expression of ApoA-1 by lowering PPARα on HepG2 cells. Zhao et al. Food Chem. Induction of apo A-I mRNA with no change of apo B mRNA. Therefore, they hypothesized that the mechanism of ApoA-I secretion happened via transcriptional regulation.

Supplementation of Lactobacillus curvatus HY and Lactobacillus plantarum KY in diet-induced obese mice is associated with gut microbial changes and reduction in obesity.

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Bile acid profiling and quantification in biofluids using ultra-performance liquid chromatography tandem mass spectrometry. Anal Chem 87 , —, doi: Download references. The authors would like to acknowledge Martyn Allen, Kathryn A.

Turner and Hedda L. Köhling of Cultech Limited for their technical assistance during the study. Cultech Limited, Unit 2 Christchurch Road, Baglan Industrial Park, Port Talbot, SA12 7BZ, United Kingdom. Michael, T. Davies, D. Cardiff School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff, CF14 3AX, United Kingdom.

Moss, D. Centre for Digestive and Gut Health, Imperial College London, London, SW7 2AZ, United Kingdom. Division of Infection and Immunity, Henry Wellcome Building, Cardiff University, Cardiff, CF14 4XN, United Kingdom.

Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, SW7 2AZ, London, United Kingdom. You can also search for this author in PubMed Google Scholar. and S. were responsible for the design of the study. Experiments were performed by T.

and A. Data analysis was performed by D. prepared the manuscript and all authors contributed to the review of the manuscript. Correspondence to D. This study was supported by Cultech Ltd, Port Talbot, UK. DRM, TSD, DLC and SFP are or were employees of Cultech Ltd.

JWEM is a PhD student funded by a joint studentship from the School of Biosciences, Cardiff University and Cultech Ltd. Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Skip to main content Thank you for visiting nature. nature scientific reports articles article. Download PDF. Subjects Dyslipidaemias Nutritional supplements. Abstract Hypercholesterolaemia is a major risk factor for cardiovascular disease and it has been found that some probiotic bacteria possess cholesterol-lowering capabilities.

Introduction Cardiovascular disease CVD is the cause of death in one in three people in the United Kingdom 1 and is the leading cause of global mortality 2. Results Evidence for cholesterol lowering ability by Lab4 in vitro BSH activity in Lab4 was indicated by the formation of a white precipitate and agar-clouding in the presence of 0.

Figure 1. Full size image. Figure 2. Table 1 Plasma lipid and cytokine concentrations. Full size table.

Figure 3. Figure 4. Table 2 Ratio of plasma and faecal bile acid content in relation to BL group. Discussion In this short-term feeding study, daily probiotic supplementation resulted in lower plasma cholesterol levels and suppression of diet-induced weight gain in mice fed a high fat diet.

Methods Reagents All chemicals were purchased from Sigma-Aldrich Poole, UK unless otherwise stated. Studies in vitro Lab4 was assessed for its ability to deconjugate bile salts, assimilate cholesterol and regulate Caco-2 cell cholesterol transport as previously described Plasma lipid and cytokine analysis TC, HDL and TG concentrations were measured at the Clinical Biochemistry Service, Cardiff University, on an Aeroset automated analyzer Abbott Diagnostics, Berkshire, UK.

UPLC-MS profiling of plasma and faecal bile acids Plasma samples were prepared for analysis using a previously described method References Bhatnagar, P.

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