Cholesterol in the CNS: functions, recycling and remyelination

Abstract Cholesterol plays critical roles throughout the body, including its function in cellular membrane formation and as a precursor for hormones and bile acids. Notably, the brain contains 25% of the body’s cholesterol, which remains separate from peripheral sources. Consequently, cholesterol within the central nervous system (CNS) must be efficiently recycled among neural cells, and disruptions in this recycling and metabolism have pathological consequences. This review explores the physiological functions of cholesterol particularly in the CNS, highlights lipid metabolism and recycling mechanisms within CNS cells for remyelination, and examines the role of cholesterol dysregulation in multiple sclerosis. Finally, we discuss therapeutic approaches targeting cholesterol metabolism, including statins, cyclodextrins and liver X receptor (LXR) agonists.