Cholesterol Synthesis
Stage 1: Mevalonate Synthesis
- Two molecules of cytosolic acetyl-CoA condense to form acetoacetyl-CoA.
- The reaction is catalyzed by a thiolase.
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- Acetoacetyl-CoA condenses with another acetyl-CoA forming hydroxymethylglutaryl CoA (HMG-CoA).
- The reaction is catalyzed by HMG-CoA synthase.
- HMG-CoA, a key intermediate in the biosynthesis of cholesterol, is reduced in the endoplasmic reticulum to mevalonic acid. This reduction results in the hydrolysis of the thioester bond of HMG-CoA producing mevalonate and CoA-SH (reduced CoA).
- This is the committed step of cholesterol biosynthesis.
- The reaction is catalyzed by the regulatory enzyme HMG-CoA reductase. This enzyme catalyzes the four-electron reduction of HMG-CoA to coenzyme A and mevalonate, which is the rate limiting step in sterol biosynthesis.
HMG-CoA + 2NADPH + 2H+ —› HMGR mevalonate + 2NADP+ + CoASH
- HMG-CoA reductase is inhibited by cholesterol. In the liver, it is also inhibited by bile salts.
- The reaction utilizes 2 molecules of NADPH, which is oxidized to NADP.
Stage 2: Conversion of Mevalonate to Activated Isoprenes
- Mevalonic acid is phosphorylated 3 times at C5 (two phosphates forming pyrophosphate) and C3.
- These reactions require 3 molecules of ATP.
- Phosphorylated mevalonate is decarboxylated.
- An activated 5-carbon isoprenoid, isopentenyl pyrophosphate (IPP), is formed.
- IPP is isomerized to another activated isoprene - DPP.
Stage 3: Condensation of Isoprenoids to Form Squalene
- Two molecules of isopentenyl pyrophosphate (one of them is an isomer) condense, forming a 10-carbon compound, geranyl pyrophosphate.
- Geranyl pyrophosphate reacts with another isopentenyl pyrophosphate to form a 15-carbon compound, farnesyl pyrophosphate. The reaction is catalyzed by prenyl transferase.
- Squalene is formed from two 15-carbon units in the reaction catalyzed by squalene synthase. This is the second reaction in the cholesterol synthesis pathway that requires NADPH as a coenzyme.
Stage 4: Conversion of Squalene to Lanosterol and Cholesterol

- Squalene is oxidized by squalene monooxygenase using another molecule of NADPH as a coenzyme.
- Cyclization reaction forms lanosterol.
- Lanosterol is converted to cholesterol in the last series of reactions. The conversion of lanosterol to cholesterol requires 19 additional reaction steps.
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