Quantitative determination of D-glucaric acid in bile in relation to inhibitory effect of bile on bacterial beta-glucuronidase

Establishment of Lactobacillus and Bifidobacterium species in germfree mice and their influence on some microflora-associated characteristics

Germfree mice were inoculated with both Lactobacillus acidophilus A10 and Bifidobacterium bifidum B11. Both strains were established and present in more than 10(8) cells per g of cecum and colon contents. Furthermore, L. acidophilus A10 was established in high numbers in stomach and small intestine. Contents from different parts of the intestine were investigated with regard to the following microflora-associated characteristics: degradation of mucin, beta-aspartylglycine and tryptic activity, conversion of cholesterol to coprostanol and bilirubin to urobilinogen, deconjugation of bilirubin glucuronides, and reduction of the cecum size. In spite of being established, the microbes were not able to mediate any alterations of the parameters investigated. All animals retained values as found in their germfree counterparts.

Biliary D-glucaric acid: its quantitation and preventive role in gallstone formation

A method for quantitation of D-glucaric acid in bile has been developed involving extraction with tetrahexylammonium chloride, boiling for 40-60 min, and determination of the percentage inhibition of beta-glucuronidase activity at 56 degrees C and pH 4. D-glucaric acid, bilirubin, bile acid, and protein were determined in 106 human gallbladder biles obtained at autopsy, including 20 with gallstones. The mean D-glucaric acid content was 1125 +/- 159 microM (mean +/- SE). Biliary beta-glucuronidase activity was not affected by D-glucaric acid because of 1) no difference in biliary D-glucaric acid content, either absolute or corrected for per unit of bilirubin, bile acid, or protein, between those with and those without gallstones; 2) no negative correlation between D-glucaric acid content and beta-glucuronidase activity in the bile; and 3) minimal conversion of D-glucaric acid to D-glucaro-1,4-lactone at the usual pH of bile. We conclude that biliary D-glucaric acid plays no role in the prevention of gallstone formation.

High-performance liquid chromatography of bilirubin conjugates in bile: effect of beta-glucuronidase on the bile pigments

A simple, specific, and technically easy high-performance liquid chromatography (HPLC) method for the separation and quantification of unconjugated bilirubin, bilirubin monoglucoside-monoglucuronide, bilirubin diglucuronide, and bilirubin monoglucuronide has been developed. The method was used to determine the bilirubin compounds of bile obtained endoscopically from the common bile duct in 43 patients with gallstone disease and in 6 subjects without gallstones or liver disease. The bile samples were also assessed for the presence of beta-glucuronidase-producing bacteria. The amount of unconjugated bilirubin was significantly higher (p less than 0.01) in bile containing bacteria producing beta-glucuronidase than in bile without such bacterial strains. In six 'normal' bile samples the following quantities of bilirubin conjugates and unconjugated bilirubin were found (median and range): bilirubin monoglucoside-monoglucuronide (mixed conjugate), 61 (27-80) mumol/l; bilirubin diglucuronide, 632 (512-861) mumol/l; bilirubin monoglucuronide, 113 (70-175) mumol/l; and unconjugated bilirubin, 3 (1-7) mumol/l. These results are in good agreement with those obtained with other HPLC methods. The concentrations of unconjugated bilirubin were lower than those found when using conventional diazo methods and thin-layer chromatography. HPLC proved to be a useful tool in gallstone pathogenesis studies. Our results support bacterial glucuronidase as a possible pathogenic factor in pigment gallstone disease.

Beta-glucuronidase activity related to bacterial growth in common bile duct bile in gallstone patients

Beta-glucuronidase activity in the bile may be of importance in the etiology of pigment gallstones. This enzyme is of hepatic or bacterial origin. We have described a method to measure the activity of bacterial beta-glucuronidase in human bile, using 4-nitrophenyl-beta-D-glucopyranosiduronic acid as substrate. The method was used to measure the beta-glucuronidase activity in the bile from 51 patients with gallstone disease. This activity was related to the presence of beta-glucuronidase-producing bacteria in the bile. Escherichia coli, Bacteroides species, and Clostridium perfringens were the only species found to produce beta-glucuronidase. Patients with beta-glucuronidase-producing bacteria had on an average significantly higher enzyme activity in the bile than patients without such bacteria (p less than 0.01). The limitations of using artificial substrates in this type of studies are discussed.

Beta-glucuronidase-producing bacteria in bile from the common bile duct in patients treated with endoscopic papillotomy for gallstone disease

This paper reports the occurrence of beta-glucuronidase-producing bacteria in the bile in gallstone patients treated with endoscopic papillotomy (EPT). The study included 36 patients--18 women and 18 men, aged 43-87 years, with a median of 72.5 years. Bile sampling was done with an endoscopic technique. All bacterial strains were tested for beta-glucuronidase activity with a rapid chromogenic tablet test, using 4-nitrophenyl-beta-D-glucuronic acid as substrate. Bacterial growth was found in the bile in 35 patients. Of 103 strains isolated, 30 produced beta-glucuronidase. Twenty-five of the patients had at least one beta-glucuronidase-producing strain in the bile. All 26 strains of Escherichia coli were producing the enzyme. Both strains in the Bacteroides fragilis group and one out of two strains of Clostridium perfringens were producing beta-glucuronidase. The activity of the bacterial beta-glucuronidase was found within the pH range of the bile in these patients. A relationship between the presence of beta-glucuronidase-producing bacteria in the bile and pigment gallstone is suggested.

The etiology of pigment gallstones

Pigment gallstones are of two major types, black and earthy brown, each consisting of calcium salts of bilirubin and other anions, along with an unmeasured residue that is largely mucin glycoproteins. Studies in model systems indicate that the small proportion of unconjugated bilirubin in bile is solubilized by bile salts and that the ionized bilirubin is more soluble than the protonated diacid. Solubility is decreased by added lecithin but is unaffected by cholesterol. At the pH of bile, unconjugated bilirubin exists mainly as a monoanion with sufficient solubility in mixed micelles not to precipitate, were it not for the presence of calcium, which forms highly insoluble salts with unconjugated bilirubin anions. Supersaturation of bile with calcium bilirubinates is inhibited by bile salts, which bind calcium, reducing the activity of free calcium ions. When supersaturation occurs, usually due to increased concentrations of bilirubinate anion, nucleation may be initiated by binding of calcium bilirubinate to mucin glycoproteins in bile. In earthy brown stones, which form mainly in the bile ducts, the pigment is mostly calcium bilirubinate, combined with calcium palmitate. These components form due to hydrolysis, by enzymes in infecting bacteria, of conjugated bilirubin and lecithin, respectively. In black stones, which form mainly in the gallbladder, the pigment is mostly a highly cross-linked network polymer of bilirubin, which is insoluble in all solvents. Concomitant polymerization and oxidation of calcium bilirubinate probably occur in the solid state, after precipitation of the pigment due to hydrolysis of conjugated bilirubin by endogenous beta-glucuronidase from the biliary tract and/or liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenesis of calcium bilirubinate gallstone: role of E. coli, beta-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation

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