Cysteinyl leukotrienes in the bile of patients with obstructive jaundice.
BACKGROUND
Cysteinyl leukotrienes (LTs) are potent proinflammatory mediators. They are predominantly excreted from blood by hepatobiliary elimination. To explore the clinical significance of biliary cysteinyl LTs, we determined their concentration changes in bile during treatment in patients with obstructive jaundice.


METHODS
Bile samples were obtained during endoscopic or transhepatic biliary drainage. Leukotrienes C(4), D(4), and E(4) were quantified by two-step reversed-phase high-performance liquid chromatography and subsequent radioimmunoassay.


RESULTS
The increased excretion of cysteinyl LTs (LTC(4) + LTD(4) + LTE(4)) decreased between day 1 and 14 after drainage (means, 171 pmol/h to 79 pmol/h; P < 0.02). During drainage, the excretion was higher when there was additional cholangitis (mean, 225 and 86 pmol/h, with and without cholangitis, respectively; P < 0.001). The concentrations of LTD(4) and LTE(4) were also higher with additional cholangitis than without (LTD(4), mean 6.0 vs 2.0 nM; P < 0.05; LTE(4), 6.8 vs 2.4 nM; P < 0.02, respectively). Biliary LTC(4) was detected only in patients with cholangitis. The biliary excretion of cysteinyl LTs was positively correlated with leukocyte concentration ( r = 0.68; P < 0.005) and C-reactive protein ( r = 0.73; P < 0.005) in blood. Furthermore, only in the absence of cholangitis, the excretion was positively correlated with serum gamma-glutamyl transferase ( r = 0.76; P < 0.02) and alanine aminotransferase ( r = 0.72; P < 0.02).


CONCLUSIONS
The excretion of biliary cysteinyl LTs increases with the severity of cholestasis and hepatic inflammation in patients with obstructive jaundice. An additional increase of cysteinyl LTs was observed during bacterial cholangitis. The increased biliary excretion of biologically active cysteinyl LTs may contribute to the aggravation of cholestasis and inflammatory reaction in obstructive jaundice.
Uemura
Masahito
M
Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan.
Kojima
Hideyuki
H
Buchholz
Ulrike
U
Kikuchi
Eiryo
E
Matsumoto
Masami
M
Kikukawa
Masaji
M
Imazu
Hiroo
H
Fukui
Hiroshi
H
Tsujii
Tadasu
T
Keppler
Dietrich
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry*; D002779:Cholestasis / Q000378:metabolism* / Q000652:urine; D002851:Chromatography, High Pressure Liquid; D003545:Cysteine; D005260:Female; D006801:Humans; D017997:Leukotriene C4 / Q000032:analysis / Q000652:urine; D017998:Leukotriene D4 / Q000032:analysis / Q000652:urine; D017999:Leukotriene E4 / Q000031:analogs & derivatives* / Q000032:analysis / Q000652:urine; D008297:Male; D008875:Middle Aged; D011863:Radioimmunoassay
D017997:Leukotriene C4; D017998:Leukotriene D4; D017999:Leukotriene E4; C047630:N-acetylleukotriene E4; D003545:Cysteine