title: Impaired human gallbladder lipid absorption in cholesterol gallstone disease and its effect on cholesterol solubility in bile.
abstract: OBJECTIVE
  The role of the gallbladder in gallstone pathogenesis is still unclear. We examined the effects of gallbladder mucosal lipid absorption on lipid composition and cholesterol crystallization in bile.
  
  
  METHODS
  The in vitro-isolated, intra-arterially perfused gallbladder model was used (1) to compare the absorption rates of lipids from standard bile by gallbladders obtained from 7 patients with cholesterol gallstones and 6 controls; and (2) to measure the microscopic cholesterol crystal detection time in cholesterol-enriched pig bile before and after lipid absorption by the pig gallbladder.
  
  
  RESULTS
  Control gallbladders, but not cholesterol gallstone gallbladders, significantly reduced cholesterol (P < 0.02) and phospholipid (P < 0.01) and increased bile salt (P < 0.01) molar percentages in bile over a 5-hour period by efficient and selective cholesterol and phospholipid absorption. A histomorphometric study of the epithelial cells showed significantly higher values for nuclear density (P < 0.01) and nuclear (P < 0.05) and cytoplasmic (P < 0.05) areas in the cholesterol gallstone than the control group. Sequential microscopy of cholesterol-enriched pig bile showed significantly shorter cholesterol filament (P < 0.01) and typical cholesterol plate (P < 0. 02) detection times before than after exposure of bile to the gallbladder lipid absorption.
  
  
  CONCLUSIONS
  In cholesterol gallstone disease, the human gallbladder epithelium loses its capacity to selectively and efficiently absorb cholesterol and phospholipids from bile, even if it is hyperplastic and hypertrophic. This epithelial dysfunction eliminates the positive effect that the normal gallbladder exerts on cholesterol solubility in bile and might be a pathogenetic cofactor for cholesterol gallstone formation.
authors.affiliation: Divisione di Gastroenterologia del Dipartimento di Medicina Clinica, Universitá "La Sapienza," Rome, Italy. carradini@uniroma1.it
authors.forename: S G
authors.initials: SG
authors.lastname: Corradini
authors.forename: W
authors.initials: W
authors.lastname: Elisei
authors.forename: L
authors.initials: L
authors.lastname: Giovannelli
authors.forename: C
authors.initials: C
authors.lastname: Ripani
authors.forename: P
authors.initials: P
authors.lastname: Della Guardia
authors.forename: A
authors.initials: A
authors.lastname: Corsi
authors.forename: A
authors.initials: A
authors.lastname: Cantafora
authors.forename: L
authors.initials: L
authors.lastname: Capocaccia
authors.forename: V
authors.initials: V
authors.lastname: Ziparo
authors.forename: V
authors.initials: V
authors.lastname: Stipa
authors.forename: P
authors.initials: P
authors.lastname: Chirletti
authors.forename: R
authors.initials: R
authors.lastname: Caronna
authors.forename: D
authors.initials: D
authors.lastname: Lomanto
authors.forename: A F
authors.initials: AF
authors.lastname: Attili
mesh_terms: D000042:Absorption; D000818:Animals; D001646:Bile / Q000737:chemistry / Q000378:metabolism*; D002769:Cholelithiasis / Q000737:chemistry / Q000378:metabolism* / Q000473:pathology; D002784:Cholesterol / Q000737:chemistry / Q000378:metabolism*; D004847:Epithelial Cells / Q000473:pathology / Q000648:ultrastructure; D005260:Female; D005704:Gallbladder / Q000378:metabolism* / Q000473:pathology / Q000648:ultrastructure; D006168:Guinea Pigs; D006801:Humans; D066298:In Vitro Techniques; D050356:Lipid Metabolism; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism; D010713:Phosphatidylcholines / Q000378:metabolism
chemical_list: D010713:Phosphatidylcholines; D002784:Cholesterol