CHLE - Overview: cholesterol esters, serum (2023)

Handy for

Suggests clinical conditions or environments where testing may be useful

Establishing a diagnosis of lecithin cholesterol acyl transferase deficiency

Assessment of the degree of metabolic dysregulation due to bile stasis or liver disease

Method name

Brief description of the method used to perform the test


State of New York available

Indicates the status of New York State approval and whether the test can be ordered for customers in New York State.


Reference name

Displays a shorter or abbreviated version of the published name for a test

Cholesterylesters, S


Displays additional common names for a test as a search aid


Kind of sample

Describes the type of sample validated for testing

(Video) Estimation of Serum Total Cholesterol by Enzymatic (CHOD-POD) Method || Biochemistry Practical


A sample is required

It determines the optimal sample needed to perform the test and the desired volume to complete the test



Accepted:red top

Submission container/tube:Plastic vial

Monstervolume:1 ml

Collection instructions:Centrifuge and subject to a serum sample in a plastic vial. Send in the refrigerator.

Printed matter

If not ordering online, please fill in, print and mail aApplication form for cardiovascular examination(T724)with the sample.

Minimum sample volume

Determines the amount of sample required to give a clinically relevant result, as determined by the testing lab

0,5 ml

Rejection due to

Identifies sample types and conditions that may lead to sample rejection

Massive hemolysis Reject
serious lipemia Okay
Mixed jaundice Reject

Sample stability information

Describes the temperatures required to transport a sample to the performance laboratory, alternate acceptable temperatures are also included

Kind of sample Temperature year Special holder
Serum Fridge (preferably) 7 days
Frosted 60 days
Around 24 hours

Handy for

Suggests clinical conditions or environments where testing may be useful

Establishing a diagnosis of lecithin cholesterol acyl transferase deficiency

Assessment of the degree of metabolic dysregulation due to bile stasis or liver disease

Clinical information

Discusses physiology, pathophysiology and general clinical aspects associated with a laboratory test

Serum cholesterol is normally 60% to 80% esterified with fatty acids, largely due to the action of the enzyme lecithin-cholesterol acyltransferase (LCAT), which circulates in the blood along with high-density lipoproteins.

Familial LCAT deficiency is uncommon, usually occurs in individuals of Northern European descent, and is associated with erythrocyte abnormalities (target cell abnormalities) and decreased (20% or less) serum cholesterol esterification. This is associated with early atherosclerosis, corneal clouding, hyperlipidemia and mild haemolytic anaemia.

People with liver disease may have impaired LCAT formation and therefore acquired LCAT deficiency and decreased cholesterol ester concentration.

Reference prices

Describes reference intervals and additional information for interpreting test results. May include intervals based on age and gender if applicable. Intervals are from Mayo unless otherwise stated. If an interpretive report is provided, this will be indicated in the reference value field.

> or =18 years: 60-80% of the total cholesterol

No reference values ​​have been established for patients under 18 years of age.


Provides information to help interpret test results

In patients with lecithin cholesterol acyltransferase deficiency, the concentration of unesterified serum cholesterol may be increased 2 to 5 times the normal value, resulting in a reduction of esterified serum cholesterol to 20% or less of total serum cholesterol.

Precautionary measures

Discusses situations that can cause diagnostic confusion, including improper sample collection and handling, improper test selection, and interfering substances

In severe form, cholesterol storage disease can be fatal before 1 year of age (Wolman's disease) and, in some less severe cases, may not be discovered until adulthood. This defect is caused by a deficiency of a lysosomal enzyme, cholesteric acid hydrolase (also known as acid lipase). It causes an accumulation of cholesterol esters in the tissues, but has no effect on the percentage of cholesterol circulating in the blood serum in the esterified form. Detection of the defect requires careful evaluation of cholesteryl ester hydrolase activity and cholesteryl ester content of leukocytes, cultured fibroblasts, and liver biopsy.

The result may be falsely diminished in patients with elevated levels of N-acetyl-p-benzoquinonimine (NAPQI) - a metabolite of paracetamol, N-acetylcysteine ​​(NAC) and metamizole.

(Video) Estimation of Serum Cholesterol

Clinical report

Recommendations for in-depth reading of a clinical nature

1. Meikle PJ, Mundra PA, Wong G, et al: Circulating lipids are associated with alcoholic liver cirrhosis and represent potential biomarkers for risk assessment. PLoS One. Jun 24, 2015;10(6):e0130346. doi: 10.1371/journal.pone.0130346

2. Leach NV, Dronca E, Vesa SC, et al: Serum homocysteine ​​levels, oxidative stress, and cardiovascular risk in nonalcoholic steatohepatitis. Eur J Intern Med. 2014 Oct;25(8):762-767. doi: 10.1016/j.ejim.2014.09.007

3. Santamarina-Fojo S, Hoeg JM, Assmann G, Brewer B: Lecithin cholesterol acyltransferase deficiency and fish eye disease. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. ed. The online metabolic and molecular basis of inherited diseases. McGraw Hill; 2019. Accessed June 8, 2021. Available at

(Video) LDL Cholesterol, ये अच्छा है या बुरा ? | Dr Bimal Chhajer | SAAOL

Method description

Describes how the test is performed and provides a method-specific reference

Free cholesterol reacts with cholesterol oxidase to generate hydrogen peroxide which reacts with 3,5-dimethoxy-N-(2-hydroxy-3-sulfopropyl)aniline sodium (DAOS) and 4-aminoantipyrene to produce a blue dye. The product is proportional to the concentration of free cholesterol in the serum. (Fujifilm Free Cholesterol E. Fujifilm Wako Pure Chemical Corporation; 01/04/2018)


Indicates whether the report contains an additional document with charts, images, or other detailed information


Day(s) held

Describes the days on which the test takes place. This field indicates the day the sample must be in the testing lab for the testing process to begin, and includes sample preparation and processing time prior to running the test. Some tests are called continuous tests, which means that the tests are performed several times a day.

Monday till Friday

Reference available

Time frame (specimen receipt at Mayo Clinic laboratories until available results) considering typical facility days and weekends. The first day is the time it usually takes for a result to be available. The last day is the time it can take, taking into account any necessary repeat examinations.

1 to 3 days

Storage time of the sample

It describes the amount of time after testing that a sample is kept in the lab before being discarded

(Video) CHOLESTEROL Test Procedure | CHOLESTEROL Reagent | Procedure for performing CHOLESTEROL Reagent Test

7 days

Run lab location

Indicates the location of the lab performing the test



Several factors determine the fee charged for performing a test. Contact your US Regional Director or International Director for information on creating a reimbursement schedule or for more information on resources to optimize your test selection.

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Classification of tests

Provides medical device classification information for laboratory test kits and reagents. Tests can be classified as approved by the U.S. Food and Drug Administration (FDA) or approved and used according to manufacturer's instructions, or as products that are not fully reviewed and approved by the FDA and then labeled as a specialty product. .

This test has been developed and its performance characteristics determined by the Mayo Clinic in a manner consistent with CLIA requirements. This test has not been endorsed or approved by the US Food and Drug Administration.

CPT code information

Provides guidelines for determining the correct CPT code(s) for each test or profile. CPT codes listed reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine the correct CPT codes to be used for billing.

CPT codes are provided by the performing laboratory.


LOINC® information

Provides guidance for determining Logical Observation Identifier Names and Codes (LOINC) values ​​for sequence and result codes for this test. LOINC values ​​are provided by the performance lab.

Test-ID Test order name Order LOINC Value
PLEASE Cholesterylesters, S 21197-9
Result ID Test result name Result Value LOINC

Only valid for results expressed in units of measurement originally reported by the performing laboratory. These values ​​do not apply to results converted to other units of measurement.

CHLES Cholesterylesters, S 21197-9


What is the difference between cholesterol and cholesterol esters? ›

The key difference between cholesterol and cholesteryl esters is the active and the inactive forms. Cholesterol is an active sterol form whereas cholesteryl ester is an inactive esterified form in which cholesterol is transported in the circulatory system.

What is the significance of cholesterol esters? ›

Cholesterol esters, i.e., with long-chain fatty acids linked to the hydroxyl group, are much less polar than free cholesterol, and they appear to be the preferred form for transport in plasma and as a biologically inert storage or de-toxification form to buffer an excess.

Is cholesteryl ester hydrophobic? ›

Among these, glycerophospholipids and sphingolipids are the most polar and hydrophilic, and triglycerides and cholesteryl esters are the least polar and most hydrophobic (7).

What are the two pathways of esterification of cholesterol? ›

Cellular cholesterol esterification is accomplished by two enzymes: ACAT1, which is widely distributed, but expressed at low levels in the liver and intestine; and ACAT2, which is the enzyme responsible for cholesterol esterification in these tissues (69).

Where do cholesterol esters come from? ›

Plasma Lipoprotein and Intracellular Cholesterol Esters

In this scenario, cholesterol may come either from plasma low-density lipoprotein (LDL) or high-density lipoprotein (HDL). Cholesterol esters released from LDL are delivered to the plasma membrane or to lipid droplets and mitochondria for androgen synthesis.

What is the difference between dietary cholesterol and serum cholesterol? ›

Dietary cholesterol is consumed in foods including eggs, beef, fish, and pork, whereas endogenous serum cholesterol is synthesized in the liver and extrahepatic tissues and circulates in the bloodstream.

What is benefits of cholesteryl ester? ›

Cholesteryl ester transfer protein (CETP) plays a pivotal role in lipoprotein metabolism by facilitating the transfer of esterified cholesterol from high-density lipoprotein (HDL) to triglyceride-rich lipoproteins and low-density lipoprotein (LDL) in exchange for triglycerides.

What is the advantage of having cholesterol esterified? ›

By converting cholesterol to cholesteryl esters more cholesterol can be packaged into the interior of lipoproteins. This vastly increases the capacity of lipoproteins, allowing for more efficient cholesterol transport through the blood stream. Figure 1.

What are esters and why are they important? ›

Esters have characteristic smells and are insoluble in water. They have the functional group: The functional group (-COO) is known as the ester link. The main use of esters is for flavourings and perfumes, however they can also be used in the chemicals industry as solvents.

Where are cholesteryl esters found? ›

Cholesteryl ester is found in human brains as lipid droplets which store and transport cholesterol. Increased levels of cholesteryl ester have been found in certain parts of the brain of people with Huntington disease.

Which lipoprotein has highest cholesteryl ester? ›

Low-Density Lipoproteins (LDL)

These particles are derived from VLDL and IDL particles and they are even further enriched in cholesterol. LDL carries the majority of the cholesterol that is in the circulation.

Which of the following has the highest cholesterol and cholesteryl ester contents LDL? ›

The lipoprotein with the most cholesterol content is LDL (option C). Low-density lipoprotein (LDL) has the highest cholesterol content among the lipoproteins in the body.

What enzyme makes cholesterol esters? ›

Abstract. Plasma cholesterol esters are formed within the circulation by lecithin-cholesterol acyltransferase (LCAT), an enzyme produced by the liver.

What is the primary enzyme for digesting cholesterol esters? ›

Cholesterol esterase (CE) (bile salt-stimulated esterase or carboxyl ester lipase) primarily hydrolyzes cholesterol esters. It is synthesized in the pancreas and is released in response to CCK in a fully active form.

What is the most important enzyme in cholesterol synthesis? ›

Abstract. In eukaryotes, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase is a key enzyme that catalyses the synthesis of a precusor of cholesterol as well as non-sterol isoprenoids, mevalonate.

What type of lipid is cholesterol ester? ›

Cholesteryl esters (cholesterol esters, or CE) belong to the group of cholesterol lipids within the sterol lipids. Their structure consists of cholesterol where an ester bond is formed between the hydroxyl group of the steroid structure and a fatty acid.

Which particle converts cholesterol to cholesterol ester? ›

Abstract. Abstract Lecithin:cholesterol acyltransferase (LCAT) and cholesteryl ester transfer protein (CETP) are responsible for the esterification of cell-derived cholesterol and for the transfer of newly synthesized cholesteryl esters (CE) from HDL to apoB-containing lipoproteins in human plasma.

Is cholesterol ester a fatty acid? ›

Cholesteryl esters are cholesterol backbones with long-chain fatty acid chains linked to the hydroxyl group. These molecules are much less polar than their non-ester counterparts and are the preferred form for transport in plasma.

What happens if serum cholesterol is high? ›

If there's too much cholesterol in the blood, the cholesterol and other substances may form deposits (plaques) that collect on artery walls. Plaques can cause an artery to become narrowed or blocked. If a plaque ruptures, a blood clot can form. Plaques and blood clots can reduce blood flow through an artery.

What should my serum cholesterol level be? ›

Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L. As a general guide, total cholesterol levels should be: 5mmol/L or less for healthy adults. 4mmol/L or less for those at high risk.

What raises serum cholesterol? ›

Eating a lot of foods high in saturated fats raises “bad” LDL cholesterol levels. Saturated fats are found in fatty cuts of meat and dairy products. No more than 10% of your daily calories should come from saturated fats. Smoking lowers HDL cholesterol, particularly in women, and raises LDL cholesterol.

Does walking increase HDL? ›

Walking raises your “good” cholesterol and lowers your “bad” cholesterol. A brisk 30-minute walk three times per week is enough to raise your “good” cholesterol (HDL) and lower your “bad” cholesterol (LDL) a few points. This amount of exercise, even without weight loss, is shown to improve your cholesterol levels.

What enzyme breaks down LDL? ›

Lipoprotein lipase (LPL) is a rate-limiting enzyme that hydrolyzes circulating triglyceride-rich lipoprotein such as very low density lipoproteins and chylomicrons.

How is excess cholesterol excreted from the body? ›

The liver processes the excess cholesterol for elimination via bile. Transport of cholesterol to the liver for biliary elimination is essential for maintaining cholesterol balance and is sometimes referred to as reverse cholesterol transport.

What is the name of good cholesterol why it is good? ›

HDL (high-density lipoprotein) cholesterol, sometimes called “good” cholesterol, absorbs cholesterol in the blood and carries it back to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.

What does Cholesteryl ester transfer protein do? ›

Cholesteryl ester transfer protein (CETP) is a hydrophobic plasma glycoprotein that mediates the transfer and exchange of cholesteryl ester (CE) and triglyceride (TG) between plasma lipoproteins, and also plays an important role in HDL metabolism.

What are three common uses of esters? ›

These and other volatile esters with characteristic odours are used in synthetic flavours, perfumes, and cosmetics. Certain volatile esters are used as solvents for lacquers, paints, and varnishes; for this purpose, large quantities of ethyl acetate and butyl acetate are commercially produced.

What are the disadvantages of esters? ›

Many esters are flammable or highly flammable. Low-molecular-weight esters like methyl formate have low flash points and wide flammability limits, making them dangerous flammability hazards.

What is the most important ester? ›

Among the most important of the natural esters are fats (such as lard, tallow, and butter) and oils (such as linseed, cottonseed, and olive oils), which are esters of the trihydroxyl alcohol glycerine, C3H5(OH)3, with large carboxylic acids, such as palmitic acid, CH3(CH2)14CO2H, stearic acid, CH3(CH2)16CO2H, and oleic ...

What is cholesteryl ester storage disease also known as? ›

Cholesteryl ester storage disease (CESD) is a type of lysosomal acid lipase (LAL) deficiency. LAL deficiency (LAL-D) is caused by pathogenic variants in the LIPA, which encodes the enzyme LAL[1-3]. LAL-D is inherited in an autosomal recessive manner.

What drugs are Cholesteryl ester transfer protein? ›

Cholesteryl ester transfer protein (CETP) inhibitors, including dalcetrapib, evacetrapib, and anacetrapib, are novel agents that have been developed to increase serum high-density lipoprotein cholesterol (HDL-c) concentration.

What causes high cholesterol but normal triglycerides? ›

When you have low triglyceride levels but high LDL levels, it could indicate that you have a diet filled with healthy fats. Healthy fats will not only cause an increase in good cholesterol (HDL) but can also change the type of the LDL particles in the blood.

What fat lowers LDL and raises HDL? ›

Healthy fats contain omega-3 fatty acids, monounsaturated fats and polyunsaturated fats, which help increase HDL cholesterol and lower LDL cholesterol. Omega-3 fatty acids: salmon, mackerel, sea bass, herring, oysters, sardines, anchovies, flax seeds, chia seeds, walnuts, soybeans, edamame, kidney beans, soybean oil.

What does it mean when your lipoprotein is high? ›

High levels of Lp(a) can create plaque in your blood vessels. This is a buildup of cholesterol that lessens blood flow through your arteries. A high level of Lp(a) can be a sign of cholesterol-related disease, such as coronary artery disease. Research has found it to be an independent risk factor for heart disease.

Which one of the 3 fatty acid types is most likely to raise blood cholesterol? ›

Saturated fats (sometimes called 'bad fats') contribute to the risk of cardiovascular diseases (such as heart disease and stroke), because they raise our blood LDL cholesterol levels.

Which type of cholesterol is known as the good cholesterol which is carried to the liver and excreted from the body? ›

HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

Which type of fat increases LDL only? ›

Trans fats raise your bad (LDL) cholesterol levels and lower your good (HDL) cholesterol levels. These changes are associated with a higher risk of heart disease. Trans fats are found in many fried foods. Baked goods, such as pastries, pizza dough, pie crust, cookies and crackers also can contain trans fats.

What is the difference between cholesterol and cholesterol ester? ›

Cholesterol is present as unesterified (free) and esterified portions in the body fluids (1). Free cholesterol is biologically active and has cytotoxic effects whereas cholesteryl ester (CE) is protective form for storage in the cells and transporting in plasma (23).

What is the difference between cholesteryl ester and cholesterol ester? ›

The key difference between cholesterol and cholesteryl esters is the active and the inactive forms. Cholesterol is an active sterol form whereas cholesteryl ester is an inactive esterified form in which cholesterol is transported in the circulatory system.

Which digestive enzyme breaks triglycerides? ›

lipase, any of a group of fat-splitting enzymes found in the blood, gastric juices, pancreatic secretions, intestinal juices, and adipose tissues. Lipases hydrolyze triglycerides (fats) into their component fatty acid and glycerol molecules.

Which enzyme helps break down lipids? ›

Lipase is an enzyme the body uses to break down fats in food so they can be absorbed in the intestines.

Which of the following have the biggest impact on blood cholesterol levels? ›

The biggest influence on blood cholesterol level is the mix of fats and carbohydrates in your diet—not the amount of cholesterol you eat from food.

What organ does most cholesterol synthesis occur in? ›

Cholesterol synthesis takes place in all cell types. However, the liver represents the main site for de novo cholesterol synthesis contributing to approximately 80% of total cholesterol synthesis in mammals.

What are the 3 stages of cholesterol synthesis? ›

6.1: Cholesterol synthesis
  • Transcriptional control.
  • Proteolytic degradation of HMG-CoA reductase.
  • Regulation by covalent modification.
  • Several fates of cholesterol.
  • Cholesterol esterification and transport.
Nov 2, 2021

Which enzyme deficiency will result in impaired synthesis of cholesterol? ›

Mevalonate kinase deficiency, an inborn error of presqualene cholesterol synthesis that can result in mevalonic aciduria or hyperimmunoglobulinemia D syndrome, has previously been reviewed by Hass and Hoffmann (1).

What is the difference between the two types of cholesterol? ›

As a general rule, HDL is considered “good” cholesterol, while LDL is considered “bad.” This is because HDL carries cholesterol to your liver, where it can be removed from your bloodstream before it builds up in your arteries. LDL, on the other hand, takes cholesterol directly to your arteries.

What enzyme converts cholesterol to cholesterol ester? ›

The conversion of cholesterol to cholesteryl esters (CE) is catalyzed by the enzyme acyl-coenzyme A (CoA):cholesterol acyltransferase (ACAT) (Fig. 1). In most cell types, CE are present only in low levels, mainly as cytoplasmic lipid droplets.

Are cholesterol esters included in a total cholesterol assay? ›

The assay detects total cholesterol (cholesterol and cholesteryl esters) when cholesterol esterase is included in the reaction, or free cholesterol when it is not included.

Which type of cholesterol is artery clogging? ›

It's also called "hardening of the arteries." LDL, or "bad cholesterol," is the raw material of cholesterol plaques. It can damage the arteries that carry blood from your heart to the rest of your body. Then, once the damage has started, LDL keeps on building up in the artery walls.

What is a good cholesterol number? ›

Here are the ranges for total cholesterol in adults: Normal: less than 200 mg/dL. Borderline high: 200 to 239 mg/dL. High: at or above 240 mg/dL.

What is a good triglyceride level? ›

Triglyceride levels usually fall into the following categories: Healthy: Below 150 milligrams per deciliter (mg/dL) for adults; lower than 90 mg/dL for children and teens (ages 10-19) Borderline high: Between 150 and 199 mg/dL. High: Between 200 and 499 mg/dL.

What are the 5 signs of high cholesterol? ›

These symptoms include:
  • sudden loss of balance and coordination.
  • sudden dizziness.
  • facial asymmetry (drooping eyelid and mouth on just one side)
  • inability to move, particularly affecting just one side of your body.
  • confusion.
  • slurring words.
  • numbness in your face, arm, or leg, especially on one side of your body.

What is a healthy LDL level by age? ›

For most healthy adults (19 and older), your total cholesterol should be less than 200 mg/dL, your LDL less than 100 mg/dL, and your HDL greater than 40 mg/dL. For children (19 and younger), total cholesterol should be less than 170 mg/dL, LDL less than 110 mg/dL, and HDL greater than 45 mg/dL.

What is stroke level cholesterol? ›

Levels of LDL cholesterol higher than 130 milligrams per deciliter (mg/dL) are linked to an increased risk for ischemic stroke.

What is the normal range of serum cholesterol? ›

Normal: less than 150 mg/dL. Mild hypertriglyceridemia: 150 to 499 mg/dL. Moderate hypertriglyceridemia: 500 to 886 mg/dL. Very high or severe hypertriglyceridemia: greater than 886 mg/dL.


1. LDL and HDL Cholesterol | Good and Bad Cholesterol | Nucleus Health
(Nucleus Medical Media)
2. The effect of dietary cholesterol on blood cholesterol & individual variability | Dr. Tom Dayspring
(Nutrition Made Simple!)
3. Estimation of Serum Cholesterol [CHOD-POD] Method, Calculation| Clinical Importance of Cholesterol
4. Cholesterol Levels | కొలెస్ట్రాల్ ఎంత ఉండాలి? | Aarogyamastu | 16th April 2022 | ETV Life
(ETV Life India)
5. Estimation of serum total cholesterol by CHOD-POD method
(nandini muchchandi)
6. Simple ways to get rid of cholesterol | Cholesterol Control Tips in Kannada | Cholesterol Diet plan
(Ayurveda Tips In Kannada)


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