Severe hypocholesterolaemia is often neglected in haematological malignancies Luca Pugliese a , Ilaria Bernardini b , Nazareno Pacifico c , Manola Peverini b , Eleni Damaskopoulou b , Samuela Cataldi b , Elisabetta Albi b, * a Polispecialistica Bios, Crotone, Italy b Department of Clinical and Experimental Medicine, Physiopathology Section, University of Perugia, Italy c Chemo-Clinical Analysis Laboratory, Silvestrini Hospital, 06100 Perugia, Italy ARTICLE INFO Article history: Received 18 December 2009 Received in revised form 25 March 2010 Accepted 31 March 2010 Available online 29 April 2010 Keywords: Cancer Hypocholesterolaemia Leukaemia Lymphoma Mevastatin ABSTRACT Aim of the study: It is generally believed that high levels of cholesterol (hypercholesterola- emia) are life-threatening, while low levels seem to be positive. Unfortunately this assump- tion is far from true, and can be indicative of an underlying serious medical condition in most of the cases (i.e. cancer). However, the biological role of severe hypocholesterolaemia is poorly understood. Here, the possible biological process is being investigated. Cholesterol plays a key role in cell proliferation, hence it has been suggested that low cholesterol levels are probably linked to the high cellular cholesterol demands from neoplastic cells. Summary of the methods: We used serum and isolated T-lymphocytes from patients with acute lymphoblast leukaemia and human lymphoblast cell line to test this hypothesis. Results: We found that patients with low serum cholesterol levels have instead high levels of cholesterol in lymphocytes. These data were supported with in vitro studies. In fact we have demonstrated that low cholesterol level in the culture medium was related to the neo- plastic cellular growth, suggesting a greater use by lymphoma cells for their proliferation. Therefore by inhibiting cholesterol synthesis by mevastatin, in vitro, we showed that cho- lesterol levels did not change significantly in culture medium and the cellular growth was inhibited. Concluding statement: Following these preliminary results, blood cholesterol levels could be potentially considered a good biological marker to follow up the neoplastic process. Ó 2010 Elsevier Ltd. All rights reserved. 1. Introduction High levels of blood cholesterol (CHO) have always been an interesting and highly speculated issue for both public and scientific community, 1 given their association with increased risk of cardiovascular disease. Conversely low levels of CHO (hypoCHO) are often neglected. However, there is evidence of hypoCHO in patients with solid tumours and haematolog- ical malignancies, 2–4 although the reason and the biological role of hypoCHO in patients with cancer are not known. To understand the possible relation between CHO and tu- mour, it is important to look inside the CHO metabolism and how this could potentially drive the tumour growth. It is generally known that CHO and its precursor mevalonate 0959-8049/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2010.03.041 * Corresponding author: Address: Department of Clinical and Experimental Medicine, Physiopathology Section, University of Perugia, Via Enrico dal Pozzo, 06100 Perugia, Italy. Tel./fax: +39 075 575855835. E-mail address: ealbi@unipg.it (E. Albi). EUROPEAN JOURNAL OF CANCER 46 (2010) 1735 – 1743 available at www.sciencedirect.com journal homepage: www.ejconline.com