Role of sodium, bicarbonate, and plasma osmolality in biliary secretion

Dose-dependent effects of glycine, alanine, and glucose on hepatic bile secretion, oxygen consumption, and hemodynamics

To assess the effects of a small (0.5%) and a large dose (5%) of glycine and alanine and of hypertonic glucose on hepatic bile secretion, oxygen consumption, and hemodynamics, experiments were performed on anesthetized pigs. Only the large dose of amino acids exerted significant changes. Glycine, alanine, and glucose reduced bile acid-dependent bile secretion gradually, which was nearly halved from a control value of 0.32 +/- 0.04 ml/min. Oxygen consumption was thereby continuously stimulated during amino acid and glucose infusion and increased from 448 +/- 132 mumol/min before to 995 +/- 226 mumol/min after the infusion of glycine, alanine, and glucose. Hepatic arterial blood flow increased from 214 +/- 14 ml/min to 238 +/- 14 ml/min after glycine infusion, whereas portal venous blood flow decreased from 542 +/- 50 ml/min to 481 +/- 47 ml/min. Total hepatic blood flow remained unchanged. Alanine and glucose provoked no further changes in hepatic blood flow. Bile secretion is a sensitive marker of hepatic metabolism, whereas hepatic blood flow is not a dominant regulator of bile secretion. Stimulation of hepatic metabolism is not followed by changes in total hepatic blood flow.

Amino acid- and glucose-induced cholestasis before and during secretin stimulation

To identify the mechanisms of reduced bile flow after hypertonic amino acid and glucose infusion, acute experiments were performed on anesthetized pigs. When secretin was not administered, amino acids or glucose reduced bile acid-dependent bile secretion to 65 +/- 3% of control. During secretin stimulation amino acids or glucose diminished bile acid-independent bile secretion to 78 +/- 2% of control. No changes in serum bilirubin, alanine aminotransferase, and aspartate aminotransferase were observed. Amino acids and glucose attack different mechanisms responsible for bile formation, but the result is that when secretin is not administered, biliary secretion of bile acids is reduced, and, accordingly, bile acid-dependent bile flow diminished. During secretin stimulation biliary NaHCO3 secretion is depressed, accounting for a fall in bile acid-independent bile flow. Amino acids exert no effect on bile acid secretion or, as a result, on bile acid-dependent bile flow after secretin infusion.

The effect of amiloride on biliary HCO3- secretion in the anaesthetized pig

The present study was performed on 29 anaesthetized pigs and shows that the bile acid ursodeoxycholic acid (UDCA) produces a flow of bile rich in HCO3- compared with taurocholic acid (TCA). The slope relating biliary HCO3- secretion to bile acid secretion was 0.59 (0.44-0.82) and 0.33 (0.29-0.38) during venous infusion of UDCA and TCA, respectively. We next wanted to evaluate the importance of Na+/H+ ion exchange for biliary HCO3- secretion. High doses of amiloride were employed in order to impair the hepatic Na+/H+ ion exchanger. It was reasoned that any reduction in H+ efflux through the hepatic Na+/H+ ion exchanger involved in causing biliary HCO3- secretion would be translated into an equimolar fall in biliary HCO3- secretion. We found that amiloride (2.0 X 10(-4) mol l-1 plasma) reduced UDCA-dependent canalicular HCO3- secretion by 26 (14-35)% without concurrently reducing bile acid secretion. Amiloride (2.9 X 10(-4) mol l-1 plasma) did not significantly reduce secretin-dependent ductular HCO3- secretion. In this group of animals amiloride reduced bile acid secretion by 13 (5-22)%. It is concluded that Na+/H+ ion exchanger is essential for UDCA-dependent canalicular HCO3- secretion, but not for secretin-dependent ductular HCO3- secretion.

DCCD (N,N'-dicyclohexylcarbodiimide) inhibits biliary secretion of HCO-3

To study whether a proton pump is an integral part of the mechanism responsible for secretin-dependent biliary secretion of HCO-3 ions, the proton pump inhibitor N,N'-dicyclohexylcarbodiimide (DCCD) was systemically administered to six anesthetized, secretin-infused pigs. Because biliary HCO-3 secretion varies with arterial pH, secretion rate was measured at several different arterial pH values, before and after DCCD (25 mumol/kg). At arterial pH 7.45, bile flow was 2.1 (1.6-2.9) ml/min, and HCO-3 secretion was 224 (157-311) mumol/min. DCCD reduced bile flow and HCO-3 secretion by 30% and 40%, respectively, independent of arterial pH. In contrast, bile acid secretion, 46 (41-59) mumol/min, was not changed by DCCD. The hepatic adenosine triphosphatase (ATP) level, 2.0 (1.8-2.1) mumol/g wet tissue, was not changed by DCCD. DCCD (10(-4) mol/l) affected neither Na,K-ATPase nor carbonic anhydrase activities in separate in vitro assay systems. The reduction in biliary HCO-3 secretion induced by the proton pump inhibitor DCCD may indicate that a proton pump is integrated into the mechanism responsible for secretin-dependent biliary secretion of HCO-3.

Improvements of metabolic imbalances after enteral sodium bicarbonate supplementation in infants of very low birth weight (VLBW)

One of the main points of clinical care is the catch-up growth of VLBW infants especially those of small gestational age (SGA). The required high amounts of protein are often not tolerated [1]. Metabolic imbalances due to immaturities of protein metabolism are described [2, 3] also in infants SGA feeding amounts of proteins comparable to mature newborns [4]. Remarkable signs of overloading by proteins are the elevation of amino acid and the bile acid concentrations in the serum [3, 5, 6]. In some of those cases [7] late metabolic acidosis (LMA) is to be seen. There is evidence in the literature that sodium bicarbonate influences nitrogen [8] and ionic balances [9] in newborn animals without any signs of acidosis, besides its simple buffer function. The aim of this study was to control changes of metabolic imbalances after bicarbonate supplementation before development of acidosis in predisposed infants. Therefore we determined parameters, which were significantly changed with LMA [6] during two feeding schedules: firstly, during bolus supplementation in infants feeding (2.0 +/- 0.4) g/kg BW.d protein and secondly during chronic supplementation of bicarbonate to (3.0 +/- 0.4) g/kg BW.d protein. In relation to the improvement of the nitrogen balance in growing lambs [7] we supposed comparable effect of bicarbonate on metabolic imbalances caused by protein overloading.

Changes in biliary secretion and lactate metabolism induced by diethyl maleate in rabbits

Diethyl maleate is a compound which binds with glutathione by means of a glutathione S-transferase and is excreted into bile leading to a rapid depletion of hepatic glutathione. In the rabbit, the activity of the enzyme is fairly low and we were thus prompted to study the possible effects of diethyl maleate on biliary secretion and metabolic status in this species. The administration of diethyl maleate induced a transient choleresis followed by cholestasis. The choleresis coursed with increases in the biliary output of sodium and unaccounted anions, whereas those of chloride, bicarbonate and bile acids were unaffected. Our data seem to confirm that choleresis is due to the osmotic activity of diethyl maleate compounds excreted into bile, as has been reported in rats and dogs. The cholestasis observed coursed with falls in the outputs of sodium, chloride and bicarbonate though that of bile acids remained constant. Following diethyl maleate administration, a metabolic acidosis appeared with progressive increases of blood lactate concentration. In bile the concentration of this anion closely followed that of plasma. The cholestasis is attributed to a lowered biliary secretion of bicarbonate probably secondary to the metabolic alteration. The hepatic values of cytoplasmatic and mitochondrial NADH/NAD ratios and of adenine nucleotide concentrations suggest that the increase in blood lactate results rather from a fall in its hepatic utilization that from an increase in its production.

The effect of drugs on bile flow and composition. An overview

Many drugs are eliminated via the hepatobiliary route, after biotransformation in the liver. Some of them may affect bile flow and/or the hepatic secretion of biliary lipids such as bile acids, cholesterol and phospholipids. Bile acids are the most potent agents which increase bile flow, especially unconjugated bile acids. Other drugs which increase bile flow include phenobarbitone (phenobarbital), theophylline, glucagon and insulin. In contrast, ethacrynic acid, amiloride, ouabain, oestrogens and chlorpromazine are among those agents which decrease bile flow. Biliary bile acid secretion is altered by a variety of drugs, including cheno- and ursodeoxycholic acids (CDCA and UCDA), the bile acid sequestrants cholestyramine and colestipol, and ethinyloestradiol. The composition of bile can also be altered by drug therapy. Thus, clofibrate increases biliary cholesterol secretion, and reduces bile acid concentrations, without altering biliary phospholipid concentrations. However, other clofibrate derivatives may produce changes of a different pattern, suggesting that the risk of developing gallstones may differ for each derivative. Nicotinic acid and d-thyroxine also increase biliary cholesterol saturation, while CDCA and UDCA reduce biliary cholesterol concentration. The potential consequences of drug-induced changes in bile flow and composition extend to the liver, the gallbladder and the intestine. If adverse effects are to be avoided, further study in this often overlooked area is required.

Role of osmosis in biliary NaCl secretion and bile formation

To challenge the osmotic hypothesis of biliary NaCl secretion and bile formation, experiments were performed in anaesthetized pigs. An increase in plasma osmolality of 7 +/- 1 mosm/kg H2O induced by intravenous sucrose infusion decreased NaCl secretion, NaHCO3 secretion, and bile flow by 36 +/- 3%, 34 +/- 2%, and 34 +/- 3%, respectively. There was no change in the biliary concentration of NaCl and NaHCO3. When bile acids were infused intravenously, the secretion of 1 mmol bile acids caused an osmotic flow of 12.0 ml bile containing 0.92 mmol NaCl and 0.30 mmol NaHCO3 in an isotonic solution. Bile acids are therefore much stronger choleretic substances than NaHCO3. When the plasma sodium concentration was increased to 200 mM, bile flow increased by 31 +/- 5% and the secretion of bile acids, NaHCO3, and NaCl was increased by 63 +/- 3%, 96 +/- 4%, and 93 +/- 4%, respectively. These data are consistent with osmotic transport as the main mode of bile formation, but diffusion could be responsible for a small fraction. A raised plasma sodium concentration stimulates osmotic formation of bile by increasing both the bile acid-dependent and -independent secretion through stimulation of biliary bile acid and NaHCO3 secretion.