Role of nucleation of bile liquid crystal in gallstone formation

MUC Expression in Gallbladder Epithelial Tissues in Cholesterol-Associated Gallbladder Disease

Background/Aims

Gallstone pathogenesis is linked to mucin hypersecretion and bacterial infection. Several mucin genes have been identified in gallbladder epithelial cells (GBECs). We investigated MUC expression in cholesterol-associated gallbladder disease and evaluated the relationship between mucin and bacterial infection.

Methods

The present study involved 20 patients with cholesterol stones with cholecystitis, five with cholesterol stones with cholesterolosis, six with cholesterol polyps, two with gallbladder cancer, and six controls. Canine GBECs treated with lipopolysaccharide were also studied. MUC3, MUC5AC, MUC5B, and MUC6 antibodies were used for dot/slot immunoblotting and immunohistochemical studies of the gallbladder epithelial tissues, canine GBECs, and bile. Reverse-transcription polymerase chain reaction was performed to evaluate MUC3 and MUC5B expression.

Results

MUC3, MUC5AC, MUC5B, and MUC6 were expressed in the normal gallbladder epithelium, and of those, MUC3 and MUC5B exhibited the highest expression levels. Greatly increased levels of MUC3 and MUC5B expression were observed in the cholesterol stone group, and slightly increased levels were observed in the cholesterol polyp group; MUC3 and MUC5B mRNA was also upregulated in those groups. Canine GBECs treated with lipopolysaccharide also showed upregulation of MUC3 and MUC5B.

Conclusions

The mucin genes with the highest expression levels in gallbladder tissue in cholesterol-associated diseases were MUC3 and MUC5B. Cholesterol stones and gallbladder infections were associated with increased MUC3 and MUC5B expression.

Treatment of chronic proliferative cholangitis with c-myc shRNA

AIM: To investigate the feasibility and effectiveness of c-myc shRNA in inhibiting the hyperplastic behavior and lithogenic potentiality of chronic proliferative cholangitis (CPC), in order to prevent stone recurrence and biliary restenosis.

METHODS: An animal model of CPC was established by giving intralumenally 0.5 mL of c-myc shRNA. Then, the effects of c-myc shRNA on hyperplastic behavior and lithogenic potentiality of CPC were evaluated by histological observation, immunohistochemistry, real-time PCR and Western blotting for c-myc, proliferating cell nuclear antigen (PCNA), procollagen III, mucin 5AC, enzymatic histochemistry for β-glucuronidase, and biochemistry for hydroxyproline in the diseased bile duct.

RESULTS: Treatment with c-myc shRNA efficiently suppressed the hyperplasia of biliary epithelium, submucosal gland, and collagen fiber by inhibiting mRNA and protein expression of c-myc. More importantly, it decreased the lithogenic potentiality of CPC by inhibiting the expression of mucin 5AC and the secretion of endogenous β-glucuronidase. Further investigation indicated that c-myc shRNA-3 had a better inhibitory effect on CPC.

CONCLUSION: Treatment with c-myc shRNA-3 can control CPC and reduce the lithogenic potentiality of CPC.

Effect of portal azygous disconnection on gallbladder motor function

AIM: To investigate and clarify the effect of vagus on gallbladder motility through a comparative study.

METHODS: Twenty-three hepatocirrhosis patients with portal hypertension were included in this study. In Hassab operation group, the anterior and posterior trunk of vagus were surgically excised (H, n = 18); In vena coronaria ventriculi embolization group, the vena coronaria ventriculi bole was ligated and injected TH adhesive (8 mL) after splenectomy (VCE, n = 5). Before operation and 10 d after operation, ^99mTc-labeled diethyl acetyl acid anilide iminodiacetic acid (^99mTc-EHIDA, 185 MBq) was administered intravenously to the patients, and then scintigraphic method was used to assess the motor function of gallbladder. The index including radiocounting 30 min after injected ^99mTc-EHIDA (GBRC 30min), emptying fraction (GBEF), emptying period (GBEP), emptying rate (GBER), latent period (GBLP), latent period radiocounting increment (GBLI) and latent period radiocounting increment rate (GBLR) were analyzed.

RESULTS: GBRC 30 min in H group was significantly lower after operation than that before operation (74.8 ± 66.9 vs 155.7 ± 72.9,P < 0.05); GBLP was very short in pre-operation, and GBLP prolonged significantly after operation (13.36 ± 5.92 vs 2.24 ± 1.48, P < 0.01); the gallbladder radiocounting increased gradually during GBLP; the GBLI and GBLP level were very low before operation, but the GBLI and GBLP increased significantly after operation (79.5 ± 56.3 vs 9.2 ± 11.7, 113.4 ± 49.5 vs 7.6 ± 10.8, P < 0.01); GBEP shortened significantly after operation (18.5 ± 6.3 vs 24.1 ± 6.4, P < 0.05); GBEF and GBER decreased obviously after operation (13.1 ± 5.4 vs 32.3 ± 16.3, 0.7 ± 0.3 vs 1.4 ± 0.8, P < 0.01). The preceding parameters in VCE group had no significant difference before and after operation (P > 0.05).

CONCLUSION: The gallbladder tension weakens obviously in interdigestive phase after the vagus is excised; the gallbladder contraction delays, and the motor function weakens obviously after meals.