Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Centre Utrecht, the Netherlands (N. G. Venneman, G. P. vanBerge-Henegouwen, K. J. van Erpecum); Semeiotica Medica, Department of Internal and Public Medicine, University Hospital Bari, Italy (P. Portincasa).
Cholesterol saturation rather than phospholipid/bile salt ratio or protein content affects crystallization sequences in human gallbladder bile
Article first published online: 7 OCT 2004
European Journal of Clinical Investigation
Volume 34, Issue 10, pages 656–663, October 2004
How to Cite
Venneman, N. G., Portincasa, P., VanBerge-Henegouwen, G. P. and Van Erpecum, K. J. (2004), Cholesterol saturation rather than phospholipid/bile salt ratio or protein content affects crystallization sequences in human gallbladder bile. European Journal of Clinical Investigation, 34: 656–663. doi: 10.1111/j.1365-2362.2004.01409.x
- Issue published online: 7 OCT 2004
- Article first published online: 7 OCT 2004
- Received 30 June 2004; accepted 26 August 2004
- Bile salts;
- cholesterol saturation index;
- crystallization pathways;
Background In model biles, cholesterol crystallization (an important factor in gallstone formation) mainly depends on phospholipid/bile salt ratios with characteristic sequences of plate-like (monohydrate) vs. non-plate-like (presumed anhydrous: arcs, needles, tubules, spirals) cholesterol crystals (Wang, J Lipid Res 1996; 37: 606). We now investigate whether the same phenomenon occurs in human bile.
Methods Appearances of plate-like and non-plate-like cholesterol crystals were determined in filtered bile of 80 cholesterol gallstone patients, and related to biliary lipid and pro-nucleating protein composition.
Results Non-plate-like crystals appeared before plate-like crystals in 9 biles, on the same day in 24 biles, and after plate-like crystals in 31 biles. In 16 biles only plate-like crystals were observed. Crystal sequences did not depend on biliary lipid or protein composition. Cholesterol saturation indexes were higher in biles with than without non-plate-like crystals (150 ± 6 vs. 125 ± 12, P = 0·02). In contrast, phospholipid/(bile salt + phospholipid) ratios, bile salt species, phospholipid classes, concentrations of mucin, IgG, IgM, IgA, haptoglobin and α-1 acid glycoprotein did not differ.
Conclusions Cholesterol crystallization sequences in human bile depend on cholesterol saturation index rather than on phospholipid/bile salt ratio.