Bile Acids – Friend or Foe? A Review of Pathological Significance and Therapeutic Potential

Abstract

Bile acids have significant therapeutic and pathological interest in diagnostic and research-based investigations. This review describes the key processes involved in bile acid synthesis from cholesterol in addition to the conversion from primary to secondary bile acids. The normal physiological properties of bile acids are described, with particular focus on bile acids’ role as signalling molecules and their intra- and extra-hepatic circulation. The role of bile acids in pathology is also discussed, with particular emphasis on the role of bile acids in intrahepatic cholestasis of pregnancy. Measurement of bile acid concentration in the clinical laboratory is discussed in detail, including current methods of quantification. Finally, the role of exogenous bile acids is discussed to highlight how bile acids are utilised therapeutically and how they are being used in research settings for the delivery of various therapeutics. Overall, this review presents the dichotomy of bile acids as a pathological feature and a therapeutic interest in research.