Increased Biliary Lithogenicity Through Cholesterol Supersaturation

  • M. C. Carey
Conference paper


Cholesterol monohydrate (ChM) is the major organic component of most gallbladder stones in Western populations [1]. An essential thermodynamic prerequisite for the precipitation of cholesterol (Ch) from bile is that bile becomes supersaturated with Ch [2]. Although Ch is virtually insoluble in water, it is present in high concentrations in the hepatic and gallbladder biles of adult human beings [2], where it is solubilized in thermodynamically stable bile salt (BS) and BS-phospholipid (PL) micelles and dispersed in a thermodynamically metastable state by unilamellar PL-Ch vesicles [3]. Hepatic secretion of vesicles appears to be the principal conduit for PL and Ch secretion into bile [4]. Since the transhepatic flux of BS drives PL-Ch secretion, i.e., vesicle exocytosis [5], the origin of supersaturated bile must perforce lie in the hypersecretion of Ch-enriched vesicles in the face of normal BS secretion or the normal secretion of Ch-enriched vesicles in the face of BS hyposecretion [6].


Bile Acid Bile Salt Cholesteryl Ester Hydrolase Biliary Lipid Pigment Stone 
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Copyright information

© Springer-Verlag, Berlin Heidelberg 1990

Authors and Affiliations

  • M. C. Carey
    • 1
  1. 1.Department of MedicineBrigham and Women’s HospitalBostonUSA

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