High density lipoprotein cholesterol and apolipoprotein A-I are associated with greater cerebral perfusion in multiple sclerosis

J Neurol Sci. 2020 Nov 15;418:117120. doi: 10.1016/j.jns.2020.117120. Epub 2020 Sep 8.


Background: The pathophysiological mechanisms underlying the associations of multiple sclerosis (MS) neurodegeneration serum cholesterol profiles is currently unknown.

Objective: To determine associations between lipid profile measures and cerebral perfusion-based indices in MS patients.

Methods: Seventy-seven MS patients underwent 3 T MRI. Cerebral blood volume (CBV), time-to-peak (TTP) and mean transit time (MTT) measures were computed from dynamic susceptibility contrast (DSC) perfusion-weighted imaging (PWI) for normal-appearing brain tissue (NABT), GM, cortex, deep gray matter (DGM) and thalamus. Total cholesterol, low and high-density lipoprotein cholesterol (LDL-C and HDL-C) and the apolipoproteins (Apo), ApoA-I, ApoA-II, ApoB, ApoC-II and ApoE levels were measured in plasma. Age and body mass index (BMI)-adjusted correlations were used to assess the associations between PWI and lipid profile measures.

Results: Higher HDL-C levels were associated with shorter MTT, which are indicative of greater perfusion, in NABT (p = 0.012), NAWM (p = 0.021), GM (p = 0.009), cortex (p = 0.014), DGM p = 0.015; and thalamus p = 0.015). The HDL-C-associated apolipoproteins, ApoA-I and ApoA-II, were associated with shorter MTT of the same brain regions (all p < 0.028). HDL-C and ApoA-I levels were also associated with shorter TTP, indicative of faster cerebral blood delivery. ApoC-II was associated with lower nCBV of the GM and cortex (p = 0.035 and p = 0.014, respectively).

Conclusion: The HDL pathway is associated with better global brain perfusion and faster cerebral blood delivery as measured by shorter MTT and TTP, respectively. ApoC-II may be associated with lower cortical and DGM perfusion.

Keywords: ApoAI; ApoAII; ApoCII; ApoE; Cholesterol; DSC; HDL; MRI; Multiple sclerosis; Perfusion.

MeSH terms

  • Apolipoprotein A-I*
  • Cerebrovascular Circulation
  • Cholesterol, HDL
  • Humans
  • Multiple Sclerosis* / diagnostic imaging
  • Perfusion


  • Apolipoprotein A-I
  • Cholesterol, HDL