A Retrospective Clinical Analysis of the Serum Bile Acid Alteration Caused by Traumatic Brain Injury

Traumatic brain injury (TBI) can cause damage to peripheral organ systems, such as digestive organ system, and alterations of gut microbiota in addition to brain injury. Our previous study found that TBI induced gastrointestinal dysfunction accompanied by alterations of bile acid metabolism. Bile acid and its receptors have been reported to play important roles in various neurological diseases. To further examine the changes of bile acid metabolism in TBI patients, we performed a retrospective clinical analysis. In this study, 177 patients were included, and the results showed that TBI patients had more frequent antibiotic use compared with a control group. Regression analysis identified TBI as an independent factor for reduction of serum bile acid level (B = −1.762, p = 0.006), even with antibiotic use taken into a regression model. Sub-group regression analysis of TBI patients showed that antibiotic use was negatively associated with bile acid level, while creatinine and triglyceride were positively associated with bile acid level. In conclusion, these data indicated that TBI could greatly reduce serum bile acid. This study provided preliminary but novel clinical evidence of TBI interfering with bile acid metabolism, and further studies with large sample sizes are needed to validate these findings in the future.

Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine – Section on Maternal Disorders

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.

Association between proliferative diabetic retinopathy and serum bile acid level in patients with type 2 diabetes mellitus

Background: Diabetic retinopathy (DR) is one of the diabetic microvascular complications, which is also one of the important causes of blindness in adults. Objective: To investigate the association between proliferative retinopathy and serum bile acid level in patients with type 2 diabetes mellitus (T2DM). Methods: Three hundred and thirty-six patients with T2DM were included, of which, 229 had a history of more than 10 years without diabetic retinopathy (no diabetic retinopathy, NDR) and 107 had proliferative diabetic retinopathy (PDR). The baseline characteristics of the two groups were compared. According to the level of bile acid, the patients were divided into low, medium and high bile acid groups. The ratio of proliferative retinopathy in each group was compared. The presence of retinopathy was taken as the dependent variable, and the significant variables were analyzed by logistic regression. Results: The level of total bilirubin and bile acid in the NDR group was significantly higher than that in the PDR group, while the level of triglyceride, cholesterol and LDL-C were significantly lower than that in the PDR group (P＜0.05). With the increase of bile acid level, the proportion of proliferative retinopathy decreased. Logistic regression analysis showed that bilirubin and bile acid were protective factors of diabetic retinopathy, while SBP, LDL-C and UAER were risk factors of diabetic retinopathy. Conclusion: Bile acid might be a protective factor for diabetic retinopathy in T2DM, which might be a potential therapeutic role in retinal disorders.

Perinatal follow up and neonatal outcomes of pregnancies with obstetric cholestasis

Introduction. Obstetric cholestasis is the most common liver disease during pregnancy, which is predominantly associated with fetal complications. Material and Methods. This retrospective study included a total of 44 pregnant women with obstetric cholestasis who gave birth at the Clinic of Obstetrics and Gynecology, Clinical Center of Vojvodina, Novi Sad, from January 1, 2014 to December 31, 2018. Results. The average maternal age was 34 years. The mean gestational age at diagnosis of obstetric cholestasis was 31 weeks, and at the time of delivery 35 weeks of gestation. Abdominal pruritus was the main symptom of the disease affecting 72.72% of patients. The mean bile acid level in the blood at the time of diagnosis was 25.26 ?mol/L. Twenty nine patients (65.90%) gave birth vaginally, while 15 (34.09%) underwent cesarean section. The main maternal complication was postpartum hemorrhage. The average blood loss was 567 ml. There were no maternal deaths or stillbirths. The average newborn birth weight was 2830 g. Respiratory distress syndrome was diagnosed in 8 newborns (15.09%). The mean Apgar score at 1minute was 7, while at 5 minutes it was 9. Conclusion. Individual approach, continuous clinical and laboratory monitoring with adequate therapeutic treatment are necessary in patients with obstetric cholestasis.

The role of serum bile acid profile in differentiation between nonalcoholic fatty liver disease and chronic viral hepatitis

Background 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. 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. Results The 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). Conclusion BA 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.

Effects of alcohol extract from defatted soybean meal on bile acid level, digestive enzyme activity and nutrient digestibility of pompano (Trachinotus blochii)

Defatted soybean meal (SBM), which is produced by defatting soybean with solvents, has been considered as the most cost-effective substitute for fish meal (FM) in fish diets. However, SBM contains alcohol-soluble components which may interfere with growth performance and digestive physiology of fish. This study examined the effects of alcohol extract (Ext) containing alcohol-soluble components extracted from SBM on bile acid level, digestive enzyme activity and nutrient digestibility of pompano Trachinotus blochii. SBM was processed and separated into Ext and ethanol-extracted SBM (ESBM), thus, ESBM was SBM without alcohol-soluble components. Four experimental diets were formulated, denoted as FMD (FM-based diet), SBMD (SBM-based diet), ESBMD (ESBM-based diet), and ESBM+ExtD (ESBM-based diet plus Ext). Each diet was fed to two groups of fish (20 fish/group, 25 g/fish) for 4 weeks. Results showed that plasma lipid components, anterior intestinal bile acid level, anterior intestinal trypsin and lipase activities, and protein and lipid apparent digestibility coefficients (ADCs) of SBMD -fed fish were similar to those of ESBM+ExtD-fed fish. These parameters were significantly lower in SBMD-fed and ESBM+ExtD-fed fish than in ESBMD-fed and FMD-fed fish (P < 0.05). There were no significant differences in plasma total cholesterol level, trypsin activity, and protein ADC between ESBMD and FMD groups, however, total bile acid level, lipase activity, and lipid ADC were significantly lower in ESBMD -fed fish than fish fed FMD (P < 0.05). These results indicated that alcohol extract containing alcohol-soluble components extracted from SBM inhibited the secretions of bile acids and pancreatic digestive enzymes in pompano fish, and these abnormalities might impair nutrient digestion and absorption. The findings of the present study suggested that removing alcohol extract and supplementation of taurine could be effective for improving nutritional quality of SBM and enhancing feed utilization and growth performance of pompano which were fed SBM-based diets.

A maple syrup extract alters lipid metabolism in obese type 2 diabetic model mice

Background Some polyphenols are known to improve the symptoms of diabetes. In the present study, we investigated the effects of a polyphenol-rich extract of maple syrup (MSx) on a diabetic mouse model. Methods KK-Ay mice were fed a normal or 0.05% MSx-supplemented diet for 42 days. Body weight, food intake, serum biochemical parameters, and fecal total bile acid were measured. Gene expression of liver and epididymal white adipose tissue (WAT) and cecal microbiota were analyzed. Data were analyzed with an unpaired two-tailed Student’s t test or Welch’s t test according to the results of the F test. Results Serum low-density lipoprotein cholesterol levels were significantly reduced in mice that consumed MSx. Hepatic genes related to fatty acid degradation and cholesterol catabolism were upregulated in mice that consumed MSx. In contrast, the expression of genes related to lipid metabolism in WAT was unaffected by the intake of MSx. There were no significant differences between the two groups in terms of total bile acid level in the feces and the relative abundance of bacteria in the cecum. Conclusion Our results primarily indicate that MSx can help alleviate one of the symptoms of dyslipidemia.