Abstract
BackgroundBile acids are essential organic molecules synthesized from cholesterol in the liver. They have been utilized as indicators of hepatobiliary impairment because synthesis of BAs and their metabolism are influenced by liver diseases. We aimed to investigate the role of serum bile acid level and composition in differentiation between nonalcoholic fatty liver disease (NAFLD) and chronic viral hepatitis. An ultra-performance liquid chromatography coupled with mass spectrometry assay was used to measure the serum level of 14 bile acids in chronic viral hepatitis and NAFLD patients beside normal healthy control subjects.ResultsThe mean serum levels of 11 out of the 14 bile acids (two primary, six conjugated, and three secondary) were significantly higher in viral hepatitis compared to control. Only 4 bile acids [2 primary, one glycine conjugated (GCDCA), and one secondary (LCA)] had statistically significant increase in their mean serum bile acid level in NAFLD compared to control. Comparing viral hepatitis group against NAFLD group revealed that the mean serum levels of five conjugated and one secondary bile acid (DCA) were significantly higher in viral hepatitis group. Receiver operating characteristic (ROC) curve analysis revealed that LCA had the best diagnostic performance for viral hepatitis followed by TCA and GCDCA. ROC curve for the combined three parameters had better sensitivity and specificity (70.55% and 94.87% respectively).ConclusionBA compositions including primary, secondary, and conjugated ones could differentiate between chronic viral hepatitis and NAFLD patients, and they might be potential distinguishing biomarkers for this purpose.
Highlights
Bile acids are essential organic molecules synthesized from cholesterol in the liver
The present study aimed to investigate the serum Bile acids (BAs) compositions, including the levels of primary, secondary, and conjugated BAs, using ultra-performance liquid chromatography tandem mass spectrometer (UPLC-MS/MS) in a number of patients with chronic viral hepatitis and nonalcoholic fatty liver disease (NAFLD) in addition to healthy control, and to study how bile acid composition can differentiate between chronic viral hepatitis and NAFLD patients and possibility of individual bile acids (IBA) and their profiles to be potential biomarkers for this purpose
Higher serum levels of Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP) and significantly lower serum levels of albumin were found in viral hepatitis and NAFL D groups compared to control, and significantly higher levels of serum total bilirubin and AFP was found in viral hepatitis group compared to NAFLD group (p = 0.042, < 0.001 respectively)
Summary
Bile acids are essential organic molecules synthesized from cholesterol in the liver They have been utilized as indicators of hepatobiliary impairment because synthesis of BAs and their metabolism are influenced by liver diseases. BAs are synthesized in the liver as primary bile acids chenodeoxycholic acid (CDCA) and cholic acid (CA) They are completely conjugated with taurine or glycine to form tauroconjugates and glycoconjugates respectively before being secreted into the biliary tree. The conjugated primary bile acids are known as taurocholic acid (TCA), glycocholic acid (GCA), taurochenodeoxycholic acid (TCDCA), and glycochenodeoxycholic acid (GDCA). All these conjugated bile acids are named bile salt [1]. They were modified by intestinal bacteria after their secretion into the small intestine into secondary bile acids lithocholic acid (LCA), deoxycholic acid (DCA), and ursodeoxycholic acid (UDCA) [2]
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