Therapeutic effect of yinchenhao decoction on cholelithiasis via mucin in the gallbladder and intestine

Cholelithiasis is a common and frequently occurring disease worldwide that belongs to the category of jaundice in traditional Chinese medicine. Yinchenhao decoction (YD) consists of Artemisia capillaris Thunb., Gardenia jasminoides J.Ellis, and Rheum palmatum L., and is traditionally used to treat jaundice, which has a significant therapeutic effect on cholelithiasis. Our study aimed to investigate the pathological mechanism of cholelithiasis and the therapeutic mechanism of YD via mucin in the gallbladder and intestine. YD was prepared and analyzed using HPLC. The supersaturation stability experiment was designed by the solvent-shift method. The cell transport experiment was conducted by coculture monolayers. The animal experiment was performed using a cholelithiasis model with a high-cholesterol diet. The related indicators were detected by automatic biochemical analyzer, PCR, western blot, or ELISA. Statistics were analyzed using χ2-tests and t-tests. As the results, in cholelithiasis, MUC5AC highly expressed in the gallbladder shortened cholesterol supersaturation and promoted cholesterol crystallization via the inflammatory cytokine signaling pathway; MUC2 highly expressed in the small intestine prolonged cholesterol supersaturation and promoted cholesterol absorption via the inflammatory cytokine signaling pathway. YD inhibited mucin expression in the gallbladder and intestine in a concentration-dependent manner for cholelithiasis treatment by inhibiting the inflammatory cytokine signaling pathway, which was attributed to the active components, including chlorogenic acid, geniposide, and rhein.

Hypothyroidism Increases Cholesterol Gallstone Prevalence in Mice by Elevated Hydrophobicity of Primary Bile Acids

Background: Thyroid hormone (TH) deficiency has been associated with increased cholesterol gallstone prevalence. Hypothyroidism impacts hepatic lipid homeostasis, biliary secretion, gallbladder motility, and gallstone (LITH) gene expression, all potential factors contributing to cholesterol gallstone disease (CGD). However, how TH deficiency may lead to gallstone formation is still poorly understood. Therefore, we performed molecular studies in a CGD mouse model under lithogenic conditions and modulation of TH status. Methods: Male, three-month-old C57BL/6 mice were randomly divided into a control (euthyroid) group, a hypothyroid (hypo) group, a gallstone (litho) group, and a gallstone+hypothyroid (litho+hypo) group and were treated for 2, 4, and 6 weeks (n = 8/treatment period). Gallstone prevalence, biliary composition and cholesterol crystals, hepatic expression of genes participating in cholesterol, bile acid (BA), and phosphatidylcholine synthesis (Hmgcr, Cyp7a1, Pcyt1a), and canalicular transport (Abcg5, Bsep, Abcb4) were investigated. Results: Increased cholesterol gallstone prevalence was observed in hypothyroid mice under lithogenic diet after 4 and 6 weeks of treatment (4 weeks: 25% vs. 0%; 6 weeks: 75% vs. 37.5%). Interestingly, neither the composition of the three main biliary components, cholesterol, BAs, and phosphatidylcholine, nor the hepatic expression of genes involved in synthesis and transport could explain the differences in cholesterol gallstone formation in the mice. However, TH deficiency resulted in significantly increased hydrophobicity of primary BAs in bile. Furthermore, downregulation of hepatic sulfonation enzymes Papss2 and Sult2a8 as well as diminished biliary BA sulfate concentrations in mice were observed under hypothyroid conditions all contributing to a lithogenic biliary milieu as evidenced by microscopic cholesterol crystals and macroscopic gallstone formation. Conclusions: We describe a novel pathogenic link between TH deficiency and CGD and suggest that the increased hydrophobic character of biliary BAs due to the diminished expression of hepatic detoxification enzymes promotes cholesterol crystal precipitation and enhances cholesterol gallstone formation in the bile of hypothyroid mice.

Hepatic expression of cholesterol regulating genes favour increased circulating low-density lipoprotein in HIV infected patients with gallstone disease: a preliminary study

BACKGROUND

HIV endemic populations are displaying higher incidence of metabolic disorders. HIV and the standard treatment are both associated with altered lipid and cholesterol metabolism, however gallstone disease (a cholesterol related disorder) in Sub-Saharan African populations is rarely investigated.

METHODS

This study sought to evaluate hepatic expression of key genes in cholesterol metabolism (LDLr, HMGCR, ABCA1) and transcriptional regulators of these genes (microRNA-148a, SREBP2) in HIV positive patients on antiretroviral therapy presenting with gallstones. Liver biopsies from HIV positive patients (cases: n = 5) and HIV negative patients (controls: n = 5) were analysed for miR-148a and mRNA expression using quantitative PCR.

RESULTS

Circulating total cholesterol was elevated in the HIV positive group with significantly elevated LDL-c levels(3.16 ± 0.64 mmol/L) relative to uninfected controls (2.10 ± 0.74 mmol/L; p = 0.04). A scavenging receptor for LDL-c, LDLr was significantly decreased (0.18-fold) in this group, possibly contributing to higher LDL-c levels. Transcriptional regulator of LDLr, SREBP2 was also significantly lower (0.13-fold) in HIV positive patients. Regulatory microRNA, miR-148a-3p, was reduced in HIV positive patients (0.39-fold) with a concomitant increase in target ABCA1 (1.5-fold), which regulates cholesterol efflux.

CONCLUSIONS

Collectively these results show that HIV patients on antiretroviral therapy display altered hepatic regulation of cholesterol metabolizing genes, reducing cholesterol scavenging, and increasing cholesterol efflux.

Cholesterol cholelithiasis: part of a systemic metabolic disease, prone to primary prevention

Cholesterol gallstone disease have relationships with various conditions linked with insulin resistance, but also with heart disease, atherosclerosis, and cancer. These associations derive from mechanisms active at a local (i.e. gallbladder, bile) and a systemic level and are involved in inflammation, hormones, nuclear receptors, signaling molecules, epigenetic modulation of gene expression, and gut microbiota. Despite advanced knowledge of these pathways, the available therapeutic options for symptomatic gallstone patients remain limited. Therapy includes oral litholysis by the bile acid ursodeoxycholic acid (UDCA) in a small subgroup of patients at high risk of postdissolution recurrence, or laparoscopic cholecystectomy, which is the therapeutic radical gold standard treatment. Cholecystectomy, however, may not be a neutral event, and potentially generates health problems, including the metabolic syndrome. Areas covered: Several studies on risk factors and pathogenesis of cholesterol gallstone disease, acting at a systemic level have been reviewed through a PubMed search. Authors have focused on primary prevention and novel potential therapeutic strategies. Expert commentary: The ultimate goal appears to target the manageable systemic mechanisms responsible for gallstone occurrence, pointing to primary prevention measures. Changes must target lifestyles, as well as experimenting innovative pharmacological tools in subgroups of patients at high risk of developing gallstones.

[Clinical and laboratory features of cholelithiasis in patients with type 2 diabetes by gender]

OBJECTIVE

Introduction: Today, diabetes is considered a factor that provokes the development of bile duct disease. Cholelithiasis is associated with such risk factors as aging, high body mass index, female sex, genetic predisposition, alcohol abuse, high concentration of triglycerides and cholesterol, low density lipoprotein in blood plasma The aim of the work is to analyze the clinical and laboratory features of the pathology of the gall bladder in patients with type 2 diabetes, depending on the sex.

PATIENTS AND METHODS

Materials and methods: Complex examination of 126 patients with cholelithiasis and type 2 diabetes mellitus was performed. Diagnosis of chronic cholecystitis was verified on the basis of clinical data, characteristic changes of the wall of the gallbladder according to the data of the echography. In the presence of concretions in the lumen of the gall bladder, bile marijuana was diagnosed. The verification of the diagnosis of diabetes mellitus was based on the determination of carbohydrate balance and glycosylated hemoglobin levels.

RESULTS

Results: Among the examined patients there were 88 women (69,8%) and 38 men (30,2%). The average age of patients was 61,9 ± 0,9 years. The main complaints revealed in patients with combined pathology were: general weakness, daily fluctuations in blood pressure, abdominal distension, irritability, discomfort in the right hypochondrium, bitter taste in the mouth, heartburn, constipation, vomiting with bile. According to ultrasonography, hepatomegaly was noted in 88 (51,8%) patients. An increase in the size of the gall bladder was found in only 27 (15,9%) patients. The individual biochemical parameters of patients with combined pathology are analyzed.

CONCLUSION

Conclusions: Established a significant prevalence of female subjects among patients with combined pathology. There were no reliable signs of clinical symptoms and changes in biochemical parameters, depending on sex. A reliable method for diagnosing the changes in the gall bladder in both women and men is ultrasound.

Gastroesophageal Mucosal Injury after Cholecystectomy: An Indication for Surveillance?

BACKGROUND

Cholecystectomy alters bile release dynamics from pulsatile meal-stimulated to continuous, and results in retrograde duodeno-gastric bile reflux (DGR). Bile is implicated in mucosal injury after gastric surgery, but whether cholecystectomy causes esophagogastric mucosal inflammation, therefore increasing the risk of metaplasia, is unclear.

STUDY DESIGN

This study examined whether cholecystectomy-induced DGR promotes chronic inflammatory mucosal changes of the stomach and/or the esophagogastric junction (EGJ). Four groups of patients were studied and compared with controls. A group of patients was studied before and 1 year after cholecystectomy; 2 further groups were studied long-term post-cholecystectomy (LTPC) at 5 to 10 years and 10 to 20 years. All underwent abdominal ultrasound and upper gastrointestinal endoscopy with gastric antral and EGJ biopsies, noting the presence of gastric bile pooling. Biopsy specimens were stained for Ki67 and p53 overexpression, and the bile reflux index (BRI) was calculated.

RESULTS

At endoscopy, bile pooling was observed in 9 of 26 (34.6%) controls, in 8 of 25 (32%) patients pre-cholecystectomy, in 15 of 25 (60%) 1 year post-cholecystectomy patients (p = 0.047), and 23 of 29 (79.3%) LTPC patients (p = 0.001). Bile reflux index positivity at the EGJ increased from 19% of controls through 41% of LTPC patients (p = 0.032). Ki67 was overexpressed at the EGJ in 19% of controls, but in 62% of LTPC patients (p = 0.044); p53 was overexpressed at the EGJ in 19% of controls compared with 66% of LTPC patients (p = 0.001).

CONCLUSIONS

Duodeno-gastric bile reflux was more common in patients with gallstones than in controls, and its incidence doubled after cholecystectomy. This was associated with inflammatory changes in the gastric antrum and the EGJ, evident in most LTPC patients. Ki67 and p53 overexpression at the EGJ suggests cellular damage attributable to chronic bile exposure post-cholecystectomy, increasing the likelihood of dysplasia. Further studies are required to determine whether DGR-mediated esophageal mucosal injury is reversible or avoidable, and whether surveillance endoscopy is indicated after cholecystectomy.

The effect of chronic estrogen application on bile and gallstone composition in women with cholelithiasis

BACKGROUND

Chronic application of third generation progestagens as contraceptives or hormone replacement therapy (HRT) could influence the serum lipid profile, and consequently the bile and gallstone composition. The aim of this study was to determine components of serum, bile and gallstones in women of reproductive age or postmenopausal women using hormonal third generation for at least two years.

METHODS

We enrolled 101 Caucasian women with cholelithiasis. The study included 45 women of reproductive age and 56 postmenopausal women who were divided into subgroups receiving or not exogenous female hormones. In patients we determined serum levels of 17β-estradiol, triglycerides, HDL and LDL cholesterol as well as composition of gallstones and bile.

RESULTS

The postmenopausal women showed a significant reduction in the concentration of bile acids in serum while the application of HRT caused an increase in their contents. Serum total and LDL cholesterol in postmenopausal women was higher than in women without hormonal contraception and postmenopausal patients with HRT. Moreover, women taking the exogenous hormones showed a reduced content of calcium ions in both serum, bile and gallstones.

CONCLUSIONS

Our observations confirm that the chronic use of oral contraceptives and hormone replacement therapy cause an increase in bile lithogenity.

[COMPARATIVE EVALUATION OF THE EFFECTIVENESS OF THE USE OF 13C-LABELED MIXED TRIGLYCERIDE AND 13C-STARCH BREATH TESTS IN PATIENTS WITH CHRONIC PANCREATITIS AFTER CHOLECYSTECTOMY]

The results of a comprehensive study of 96 patients after cholecystectomy are provided. The higher sensitivity and informativeness of the 13C-labeled mixed triglyceride breath .test compared with 13C-starch breath test for determining functional pancreatic insufficiency in patients after cholecystectomy in early stages of its formation was set.

Cholesterol lowering effect in the gall bladder of dogs by a standardized infusion of Herniaria hirsuta L

ETNOPHARMACOLOGICAL RELEVANCE

Infusions of Herniaria hirsuta L., Herniaria glabra L. and Herniaria fontanesii J.Gay are well known in Moroccon folk medicine for the treatment of biliary dyskinesia, (uro)lithiasis or as a diuretic. Herniariae Herba which can contain H. glabra and H. hirsuta is known in Europe as an urological drug.

AIM OF THE STUDY

To investigate the efficacy of a standardized infusion of Herniaria hirsuta against choleltihiasis, and evaluation of its genotoxicity.

METHODS AND MATERIALS

An analytical HPLC-UV method to quantify flavonoids and saponins present in the extract of H. hirsuta was developed and validated. An in vivo experiment to evaluate the cholesterol lowering effect of a infusion of H. hirsuta in the gall bladder of dogs was carried out. Dogs were divided into 3 groups i.e. control dogs (CG), dogs treated with ursodeoxycholic acid (UDCA) (2×7.35mg/kg body weight/day) and dogs treated with the standardized infusion (HG) (2×48.5mg/kg body weight/day). Dogs were fed a fatty diet during 120 days after which a diet without additional fat was introduced till day 180. Treatment started 30 days after introduction of the fatty diet and lasted till the end of the experiment. A bile and blood sample of each dog was collected every 30 days, after which the concentration of cholesterol was determined. An Ames test was performed according to the OECD-guidelines.

RESULTS

The validated HPLC-UV method showed a linear calibration model and an acceptable precision for the total flavonoid content (total content 4.51%) as well as the total saponin content (12.74%). The in vivo experiments already showed a minor difference for bile cholesterol between CG and HG after 30 days of treatment with the infusion, and the difference was more pronounced after 90 days of treatment. Even 30 days after discontinuation of the cholesterol-rich diet a significant difference remained between CG and HG. There was no statistically significant difference in blood cholesterol. The Ames test showed that the infusion of H. hirsuta could be considered as being free from genotoxic risks.

CONCLUSION

A method for the standardization of a infusion of Herniaria hirsuta was developed and validated. Prolonged use of this standardized H. hirsuta extract resulted in a cholesterol-lowering effect in the bile of dogs. Since this pharmacological effect prevents the formation of gallstones and can contribute to solving existing gallstones, a standardized infusion of H. hirsuta may have a positive effect in the treatment of gallstones in human patients.

[COURSE OF BILIARY SLUDGE ON THE BACKGROUND NON-ALCOHOLIC FATTY LIVER DISEASE]

To date, the factors significantly reduces the tolerance of the liver against the development of NAFLD and GSD. At the stage of biliary sludge cholelithiasis is found in more than half of the patients suffering from NAFLD. BS violates jelchnokamennouu and releaxation activity of hepatocytes, thereby slowing the passage of bile through the intrahepatic and extrahepatic bile ducts that aggravate the course of NAFLD. The reasons for the formation of sludge is not completely understood. To date there are no accepted tactics of conducting and treatment of patients with HB in the background of NAFLD. In our work we demonstrate one possible way to tackle this important problem.

Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment

Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.

Enhancement of interaction of BSEP and HAX-1 on the canalicular membrane of hepatocytes in a mouse model of cholesterol cholelithiasis

We induced gallstones in C57L mice fed with a high cholesterol diet and examined the expression of bile salt export pump (BSEP) on the canalicular membrane of hepatocytes and its relation with PKCα and HAX-1.Twenty-four gallstone-prone C57L mice were randomly assigned to receive a high cholesterol diet or a regular diet. Gallstone formation was recorded. BSEP, PKCα and phospho-PKCα expression was examined by immunoblotting assays. Co-expression of BSEP and HAX-1 was studied by immunofluorescent microscopy and immunoprecipitations. Gallstones were formed in all 12 mice fed with the high cholesterol diet. In Gallstone group, BSEP levels on the canalicular membrane of hepatocytes were markedly lower while a significant increase was observed in phosphorylated PKCα. Immunofluorescent microscopy showed that BSEP and HAX-1 were co-localized on the canalicular membrane, which was apparently enhanced by feeding with the high cholesterol diet. The immunoprecipitation assays further demonstrated that BSEP and HAX-1 showed enhanced interaction in the hepatocytes of mice fed with the high cholesterol diet. Cholesterol gallstone formation is associated with downregulation of BSEP expression on the canalicular membrane of hepatocytes with increased phosphorylation of PKCα. BSEP and HAX-1 show enhanced interaction with one another on the canalicular membrane during gallstone formation.

[Dyslipidemia in children with cholelithiasis as a marker of metabolic syndrome development]

In the article based on own research shows changes in lipid and carbohydrate metabolism in children with gallstone disease (GSD), characteristic of the metabolic syndrome (MS). The data obtained suggest that obesity is not always a marker of the metabolic syndrome. A key element in the development of MS are the changes of lipid and carbohydrate metabolism.

[Evaluation of prognostic factors for the development of cholelithiasis in patients with metabolic syndrome]

The aim of study to determine the leading clinical and immunological parameters, reflecting the high risk of development and progression of gallstone disease in patients with metabolic syndrome.

MATERIALS AND METHODS

An assessment of clinical, biochemical and immunological parameters in 54 patients with gallstone disease associated with the metabolic syndrome and in comparison groups (31 with metabolic syndrome without gallstone disease and 29 with gallstone disease only) were made. For modeling the significant correlation and prediction of the effect of different combinations of factors on the risk of gallstone disease formation in patients with metabolic syndrome was used the multiple logistic regression analysis.

RESULTS

In accordance with our results the main risk factors of gallstone formation in patients with metabolic syndrome are the age (P = 0.02), waist volume (P = 0.0002), the increase of serum concentration of GGTP (P = 0.00001), MMP-9 (P = 0.002) and TIMP-1 (P = 0.02).

CONCLUSION

The results of our study have shown that in patients with metabolic syndrome was estimated the high risk of gallstone disease formation compared and the most significant factors of it formation are the patients age, waist volume and increase of serum concentration of GGTP, MMP-9 and TIMP-1.

Metabolism of bile with respect to etiology of gallstone disease - systematic review

Based on current literature authors reviewed information on bile metabolism, i.e. production and chemical compounds, synthesis of bile acids, their hepato-intestinal circulation with respect to etiology of cholelithiasis - its epidemiology and clinical aspects.

Comparative proteomic analysis of gallbladder bile proteins related to cholesterol gallstones

Background

Nucleation of cholesterol monohydrate crystals following the aggregation and fusion of cholesterol-enriched vesicles is a critical procedure in the formation of cholesterol gallstone. Biliary proteins play important roles in the process. It is inefficient to screen pro-nucleating or anti-nucleating proteins with routine physiochemical techniques, by which we discovered several pro-nucleating proteins.

Methodology/Principal Findings

Based on comparative proteomic technologies, we investigated the differentially expressed proteins between the cholesterol gallstone and control groups, and between the vesicular phase and micellar phase. There are 401±75 spots detected on the cholesterol gallstone group and 389±94 spots on the control group gels, 120±24 spots detected on vesicular phase and 198±37 on micellar phase gels, and accordingly 22 and 8 differentially expressed proteins were identified successfully, respectively. Three of them, HSA, Profilin and Retinol Binding Protein, were validated by Western blot.

Conclusion/Significance

Some of the identified proteins are in good agreement with proteins reported to be involved in the gallstone formation before. The information from this study might provide some important clues to uncover the key proteins involved in the formation of cholesterol gallstone.

Role of biochemical investigation in prediction of biliary etiology in acute pancreatitis

INTRODUCTION

Acute pancreatitis is common clinical presentation. Gall stone disease and alcohol consumption are most common etiologies. Detection of biliary etiology is important in order to provide definite management in form of cholecystectomy to prevent further attacks. Sensitivity for abdominal ultrasound to detect cholelithiasis is decreased to 67-87% in presence of acute pancreatitis. Difference in biochemical investigations of acute biliary and non-biliary pancreatitis has been proposed to increase the suspicion of biliary etiology.

METHODS

Sixty patients admitted with diagnosis of acute pancreatitis from March 2012 to December 2012 were included in the study. The relation between etiology with age, sex, admission serum amylase and liver function test were evaluated.

RESULTS

Out of 60 patients 38 (63.33%) and 22 (36.66%) had biliary and non-biliary etiology respectively. Biliary pancreatitis was more common in females (25 vs. 3). Distribution of severity was comparable between both groups. Biliary pancreatitis group had significantly higher amylase level (3466.42 vs. 1987.5, p 0.003) whereas values of liver function test were higher in biliary pancreatitis though not statistically significant.

CONCLUSIONS

A simple, rapid and accurate prediction of biliary etiology of acute pancreatitis can be provided by changes in biochemical parameters.

[Obesity and diseases of digestive organs]

Obesity is non-infectious pandemic. Its association with cardiovascular pathology is especially widely discussed, but an overweight patient is actually polymorbid. An increase of body mass provides a pathogenetic basis for many diseases including those of digestive system This review deals with pathogenesis, clinical features, and treatment of gastroesophageal reflux disease, cholelithiasis and non-alcoholic fatty liver disease in obese patients. This pathology and its aggravation result from such pathophysiological processes as a rise in intra-abdominal pressure, excess adipokine, cholesterol and free fatty acid synthesis, activation of lipid peroxidation. Gastroesophageal reflux disease in obese patients has an atypical clinical course characterized by discrepancy between clinical, endoscopic and morphological features in oesophagus and frequent formation of Barrett's oesophagus. Cholelethiasis in obesity is fraught with further progress of the disease after prescription of low-fat diet. The risk of calculi formation can be reduced by prescription of ursodeoxycholic acid that produces both litholytic and hypolipidemic effects. Treatment of non-alcoholic fatty liver disease requires combined therapy with statins, insulin sensitizers, hepatoprotectors and adequate physical activity. Sustained remission of diseases of digestive organs is impossible without correction of body mass and their pharmacotherapy requires increasing doses of medicines and duration of their administration.

[Metabolism-related risk factors of cholelithiasis among Beijing residents: a case-control study]

OBJECTIVE

To explore the metabolism-related risk factors of cholelithiasis among residents in Beijing.

METHODS

The clinical data including previous disease history, findings of physical examination, and results of cholecystosonography of 2270 patients with cholelithiasis identified in the Health Screening Center of Peking Union Medical College Hospital between August 2007 and August 2010 were retrospectively reviewed (the case group). Meanwhile, 4336 healthy individuals during the same period were randomly chosen as the control group.

RESULTS

Total cholesterol, triglyceride, low-density lipoprotein cholesterol, fasting blood glucose, body mass index, and systolic blood pressure were positively correlated with the incidence of cholelithiasis (P < 0.05), while high-density lipoprotein cholesterol was negatively correlated (P < 0.05). Diastolic blood pressure showed no association with cholelithiasis (P > 0.05).

CONCLUSION

Cholelithiasis is resulted from multiple factors including elevated blood lipids, blood glucose, and systolic blood pressure among residents in Beijing.

[Wether cholescystectomy affects bile lithogenicity in cholelithiasis]

THE AIM

The studying of physical-chemical qualities of liver bile and lipid exchange before and after cholecystectomy.

MATERIALS AND METHODS

We spent the complex investigation of physical-chemical qualities of bile and lipid levels in 210 patients with cholelithiasis stage I (pre-stone) and in 90 patients with cholelithiasis stage II and III (with gallstones) after cholecystectomy.

THE RESULTS

In all examined patients we revealed disturbances of physical-chemical qualities of bile and lipid exchange. With correlation analysis it was found that bile lithogenity increases in high bile density, in progressing of inflammation process in bile ducts, in increasing of aterogene fractions of blood cholesterol.

CONCLUSION

After cholecystectomy in liver-cells dyscholia the ability to stones formation preserves. It means that patients after cholecystectomy need in following-up with using of prophylactic measures to restoring of bile-formation.

[The role of feeding behaviour hormones in the development of cholelithiasis]

THE PURPOSE. To analyze the possible association between gallstone disease (GSD), and some adipokine: leptin, adiponectin, ghrelin, resistin, kaheksin (TNFalpha), visfatin. RECENT EVIDENCE IN THE LITERATURE. The prevalence of GSD increases by a factor not so much with age (in women - 6.0%, 7.9%, 8.5% and 18.6%, respectively, four age decade from 25 to 64 years - according to the epidemiological study in the frame of the WHO "Monica" in Novosibirsk in 1994-1995 years), but with metabolic disorders: GSD diagnosed in 17.6% in diabetes mellitus, in obesity III-IV degree - up to 100%. Leptin regulates the expression of genes responsible for the pathogenesis of cholesterol GSD -cholecystokinin receptor gene A, acetylcholine receptor beta2, Ca-calmodulin-dependent protein kinase, mucin3, carboxylesterazy, HMG-CoA reductase. Was found negative correlation of GSD with adiponectin levels and positive - with visfatin levels. Elevated ghrelin levels performs protective role to GSD (OR = 0,27, p = 0,02). In the analysis of GSD-associated regions on chromosome 1 p, genes TNFR2 receptor and TNFRSF1B included in a number of positional candidate genes.

[The role of metabolism disorders in genesis of gallstone disease in children]

Identified changes lipid metabolism in children with biliary disease, characteristic of the metabolic syndrome. The correlation between indices of lipid metabolism with body weight in children with cholelithiasis. However, the degree of impairment of carbohydrate metabolism was independent of body mass index. Obtained data allow us to state that obesity is not always a marker of the metabolic syndrome.

[Current principles of cholelithiasis prophylaxis in the practice of district physician]

The key task of the district physician is staged diagnostic search and clinical detection of functional disorders--conduction of laboratory tests and device investigations (in cholelithiasis patients--ultramicroscopic investigation of bile, x-ray methods, ultrasonography) to initiate prophylactic-therapeutic measures (medico-social, pharmacological and therapeutic-dietary).

[Gallstone disease in children with obesity]

Based on the authors own research shown a relationship of metabolic disorders in children with GSD with the metabolic syndrome. Studied the parameters of lipid and carbohydrate metabolism in children with both abdominal and endocrine obesity. Was shown the Significance a high direct correlation in children with cholelithiasis on the background of obesity and metabolic syndrome. Obtained data enable us to assert that in children with cholelithiasis on the background of obesity forms classical clinical picture of metabolic syndrome.

Cytokeratin 8 and 18 tissue expression in gallbladder mucosa of patients with cholelithiasis

Cytokeratins (CKs) 8 and 18 are normally expressed in simple epithelia. This unique pair of CKs is believed to be involved in hepatic diseases and many human cancers. Little is known about the role of tissue expression of both CKs in patients with cholelithiasis (CH). The aim of the study was to analyse tissue expression of CK8 and 18 in the specimens of gallbladder mucosa in 35 young (up to 25 years of age) and 20 older patients (approximately 50 years of age) with CH. An immunocytochemical ABC method and the spatial visualization technique were conducted. Our study demonstrated significantly lower amounts of both CKs in young patients, as compared to older patients. The higher cellular expression of CK8 in older patients was linked to acute clinical course vs. chronic ones. Tissue expression of neither CK correlated with inflammatory activity (grading) of the gallbladder mucosa. A positive correlation between reciprocal expressions of the two CKs may confirm a cytoprotective role of the two proteins in both groups of patients with symptomatic CH. Significantly higher expression of CK18 than that of CK8 in younger patients suggests a different role of CK8 and 18 in lithogenesis in this group.

[Possibilities of using of crystal-optic qualities of bile in early diagnostic stage of cholelithiasis]

The aim of our investigation was to study the changes of bile morphology and possibilities of its using in early diagnostic stage of cholelithiasis. We spent the complex investigation of biochemical and crystal-optic qualities of bile in 207 patients with cholelithiasis stage I with different disease duration. The revealed crystal-optic morphotypes have selective morphology due to the bile lithogene level that allows to determine the disease duration and the bile instability to make in-time adequate profilactic.

Pathophysiological conditions in cholelithiasis formation in North Indian population: spectroscopic, biophysical, and biochemical study

Knowledge of the chemical, structural, and elemental composition of gallstones is essential for etiopathogenesis of gallstone disease. To identify the predisposing factors for gallstone formation, X-ray diffraction powder analysis, atomic absorption spectroscopy, and various biochemical estimations were carried out. In the present study, trace elemental analysis revealed calcium as the major constituent element in addition to the iron, magnesium, and zinc in the majority of the gallstones. Patients with gallstones exhibited increased serum total bilirubin and conjugated bilirubin levels and liver function parameters (serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, and alkaline phosphatase). In patients with gallstones, higher concentrations of malondialdehyde, significantly higher glutathione disulfide/glutathione (GSH) ratio, reduced total GSH levels, and significantly decreased antioxidant enzymes activities (superoxide dismutase, catalase, and glutathione peroxidase) were found than in patients without gallstones. Further studies are needed to establish whether the observed differences are a cause or an effect of gallstone formation. Such studies could ultimately result in the development of new strategies for the treatment of gallstones and might provide clues for prevention of gallstones formation.

Prevalence of cholelithiasis in a Turkish population sample of postmenopausal women

BACKGROUND/AIMS

Gallstone disease is a global health problem worldwide. Potential risk factors for gallstone disease have not been well established except for age and gender. We aimed to investigate the prevalence and potential risk factors for gallstone disease in a population of postmenopausal women.

METHODS

A detailed Turkish questionnaire was prepared, and 474 of 502 postmenopausal women seen at the menopause clinic of Dr. Zekai Tahir Burak Hospital were included in the study. Sociodemographic, medical and reproductive characteristics were analyzed. Subjects were divided into two groups. The gallstone disease group (Group 1, n=73) was defined by both prior histories of gallstones diagnosis or cholecystectomy in the postmenopausal period and the presence of current sonographically diagnosed gallstones; Group 2 (n=401) included women with no gallstone disease.

RESULTS

The present study found a 15.4% prevalence rate of cholelithiasis in a Turkish population sample of postmenopausal women. The demographic characteristics were similar between the two groups. The mean gravidity was 5.25 in Group 1 and 4.9 in Group 2. The number of subjects with past oral contraceptive use was 17 (23.3%) in Group 1 and 56 (13.9%) in Group 2. The number of women who took hormone replacement therapy was 40 (54.8%) in Group 1 and 222 (55.3%) in Group 2. There was no significant difference related to mean total cholesterol levels (216.5±44.9 mg/dl versus 215.9±44.3 mg/dl; p=0.915) and mean triglycerides (134.5±54.8 mg/dl versus 143.2±77 mg/dl; p=0.202) between the two groups.

CONCLUSIONS

No risk factors for developing gallstones were determined among the evaluated parameters in postmenopausal women.

[Cholelitiasis and age: tactic of surgical treatment]

We examined the resultants of treatment of 268 old patients. RESULTATES: The global demographic transition to an older population effects developing as well as developed coutries. Cganges in mitochondria with age, in body composition, in biliary tract gives to start for many diseases such as cholelitiasis. It has recommended the special surgic tactict of treatment such situations.

[Disorders of bone mineral density in patients with cholelithiasis and postcholecystectomic syndrome]

to justify the role of biliary insufficiency (BI) in the development of disorders of bone mineral density (BMD) in patients with cholelithiasis and after cholecystectomy, to introduce with main methods of diagnosis, prevention and treatment of osteoporosis and osteopenia in biliary pathology. Recent literature data showed that development of BI in the CL and PS leads to malabsorption of vitamin D and thereby contribute to the development of osteoporosis and osteopenia. The main method of diagnosis of BMD is twoenergic X-ray densitometry.

Biliary proteins and their redox status changes in gallstone patients

BACKGROUND

Proteins might act as pronucleating agents of cholesterol crystallization in bile. However, little is known about the redox status of biliary proteins in humans and their interaction with crystallization of biliary cholesterol.

MATERIALS AND METHODS

Gallbladder biles were obtained at cholecystectomy from 86 symptomatic patients with either cholesterol gallstones (32 multiple and 32 solitary stones) or pigment stones (n = 22), and studied for protein redox status [carbonyl and sulfhydryl (PSH) concentrations], total lipid and protein levels and cholesterol saturation index (CSI). First appearance of cholesterol crystals in ultrafiltered bile (crystal observation time, COT) was studied with polarizing light microscopy during 21 days.

RESULTS

Patients with cholesterol stones had significantly shorter COT (3 days vs. >21 days, P < 0.05), higher CSI (149 +/- 10% vs. 97 +/- 7%, P < 0.05) and higher total biliary proteins (1.96 +/- 0.1 mg mL(-1) vs. 0.55 +/- 0.1 mg mL(-1), P < 0.05) than patients with pigment stones. Patients with cholesterol stones had significantly lower (P < 0.05) level of protein sulfhydryl concentrations (18 +/- 4 nmol mg(-1) protein vs. 49 +/- 16 nmol mg(-1) protein), while total lipid and carbonyl proteins concentrations were similar between cholesterol and pigment stone patients. Crystallization probability was influenced by the number/type of gallstones (multiple > solitary > pigment stones, P = 0.009) and total protein concentration (high > low levels, P = 0.004). COT was negatively correlated with total protein content (r = -0.45, P = 0.03).

CONCLUSIONS

Biles with cholesterol stones show high CSI and total protein concentration, and rapid COT, which is even faster in patients with multiple stones and high protein concentration. Low PSH levels in cholesterol stone patients point to a biochemical shift, potentially able to affect cholesterol crystallization.

[Expression and regulation of megalin in gallbladder mucosa associated with cholesterol gallstone disease]

OBJECTIVE

To explore the relationship between expression and regulation of Megalin in gallbladder mucosa and cholesterol gallstone disease.

METHODS

Gallbladder mucosa, gallbladder wall, bile, gallstone were collected from 29 patients with cholesterol gallstone disease (GS) and 12 patients with gallstone free (GSF). Lipids of bile and stone were measured by kits. Expression of Megalin and Cubilin was analyzed by Real-time PCR. GBC-SD cell line were treated with T0901317, 9-cis retinoic acid, chenodeoxycholic acid (CDCA), the agonists of LXR, RXR, FXR, respectively. Gene expressions were detected.

RESULTS

Biliary cholesterol % molar and CSI increased significantly in GS group [(7.98 +/- 0.44) mol% vs (4.87 +/- 0.39) mol%, P < 0.01]. Megalin expression in GS group was significantly higher than that in GSF group (P < 0.05) and cubilin expression was similar between two groups. In vitro experiments showed that CDCA markedly increased expression of megalin.

CONCLUSION

This study shows that the increased expression Megalin may help to increase cholesterol uptake in gallbladder and play a compensative role in GS. FXR may participate in the transcription regulating of Megalin.

Coagulation function in patients with pancreatic carcinoma

BACKGROUND

The coagulation function in patients with pancreatic carcinoma is abnormal and the reason is not very clear. In this study, we retrospectively analyzed the coagulation function in patients with pancreatic carcinoma.

METHODS

From June 2004 to December 2007, 132 patients received diagnosis and treatment in our hospital. The coagulative parameters including the prothrombin time, activated partial thromboplastin time, and fibrinogen levels were collected and studied retrospectively.

RESULTS

The average fibrinogen levels in patients with pancreatic carcinoma, (476.21 +/- 142.05) mg/dl, were significantly higher than in patients with cholangiolithiasis, (403.28 +/- 126.41) mg/dl (P < 0.05). In patients with pancreatic carcinoma, the levels of fibrinogen in the group with jaundice were significantly higher than in patients without jaundice (P < 0.05). In patients who received Pancreaticoduodenectomy, Whipple's operation, the level of fibrinogen in the group with local invasiveness was significantly higher than in the group without invasiveness. The group with lymphatic metastasis had higher levels than the group without lymphatic metastasis (P < 0.05). There was no significant difference of intraoperative blood loss between patients with vitamin K, (748.27 +/- 448.51) ml, and those without vitamin K, (767.31 +/- 547.89) ml (P > 0.05).

CONCLUSIONS

The level of fibrinogen in patients with pancreatic carcinoma was elevated. The elevated fibrinogen level may be associated with invasiveness and lymphatic metastasis. Using vitamin K in perioperation management did not reduce intraoperative blood loss.

[APOE gene polimorphism and lithogenicity of the bile in the women with cholelithiasis]

AIM

to study the frequency of alleles and genotypes of APOE gene in women with gallstone disease (GSD), and also to research the association of the APOE gene polymorphism and bile lithogenicity indices.

MATERIALS AND THE METHODS

were investigated 104 women after cholecystectomy about verified cholesterol gallstones, and 176 women from the female Novosibirsk population, they were control group for the comparison of the frequency of APOE alleles and genotypes. Gallbladder bile (bile cholesterol, common bile acids) was investigated in women with GSD. Blood serum lipids and APOEgene polymorphism were studied in all women.

RESULTS

APOE gene polymorphism in the women with GSD did not differ from those registered in control group from women population. At the presence of APOE4 allele at the women with GSD the significant increase of gallbladder biliary cholesterol level was marked. In the women with GSD with various APOE genotypes average levels of blood serum lipids, common bile acids and bile cholesterol indices were similar.

[The functional condition of the hepato-biliary system in fatty hepatosis with concomitant diabetes mellitus]

It was made an organized study of the functional condition of hepato-biliary system beside 200 patients with fatty hepatosis and fatty hepatosis with concomitant sugar diabetes. In verification of the diagnosis were used results of the biochemical blood's study, ultrasonography study, computer and MR tomography. All patients were conducted with duodenal tubing with following biochemical bile study. Breach of the functional condition liver was revealled beside majority sick fatty hepatosis, moreover degree of the breaches becomes above under accompanying sugar diabetes. Unidirectional change in biochemical bile characteristic wasn't noted beside patient fatty hepatosis and fatty hepatosis with accompanying sugar diabetes, corresponding to I stage cholelithiasis.

[Lipid peroxidation and antiradical defense in patients after endosurgical cholelithiasis]

The peroxide status was studied after cholecystectomy depending on the procedure of a surgical access and the duration of exposure to the pneumoperitoneum during laparoscopic operations. Endosurgical interventions, unlike open operations and miniaccess operations, were found to have the least impact on the values of lipid peroxidation (LPO) expirate. There was evidence that a marked imbalance occurred in the LPO-antioxidant system with longer exposure to the peritoneum.

[Lipoprotein(a)--a new independent cholelithiasis risk factor?]

AIM

To study the level of lipoprotein(a)--Lp(a) in the blood serum and incidence of isoforms of apolipoprotein(a)--apo(a) in males and females with cholelithiasis and free of it in population of Novosibirsk; to assess possible correlations between Lp(a) level in the blood, apo(a) isoforms and bile lithogenicity in females with cholesterol cholelithiasis.

MATERIAL AND METHODS

Examination of the representative samples of 870 females aged 25-64 years and 405 males aged 35-54 years has detected cholelithiasis in 91 females and 19 males.

RESULTS

Serum levels of Lp(a) are associated with cholelithiasis. Risk of the latter in males (Lp(a) > 28 mg/dl) and females (Lp(a) > 24 mg/dl) is estimated. It is confirmed that isoforms of apo(a) B, S1 and S2 in females and isoforms of apo(a) B, S2 in males with cholelithiasis occur much more frequently than in individuals free of cholelithiasis while isoform apo(a) S4 is rare. Females with cholesterol cholelithiasis have positive correlation between blood Lp(a) levels, the presence of isoforms apo(a) B, S1 and bile lithogenicity.

CONCLUSION

Males and females with cholelithiasis have more frequent high concentrations of Lp(a) (> 30 mg.dl) while low levels (0-5 mg/dl) are rare. There is a correlation between blood levels of Lp(a), apo(a) isoforms, bile lithogenicity in females with cholesterol cholelithiasis.

[Comparative assessment of bile and blood cholesterol, pigment, and protein metabolic parameters in patients with cholelithiasis in the presence and absence of opisthorchiasis]

AIM

to study the regularities of lithogenesis in patients with cholelithiasis (CL) and opisthorchiasis.

SUBJECTS AND METHODS

Fifty-one patients with CL and opisthorchiasis were examined. Comparison groups comprised 32 with CL without opisthorchiasis and 14 patients with opisthorchiasis without CL. All the patients underwent a comprehensive examination involving laboratory and ultrasound studies.

RESULTS

Opisthorchis invasion leads to increases in vesicular and hepatic bile cholesterol saturation and bile albumin levels due to intrahepatic ductal cholestasis, to a rise in bile unconjugated bilirubin concentration, which is caused by the activation of proliferative inflammation in the bile ducts and by the increased deposits of bilirubin complexes resulting from higher bile globulin levels.

CONCLUSION

In opisthorchiasis, bile lithogenic factors mostly activate in the development of CH in patients with significant manifestations of cholestasis, angiocholitis with the most preserved concentration function of the gallbladder.

[Differential analysis of protein profiles of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients]

OBJECTIVE

To identify the proteins which play key roles during the formation of cholesterol gallstone, differential analysis was carried out that the proteome of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients.

METHODS

Vesicular and micellar phases were isolated by the density gradient ultracentrifugation method. Total proteins from the two phases were extracted, and the protein expressional profiles were established by two-dimensional electrophoresis respectively. The differentially expressed protein spots analyzed by ImageMaster two-dimensional electrophoresis analysis software were identified with matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS).

RESULTS

The concentrations of proteins from vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients were (1.5358 +/- 0.0682) mg/ml and (7.1222 +/- 0.2022) mg/ml (P < 0.01) respectively. The average matched protein spots were 120 +/- 24 and 198 +/- 37 in the two groups respectively. There were 72 +/- 16 matched spots in the two representative gels maps and the matched rate was 45.30%. Eight differentially expressed protein spots were identified from the two cholesterol-carrier phases. Among them, 6 were up-regulated with 2 down-regulated in vesicular phase compared with micellar phase. The abundance differentiation of RBP and HSA was confirmed by immunoblotting.

CONCLUSIONS

The differential protein profiles of vesicular phase and micellar phase of gallbladder bile from cholesterol gallstone patients were established and 8 differential protein spots were identified successfully. The data may be a basis for further screening the key regulators of formation of cholesterol gallstone.

Effect of ezetimibe on the prevention and dissolution of cholesterol gallstones

BACKGROUND & AIMS

Cholesterol cholelithiasis is one of the most prevalent and most costly digestive diseases in developed countries and its incidence has increased markedly in Asian countries owing to the adoption of Western-type dietary habits. Because animal experiments showed that high efficiency of intestinal cholesterol absorption contributes to gallstone formation, we explored whether the potent cholesterol absorption inhibitor ezetimibe could prevent gallstones and promote gallstone dissolution in mice and reduce biliary cholesterol content in human beings.

METHODS

Male gallstone-susceptible C57L mice were fed a lithogenic diet and concomitantly administered with ezetimibe at 0, 0.8, 4, or 8 mg/kg/day for 8 or 12 weeks. Gallbladder biles and gallstones were examined by microscopy. Gallbladder emptying in response to cholecystokinin octapeptide was measured gravimetrically. Biliary lipid outputs were analyzed by physical-chemical methods. Cholesterol absorption efficiency was determined by fecal dual-isotope ratio and mass balance methods. Lipid changes in gallbladder biles of gallstone patients vs overweight subjects without gallstones were examined before (day 0) and at 30 days after ezetimibe treatment (20 mg/day).

RESULTS

Ezetimibe prevented gallstones by effectively reducing intestinal cholesterol absorption and biliary cholesterol secretion, and protected gallbladder motility function by desaturating bile in mice. Treatment with ezetimibe promoted the dissolution of gallstones by forming an abundance of unsaturated micelles. Furthermore, ezetimibe significantly reduced biliary cholesterol saturation and retarded cholesterol crystallization in biles of patients with gallstones.

CONCLUSIONS

Ezetimibe is a novel approach to reduce biliary cholesterol content and a promising strategy for preventing or treating cholesterol gallstones by inhibiting intestinal cholesterol absorption.

[Association of fatty acid composition of blood serum with bile lipid composition in cholelithiasis patients]

AIM

To examine correlations between bile lipid composition and fatty acid composition of blood serum in cholelithiasis patients.

MATERIAL AND METHODS

Cholelithiasis prevalence in Khakasia Republic was studied in a clinico-epidemiological trial with participation of 1393 European people and 1060 mongoloid people--Khakasians. Bile lipids and serum fatty acids were measured.

RESULTS

Europeans had cholelithiasis in 7.3%, Khakasians--3.4% (p < 0.001). Total cholesterol in bile of cholelithiasis patients was higher than in healthy subjects (both in Europeans and Khakasians). Fatty acids content was higher in cholelithiasis patients of both populations.

CONCLUSION

Cholelithiasis was more prevalent in Europeans because of genetical differences in lipid metabolism. Rise in contents of saturated fatty acids and lowering of the proportion of unsaturated acids in blood is a universal aspect of lipid metabolism disturbance in cholelithiasis patients in genetically diferent populations.

[Using simvastatin in combination with chophytol at early stages of cholelithiasis in elderly patients]

In the treatment of 78 elderly patients with the gallstone disease were used chophytol and vasilip. To estimate the efficiency of treatment we used modern laboratory-instrumental, ultrasonic and biochemical methods of examinations. The examinations of indexs of fat exchange in bile and blood showed the communication of theirs disturbances. The application of chophytol and vasilip in the treatment of the first stage of gallstone disease is prove the positive changes of clinical symptoms of illness and lead to improvement of liver functional condition and biochemical composition of bile. These changes are cause to decrease of risk of formation the gallstones.

Role of bile bacteria in gallbladder carcinoma

BACKGROUND/AIMS

Long standing calculus disease has been observed to be a risk factor for gallbladder carcinoma. However it is possible that calculi may be incriminated by some means other than just chronic irritation. Calculi may induce an element of stasis, promoting chronic infection leading to increased turnover of primary bile acids to secondary bile acids, which are known tumor promoters and initiators. This study aimed to find the prevalence of biliary microflora in gallbladder carcinoma and association of gallbladder carcinoma with chronic bacterial infection and bile acid profile.

METHODOLOGY

Bile culture was done in 390 patients divided into 3 groups--gallbladder carcinoma 65 (17%), cholelithiasis 125 (32%) and control group 200 (51%). Serum samples were analyzed for presence of Vi antibody for chronic typhoid carrier state and bile acid analysis was done in 10 patients in each group.

RESULTS

116 (30%) patients had culture positive bile. Significantly higher number of patients with gallbladder carcinoma 40 (65%) had culture positive bile as compared to cholelithiasis 52 (42%) and control 24 (12%). Vi Antibodies suggestive of chronic typhoid carrier state were found to be significantly higher in the gallbladder carcinoma group 20 (31%) as compared to controls 22 (11%) (OR 3.596, p < 0.05) however, the difference was statistically insignificant in the cholelithiasis group 12 (11%) (OR 0.859, p > 0.05). There was a 6.84 times higher risk of developing gallbladder carcinoma in culture positive cholelithiasis patients and 5.14 times if both Vi antibody and cultures were positive. Bile analysis showed primary bile acids cholic acid and chenodeoxycholic acid to be lower while secondary bile acids deoxycholic acid and lithocholic acid to be more in the gallbladder carcinoma group (7.268 mg/mL, 9.183 mg/ mL, 14.468 mg/mL, 3.312 mg/mL respectively) than cholelithiasis (17.50 mg/mL, 13.80 mg/mL, 6.07 mg/ mL, 2.05 mg/mL) and control group (19.85 mg/mL, 16.53 mg/mL, 2.71 mg/mL, 1.128 mg/mL respectively). The difference was statistically significant.

CONCLUSIONS

Chronic bacterial infection of bile leading to production of carcinogenic precursors might be one of the etiological factors in the pathogenesis of gallbladder carcinoma and hence a target for its prevention.

A genome-wide association scan identifies the hepatic cholesterol transporter ABCG8 as a susceptibility factor for human gallstone disease

With an overall prevalence of 10-20%, gallstone disease (cholelithiasis) represents one of the most frequent and economically relevant health problems of industrialized countries. We performed an association scan of >500,000 SNPs in 280 individuals with gallstones and 360 controls. A follow-up study of the 235 most significant SNPs in 1,105 affected individuals and 873 controls replicated the disease association of SNP A-1791411 in ABCG8 (allelic P value P(CCA) = 4.1 x 10(-9)), which was subsequently attributed to coding variant rs11887534 (D19H). Additional replication was achieved in 728 German (P = 2.8 x 10(-7)) and 167 Chilean subjects (P = 0.02). The overall odds ratio for D19H carriership was 2.2 (95% confidence interval: 1.8-2.6, P = 1.4 x 10(-14)) in the full German sample. Association was stronger in subjects with cholesterol gallstones (odds ratio = 3.3), suggesting that His19 might be associated with a more efficient transport of cholesterol into the bile.

Low phospholipid associated cholelithiasis: association with mutation in the MDR3/ABCB4 gene

Low phospholipid-associated cholelithiasis (LPAC) is characterized by the association of ABCB4 mutations and low biliary phospholipid concentration with symptomatic and recurring cholelithiasis. This syndrome is infrequent and corresponds to a peculiar small subgroup of patients with symptomatic gallstone disease. The patients with the LPAC syndrome present typically with the following main features: age less than 40 years at onset of symptoms, recurrence of biliary symptoms after cholecystectomy, intrahepatic hyperechoic foci or sludge or microlithiasis along the biliary tree. Defect in ABCB4 function causes the production of bile with low phospholipid content, increased lithogenicity and high detergent properties leading to bile duct luminal membrane injuries and resulting in cholestasis with increased serum gamma-glutamyltransferase (GGT) activity. Intrahepatic gallstones may be evidenced by ultrasonography (US), computing tomography (CT) abdominal scan or magnetic resonance cholangiopancreatography, intrahepatic hyperechogenic foci along the biliary tree may be evidenced by US, and hepatic bile composition (phospholipids) may be determined by duodenoscopy. In all cases where the ABCB4 genotyping confirms the diagnosis of LPAC syndrome in young adults, long-term curative or prophylactic therapy with ursodeoxycholic acid (UDCA) should be initiated early to prevent the occurrence or recurrence of the syndrome and its complications. Cholecystectomy is indicated in the case of symptomatic gallstones. Biliary drainage or partial hepatectomy may be indicated in the case of symptomatic intrahepatic bile duct dilatations filled with gallstones. Patients with end-stage liver disease may be candidates for liver transplantation.

[Determination of intestinal permeability in cholelithiasis patients by oral administration of technetium-99m-diethylenetriaminepentaacetatic acid]

OBJECTIVE

To investigate the intestinal permeability of patients with cholelithiasis of different types.

METHODS

Technetium-99m-diethylenetriaminepentaacetatic acid (99mTc-DTPA) at the dose of 185 MBq (5 mCi) was administered orally to 56 patients of cholelithiasis, 15 cases of cholesterol stone (CS group) and 41 cases of pigment stone (PS group) based on the cross section of the stone during operation, and 17 healthy controls. A 24 h urine collection was obtained after the ingestion of the tracer to calculate the urinary excretion of DTPA.

RESULTS

The mean percentage of the total ingested dose of 99mTc-DTPA excreted in a 24 h urinary excretion was 5.0%+/-3.6% in the CS group, not significantly different from that in the control group (4.5%+/-3.4%. F=2.18, P>0.05), and the mean percentage of the total ingested dose of 99mTc-DTPA excreted in a 24 h urinary excretion of the PS group was 10.5%+/-6.9%, significantly higher than that in the control group (F=7.62, P<0.05), showing a significantly increase of intestinal permeability (P<0.05).

CONCLUSION

The intestinal permeability of the patients of pigment stone is higher than that of the healthy subjects. Hyperpermeability may be a factor of the pathogenesis of pigment stone.