---
title: "Mechanisms of Statin–Ezetimibe Combinations Revealed by Boolean Modeling and Transcriptomics"
id: "pubmed-42678094"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42678094"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42678094/"
doi: "10.1002/psp4.70329"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Mechanisms of Statin–Ezetimibe Combinations Revealed by Boolean Modeling and Transcriptomics
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42678094
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42678094/)
- **DOI:** [10.1002/psp4.70329](https://doi.org/10.1002%2Fpsp4.70329)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Objective: to decipher mechanisms of action (MoA) for combinations of a **statin** (atorvastatin or simvastatin) plus **ezetimibe** by integrating drug‑treated transcriptomes with network modeling. - Data sources: RNA‑seq from human hepatocyte‑like SOAT2‑only‑HepG2 cells treated with drugs, and liver biopsies from non‑obese normolipidemic patients with uncomplicated cholesterol gallstone disease (Stockholm Study). - Modeling approach: a novel **Boolean logical modeling** framework using fourteen two‑variable Boolean models to generate idealized differential expression templates for combinatorial modes. - Pattern matching: drug‑induced **differentially expressed genes** (DEGs) were associated with Boolean model templates using a template‑matching approach to infer combinatorial modes of action. - Differential expression results: 1,560 DEGs identified in at least one treatment condition in SOAT2‑only‑HepG2 cells; 565 DEGs in liver biopsy samples. - Findings: analysis revealed both expected and novel combinatorial modes between statins and ezetimibe across datasets. - Network mapping: downstream genes from each combinatorial mode were mapped to the **human protein‑protein interactome** to identify underlying pathways relevant to therapeutic effects. - Enrichment and disease association: functional enrichment and disease‑association analyses of downstream genes provided additional insight into potential therapeutic actions beyond cholesterol lowering. - Conclusion: integrating drug‑induced **transcriptomes** with the human interactome and Boolean logical modeling is informative for deciphering MoA of drug combinations. - Scope and novelty: the study proposes a computational framework to systematically interpret combination therapy transcriptomes; specific pathway names, quantitative effect sizes, and detailed lists of mapped pathways were not reported in the abstract.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Medicine, Brigham and Women's Hospital, Boston, USA. * 2 Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden. * 3 Medical Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden. * 4 Department of Biochemistry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain. * 5 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy. * PMID: **42678094** * DOI: [ 10.1002/psp4.70329 ](https://doi.org/10.1002/psp4.70329) Item in Clipboard # Deciphering the Mechanisms of Statin-Ezetimibe Drug Combinations Using Boolean Logical Modeling and Transcriptomic Data Rui-Sheng Wang et al. CPT Pharmacometrics Syst Pharmacol. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID CPT Pharmacometrics Syst Pharmacol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22CPT+Pharmacometrics+Syst+Pharmacol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22CPT+Pharmacometrics+Syst+Pharmacol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42678094/) . 2026 Sep;15(9):e70329. doi: 10.1002/psp4.70329. ### Authors [Rui-Sheng Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+RS&cauthor_id=42678094)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-1 "Department of Medicine, Brigham and Women's Hospital, Boston, USA."), [Matteo Pedrelli](https://pubmed.ncbi.nlm.nih.gov/?term=Pedrelli+M&cauthor_id=42678094)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-2 "Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-3 "Medical Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden."), [Osman Ahmed](https://pubmed.ncbi.nlm.nih.gov/?term=Ahmed+O&cauthor_id=42678094)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-2 "Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-4 "Department of Biochemistry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain."), [Garagnani Paolo](https://pubmed.ncbi.nlm.nih.gov/?term=Paolo+G&cauthor_id=42678094)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-2 "Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-5 "Department of Experimental, Diagnostic and Specialty Medicine \(DIMES\), University of Bologna, Bologna, Italy."), [Paolo Parini](https://pubmed.ncbi.nlm.nih.gov/?term=Parini+P&cauthor_id=42678094)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-2 "Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-3 "Medical Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden."), [Joseph Loscalzo](https://pubmed.ncbi.nlm.nih.gov/?term=Loscalzo+J&cauthor_id=42678094)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-1 "Department of Medicine, Brigham and Women's Hospital, Boston, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42678094/#short-view-affiliation-2 "Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden.") ### Affiliations * 1 Department of Medicine, Brigham and Women's Hospital, Boston, USA. * 2 Cardio Metabolic Unit, Department of Medicine and Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden. * 3 Medical Unit Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden. * 4 Department of Biochemistry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain. * 5 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy. * PMID: **42678094** * DOI: [ 10.1002/psp4.70329 ](https://doi.org/10.1002/psp4.70329) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Drug Combinations offer increased therapeutic efficacy and reduced toxicity compared with single agents. Understanding a drug combination's mechanisms of action (MoA) can provide important insights into therapeutic efficacy. The MoA of many FDA-approved drugs, however, often remains unclear. To decipher the underlying molecular mechanisms of drugs used alone and in combination, we investigated the combination of a statin (atorvastatin or simvastatin) plus ezetimibe using drug-treated RNA-seq transcriptome data from the human hepatocyte-like SOAT2-only-HepG2 cells and from liver biopsies of non-obese normolipidemic patients with uncomplicated cholesterol gallstone disease in the Stockholm Study. We proposed a novel Boolean logical modeling framework to simulate the MoA of a drug combination using fourteen two-variable Boolean models. Thereafter, a pattern matching approach was applied to associate drug-induced differentially expressed genes with the idealized differential expression templates derived from Boolean models. We found 1560 and 565 genes differentially expressed in at least one treatment condition in SOAT2-only-HepG2 cells and liver biopsies, respectively. Our analysis revealed both expected and novel combinatorial modes of the statins and ezetimibe. We mapped the downstream genes of each combinatorial mode to the human protein-protein interactome and obtained underlying pathways, which are important for understanding the therapeutic effects of the drug combinations. Functional enrichment and disease-association analyses of the downstream genes also provide critical insights into the additional therapeutic actions of the drugs. Our study demonstrates that drug-induced transcriptomes, integrated with the human interactome, are informative in deciphering the MoA of drug combinations using Boolean logical modeling. **Keywords:** Boolean logical modeling; drug combinations; ezetimibe; mechanisms of action; network biology; statins. © 2026 The Author(s). CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ ABCA1 and ABCG1 expressions are regulated by statins and ezetimibe in Caco-2 cells. ](https://pubmed.ncbi.nlm.nih.gov/21417795/) Genvigir FD, Rodrigues AC, Cerda A, Hirata MH, Curi R, Hirata RD.Genvigir FD, et al.Drug Metabol Drug Interact. 2011;26(1):33-6. doi: 10.1515/DMDI.2011.101. Epub 2011 Mar 16.Drug Metabol Drug Interact. 2011.PMID: 21417795 * [ Pretreatment with high-dose statin, but not low-dose statin, ezetimibe, or the combination of low-dose statin and ezetimibe, limits infarct size in the rat. ](https://pubmed.ncbi.nlm.nih.gov/18287593/) Birnbaum Y, Lin Y, Ye Y, Merla R, Perez-Polo JR, Uretsky BF.Birnbaum Y, et al.J Cardiovasc Pharmacol Ther. 2008 Mar;13(1):72-9. doi: 10.1177/1074248407312839.J Cardiovasc Pharmacol Ther. 2008.PMID: 18287593 * [ Vascular and metabolic effects of ezetimibe combined with simvastatin in patients with hypercholesterolemia. ](https://pubmed.ncbi.nlm.nih.gov/26188833/) Koh KK, Oh PC, Sakuma I, Kim EY, Lee Y, Hayashi T, Han SH, Park YM, Shin EK.Koh KK, et al.Int J Cardiol. 2015 Nov 15;199:126-31. doi: 10.1016/j.ijcard.2015.07.016. Epub 2015 Jul 11.Int J Cardiol. 2015.PMID: 26188833 * [ Evaluating the efficacy and safety of atorvastatin + ezetimibe in a fixed-dose combination for the treatment of hypercholesterolemia. ](https://pubmed.ncbi.nlm.nih.gov/30908086/) Ma YB, Chan P, Zhang Y, Tomlinson B, Liu Z.Ma YB, et al.Expert Opin Pharmacother. 2019 Jun;20(8):917-928. doi: 10.1080/14656566.2019.1594776. Epub 2019 Mar 25.Expert Opin Pharmacother. 2019.PMID: 30908086Review. * [ [Dual inhibition of cholesterol using the drug combination ezetimibe/simvastatin?]. ](https://pubmed.ncbi.nlm.nih.gov/17578178/) Vaverková H.Vaverková H.Vnitr Lek. 2007 Apr;53(4):421-7.Vnitr Lek. 2007.PMID: 17578178Review.Czech. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42678094) ## References 1. 1. X. Sun, S. Vilar, and N. P. Tatonetti, “High‐Throughput Methods for Combinatorial Drug Discovery,” Science Translational Medicine 5 (2023): 205rv201. 2. 1. G. Mancia, F. Rea, G. Corrao, and G. Grassi, “Two‐Drug Combinations as First‐Step Antihypertensive Treatment,” Circulation Research 124 (2019): 1113–1123. 3. 1. P. Jaaks, E. A. Coker, D. J. Vis, et al., “Effective Drug Combinations in Breast, Colon and Pancreatic Cancer Cells,” Nature 603 (2022): 166–173. 4. 1. W. Zheng, W. Sun, and A. Simeonov, “Drug Repurposing Screens and Synergistic Drug‐Combinations for Infectious Diseases,” British Journal of Pharmacology 175, no. 2 (2018): 181–191. 5. 1. J. H. Woo, Y. Shimoni, W. S. Yang, et al., “Elucidating Compound Mechanism of Action by Network Perturbation Analysis,” Cell 162, no. 2 (2015): 441–451. Show all 50 references ## MeSH terms * Anticholesteremic Agents* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anticholesteremic+Agents%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anticholesteremic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42678094/) * Anticholesteremic Agents* / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anticholesteremic+Agents%2Fpharmacology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anticholesteremic+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42678094/) * Atorvastatin* / administration & dosage Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Atorvastatin%2Fadministration+and+dosage%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Atorvastatin) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42678094/) * Atorvastatin* / pharmacology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Atorvastatin%2Fpharmacology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Atorvastatin) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42678094
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