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Cholesterol crystallization in human gallbladder bile: Relation to gallstone number, bile composition, and apolipoprotein E4 isoform
Author(s) -
Van Erpecum Karel J.,
Van BergeHenegouwen Gerard P.,
Eckhardt Erik R.M.,
Portincasa Piero,
Van De Heijning Bert J.M.,
DallingaThie Geesje M.,
Groen Albert K.
Publication year - 1998
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510270607
Subject(s) - cholesterol , medicine , apolipoprotein b , crystallization , gallbladder , gallstones , taurine , endocrinology , chemistry , gastroenterology , biology , biochemistry , amino acid , organic chemistry
Abstract Patients with multiple cholesterol gallstones are at increased risk of recurrence after nonsurgical therapy, possibly because of fast biliary cholesterol crystallization. Serum apolipoprotein E4 (apo E4) is a risk factor for primary cholesterol gallstone formation as well as recurrence. We examined potential effects of stone number and apolipoprotein E genotype on crystallization and on various crystallization‐influencing factors in gallbladder biles of 36 cholesterol stone patients (25 multiple stones: 10 carrying the ϵ4 allele). Biliary cholesterol saturation, bile salt composition or concentrations of total protein, immunoglobulin (Ig)A, IgG, α 1 ‐acid glycoprotein, haptoglobin, or mucin—all crystallization promoters—did not differ between multiple and solitary stone patients, apparently not explaining different speed of crystallization (crystal observation time 3.5 ± 0.6 days vs. 12.7 ± 2.4 days, respectively; P = .0003). In contrast, biliary aminopeptidase‐N activities (2,607 ± 592 mU/mL vs. 947 ± 185 mU/mL; P = .04) were higher and IgM levels (179 ± 39 vs. 65 ± 8 mg/L; P = .09) tended to be higher in the case of multiple stones. Although patients carrying the ϵ4 allele had similar stone numbers and crystallization as patients without the ϵ4 allele, their cholesterol saturation index (CSI) was lower (1.08 ± 0.09 vs. 1.54 ± 0.13; P = .01), whereas total protein and bile salt concentrations tended to be higher with preferential taurine‐conjugation. In conclusion, fast cholesterol crystallization is associated with multiple stones but not with apolipoprotein E4. Whereas fast crystallization may contribute to high recurrence rates after nonsurgical therapy in case of multiple gallstones, the mechanism for increased risk of gallstone formation in patients carrying the ϵ4 allele remains unknown.