title: Relation of cholesterol metabolism to pediatric gallstone disease: a retrospective controlled study.
abstract: BACKGROUND
  Cholesterol metabolism may be involved in pediatric gallstone disease. We aimed to reveal cholesterol metabolites and phytosterols and their relation to stone composition of sterols in children having black pigment and cholesterol stones.
  
  
  METHODS
  We performed retrospective controlled clinical study, in which we examined parameters of cholesterol metabolism and liver function values in serum (n = 28) and gallstones (n = 46) of consecutively cholecystectomized children. Serum values of age-, body mass index- and sex-matched children (n = 82) and adult gallstones (n = 187) served as controls.
  
  
  RESULTS
  Surrogate markers of cholesterol synthesis in serum (squalene/cholesterol, cholestenol/cholesterol and lathosterol/cholesterol) were 26-52 % higher in both stone subclasses compared to controls (p < 0.05 for all). Respectively, cholestanol/cholesterol and plant sterols campesterol/cholesterol and sitosterol/cholesterol (cholesterol absorption markers) had decreasing order in serum: black pigment stone group > controls > cholesterol stone group (p < 0.05 for all). In black pigment stone group, stone cholestanol/cholesterol was associated with serum bile acids (r = 0.620, p = 0.018). In cholesterol stone group, surrogate markers of cholesterol synthesis in serum (e.g., lathosterol/cholesterol) inversely reflected those of absorption (r-range -0.633--0.706, p-range 0.036-0.015). In cholesterol stone group, serum and stone lathosterol/cholesterol and cholestanol/cholesterol were positively interrelated (r-range 0.727-0.847, p < 0.05 for both).
  
  
  CONCLUSIONS
  Gallstone subclasses shared enhanced cholesterol synthesis. Cholesterol stone children were low cholesterol absorbers with intact homeostasis of cholesterol metabolism. Black pigment stone group was characterized by deteriorated cholesterol metabolism, and accumulation of cholestanol, campesterol and sitosterol in serum and stones suggesting their participation in pathogenesis.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. antti.koivusalo@hus.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Koivusalo
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. mikko.pakarinen@hus.fi.
authors.forename: Mikko
authors.initials: M
authors.lastname: Pakarinen
authors.affiliation: Department of Medicine, Division of Internal Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. helena.gylling@hus.fi.
authors.forename: Helena
authors.initials: H
authors.lastname: Gylling
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. markku.nissinen@DLC.fi.|Biomedicum Helsinki, Room C422, POB 700, FI-00029 HUS, Helsinki, Finland. markku.nissinen@DLC.fi.
authors.forename: Markku J
authors.initials: MJ
authors.lastname: Nissinen
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000378:metabolism*; D005260:Female; D042882:Gallstones / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D010840:Phytosterols / Q000378:metabolism*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D010840:Phytosterols; D002784:Cholesterol