Editorial Open Access
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Immunol. Jul 27, 2015; 5(2): 51-61
Published online Jul 27, 2015. doi: 10.5411/wji.v5.i2.51
Antimicrobial lipids: Emerging effector molecules of innate host defense
Edith Porter, Daniel C Ma, Sandy Alvarez, Kym F Faull
Edith Porter, Daniel C Ma, Sandy Alvarez, Department of Biological Sciences, California State University Los Angeles, Los Angeles, CA 90032, United States
Edith Porter, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
Daniel C Ma, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
Kym F Faull, Pasarow Mass Spectrometry Laboratory, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA 90095, United States
Author contributions: Porter E, Ma DC, Alvarez S and Faull KF contributed to conception and design of the study, literature search and analysis and interpretation of data; Porter E drafted the article; Ma DC, Alvarez S and Faull KF made critical revisions related to important intellectual content of the manuscript; all authors gave final approval of the version of the article to be published.
Supported by The National Institutes of Health, Nos. 1R21AI55675, 1P20MD001824, 1SC1GM096916 and 1S10RR023718-01A2; and by the Cystic Fibrosis Foundation, Pilot Research, No. PORTER12I0.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edith Porter, MD, Professor of Microbiology and Immunology, Department of Biological Sciences, California State University Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, United States. eporter@calstatela.edu
Telephone: +1-323-3436353 Fax: +1-323-3436451
Received: May 20, 2015
Peer-review started: May 21, 2015
First decision: June 18, 2015
Revised: June 24, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: July 27, 2015


The antimicrobial properties of host derived lipids have become increasingly recognized and evidence is mounting that antimicrobial lipids (AMLs), like antimicrobial peptides, are effector molecules of the innate immune system and are regulated by its conserved pathways. This review, with primary focus on the human body, provides some background on the biochemistry of lipids, summarizes their biological functions, expands on their antimicrobial properties and site-specific composition, presents modes of synergism with antimicrobial peptides, and highlights the more recent reports on the regulation of AML production as well as bacterial resistance mechanisms. Based on extant data a concept of innate epithelial defense is proposed where epithelial cells, in response to microbial products and proinflammatory cytokines and through activation of conserved innate signaling pathways, increase their lipid uptake and up-regulate transcription of enzymes involved in lipid biosynthesis, and induce transcription of antimicrobial peptides as well as cytokines and chemokines. The subsequently secreted antimicrobial peptides and lipids then attack and eliminate the invader, assisted by or in synergism with other antimicrobial molecules delivered by other defense cells that have been recruited to the site of infection, in most of the cases. This review invites reconsideration of the interpretation of cholesteryl ester accumulation in macrophage lipid droplets in response to infection as a solely proinflammatory event, and proposes a direct antimicrobial role of lipid droplet- associated cholesteryl esters. Finally, for the interested, but new- to- the-field investigator some starting points for the characterization of AMLs are provided. Before it is possible to utilize AMLs for anti-infectious therapeutic and prophylactic approaches, we need to better understand pathogen responses to these lipids and their role in the pathogenesis of chronic infectious disease.

Key Words: Atopic dermatitis, Cholesterol, Infectious disease, Cystic fibrosis, Mucosa

Core tip: The antimicrobial properties of host derived lipids have become increasingly recognized. This review develops the concept of antimicrobial lipids (AMLs) as effectors of the innate immune response that work together with antimicrobial peptides to prevent infection, and highlights more recent reports on the regulation of AML production as well as bacterial resistance mechanisms. Furthermore, this review invites reconsideration of the interpretation of cholesteryl ester accumulation in macrophage lipid droplets in response to infection as a solely proinflammatory event, and proposes a direct antimicrobial role of lipid droplet- associated cholesteryl esters.


Innate immunity is the first line of host defense; it engages pattern recognition receptors as opposed to highly variable antigen specific receptors utilized by the adaptive immune system; its response is preformed or rapidly induced within minutes to hours after pathogen contact; it provides no memory, but is essential for priming the adaptive immune response; and in return it can be augmented by effectors of the adaptive immune response[1,2]. The innate immune response is activated by microbial products and proinflammatory cytokines when general physical and chemical defense mechanisms on body surfaces have failed to eliminate potential intruders. Ligand-binding to surface-expressed and intracellular pattern recognition and cytokine receptors leads to increased output of antimicrobial effector molecules, chemokines, and cytokines to attack the pathogen, recruit, and activate additional immune cells, respectively. The associated signaling pathways are conserved and utilize common central transcription factors including nuclear factor κB and interferon response factors.

Key effector cells of the innate immune response are epithelial cells, granulocytes, monocytes, macrophages, dendritic cells, and natural killer cells. In particular, macrophages and dendritic cells are important for the initiation of the adaptive immune response. In addition, the more recently recognized innate lymphocytes facilitate the cross talk between innate and adaptive immune responses[3]. Key effector molecules with direct antimicrobial action include the complement system, antimicrobial peptides and proteins (AMPs), and, increasingly recognized, antimicrobial lipids (AMLs). This review aims to introduce the concept of lipids as antimicrobial effector molecules in the innate epithelial cell defense. The reader is directed to Thormar and Hilmarsson 2007[4], Drake et al[5], 2008, and Thormar[6] 2012 for more extensive previous reviews on antimicrobial properties of lipids.


Lipids are a widely heterogeneous group of molecules that share hydrophobic or mixed hydrophobic/hydrophilic properties. They are composed of hydrocarbon chains to which additional functional groups are linked which affects the degree of hydrophobicity. The major lipid classes are: fatty acids, tri-, di- and mono-acylglycerols consisting of the alcohol glycerol and fatty acid chains, cholesterol and cholesteryl esters, phospholipids and sphingolipids. Mostly, fatty acids, acyl chains with a carboxy group, are incorporated into more complex lipids. For example, sphingolipids like sphingosines consist of a fatty acid residue linked to an amino alcohol and cholesteryl esters are formed through esterification of a fatty acid to cholesterol. Phospholipids typically consist of a glycerol with two fatty acid residues attached, a phosphate group and varying additional groups such as choline, an alcohol, or amines. Phosphosphingolipids such as sphingomyelin use sphingosine instead of the diglyceride. Free fatty acids (FFA) are less abundant in the body, and among them palmitic, stearic, oleic, linoleic (the latter three differing in the number of double bonds) and docosahexaenoic acid are possibly the most important in the current context. Linoleic acid and its metabolite arachidonic acid are essential and cannot be synthesized by humans. Otherwise, our body generates all other fatty acids by two-carbon chain additions to acetyl-coenzyme A (CoA). For more detailed information on their classification refer to Fahy et al[7] and Christie and Xianlin[8].

Though lipid biosynthesis is quantitatively most active in hepatocytes and adipose tissue, every nucleated cell is capable of it. Figure 1 gives an overview of lipid biosynthesis as it relates to the production of AMLs and earmarks the enzymes for which evidence of regulation by innate immune pathways is available.

Figure 1
Figure 1 Simplified lipid biosynthesis pathway highlighting the lipids and the enzymes with a putative role in innate immunity. Lipid classes with documented antibacterial activity are in bold, key enzymes that may be induced in response to infection and inflammation (homo sapiens nomenclature) are in red. MUFA: Monounsaturated fatty acids; PUFA: Polyunsaturated fatty acids; ACC1: Acetyl-CoA carboxylase 1; FASN: Fatty acid synthase; SCD: Stearoyl-CoA desaturase-1; ACSL1: Acyl-CoA synthetase long-chain family member 1; FADS2: Fatty acid desaturase 2; SOAT1: Sterol O-acyltransferase 1 (SOAT1, also known as acyl-Coenzyme A: Cholesterol acyltransferase 1 or ACAT 1); HMG-CoA: 3-hydroxy-3-methylglutaryl-CoA.

The initial and committed step in the fatty acid synthesis pathway is mediated by acetyl-CoA carboxylase 1 that catalyzes the addition of CO2 to the methyl group of acetyl CoA generating malonyl-CoA. Malonyl-CoA serves as the donor of two carbon acetyl groups during each round of the fatty acid synthesis reaction cycle. Fatty acid synthase is a multifunctional enzyme that catalyzes seven different reactions where two carbon units from malonyl-CoA are linked together ultimately resulting in the formation of saturated fatty acids. Terminal desaturases then generate unsaturated fatty acids. Stearoyl-CoA desaturase also known as delta-9-desaturase catalyzes the synthesis of monounsaturated fatty acids (MUFAs). Biosynthesis of MUFAs occurs through the introduction of the first cis double bond in the Δ9 position between carbons 9 and 10. Fatty acid desaturase 2, encoded by FADS2 and also known as delta-6 desaturase, is required for the synthesis of polyunsaturated fatty acids (PUFAs). FADS2 is classified as a front-end desaturase because it introduces a double bond between the pre-existing double bond and the carboxyl end of the fatty acid. Long-chain-fatty-acid-CoA ligase 1 is encoded by ACSL1 and converts free long-chain fatty acids into fatty acyl-CoA esters. Acyl-CoA synthetases activate free long-chain fatty acids by converting them into fatty acyl-CoA esters. Fatty acyl-CoA esters are substrates for multiple fatty acid metabolic pathways, including mitochondrial β-oxidation and phospholipid and triacylglycerol synthesis. Sterol O-acyltransferase 1 (SOAT1, also known as acyl-Coenzyme A: cholesterol acyltransferase 1 or cholesterol acyltransferase 1), catalyzes the esterification of fatty acids to cholesterol. An ester bond is formed between the carboxylate group of a fatty acid and the hydroxyl group of cholesterol. De novo synthesis of free cholesterol via the mevalonate pathway also begins with acetyl CoA. Acetyl-CoA undergoes condensation with another acetyl-CoA subunit via acetyl-CoA transferase to form acetoacetyl-CoA. Acetyl-CoA condenses with acetoacetyl-CoA to form 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA). HMG-CoA is reduced to mevalonate with consumption of NADPH, and after sequential reactions producing the intermediates mevalonate-P, isopentenyl-PP, farnesyl-PP, squalene, lanosterol, and 7-dehydrocholesterol, free cholesterol has been generated.


Lipids are used as a form of energy storage, are precursors for steroid hormones[9], and have important structural functions. Cell membranes are composed of a phospholipid bilayer and transmembrane receptor signaling is dependent on the specific lipid composition of the cell membrane in the vicinity of these receptors. These specialized regions are referred to as lipid rafts and caveolae[10-12]. There are substantial differences in the phospholipid composition of bacterial and mammalian cell membranes, likely contributing to the preferential action of host defense molecules against bacterial targets[13-15]. Furthermore, lipids liberated from cellular membranes have been found to be strong modulators of inflammation. Initially, they were identified as strong proinflammatory second messengers such as prostaglandins and leukotrienes which are synthesized from arachidonic acid. However, in the last decade an important down regulatory role of membrane-derived lipids has been discovered. These inflammation resolving lipids are derivatives of the essential omega-6 and omega-3 PUFAs and include resolvins (coined after their inflammation resolving function), lipoxins, protectins and maresins[16-18]. Moreover, there is new evidence that lipids may also trigger increased antimicrobial peptide production as shown for the sphingolipid S1P which increased CAMP production[19], or for sebum FFA which induced beta-defensin production[18]. However, lipids can also exert direct antimicrobial activity, which is not only supported by in vitro testing but also by the association of some infectious diseases with defects in lipid metabolism.


Several chronic infectious diseases are associated with altered lipid composition in skin and in the airways. For example, Arikawa et al[20] reported reduced sphingosine levels in keratinocytes in patients with atopic dermatitis and recurrent Staphylococcus aureus (S. aureus) skin infections. In the stratum corneum of lamellar ichthyosis patients who are at higher risk of contracting chronic dermatophytosis[21], the amount of FFA is reduced and the ceramide profile is altered[22,23]. In cystic fibrosis, patients suffer from chronic lung infections with S. aureus, Burkholderia cepacia complex, Stenotrophomonas maltophilia, and, most importantly, Pseudomonas aeruginosa[24-27]. In these patients, altered fatty acid levels including reduced levels of docosahexaenoic acid[28] have been described and docosahexaenoic acid supplementation improved the clinical status in some studies[29]. Other lipid anomalies in cystic fibrosis are altered cholesterol homeostasis[30], and elevated cholesteryl ester concentrations in tracheobronchial secretions[31]. We have found an increased cholesteryl ester representation in the lipid content of bronchoalveolar lavages obtained from pediatric cystic fibrosis patients[32]. Furthermore, elevated cholesteryl linoleate levels were found in sinus washes in chronic rhinosinusitis[33].


Lipids have been well characterized in all body surfaces and tissues whereby extraction and identification method influences the outcome and caution should be applied when comparing results from different studies. Recognition of the antimicrobial activity of certain lipids and improved analytical instrumentation have invited additional surveys many of which are compiled in Thormar[6] 2011. Analysis of the lipid composition of the intestinal tract is complicated by nutritional lipids and lipids synthesized by the normal endemic microbiota and thus, is not considered in review.

Breast milk and vernix caseosa

Breast milk was one of the first human body fluids investigated for its lipid content. Thormar et al[34] reported in 1987 that FFA and monoglycerides in milk exhibit antiviral activity. It appears that milk lipases release the bioactive lipids from more complex lipids. This work was subsequently extended to include activity against various bacteria and protozoa[35]. Unique to the newborn is vernix caseosa, the waxy coat formed during the last trimester of pregnancy that covers the new born infant. This lipid-rich film is primarily derived from the stratum corneum and sebaceous glands of the fetal skin. Ten percent of its content is represented by lipids, with a relative abundance of nonpolar species such as wax esters/sterol esters/squalene, and triacylglycerol. Other vernix caseosa lipids include FFA, fatty alcohols, cholesterol, diacylglycerol, monoacylglycerol, and phospholipids[36-39]. Antibacterial activity of total lipid extract was observed against the test strain Bacillus megaterium and was attributed to FFA.


Skin lipids (sebum) are from secretions by sebaceous glands and the stratum corneum, their composition is in part further shaped by the metabolic activities of the normal microbiota[4,40] and the exogenous application of lotions and cosmetics. Employing a combined LC/MS approach Camera et al[41] identified 95 triacylglycerols, 25 diacylglycerols, numerous wax esters and squalenes, a total of 9 cholesterol esters, and more than 48 FFA in sebum. Antimicrobial activity has been attributed to fatty alcohols, monoglycerides, sphingolipids including D-sphingosine, phospholipids, and in particular FFA such as sapienic acid and lauric acid[42,43].


Very long chain wax esters and fatty acids have been of identified in meibum, the lipid rich component of tears[44]. Lipids in tear fluid reach micromolar concentrations and the most abundant species are phosphatidylcholine and phosphatidylethanolamine. Additional lipid classes are triglycerides, sphingosine and ceramides, as well as cholesteryl esters[45]. While a lubricant function has been primarily attributed to tear lipids, a recent study suggested growth inhibitory activity of whole tear lipid extracts against several Gram-positive and Gram-negative bacteria[46].

Oral mucosa

Sphingosine, sapienic and lauric acid have also been identified as key antimicrobial fatty acids in the oral mucosa[47]. Brasser et al[48] analyzed salvia from healthy adults and identified FFA, cholesterol, cholesterol esters, triglycerides, wax esters, and squalene. The neutral lipid concentration was determined to be in the low μg/mL range. Overall, FFA, triglycerides, and cholesteryl esters were the most abundant lipids in saliva.


In the airway lumen, surfactant is the main lipid source ascending from the alveolar space, its primary site of production, to the upper airways, where some local production also occurs[49]. Phospholipids comprise the majority of the lipids in surfactant, a lipoprotein complex[50], and are thought to mainly contribute to reducing lung surface tension and participate in a downregulation of immune responses. The antimicrobial properties of surfactant have been mainly attributed to surfactant proteins SP-A and SP-D[51,52]. Nasal fluid is rich in lipids with all major classes represented, namely FFA, phospholipids, triglycerides, cholesterol, and cholesteryl esters, and their origin can be at least in part attributed to epithelial cell secretions[53]. Selective removal of the non-polar portion of lipids resulted in a decreased inherent antibacterial activity against P. aeruginosa that was restored after supplementation with the extracted lipids. This suggests that lipids in nasal fluid contribute to the innate antimicrobial defense in the airways[53].

Urogenital tract

Information on the lipid composition of fluids of the urogenital tract is scarce. Urine contains predominantly phospholipids including glycerophospholipids, phosphatidylcholine, phosphatidyl serine and sphingomyelin, as well as triglycerides, but cholesterol and cholesteryl esters are also present[54,55]. Semen lipids include sphingomyelin, glycerophospholipids, and cholesterol[56,57]. A very recent metabolomics study on bacterial vaginosis suggested elevated eicosanoid levels in affected women but this study was designed to identify differentially represented metabolites in diseases patients and did not aim to provide a baseline lipid profile of healthy women[58]. To the best of our knowledge, information on the antimicrobial activity of lipids of the urogenital tract is not available.


Among human lipids, fatty acids are the best characterized as antimicrobial agents, and their spectrum of activity as a whole is broad and spans from bacteria and viruses to fungi and protozoa[6]. Other human lipids with antimicrobial properties include sphingoid bases[43], that are active against Gram positive and Gram negative bacteria. Cholesteryl esters have long been thought to serve only as a storage and transport form for either cholesterol or FFA. However, cholesteryl linoleate and cholesteryl arachidonate, when formulated in liposomes, demonstrated growth inhibitory activity against several Gram positive and Gram negative bacteria[53].


Influenced by the three dimensional shape and saturation status of the acyl chains AMLs exert their action in different ways. These include disruption caused by interference with the cell membrane with ensuing permeability changes or interference with the activity of membrane bound enzyme complexes and events following lipid peroxidation with radical formation. FFA have been substantially investigated in this respect, and a detailed review on this subject has been authored by Desbois and Smith[59]. More recent studies describe rapid membrane depolarization in S. aureus treated with palmitoleate as well as when treated with glycerol ethers, sphingosine, and acyl-amines[60]. As demonstrated by scanning electron microscopy, meibomian lipids from tears cause major structural damage including distortion, loss or regular cell shape, and cell lysis in S. aureus, P. aeruginosa, and Serratia marcescens[46].

The more pronounced antimicrobial activity of unsaturated FFA compared to their saturated counterparts[61] may be at least in part attributed to lipid peroxidation. Spontaneous generation of a lipid radical at the unsaturated bond leads, under consumption of molecular oxygen, to the production of a lipid peroxyl radical that can react with nearby fatty acids leading to a lipid peroxidation chain reaction. Eventually, these radicals covalently modify adjacent macromolecules[62].

In addition, anti-adhesive effects of lipids have been reported. Milk fat globules from bovine and goat milk reduced attachment of Salmonella Enteritidis to HT-29 human adenocarcinoma cells and subsequent internalization[63]. Another more recently described effect of AMLs is inhibition of biofilm production. For example the milk monoglyceride monolaurin (also called lauricidin[64]) inhibits biofilm mass produced by Gram positive bacteria including Streptococcus mutans and S. aureus[65,66].


Antimicrobial peptides are characterized by an amphipathic structure with cationic and hydrophobic domains and are typically less than 10 kDa in size. Antimicrobial proteins have similar amphipathic domains but are larger and typically consist of additional regions with unique functions, such as lysozyme that hydrolyzes peptidoglycan and lactoferrin that binds iron. AMPs share many of the mechanisms described for AMLs, in particular membrane disruption, and there are several studies documenting synergist activities between these two classes of antimicrobials. Tollin et al[38] reported synergistic activity between vernix caseosa lipids and the antimicrobial peptide LL37 whereby this effect was attributed to FFA in vernix. We found synergistic effects between nasal fluid lipid extracts and the antimicrobial peptide human neutrophil peptide HNP1[53], and between the free fatty acid docosahexaenoic acid and lysozyme[67]. The latter study demonstrated that in the presence of lysozyme, docosahexaenoic acid accumulates in the bacterial cell membrane. Nakatsuji et al[68] demonstrated synergistic effects between the free fatty acid lauric acid and the antimicrobial peptide HBD2 against Propionibacterium acnes. This study also showed that several sebum FFA up-regulate antimicrobial peptide production in sebocytes.

A different type of protein-lipid synergism has been described for human α-lactalbumin made lethal to tumor cells (HAMLET) from human milk, primarily known for its anti-tumor effects[69]. When complexed with oleic acid HAMLET exerts bactericidal effects against S. pneumoniae via calcium dependent membrane depolarization[70,71]. Furthermore, acetylation of cationic peptides has been shown to impart antimicrobial activity or increase their antimicrobial activity[72].


Reports on lipid profile changes in sepsis[73,74] have suggested that AML production may be regulated in the context of infection that would involve TLR and other pattern recognition receptor signaling and signaling induced by proinflammatory cytokines like IL1β. Important evidence for the regulation of AMLs by conserved pathways of innate immunity was provided by Georgel et al[75] investigating the regulation of stearoyl-CoA desaturase gene expression (scd1 in mice and scd in humans), a rate limiting enzyme for the synthesis of monosaturated fatty acids. They found that the scd1 gene has numerous NFκB elements in its promoter region and is strongly and specifically induced by TLR2 signaling and that scd expression is also induced by TLR2 signaling in a human sebocyte cell line. Furthermore, scd1-/- mice developed chronic skin infections.

Using a contrary approach, Wang et al[76] have recently shown that overexpression of fatty acid desaturases increases resistance to infection in zebrafish. Other findings that suggest that lipids are regulated by infection and inflammation include the activation of genes important for lipid synthesis in caseation of human tuberculosis granuloma[77].

SOAT1 is essential for cholesteryl ester synthesis and we have shown that non-polar lipids overall and specifically cholesteryl linoleate are elevated in sinus washes obtained from patients with chronic rhinosinusitis[33]. This data suggested an up-regulation of SOAT1 in the context of inflammation which was corroborated by a subsequent study showing increased SOAT1 mRNA expression in sinus mucosa of patients with chronic rhinosinusitis[78]. In addition, cholesteryl esters were increased within the lipid fraction and their concentrations correlated with human neutrophil peptides HNP1-3, markers of inflammation, in bronchoalveolar lavage collected from pediatric cystic fibrosis patients[32]. Direct evidence for the regulation of SOAT1 by inflammation was recently provided by Yin et al[79], who showed that oxLDL activates TLR4 and induces the expression of SOAT1 (referred to as ACAT-1 ) via MyD88 and NFκB. Thus, there is clinical and experimental evidence that in vivo cholesteryl ester biosynthesis is regulated by inflammation and infection. Additional data supporting the regulation of AMLs by TLR ligands and immunomodulatory cytokines can be found in the NCBI Gene Expression Omnibus (GEO Profiles) data base. Table 1 lists genes involved in lipid metabolism and transport which are regulated by TLR ligands and modulators of the immune system.

Table 1 Genes involved in lipid metabolism and transport regulated by innate immune pathways.
RoleGene nameEncoded proteinFunction of the encoded proteinCellular sourceRegulators
Biosynthesisacc1Acetyl-CoA carboxylase 1Catalyzes the rate limiting irreversible carboxylation of acetyl-CoA to produce malonyl-CoAHepatic tissue1LPS via sterol regulatory element-binding protein-1c
acsl1Long-chain fatty-acid-coenzyme A ligaseConverts free long-chain fatty acids into fatty acyl-CoA estersMp, DC, EN, MoLPS, IFN-γ, TNF-α, IL22, Mtb-derived lipopeptide
elovElongation of long chain fatty acidsPossibly implicated in tissue-specific synthesis of very long chain fatty acids and sphingolipids3Mp, DC, CD34+, TE,B, F, ENLPS, Zy, Schi, IL1, IFN-β, IFN-γ, IL10, TGF-β
fadFatty acid desaturaseCatalyzes biosynthesis of highly unsaturated fatty acids. FADS2 catalyzes production of the mono-unsaturated fatty acid sapienate, the most abundant fatty acid in sebumMp,DC, CD34+, TE, B, ENLPS, Zy, Schi, IL1, IFN-γ, IL10, TGF-β
fasnFatty acid synthaseCatalyzes the formation of long-chain fatty acids from acetyl-CoA, malonyl-CoA and NADPHMp, DC, CD34+, TE, F, ENLPS, Zy, Schi, IL1, IFN-γ, TGF-β
lcatLecithin cholesterol acyltransferase2Esterifies free cholesterol transported in plasma lipoproteins. Activated by apolipoprotein A-IMp, DC, CD8+ DC, B, FLPS, Schi, IFN-β, IFN-γ, Yersinia + IFN-γ, Vit D3 + IFN-γ, IL10
lipALipase A3Intracellular hydrolysis of internalized cholesteryl esters and triglycerides. Activation of endogenous cellular cholesteryl ester formationMo, Mp, DC, TE, EN, K, BrE, L, MgTLR agonists, IL1, Type I and II IFNs, γ, Diff/Polar
scd4Stearoyl-CoA desaturaseCatalyzes the desaturation of very long chain acyl-CoAsMo, Mp, L, CD8+ DC, TE, F, EN, K, BrE, MgLPS, Zy, TLR agonist, IL1, Type I and II IFNs, Yersinia + IFN-γ, Vit D3 + IFN-γ, Diff/Polar
soat15Sterol o-acyltransferase3Catalyzes the formation of fatty acid-cholesterol estersMo, Mp, DC, TE, EN, L, MgTLR agonists, Type I and II IFNs, IL1, Diff/Polar
TransportcetpCholesteryl ester transfer protein3Involved in the transfer of insoluble cholesteryl esters in the reverse transport of cholesterolMo, Mp, DC, TE, EN, K, L, MgTLR agonists, IL1,Type I and II IFNs, Diff/Polar
fabpFatty acid binding proteinsIntracellular lipid transportMp, DC, CD34+, TE, B, F, ENLPS, Zy, Schi, IL1, Type I and II IFNs, IL10, TGF-β
ffarFree fatty acid receptorReceptor for short chain fatty acids (FFAR2) and medium to long fatty acids (FFAR1). FFAR2 is expressed at relatively high levels in peripheral blood leukocytesMp, DC, CD34+,TE, ENLPS, Zy, Schi, IL1, IFN-γ, TGF-β
slc27ASolute carrier family 27Translocation of long-chain fatty acids across the plasma membrane. Some involved in bile acid synthesisMp, DC, CD34+, TE, B, F, ENLPS, Zy, Schi, IL1, IFN-γ, IFN-β, IL10, TGF-β

Other investigations propose that cholesterol and cholesteryl ester accumulation in response to inflammatory cytokines and infection serve perpetuation of inflammation. For example, Pessolano et al[80] described that IL1β increased cholesteryl ester accumulation in smooth muscle cells as part of cholesterol trafficking in atherosclerosis. Similarly, Tall and Yvan-Charvet[81] highlight the proinflammatory effects of increased cholesterol uptake through TLR signaling and inflammasome activation in macrophages. However, considering the direct antimicrobial activity of cholesteryl esters these studies could be revisited to investigate changes in the antimicrobial responses.


Bearing in mind the hydrophobic nature of AMLs and the aqueous milieu in body fluids, proteins with both hydrophilic domains and hydrophobic pockets likely serve as carriers. Albumin and fatty acid binding proteins are well established carriers for fatty acids. Sterol carrier protein 2 and cholesteryl ester transfer protein assume this role for cholesterol and cholesteryl esters, respectively[82]. In addition, in the airways, the highly hydrophobic protein short palate lung epithelial clone protein 1 binds certain phospholipids and sphingolipids[83,84] and may possibly also function as a cholesteryl ester carrier. However, much research is still needed to dissect the focused delivery of AMLs to the microbial target.


Host defense mechanisms are continuously challenged by microbial resistance factors and it would be surprising if successful pathogens do not have counter strategies that inactivate AMLs. Both, S. aureus and S. saprophyticus express a cell wall associated surface protein, SsaF and SssF, respectively, that mediates resistance to the free fatty acid linoleic acid[85,86]. Furthermore, cell wall teichoic acids of S. aureus confer resistance to fatty acids from skin sebaceous glands[87].

At this time it is still speculative whether a cholesterol esterase produced by P. aeruginosa[88] may represent an additional virulence factor aiding in the inactivation of host-derived antimicrobial cholesteryl esters. Of interest is the recent finding of Cadieux et al[89] who identified a lipase in a hypervirulent community-associated methicillin-resistant S. aureus strain USA300 that hydrolyzes triglycerides and liberates the free fatty acid linoleic acid with growth inhibitory activity against S. aureus. It is possible that the liberation of antibacterial linoleic acid is primarily targeted against other bacteria thereby conferring growth advantage to S. aureus. Such a mechanism has been proposed for Salmonella where the bacteria induce the production of antimicrobial proteins in the intestine that in turn altered the normal microbiota facilitating infection with the pathogen[90].

Successful pathogens subvert host defense mechanisms that normally control infection. Thus, the ability of Mycobacterium tuberculosis, M. leprae and other intracellular pathogens to import lipids from the cholesteryl ester-rich lipid droplets that they induce in their host cell[91,92] may be an example for subversion of antimicrobial cholesteryl ester accumulation as part of the innate defense.


Based on the evidence laid out above, we propose that AMLs take part in the innate epithelial defense controlled by regulatory pathways like antimicrobial proteins and functioning in synergism with AMPs (Figure 2). Following activation of pattern recognition receptors and cytokine receptors, epithelial cells upsurge the uptake of cholesterol and fatty acids, increase the expression of antimicrobial peptides and enzymes for lipid biosynthesis, scale up the production and secretion of AMLs and antimicrobial peptides, and, combined with antimicrobial effectors from other sources such as macrophages, lead to membrane damage and other disrupting effects on the invading pathogen.

Figure 2
Figure 2 Working model of epithelial cell mediated innate defense. In response to microbial products and cytokines epithelial cells increase the production and secretion of antimicrobial lipids and antimicrobial proteins as well as cytokines and chemokine to eradicate infection in concert with other defense components of the body. PRR: Pattern recognition receptor for microbial products; AML: Antimicrobial lipids; AMP: Antimicrobial proteins. Other sources: Other defense cells recruited to the site of infections such as macrophages and neutrophils.

The recognition that host-derived lipids form part of the innate antimicrobial defense leads to new questions including the following: What are other microbial targets beyond bacteria and viruses? How are AMLs delivered to pathogens? Do carrier proteins assume this task or do exosomes serve this purpose? Can AMLs be incorporated in novel drug design? Is resistance to AMLs a pathogenicity factor that could be targeted in the management of infectious diseases? Are certain chronic and recurrent infectious diseases linked to defective AML production and/or delivery? Can the lipid mediated arm of host defense be integrated in novel vaccine strategies?


Commercial tools to study AMLs are relatively underdeveloped compared to the extensive repertoire for proteomics and genomics. An essential technique for qualitative analysis and the ability to assess a wide range of lipid classes is separation by thin layer chromatography with colorimetric visualization with a variety of reagents. Reversed phase high performance liquid chromatography with evaporative light scattering detection allows for more quantitative studies. Definitive and highly quantitative analysis is achieved with mass spectral analysis usually combined with gas chromatography or liquid chromatography. There are several web sites (accurate at the time of printing) that offer extensive hands-on information regarding lipid handling and analysis. These include the Cyberlipid Center (http://www.cyberlipid.org/), The American Oil Chemists’ Society Lipid Library (http://lipidlibrary.aocs.org/), and the Lipidomics Gateway (http://www.lipidmaps.org/). Furthermore, some lipid manufacturers offer a wealth of technical support. Those who would like to take on the challenge of lipidomics will fare well by identifying a collaborator with a background in biochemistry and expertise in mass spectrometry and metabolomics.

While lipid extraction protocols are well established with one of the most frequently used one dating back to Bligh and Dyer[93], a major hurdle in investigating functional properties of AMLs, in particular nonpolar lipids like cholesteryl esters, is their low solubility in aqueous media used for antimicrobial activity testing. For FFA addition of low concentration of ethanol such as 0.05% allows for solubilization. However, for less polar and non-polar lipids embedding of the lipid of interest in liposomes prepared from various phospholipids has been proven successful for in vitro studies[6,94,95].


AMLs as effectors of the innate immune response and microbial counter strategies are an emerging field of study. New investigators are invited to enter the field to uncover the regulation of AML production, their delivery to pathogens and mechanism of action. We hope that this review has piqued the interest and will usher new investigators to this challenging and growing field.


We thank Charles L Bevins, Paul B McCray Jr, and Jennifer Bartlett for helpful discussions.


P- Reviewer: Poirot M, Siahanidou T S- Editor: Ji FF L- Editor: A E- Editor: Jiao XK

1.  Parker D, Prince A. Innate immunity in the respiratory epithelium. Am J Respir Cell Mol Biol. 2011;45:189-201.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 302]  [Cited by in F6Publishing: 318]  [Article Influence: 25.2]  [Reference Citation Analysis (0)]
2.  Tossi A. Host defense peptides: roles and applications. Curr Protein Pept Sci. 2005;6:1-3.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Annunziato F, Romagnani C, Romagnani S. The 3 major types of innate and adaptive cell-mediated effector immunity. J Allergy Clin Immunol. 2015;135:626-635.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 400]  [Cited by in F6Publishing: 412]  [Article Influence: 44.4]  [Reference Citation Analysis (0)]
4.  Thormar H, Hilmarsson H. The role of microbicidal lipids in host defense against pathogens and their potential as therapeutic agents. Chem Phys Lipids. 2007;150:1-11.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 118]  [Cited by in F6Publishing: 119]  [Article Influence: 7.4]  [Reference Citation Analysis (0)]
5.  Drake DR, Brogden KA, Dawson DV, Wertz PW. Thematic review series: skin lipids. Antimicrobial lipids at the skin surface. J Lipid Res. 2008;49:4-11.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 214]  [Cited by in F6Publishing: 225]  [Article Influence: 13.4]  [Reference Citation Analysis (0)]
6.  Lipids and Essential Oils as Antimicrobial Agents Thormar H, editor. Chichester, UK: John Wiley & Sons Ltd 2011; .  [PubMed]  [DOI]  [Cited in This Article: ]
7.  Fahy E, Subramaniam S, Brown HA, Glass CK, Merrill AH, Murphy RC, Raetz CR, Russell DW, Seyama Y, Shaw W. A comprehensive classification system for lipids. J Lipid Res. 2005;46:839-861.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1105]  [Cited by in F6Publishing: 1138]  [Article Influence: 61.4]  [Reference Citation Analysis (0)]
8.  Christie WW, Xianlin H.  Lipid analysis. 4th ed. Oily Press. 2010;.  [PubMed]  [DOI]  [Cited in This Article: ]
9.  He J, Cheng Q, Xie W. Minireview: Nuclear receptor-controlled steroid hormone synthesis and metabolism. Mol Endocrinol. 2010;24:11-21.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 18]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
10.  Simons K, Sampaio JL. Membrane organization and lipid rafts. Cold Spring Harb Perspect Biol. 2011;3:a004697.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 697]  [Cited by in F6Publishing: 739]  [Article Influence: 58.1]  [Reference Citation Analysis (0)]
11.  Sonnino S, Prinetti A. Membrane domains and the “lipid raft” concept. Curr Med Chem. 2013;20:4-21.  [PubMed]  [DOI]  [Cited in This Article: ]
12.  Reeves VL, Thomas CM, Smart EJ. Lipid rafts, caveolae and GPI-linked proteins. Adv Exp Med Biol. 2012;729:3-13.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 28]  [Cited by in F6Publishing: 28]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
13.  Shireen T, Basu A, Sarkar M, Mukhopadhyay K. Lipid composition is an important determinant of antimicrobial activity of alpha-melanocyte stimulating hormone. Biophys Chem. 2015;196:33-39.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 13]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
14.  Glukhov E, Stark M, Burrows LL, Deber CM. Basis for selectivity of cationic antimicrobial peptides for bacterial versus mammalian membranes. J Biol Chem. 2005;280:33960-33967.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 202]  [Cited by in F6Publishing: 207]  [Article Influence: 11.2]  [Reference Citation Analysis (0)]
15.  Lohner K. New strategies for novel antibiotics: peptides targeting bacterial cell membranes. Gen Physiol Biophys. 2009;28:105-116.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Weylandt KH, Kang JX, Wiedenmann B, Baumgart DC. Lipoxins and resolvins in inflammatory bowel disease. Inflamm Bowel Dis. 2007;13:797-799.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 39]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
17.  Serhan CN. Resolution phase of inflammation: novel endogenous anti-inflammatory and proresolving lipid mediators and pathways. Annu Rev Immunol. 2007;25:101-137.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 704]  [Cited by in F6Publishing: 738]  [Article Influence: 44.0]  [Reference Citation Analysis (0)]
18.  Serhan CN. Pro-resolving lipid mediators are leads for resolution physiology. Nature. 2014;510:92-101.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1778]  [Cited by in F6Publishing: 1838]  [Article Influence: 197.6]  [Reference Citation Analysis (0)]
19.  Park K, Elias PM, Shin KO, Lee YM, Hupe M, Borkowski AW, Gallo RL, Saba J, Holleran WM, Uchida Y. A novel role of a lipid species, sphingosine-1-phosphate, in epithelial innate immunity. Mol Cell Biol. 2013;33:752-762.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 51]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
20.  Arikawa J, Ishibashi M, Kawashima M, Takagi Y, Ichikawa Y, Imokawa G. Decreased levels of sphingosine, a natural antimicrobial agent, may be associated with vulnerability of the stratum corneum from patients with atopic dermatitis to colonization by Staphylococcus aureus. J Invest Dermatol. 2002;119:433-439.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 198]  [Cited by in F6Publishing: 206]  [Article Influence: 9.4]  [Reference Citation Analysis (0)]
21.  Scheers C, Andre J, Thompson C, Rebuffat E, Harag S, Kolivras A. Refractory Trichophyton rubrum infection in lamellar ichthyosis. Pediatr Dermatol. 2013;30:e200-e203.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 12]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
22.  Bouwstra JA, Ponec M. The skin barrier in healthy and diseased state. Biochim Biophys Acta. 2006;1758:2080-2095.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 413]  [Cited by in F6Publishing: 327]  [Article Influence: 24.3]  [Reference Citation Analysis (0)]
23.  Pilgram GS, Vissers DC, van der Meulen H, Pavel S, Lavrijsen SP, Bouwstra JA, Koerten HK. Aberrant lipid organization in stratum corneum of patients with atopic dermatitis and lamellar ichthyosis. J Invest Dermatol. 2001;117:710-717.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 166]  [Cited by in F6Publishing: 171]  [Article Influence: 7.5]  [Reference Citation Analysis (0)]
24.  Conway SP, Brownlee KG, Denton M, Peckham DG. Antibiotic treatment of multidrug-resistant organisms in cystic fibrosis. Am J Respir Med. 2003;2:321-332.  [PubMed]  [DOI]  [Cited in This Article: ]
25.  Saiman L, Siegel J. Infection control in cystic fibrosis. Clin Microbiol Rev. 2004;17:57-71.  [PubMed]  [DOI]  [Cited in This Article: ]
26.  Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med. 2003;168:918-951.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1180]  [Cited by in F6Publishing: 1235]  [Article Influence: 59.0]  [Reference Citation Analysis (0)]
27.  Waters V, Ratjen F. Multidrug-resistant organisms in cystic fibrosis: management and infection-control issues. Expert Rev Anti Infect Ther. 2006;4:807-819.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 38]  [Cited by in F6Publishing: 40]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
28.  Strandvik B, Gronowitz E, Enlund F, Martinsson T, Wahlström J. Essential fatty acid deficiency in relation to genotype in patients with cystic fibrosis. J Pediatr. 2001;139:650-655.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 138]  [Cited by in F6Publishing: 139]  [Article Influence: 6.3]  [Reference Citation Analysis (0)]
29.  Coste TC, Armand M, Lebacq J, Lebecque P, Wallemacq P, Leal T. An overview of monitoring and supplementation of omega 3 fatty acids in cystic fibrosis. Clin Biochem. 2007;40:511-520.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 45]  [Cited by in F6Publishing: 45]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
30.  White NM, Jiang D, Burgess JD, Bederman IR, Previs SF, Kelley TJ. Altered cholesterol homeostasis in cultured and in vivo models of cystic fibrosis. Am J Physiol Lung Cell Mol Physiol. 2007;292:L476-L486.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 69]  [Cited by in F6Publishing: 74]  [Article Influence: 4.1]  [Reference Citation Analysis (0)]
31.  Slomiany A, Murty VL, Aono M, Snyder CE, Herp A, Slomiany BL. Lipid composition of tracheobronchial secretions from normal individuals and patients with cystic fibrosis. Biochim Biophys Acta. 1982;710:106-111.  [PubMed]  [DOI]  [Cited in This Article: ]
32.  Ma DC, Yoon AJ, Faull KF, Desharnais R, Zemanick ET, Porter E. Cholesteryl esters are elevated in the lipid fraction of bronchoalveolar lavage fluid collected from pediatric cystic fibrosis patients. PLoS One. 2015;10:e0125326.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 9]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
33.  Lee JT, Jansen M, Yilma AN, Nguyen A, Desharnais R, Porter E. Antimicrobial lipids: novel innate defense molecules are elevated in sinus secretions of patients with chronic rhinosinusitis. Am J Rhinol Allergy. 2010;24:99-104.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 33]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
34.  Thormar H, Isaacs CE, Brown HR, Barshatzky MR, Pessolano T. Inactivation of enveloped viruses and killing of cells by fatty acids and monoglycerides. Antimicrob Agents Chemother. 1987;31:27-31.  [PubMed]  [DOI]  [Cited in This Article: ]
35.  Isaacs CE. Human milk inactivates pathogens individually, additively, and synergistically. J Nutr. 2005;135:1286-1288.  [PubMed]  [DOI]  [Cited in This Article: ]
36.  Rissmann R, Gooris G, Ponec M, Bouwstra J. Long periodicity phase in extracted lipids of vernix caseosa obtained with equilibration at physiological temperature. Chem Phys Lipids. 2009;158:32-38.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
37.  Rissmann R, Groenink HW, Weerheim AM, Hoath SB, Ponec M, Bouwstra JA. New insights into ultrastructure, lipid composition and organization of vernix caseosa. J Invest Dermatol. 2006;126:1823-1833.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 66]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
38.  Tollin M, Bergsson G, Kai-Larsen Y, Lengqvist J, Sjövall J, Griffiths W, Skúladóttir GV, Haraldsson A, Jörnvall H, Gudmundsson GH. Vernix caseosa as a multi-component defence system based on polypeptides, lipids and their interactions. Cell Mol Life Sci. 2005;62:2390-2399.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 81]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
39.  Hoeger PH, Schreiner V, Klaassen IA, Enzmann CC, Friedrichs K, Bleck O. Epidermal barrier lipids in human vernix caseosa: corresponding ceramide pattern in vernix and fetal skin. Br J Dermatol. 2002;146:194-201.  [PubMed]  [DOI]  [Cited in This Article: ]
40.  Lee SH, Jeong SK, Ahn SK. An update of the defensive barrier function of skin. Yonsei Med J. 2006;47:293-306.  [PubMed]  [DOI]  [Cited in This Article: ]
41.  Camera E, Ludovici M, Galante M, Sinagra JL, Picardo M. Comprehensive analysis of the major lipid classes in sebum by rapid resolution high-performance liquid chromatography and electrospray mass spectrometry. J Lipid Res. 2010;51:3377-3388.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 117]  [Cited by in F6Publishing: 121]  [Article Influence: 9.0]  [Reference Citation Analysis (0)]
42.  Feingold KR. The outer frontier: the importance of lipid metabolism in the skin. J Lipid Res. 2009;50 Suppl:S417-S422.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 105]  [Cited by in F6Publishing: 118]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
43.  Fischer CL, Drake DR, Dawson DV, Blanchette DR, Brogden KA, Wertz PW. Antibacterial activity of sphingoid bases and fatty acids against Gram-positive and Gram-negative bacteria. Antimicrob Agents Chemother. 2012;56:1157-1161.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 132]  [Cited by in F6Publishing: 140]  [Article Influence: 11.0]  [Reference Citation Analysis (0)]
44.  Butovich IA. Cholesteryl esters as a depot for very long chain fatty acids in human meibum. J Lipid Res. 2009;50:501-513.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 79]  [Cited by in F6Publishing: 98]  [Article Influence: 5.3]  [Reference Citation Analysis (0)]
45.  Rantamäki AH, Seppänen-Laakso T, Oresic M, Jauhiainen M, Holopainen JM. Human tear fluid lipidome: from composition to function. PLoS One. 2011;6:e19553.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 87]  [Cited by in F6Publishing: 92]  [Article Influence: 7.3]  [Reference Citation Analysis (0)]
46.  Mudgil P. Antimicrobial role of human meibomian lipids at the ocular surface. Invest Ophthalmol Vis Sci. 2014;55:7272-7277.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 43]  [Cited by in F6Publishing: 46]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
47.  Dawson DV, Drake DR, Hill JR, Brogden KA, Fischer CL, Wertz PW. Organization, barrier function and antimicrobial lipids of the oral mucosa. Int J Cosmet Sci. 2013;35:220-223.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 31]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
48.  Brasser AJ, Barwacz CA, Dawson DV, Brogden KA, Drake DR, Wertz PW. Presence of wax esters and squalene in human saliva. Arch Oral Biol. 2011;56:588-591.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 22]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
49.  Woodworth BA, Smythe N, Spicer SS, Schulte BA, Schlosser RJ. Presence of surfactant lamellar bodies in normal and diseased sinus mucosa. ORL J Otorhinolaryngol Relat Spec. 2005;67:199-202.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 16]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
50.  Agassandian M, Mallampalli RK. Surfactant phospholipid metabolism. Biochim Biophys Acta. 2013;1831:612-625.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 137]  [Cited by in F6Publishing: 138]  [Article Influence: 12.5]  [Reference Citation Analysis (0)]
51.  Wright JR. Pulmonary surfactant: a front line of lung host defense. J Clin Invest. 2003;111:1453-1455.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 32]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
52.  Glasser JR, Mallampalli RK. Surfactant and its role in the pathobiology of pulmonary infection. Microbes Infect. 2012;14:17-25.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 59]  [Cited by in F6Publishing: 59]  [Article Influence: 4.9]  [Reference Citation Analysis (0)]
53.  Do TQ, Moshkani S, Castillo P, Anunta S, Pogosyan A, Cheung A, Marbois B, Faull KF, Ernst W, Chiang SM. Lipids including cholesteryl linoleate and cholesteryl arachidonate contribute to the inherent antibacterial activity of human nasal fluid. J Immunol. 2008;181:4177-4187.  [PubMed]  [DOI]  [Cited in This Article: ]
54.  Jüngst D, Weiser H, Siess E, Karl HJ. Urinary cholesterol: its association with a macromolecular protein-lipid complex. J Lipid Res. 1984;25:655-664.  [PubMed]  [DOI]  [Cited in This Article: ]
55.  Khan SR, Glenton PA, Backov R, Talham DR. Presence of lipids in urine, crystals and stones: implications for the formation of kidney stones. Kidney Int. 2002;62:2062-2072.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 96]  [Cited by in F6Publishing: 100]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
56.  Feki NC, Thérond P, Couturier M, Liméa G, Legrand A, Jouannet P, Auger J. Human sperm lipid content is modified after migration into human cervical mucus. Mol Hum Reprod. 2004;10:137-142.  [PubMed]  [DOI]  [Cited in This Article: ]
57.  Vignon F, Clavert A, Cranz C, Koll-Back MH, Reville P. Alterations in the lipid composition of seminal plasma in patients with a chronic infection of the urogenital tract. Urol Int. 1993;50:36-38.  [PubMed]  [DOI]  [Cited in This Article: ]
58.  Srinivasan S, Morgan MT, Fiedler TL, Djukovic D, Hoffman NG, Raftery D, Marrazzo JM, Fredricks DN. Metabolic signatures of bacterial vaginosis. MBio. 2015;6:e00204-215.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 156]  [Cited by in F6Publishing: 161]  [Article Influence: 19.5]  [Reference Citation Analysis (0)]
59.  Desbois AP, Smith VJ. Antibacterial free fatty acids: activities, mechanisms of action and biotechnological potential. Appl Microbiol Biotechnol. 2010;85:1629-1642.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 779]  [Cited by in F6Publishing: 795]  [Article Influence: 55.6]  [Reference Citation Analysis (0)]
60.  Parsons JB, Yao J, Frank MW, Jackson P, Rock CO. Membrane disruption by antimicrobial fatty acids releases low-molecular-weight proteins from Staphylococcus aureus. J Bacteriol. 2012;194:5294-5304.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 127]  [Cited by in F6Publishing: 127]  [Article Influence: 11.5]  [Reference Citation Analysis (0)]
61.  Choi JS, Park NH, Hwang SY, Sohn JH, Kwak I, Cho KK, Choi IS. The antibacterial activity of various saturated and unsaturated fatty acids against several oral pathogens. J Environ Biol. 2013;34:673-676.  [PubMed]  [DOI]  [Cited in This Article: ]
62.  Catalá A. Five decades with polyunsaturated Fatty acids: chemical synthesis, enzymatic formation, lipid peroxidation and its biological effects. J Lipids. 2013;2013:710290.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 43]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
63.  Guri A, Griffiths M, Khursigara CM, Corredig M. The effect of milk fat globules on adherence and internalization of Salmonella Enteritidis to HT-29 cells. J Dairy Sci. 2012;95:6937-6945.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 19]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
64.  Clarke NM, May JT. Effect of antimicrobial factors in human milk on rhinoviruses and milk-borne cytomegalovirus in vitro. J Med Microbiol. 2000;49:719-723.  [PubMed]  [DOI]  [Cited in This Article: ]
65.  Lester K, Simmonds RS. Zoocin A and lauricidin in combination reduce Streptococcus mutans growth in a multispecies biofilm. Caries Res. 2012;46:185-193.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 7]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
66.  Schlievert PM, Peterson ML. Glycerol monolaurate antibacterial activity in broth and biofilm cultures. PLoS One. 2012;7:e40350.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 110]  [Cited by in F6Publishing: 113]  [Article Influence: 10.0]  [Reference Citation Analysis (0)]
67.  Martinez JG, Waldon M, Huang Q, Alvarez S, Oren A, Sandoval N, Du M, Zhou F, Zenz A, Lohner K. Membrane-targeted synergistic activity of docosahexaenoic acid and lysozyme against Pseudomonas aeruginosa. Biochem J. 2009;419:193-200.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 26]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
68.  Nakatsuji T, Kao MC, Zhang L, Zouboulis CC, Gallo RL, Huang CM. Sebum free fatty acids enhance the innate immune defense of human sebocytes by upregulating beta-defensin-2 expression. J Invest Dermatol. 2010;130:985-994.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 128]  [Cited by in F6Publishing: 133]  [Article Influence: 9.1]  [Reference Citation Analysis (0)]
69.  Mossberg AK, Hun Mok K, Morozova-Roche LA, Svanborg C. Structure and function of human α-lactalbumin made lethal to tumor cells (HAMLET)-type complexes. FEBS J. 2010;277:4614-4625.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 63]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
70.  Permyakov SE, Knyazeva EL, Leonteva MV, Fadeev RS, Chekanov AV, Zhadan AP, Håkansson AP, Akatov VS, Permyakov EA. A novel method for preparation of HAMLET-like protein complexes. Biochimie. 2011;93:1495-1501.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 35]  [Cited by in F6Publishing: 31]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
71.  Clementi EA, Marks LR, Duffey ME, Hakansson AP. A novel initiation mechanism of death in Streptococcus pneumoniae induced by the human milk protein-lipid complex HAMLET and activated during physiological death. J Biol Chem. 2012;287:27168-27182.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 23]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
72.  Malina A, Shai Y. Conjugation of fatty acids with different lengths modulates the antibacterial and antifungal activity of a cationic biologically inactive peptide. Biochem J. 2005;390:695-702.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 131]  [Cited by in F6Publishing: 134]  [Article Influence: 7.7]  [Reference Citation Analysis (0)]
73.  Wendel M, Paul R, Heller AR. Lipoproteins in inflammation and sepsis. II. Clinical aspects. Intensive Care Med. 2007;33:25-35.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 122]  [Cited by in F6Publishing: 129]  [Article Influence: 7.2]  [Reference Citation Analysis (0)]
74.  Kruger PS. Forget glucose: what about lipids in critical illness? Crit Care Resusc. 2009;11:305-309.  [PubMed]  [DOI]  [Cited in This Article: ]
75.  Georgel P, Crozat K, Lauth X, Makrantonaki E, Seltmann H, Sovath S, Hoebe K, Du X, Rutschmann S, Jiang Z. A toll-like receptor 2-responsive lipid effector pathway protects mammals against skin infections with gram-positive bacteria. Infect Immun. 2005;73:4512-4521.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 158]  [Cited by in F6Publishing: 164]  [Article Influence: 8.8]  [Reference Citation Analysis (0)]
76.  Wang YD, Peng KC, Wu JL, Chen JY. Transgenic expression of salmon delta-5 and delta-6 desaturase in zebrafish muscle inhibits the growth of Vibrio alginolyticus and affects fish immunomodulatory activity. Fish Shellfish Immunol. 2014;39:223-230.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 20]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
77.  Kim MJ, Wainwright HC, Locketz M, Bekker LG, Walther GB, Dittrich C, Visser A, Wang W, Hsu FF, Wiehart U. Caseation of human tuberculosis granulomas correlates with elevated host lipid metabolism. EMBO Mol Med. 2010;2:258-274.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 320]  [Cited by in F6Publishing: 337]  [Article Influence: 24.6]  [Reference Citation Analysis (0)]
78.  Lee JT, Escobar OH, Anouseyan R, Janisiewicz A, Eivers E, Blackwell KE, Keschner DB, Garg R, Porter E. Assessment of epithelial innate antimicrobial factors in sinus tissue from patients with and without chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014;4:893-900.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 12]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
79.  Yin YW, Liao SQ, Zhang MJ, Liu Y, Li BH, Zhou Y, Chen L, Gao CY, Li JC, Zhang LL. TLR4-mediated inflammation promotes foam cell formation of vascular smooth muscle cell by upregulating ACAT1 expression. Cell Death Dis. 2014;5:e1574.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 45]  [Article Influence: 4.3]  [Reference Citation Analysis (0)]
80.  Pessolano LG, Sullivan CP, Seidl SE, Rich CB, Liscum L, Stone PJ, Sipe JD, Schreiber BM. Trafficking of endogenous smooth muscle cell cholesterol: a role for serum amyloid A and interleukin-1β. Arterioscler Thromb Vasc Biol. 2012;32:2741-2750.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
81.  Tall AR, Yvan-Charvet L. Cholesterol, inflammation and innate immunity. Nat Rev Immunol. 2015;15:104-116.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 762]  [Cited by in F6Publishing: 799]  [Article Influence: 95.3]  [Reference Citation Analysis (0)]
82.  Stolowich NJ, Petrescu AD, Huang H, Martin GG, Scott AI, Schroeder F. Sterol carrier protein-2: structure reveals function. Cell Mol Life Sci. 2002;59:193-212.  [PubMed]  [DOI]  [Cited in This Article: ]
83.  Bartlett JA, Gakhar L, Penterman J, Singh PK, Mallampalli RK, Porter E, McCray PB. PLUNC: a multifunctional surfactant of the airways. Biochem Soc Trans. 2011;39:1012-1016.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 32]  [Cited by in F6Publishing: 34]  [Article Influence: 2.7]  [Reference Citation Analysis (0)]
84.  Ning F, Wang C, Berry KZ, Kandasamy P, Liu H, Murphy RC, Voelker DR, Nho CW, Pan CH, Dai S. Structural characterization of the pulmonary innate immune protein SPLUNC1 and identification of lipid ligands. FASEB J. 2014;28:5349-5360.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 17]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
85.  King NP, Sakinç T, Ben Zakour NL, Totsika M, Heras B, Simerska P, Shepherd M, Gatermann SG, Beatson SA, Schembri MA. Characterisation of a cell wall-anchored protein of Staphylococcus saprophyticus associated with linoleic acid resistance. BMC Microbiol. 2012;12:8.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 13]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
86.  Kenny JG, Ward D, Josefsson E, Jonsson IM, Hinds J, Rees HH, Lindsay JA, Tarkowski A, Horsburgh MJ. The Staphylococcus aureus response to unsaturated long chain free fatty acids: survival mechanisms and virulence implications. PLoS One. 2009;4:e4344.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 118]  [Cited by in F6Publishing: 125]  [Article Influence: 8.4]  [Reference Citation Analysis (0)]
87.  Kohler T, Weidenmaier C, Peschel A. Wall teichoic acid protects Staphylococcus aureus against antimicrobial fatty acids from human skin. J Bacteriol. 2009;191:4482-4484.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 83]  [Cited by in F6Publishing: 83]  [Article Influence: 5.9]  [Reference Citation Analysis (0)]
88.  Sugihara A, Shimada Y, Nomura A, Terai T, Imayasu M, Nagai Y, Nagao T, Watanabe Y, Tominaga Y. Purification and characterization of a novel cholesterol esterase from Pseudomonas aeruginosa, with its application to cleaning lipid-stained contact lenses. Biosci Biotechnol Biochem. 2002;66:2347-2355.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 23]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
89.  Cadieux B, Vijayakumaran V, Bernards MA, McGavin MJ, Heinrichs DE. Role of lipase from community-associated methicillin-resistant Staphylococcus aureus strain USA300 in hydrolyzing triglycerides into growth-inhibitory free fatty acids. J Bacteriol. 2014;196:4044-4056.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 56]  [Cited by in F6Publishing: 55]  [Article Influence: 6.2]  [Reference Citation Analysis (0)]
90.  Behnsen J, Jellbauer S, Wong CP, Edwards RA, George MD, Ouyang W, Raffatellu M. The cytokine IL-22 promotes pathogen colonization by suppressing related commensal bacteria. Immunity. 2014;40:262-273.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 213]  [Cited by in F6Publishing: 184]  [Article Influence: 23.7]  [Reference Citation Analysis (0)]
91.  Elamin AA, Stehr M, Singh M. Lipid Droplets and Mycobacterium leprae Infection. J Pathog. 2012;2012:361374.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 25]  [Cited by in F6Publishing: 29]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
92.  Stehr M, Elamin AA, Singh M. Cytosolic lipid inclusions formed during infection by viral and bacterial pathogens. Microbes Infect. 2012;14:1227-1237.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 22]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
93.  Bligh EG, Dyer WJ. A rapid method of total lipid extraction and purification. Can J Biochem Physiol. 1959;37:911-917.  [PubMed]  [DOI]  [Cited in This Article: ]
94.  Brecher P, Chobanian J, Small DM, Chobanian AV. The use of phospholipid vesicles for in vitro studies on cholesteryl ester hydrolysis. J Lipid Res. 1976;17:239-247.  [PubMed]  [DOI]  [Cited in This Article: ]
95.  Hamilton JA, Small DM. Solubilization and localization of cholesteryl oleate in egg phosphatidylcholine vesicles. A carbon 13 NMR study. J Biol Chem. 1982;257:7318-7321.  [PubMed]  [DOI]  [Cited in This Article: ]