title: Bilirubin monoglucuronide promotes cholesterol gallstone formation.
abstract: Recent evidence suggests that cholesterol (Ch) solubility in bile is determined by a complex interaction of mixed micelles and lecithin-cholesterol vesicles. Bilirubin monoglucuronide (BMG), which binds to bile salts and incorporates into mixed micelles, may displace cholesterol from micelles into vesicles, thus favoring cholesterol monohydrate crystal precipitation. Therefore, we designed an experiment to test the hypothesis that BMG may enhance cholesterol gallstone formation without inducing cholesterol supersaturation. For 8 weeks, 28 adult male prairie dogs were fed either a control, nonlithogenic diet (0.03% Ch), a high carbohydrate diet (CHO) which has no cholesterol but increases hepatic bilirubin secretion, or the same CHO diet plus 0.03% Ch. Cholecystectomy was then performed, and bile was examined microscopically for stones or crystals and analyzed for BMG and biliary lipids. Cholesterol saturation index was calculated. Cholesterol gallstones were found in none of the control animals and in 13% of the CHO-fed animals. However, the addition of trace cholesterol to the CHO diet resulted in an 88% incidence of cholesterol gallstones (P less than 0.001 vs control, P less than 0.01 vs CHO, respectively). Gallbladder bile was unsaturated with cholesterol in all groups. (control = 0.65 +/- 0.05, CHO = 0.46 +/- 0.05, CHO + 0.03% Ch = 0.70 +/- 0.03). CHO feeding alone or with trace cholesterol significantly elevated gallbladder bilirubin monoglucuronide, phospholipid, and cholesterol concentrations when compared to controls. These data suggest that in the prairie dog a high carbohydrate diet with only trace amounts of cholesterol increases bilirubin monoglucuronide in gallbladder bile and causes cholesterol gallstone formation without inducing cholesterol supersaturation.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: H S
authors.initials: HS
authors.lastname: Kaufman
authors.forename: T H
authors.initials: TH
authors.lastname: Magnuson
authors.forename: T H
authors.initials: TH
authors.lastname: Webb
authors.forename: P C
authors.initials: PC
authors.lastname: Watt
authors.forename: M K
authors.initials: MK
authors.lastname: Fox-Talbot
authors.forename: H A
authors.initials: HA
authors.lastname: Pitt
authors.forename: K D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000818:Animals; D001646:Bile / Q000378:metabolism; D001663:Bilirubin / Q000378:metabolism*; D002769:Cholelithiasis / Q000209:etiology*; D002784:Cholesterol / Q000502:physiology*; D002851:Chromatography, High Pressure Liquid; D004040:Dietary Carbohydrates / Q000494:pharmacology; D005965:Glucuronates / Q000378:metabolism*; D050356:Lipid Metabolism; D008297:Male; D009994:Osmolar Concentration; D012589:Sciuridae
chemical_list: D004040:Dietary Carbohydrates; D005965:Glucuronates; D002784:Cholesterol; D001663:Bilirubin