Abstract

Chile has one of the highest prevalences of cholesterol gallstone disease in the world. Recent data indicate that this is partly caused by genetic (Indian) factors. However, the causal factors inducing increased gallstone formation have not been elucidated. Aim To compare biliary composition and cholesterol crystallization promoting activity in biles from patients of high and moderate risk areas for gallstone disease, Chile and The Netherlands. Methods Bile was sampled at cholecystectomy from 39 Chilean and 26 Dutch gallstone patients. Biliary lipids and proteins were determined using similar techniques in both laboratories. The Con A-binding fraction (CABF) was extracted from fresh native bile samples by incubation with Con A-Sepharose beads. Reconstitution of the CABF to the Con Aextracted native bile induced full recovery of crystallization confirming the validity of this technique. Results There was no difference between the two groups regarding sex and age. Chilean biles nucleated significantly faster (3.5 -+ 0.6 vs 7.9 1.5 days) despite the fact that Dutch biles had a significantly higher CSI (1.6 vs 1.3, p=0.03). The total lipid content was not different. Chilean biles contained more total protein (5 vs 2.9mg/ml, p=0.008). IgG, IgM, Haptoglobin and a-l-acid glycoprotein were not different between the two groups, lgA, though, was significantly higher in the Chilean samples (0.44 vs 0.19 mg/ml, p<0.001). Extraction of CABF increased crystal detection time (CDT) and decreased crystal growth in both groups. However, the effects were much more pronounced in the chilean samples (ACDT 6 vs 2, Amax crystal growth: 1080 vs 40 crystals lal-l.hrL Conclusions. Compared to Dutch bile, Chilean bile crystallizes much faster depite a lower CSI. Chilean bile contains an increased content of Con A-binding nucleation promoting activity but this difference could not be accounted for by one of the well characterized crystallization promoters. We speculate that the difference is due to an increased content of the low density promoting particle (LDP) in Chilean bile.

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