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Cholesterol saturation rather than phospholipid/bile salt ratio or protein content affects crystallization sequences in human gallbladder bile


  • 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).

Karel J. van Erpecum MD, PhD, Department of Gastroenterology F.02·618, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands. Tel.: + 31 30 2507004; fax: + 31 30 2505533; e-mail:


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.

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