The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile

Piero Portincasa, Karel J. Van Erpecum, Agostino Di Ciaula, David Q.H. Wang

Research output: Contribution to journalArticle

Abstract

Background: Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. Methods: Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n ¼ 10) or pigment (n ¼ 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. Results: In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 6 1.6%, P ¼ 0.046) and ultrafiltered bile (-6.5 6 1.5%, P ¼ 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. Conclusions: The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.

Original languageEnglish (US)
Pages (from-to)32-41
Number of pages10
JournalGastroenterology Report
Volume7
Issue number1
DOIs
StatePublished - Feb 1 2019

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Gallstones
Crystallization
Bile
Cholesterol
Needles
Bile Pigments
Polarization Microscopy
Weights and Measures
Laparoscopic Cholecystectomy
Gallbladder

Keywords

  • Bile
  • Cholesterol crystals
  • Cholesterol stones
  • Pigment stones
  • Polarizing light microscopy
  • Supersaturated bile

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile. / Portincasa, Piero; Van Erpecum, Karel J.; Di Ciaula, Agostino; Wang, David Q.H.

In: Gastroenterology Report, Vol. 7, No. 1, 01.02.2019, p. 32-41.

Research output: Contribution to journalArticle

Portincasa, Piero ; Van Erpecum, Karel J. ; Di Ciaula, Agostino ; Wang, David Q.H. / The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile. In: Gastroenterology Report. 2019 ; Vol. 7, No. 1. pp. 32-41.
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abstract = "Background: Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. Methods: Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n ¼ 10) or pigment (n ¼ 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. Results: In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 6 1.6{\%}, P ¼ 0.046) and ultrafiltered bile (-6.5 6 1.5{\%}, P ¼ 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. Conclusions: The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.",
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T1 - The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile

AU - Portincasa, Piero

AU - Van Erpecum, Karel J.

AU - Di Ciaula, Agostino

AU - Wang, David Q.H.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. Methods: Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n ¼ 10) or pigment (n ¼ 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. Results: In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 6 1.6%, P ¼ 0.046) and ultrafiltered bile (-6.5 6 1.5%, P ¼ 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. Conclusions: The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.

AB - Background: Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. Methods: Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n ¼ 10) or pigment (n ¼ 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. Results: In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 6 1.6%, P ¼ 0.046) and ultrafiltered bile (-6.5 6 1.5%, P ¼ 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. Conclusions: The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.

KW - Bile

KW - Cholesterol crystals

KW - Cholesterol stones

KW - Pigment stones

KW - Polarizing light microscopy

KW - Supersaturated bile

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U2 - 10.1093/gastro/goy044

DO - 10.1093/gastro/goy044

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JO - Gastroenterology Report

JF - Gastroenterology Report

SN - 2052-0034

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