{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T19:29:34Z","timestamp":1770233374073,"version":"3.49.0"},"reference-count":72,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Background\/Objectives: Proprotein convertase subtilisin\/kexin type 9 (PCSK9) regulates serum cholesterol levels and inflammation, both of which are dysregulated in inflammatory bowel disease (IBD). Free cholesterol (FC) and the various types of cholesteryl ester (CE) have different functions in the body. However, it is not yet known whether these lipids undergo parallel changes in male and female patients with active IBD, nor whether PCSK9 correlates with these lipids and disease severity in either sex. The present study measured the serum levels of PCSK9, FC, and 15 CE species in IBD patients, focusing on the associations of these molecules with sex, each other, and with disease severity. Methods: The serum PCSK9 levels of 80 IBD patients (42 males and 38 females) and 24 controls (12 males and 12 females) were measured by enzyme-linked immunosorbent assay. In addition, FC and 15 CE species levels of 53 randomly selected IBD patients and 16 controls were determined by direct flow injection analysis (FIA) using a high-resolution hybrid quadrupole-orbitrap mass spectrometer (FIA-FTMS). Results: Serum PCSK9 levels in controls and IBD patients were comparable and did not correlate with disease severity in IBD patients. There was no discernible difference in serum PCSK9, FC, and CE levels between patients with Crohn\u2019s disease (CD) and those with ulcerative colitis (UC). FC and almost all CE species decreased in male patients with active IBD but were not related to disease severity in the female patients. The decrease in different CE species in male IBD patients with diarrhea compared to those with normal stool consistency appears to be related to IBD severity. Bile acids regulate serum cholesterol levels, and FC and CE levels were positively correlated with fecal levels of secondary bile acids in the patients with UC but not CD. This association also existed in male UC patients and could not be evaluated in women due to the small sample size. Conclusions: In active IBD, a reduction in FC and almost all CE species was observed only in males, while serum PCSK9 levels remained within normal ranges in both sexes. It can be hypothesized that blocking PCSK9 may further reduce serum cholesterol levels, which may have adverse effects in male patients with active IBD.<\/jats:p>","DOI":"10.3390\/pathophysiology32020013","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T10:48:58Z","timestamp":1742899738000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cholesteryl Ester Species but Not Serum Proprotein Convertase Subtilisin\/Kexin Type 9 Levels Decline in Male Patients with Active Inflammatory Bowel Disease"],"prefix":"10.3390","volume":"32","author":[{"given":"Angelika","family":"Hettenbach","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja","family":"Elger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muriel","family":"Huss","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4886-0811","authenticated-orcid":false,"given":"Gerhard","family":"Liebisch","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3651-392X","authenticated-orcid":false,"given":"Marcus","family":"H\u00f6ring","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Loibl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9065-8395","authenticated-orcid":false,"given":"Arne","family":"Kandulski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hauke Christian","family":"Tews","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5635-3994","authenticated-orcid":false,"given":"Christa","family":"Buechler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, Immunology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s00508-009-1150-6","article-title":"Cholesterol metabolism in active Crohn\u2019s disease","volume":"121","author":"Hrabovsky","year":"2009","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_2","unstructured":"Feingold, K.R., Anawalt, B., Blackman, M.R., Boyce, A., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., Dungan, K., and Hofland, J. (2000). The Effect of Inflammation and Infection on Lipids and Lipoproteins. Endotext, MDText.com, Inc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1111\/j.1572-0241.2007.01343.x","article-title":"The immune response in inflammatory bowel disease","volume":"102","author":"Brown","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.disamonth.2017.07.001","article-title":"A comprehensive review and update on Crohn\u2019s disease","volume":"64","author":"Gajendran","year":"2018","journal-title":"Dis. Mon."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5217\/ir.2018.16.1.26","article-title":"Immunological pathogenesis of inflammatory bowel disease","volume":"16","author":"Lee","year":"2018","journal-title":"Intest. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e202302453","DOI":"10.26508\/lsa.202302453","article-title":"Cholesterol and COVID-19-therapeutic opportunities at the host\/virus interface during cell entry","volume":"7","author":"Grewal","year":"2024","journal-title":"Life Sci. Alliance"},{"key":"ref_7","first-page":"181","article-title":"An overview of lipid abnormalities in patients with inflammatory bowel disease","volume":"24","author":"Agouridis","year":"2011","journal-title":"Ann. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/j.1742-4658.2008.06807.x","article-title":"SREBPs: Protein interaction and SREBPs","volume":"276","author":"Sato","year":"2009","journal-title":"FEBS J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"24641","DOI":"10.1074\/jbc.M116.723973","article-title":"Epithelial Cholesterol Deficiency Attenuates Human Antigen R-linked Pro-inflammatory Stimulation via an SREBP2-linked Circuit","volume":"291","author":"Park","year":"2016","journal-title":"J. Biol. Chem."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.bbalip.2012.02.007","article-title":"Regulation of plasma cholesterol esterification by sphingomyelin: Effect of physiological variations of plasma sphingomyelin on lecithin-cholesterol acyltransferase activity","volume":"1821","author":"Subbaiah","year":"2012","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1002\/ejlt.201100294","article-title":"Cholesteryl esters and ACAT","volume":"114","author":"Pramfalk","year":"2012","journal-title":"Eur. J. Lipid Sci. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1991","DOI":"10.1016\/S0022-2275(20)32360-9","article-title":"Differential expression of ACAT1 and ACAT2 among cells within liver, intestine, kidney, and adrenal of nonhuman primates","volume":"41","author":"Lee","year":"2000","journal-title":"J. Lipid Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1161\/01.RES.0000147558.15554.67","article-title":"Plasma cholesteryl esters provided by lecithin:cholesterol acyltransferase and acyl-coenzyme a:cholesterol acyltransferase 2 have opposite atherosclerotic potential","volume":"95","author":"Lee","year":"2004","journal-title":"Circ. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/0026-0495(94)90178-3","article-title":"Altered fatty acid metabolism in patients with angiographically documented coronary artery disease","volume":"43","author":"Siguel","year":"1994","journal-title":"Metabolism"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Weigand, K., Peschel, G., Grimm, J., M\u00fcller, M., H\u00f6ring, M., Krautbauer, S., Liebisch, G., and Buechler, C. (2022). HCV Infection and Liver Cirrhosis Are Associated with a Less-Favorable Serum Cholesteryl Ester Profile Which Improves through the Successful Treatment of HCV. Biomedicines, 10.","DOI":"10.3390\/biomedicines10123152"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.1016\/j.jacc.2020.10.027","article-title":"Inflammatory Bowel Disease and Atherosclerotic Cardiovascular Disease: JACC Review Topic of the Week","volume":"76","author":"Glassner","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1080\/26895293.2022.2085816","article-title":"Exploring antimicrobial properties of cholesterol esters: A systematic literature review","volume":"15","author":"Jong","year":"2022","journal-title":"All Life"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.2174\/0929867321666140303123602","article-title":"Role of the sex hormone estrogen in the prevention of lipid disorder","volume":"21","author":"Pellegrini","year":"2014","journal-title":"Curr. Med. Chem."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Tshikudi, D.M., Bernstein, C.N., Mishra, S., Ghia, J.E., and Armstrong, H.K. (2025). Influence of biological sex in inflammatory bowel diseases. Nat. Rev. Gastroenterol. Hepatol.","DOI":"10.1038\/s41575-025-01038-y"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.jacl.2010.08.021","article-title":"Dyslipidemia and lipoprotein profiles in patients with inflammatory bowel disease","volume":"4","author":"Putka","year":"2010","journal-title":"J. Clin. Lipidol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"117270","DOI":"10.1016\/j.atherosclerosis.2023.117270","article-title":"Sex differences in lipids: A life course approach","volume":"384","author":"Holven","year":"2023","journal-title":"Atherosclerosis"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1210\/jc.2009-0141","article-title":"Genetic and metabolic determinants of plasma PCSK9 levels","volume":"94","author":"Lakoski","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Grewal, T., and Buechler, C. (2022). Emerging Insights on the Diverse Roles of Proprotein Convertase Subtilisin\/Kexin Type 9 (PCSK9) in Chronic Liver Diseases: Cholesterol Metabolism and Beyond. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23031070"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/MCG.0000000000001607","article-title":"Serum Levels of PCSK9 Are Increased in Patients With Active Ulcerative Colitis Representing a Potential Biomarker of Disease Activity: A Cross-sectional Study","volume":"56","author":"Marinelli","year":"2022","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Katzmann, J.L., Gouni-Berthold, I., and Laufs, U. (2020). PCSK9 Inhibition: Insights From Clinical Trials and Future Prospects. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.595819"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1002\/kjm2.12225","article-title":"Inhibition of proprotein convertase subtilisin\/kexin type 9 attenuates 2,4,6-trinitrobenzenesulfonic acid-induced colitis via repressing toll-like receptor 4\/nuclear factor-kappa B","volume":"36","author":"Lei","year":"2020","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.atherosclerosis.2019.07.015","article-title":"PCSK9 inhibition and inflammation: A narrative review","volume":"288","author":"Ruscica","year":"2019","journal-title":"Atherosclerosis"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/ehjcvp\/pvz022","article-title":"PCSK9 and inflammation: A review of experimental and clinical evidence","volume":"5","author":"Gotto","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jacc.2022.10.030","article-title":"PCSK9 Inhibition During the Inflammatory Stage of SARS-CoV-2 Infection","volume":"81","author":"Navarese","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13098-023-01252-1","article-title":"Lipid-lowering drugs and inflammatory bowel disease\u2019s risk: A drug-target Mendelian randomization study","volume":"16","author":"Zhao","year":"2024","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tao, H., Yu, Z., Dong, Y., Liu, L., Peng, L., and Chen, X. (2023). Lipids, lipid-lowering agents, and inflammatory bowel disease: A Mendelian randomization study. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1160312"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e14067","DOI":"10.1111\/eci.14067","article-title":"Association between the use of lipid-lowering drugs and the risk of inflammatory bowel disease","volume":"53","author":"Liu","year":"2023","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1210\/jc.2015-4267","article-title":"Longitudinal Associations of Phospholipid and Cholesteryl Ester Fatty Acids with Disorders Underlying Diabetes","volume":"101","author":"Johnston","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_34","first-page":"163","article-title":"Correlation of serum cholesteryl ester fatty acid composition with susceptibility to atherosclerosis in different species","volume":"106","author":"Chen","year":"1993","journal-title":"Chin. Med. J. (Engl.)"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/0021-9150(89)90229-3","article-title":"Relationship between serum cholesteryl ester composition, dietary habits and coronary risk factors in middle-aged men","volume":"78","author":"Rosseneu","year":"1989","journal-title":"Atherosclerosis"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.numecd.2010.05.008","article-title":"Comparison of fatty acid proportions in serum cholesteryl esters among people with different glucose tolerance status: The CoDAM study","volume":"22","author":"Kuijsten","year":"2012","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/S1050-1738(97)00086-8","article-title":"Free cholesterol-induced cytotoxicity a possible contributing factor to macrophage foam cell necrosis in advanced atherosclerotic lesions","volume":"7","author":"Tabas","year":"1997","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ecco-jcc\/jjy114","article-title":"ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects","volume":"13","author":"Sturm","year":"2019","journal-title":"J. Crohns Colitis"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1055\/a-1015-7048","article-title":"Aktualisierung der S3-Leitlinie Colitis ulcerosa 2019","volume":"57","author":"Kucharzik","year":"2019","journal-title":"Z. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00384-023-04515-5","article-title":"A nationwide study of patients hospitalized with indeterminate colitis: A comparison with Crohn\u2019s disease and ulcerative colitis","volume":"38","author":"Prakash","year":"2023","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"123059","DOI":"10.1016\/j.jenvman.2024.123059","article-title":"Evolution of hydrochemistry and water quality of karst groundwater under the effects of intense anthropogenic activities","volume":"371","author":"Feng","year":"2024","journal-title":"J. Environ. Manag."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1139\/y59-099","article-title":"A rapid method of total lipid extraction and purification","volume":"37","author":"Bligh","year":"1959","journal-title":"Can. J. Biochem. Physiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100050","DOI":"10.1016\/j.jlr.2021.100050","article-title":"Accurate quantification of lipid species affected by isobaric overlap in Fourier-Transform mass spectrometry","volume":"62","author":"Horing","year":"2021","journal-title":"J. Lipid Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3459","DOI":"10.1021\/acs.analchem.8b05013","article-title":"Quantification of Cholesterol and Cholesteryl Ester by Direct Flow Injection High-Resolution Fourier Transform Mass Spectrometry Utilizing Species-Specific Response Factors","volume":"91","author":"Horing","year":"2019","journal-title":"Anal. Chem."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3920","DOI":"10.1016\/j.jchromb.2009.09.038","article-title":"Rapid quantification of bile acids and their conjugates in serum by liquid chromatography-tandem mass spectrometry","volume":"877","author":"Scherer","year":"2009","journal-title":"J. Chromatogr. B Analyt Technol. Biomed. Life Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/s12944-023-01971-4","article-title":"Altered fecal bile acid composition in active ulcerative colitis","volume":"22","author":"Sommersberger","year":"2023","journal-title":"Lipids Health Dis."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Gunawan, S., Elger, T., Loibl, J., Fererberger, T., Sommersberger, S., Kandulski, A., Muller, M., Tews, H.C., and Buechler, C. (2022). Urinary chemerin as a potential biomarker for inflammatory bowel disease. Front. Med., 9.","DOI":"10.3389\/fmed.2022.1058108"},{"key":"ref_48","first-page":"72","article-title":"Review article on parametric and nonparametric test","volume":"10","author":"Sharma","year":"2024","journal-title":"World J. Pharm. Med. Res."},{"key":"ref_49","first-page":"0215","article-title":"Primary prevention of CVD: Treating dyslipidaemia","volume":"2010","author":"Fodor","year":"2010","journal-title":"BMJ Clin. Evid."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1093\/ibd\/izac100","article-title":"Lipid Changes After Induction Therapy in Patients with Inflammatory Bowel Disease: Effect of Different Drug Classes and Inflammation","volume":"29","author":"Sleutjes","year":"2023","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Deng, C., Pan, J., Zhu, H., and Chen, Z.Y. (2023). Effect of Gut Microbiota on Blood Cholesterol: A Review on Mechanisms. Foods, 12.","DOI":"10.3390\/foods12234308"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/MOL.0000000000000473","article-title":"Transintestinal cholesterol excretion in humans","volume":"29","author":"Reeskamp","year":"2018","journal-title":"Curr. Opin. Lipidol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Baldan-Martin, M., Chaparro, M., and Gisbert, J.P. (2023). Systematic Review: Urine Biomarker Discovery for Inflammatory Bowel Disease Diagnosis. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241210159"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Tews, H.C., Elger, T., Grewal, T., Weidlich, S., Vitali, F., and Buechler, C. (2023). Fecal and Urinary Adipokines as Disease Biomarkers. Biomedicines, 11.","DOI":"10.3390\/biomedicines11041186"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s11845-023-03440-4","article-title":"Longitudinal variation of serum PCSK9 in ulcerative colitis: Association with disease activity, T helper 1\/2\/17 cells, and clinical response of tumor necrosis factor inhibitor","volume":"193","author":"Deng","year":"2024","journal-title":"Ir. J. Med. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e00617","DOI":"10.14309\/ctg.0000000000000617","article-title":"Fecal Calprotectin for the Diagnosis and Management of Inflammatory Bowel Diseases","volume":"14","author":"Kapel","year":"2023","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.clinbiochem.2020.01.003","article-title":"Circulating PCSK9 is associated with liver biomarkers and hepatic steatosis","volume":"77","author":"Paquette","year":"2020","journal-title":"Clin. Biochem."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.atherosclerosis.2013.03.029","article-title":"Beyond LDL-C lowering: Distinct molecular sphingolipids are good indicators of proprotein convertase subtilisin\/kexin type 9 (PCSK9) deficiency","volume":"228","author":"Janis","year":"2013","journal-title":"Atherosclerosis"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"593","DOI":"10.3390\/idr16040045","article-title":"Proprotein Convertase Subtilisin\/Kexin Type 9 Induction in COVID-19 Is Poorly Associated with Disease Severity and Cholesterol Levels","volume":"16","author":"Mester","year":"2024","journal-title":"Infect. Dis. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1152\/ajpendo.90926.2008","article-title":"Acyl-coenzyme A:cholesterol acyltransferases","volume":"297","author":"Chang","year":"2009","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.bbalip.2011.06.016","article-title":"Lipid profiling of lipoproteins by electrospray ionization tandem mass spectrometry","volume":"1811","author":"Scherer","year":"2011","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.metabol.2006.03.006","article-title":"Altered lipid, apolipoprotein, and lipoprotein profiles in inflammatory bowel disease: Consequences on the cholesterol efflux capacity of serum using Fu5AH cell system","volume":"55","author":"Nazih","year":"2006","journal-title":"Metabolism"},{"key":"ref_63","first-page":"41","article-title":"Lecithin: Cholesterol acyltransferase. An exercise in comparative biology","volume":"15","author":"Glomset","year":"1979","journal-title":"Prog. Biochem. Pharmacol."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Schafer, S.K., Weidner, K.J., Hoppner, J., Becker, N., Friedrich, D., Stokes, C.S., Lammert, F., and Kollner, V. (2017). Design and validation of a German version of the GSRS-IBS\u2014An analysis of its psychometric quality and factorial structure. BMC Gastroenterol., 17.","DOI":"10.1186\/s12876-017-0684-8"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"G839","DOI":"10.1152\/ajpgi.00061.2008","article-title":"Development and physiological regulation of intestinal lipid absorption.: III.: Intestinal transporters and cholesterol absorption","volume":"294","author":"Hui","year":"2008","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1164\/rccm.202105-1197TR","article-title":"The Many Roles of Cholesterol in Sepsis: A Review","volume":"205","author":"Hofmaenner","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_67","first-page":"266","article-title":"Role of bile acids in inflammatory bowel disease","volume":"31","author":"Tiratterra","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Calzadilla, N., Comiskey, S.M., Dudeja, P.K., Saksena, S., Gill, R.K., and Alrefai, W.A. (2022). Bile acids as inflammatory mediators and modulators of intestinal permeability. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1021924"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"dyad162","DOI":"10.1093\/ije\/dyad162","article-title":"Clinical and biochemical associations of urinary metabolites: Quantitative epidemiological approach on renal-cardiometabolic biomarkers","volume":"53","author":"Li","year":"2024","journal-title":"Int. J. Epidemiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.kint.2023.06.024","article-title":"Proprotein convertase subtilisin\/kexin type 9 targets megalin in the kidney proximal tubule and aggravates proteinuria in nephrotic syndrome","volume":"104","author":"Skeby","year":"2023","journal-title":"Kidney Int."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s12291-010-0095-x","article-title":"Serum Lipid Profile: Fasting or Non-fasting?","volume":"26","author":"Nigam","year":"2011","journal-title":"Indian. J. Clin. Biochem."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1093\/oxfordjournals.aje.a009074","article-title":"Fatty acids in serum cholesteryl esters as quantitative biomarkers of dietary intake in humans","volume":"145","author":"Zock","year":"1997","journal-title":"Am. J. Epidemiol."}],"container-title":["Pathophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1873-149X\/32\/2\/13\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:59:46Z","timestamp":1760029186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1873-149X\/32\/2\/13"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":72,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["pathophysiology32020013"],"URL":"https:\/\/doi.org\/10.3390\/pathophysiology32020013","relation":{},"ISSN":["1873-149X"],"issn-type":[{"value":"1873-149X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]}}}