More than 250 different glycero-phospholipid and sphingomyelin molecular species make up the structural backbone of the red cell lipid bilayer. While the overall composition and organization is well maintained during the life of the cell, this is a very dynamic system in which lipid molecules are continuously renewed and rapidly move in the plane, and across the bilayer. To better understand the underlying mechanisms that keep this dynamic integrity intact are important to assess the consequences of alterations of this structure to red cell pathology. Whereas the red cell lacks de novo lipid synthesis, the phospholipids in the plasma membrane are continuously renewed by a deacylation/reacylation mechanism (the Lands pathway).

Reacylation of lysophospholipid Fatty acids (FA) are taken up from the plasma, and moved to the inner monolayer of the red cell membrane, where Coenzyme A (CoA) is synthesized by Long acyl CoA synthase (LACS) using ATP. The formed, activated fatty acyl-CoA (FA-CoA) and lysophospholipid (LPL) is used by lysophospholipid acylCoA- acyltransferase (LAT) to form phospholipid (PL), releasing CoA for the next activation of a fatty acid.