The physicochemical basis of cholesterol gallstone formation in man

Abstract

A B S T R A C T The concentrations of bile, salt, lecithin, and cholesterol were determined on each of 66 samples of gall bladder bile from patients with cholesterol gallstones and 25 samples of normal gall bladder bile. When these three constituents were plotted simultaneously on triangular coordinates, a complete separation of the normal and "abnormal" bile was achieved. This separation was the result of an increase in the quantity of cholesterol relative to the amounts of bile salts and lecithin contained in the bile from patients with cholesterol gallstones. An in vitro model system was constructed (on triangular coordinates) that allows prediction of the maximum amount of cholesterol that can be solubilized in solutions containing varying proportions of bile salt and lecithin. When the bile data were compared with the solubility of cholesterol derived from the model system, normal biles were found to be less than saturated with cholesterol, whereas biles from patients with cholesterol gallstones were saturated and in some cases contained insoluble cholesterol in the form of microcrystals.It is suggested that the physical state of bile (i.e., the presence or absence of insoluble cholesAn abstract of this work has appeared in 1967 J. Clin.

Biliary lipid composition and gallstone formation in rabbits fed on soy protein, cholesterol, casein and modified casein

“…These results are in accordance with the suggestion by Holzbach et al [16] that the micellar zone for cholesterol solubility was significantly lower than that previously reported by Admirand & Small [14].…”

“…The lithogenic-index values, calculated by the equation derived from data of Hegardt & Dam [15] and Holzbach [16], were greater than those calculated by using the equation derived from data of Admirand & Small [14]. These results are in accordance with the suggestion by Holzbach et al [16] that the micellar zone for cholesterol solubility was significantly lower than that previously reported by Admirand & Small [14].…”

Bioactive sphingolipids in the biliary tract: Relevance for cholesterol gallstone disease

“…The tumor biology of HCC and the co-existing cirrhosis have presented major obstacles to HCC treatments. 2,3 The prognosis is extremely very poor in patients with advanced HCC, especially with extrahepatic metastasis. Systemic therapy with conventional cytotoxic agents is ineffective or marginally effective in those cases.…”

“…A detailed understanding of the physical-chemical interactions between lipid carriers in bile has also shed light on the mechanisms involved through the use of ternary bile salt/cholesterol/phospholipid phase diagrams in native and model biles. 2,3,4 In the evolution of this body of knowledge, there has been minor interest in sphingolipids in the biliary tract. One such focus of interest was sphingomyelin, a major structural phospholipid found on the outer leaflet of the hepatocyte canalicular membrane along with phosphatidylcholine.…”

Effect of Oestradiol Benzoate on Biliary Phospholipids in the Rat

“…Biliary phospholipids, most of which are phosphatidylcholine (Phillips 1960;Spitzer et al 1964), are important in helping to render cholesterol soluble in bile (Admirand and Small 1968). The concentration of phospholipids in the bile has been reported to be lower in women than in men (Van Der Linden and Norman 1967), and this may be important in explaining the higher incidence of cholesterol gallstones in women (see Glenn and McSherry 1969;Grundy et al 1972).…”