Z Gastroenterol 2009; 47 - P155
DOI: 10.1055/s-0029-1241405

Serum cholesterol precursor and plant sterol levels indicate increased de novo cholesterol synthesis and decreased intestinal cholesterol absorption in German gallstone patients

M Krawczyk 1, JF Miquel 2, D Lütjohann 3, R Schirin-Shokan 4, F Lammert 1
  • 1Saarland University Hospital, Department of Medicine II, Homburg, Germany
  • 2Pontificia Universidad Católica de Chile, Department of Gastroenterology, Santiago, Chile
  • 3University Hospital Bonn, Department of Clinical Pharmacology, Bonn, Germany
  • 4University Hospital Aachen, Department of Medicine III, Aachen, Germany

Aims: In humans new cholesterol derives from de novo synthesis and intestinal absorption. Serum cholesterol precursor (e.g., lathosterol, lanosterol) and plant sterol levels (e.g., sitosterol, campesterol) represent valid surrogate marker for cholesterol biosynthesis and intestinal absorption, respectively. Here we investigate if cholesterol biosynthesis and transport differ between gallstone patients and gallstone-free individuals.

Patients and methods: Our study group consisted of 112 gallstone patients (confirmed by ultrasound or cholecystectomy, age range 33–84 years, n=66 females) and 152 stone-free controls (age range 30–89 years, n=89 females). Serum levels of plant sterols, cholesterol and its precursors were measured by gas chromatography/mass spectrometry (GC/MS). Individuals with results suggesting familial hypercholesterolaemia or sitosterolaemia were excluded from analysis.

Results: Gallstone subjects were characterised by significantly higher median lathosterol concentrations (p=0.016) and lathosterol:cholesterol ratios (p=0.039). In contrast, gallstone-free subjects had higher median serum levels of sitosterol (p=0.0165) and higher sitosterol:lathosterol ratios (p=0.023). In individuals with gallstones, lathosterol levels and lathosterol:cholesterol ratios were inversely correlated with age (r=-0.345, p<0.001 and r=-0.322, p=0.001, respectively). As expected, both lathosterol and lathosterol:cholesterol ratios were positively correlated with BMI in controls (r=0.252, p=0.002 and r=0.169, p=0.002, respectively).

Conclusions: Individuals developing gallstones are characterised by lower intestinal cholesterol absorption and increased de novo cholesterol synthesis as compared to gallstone free controls. Our results point to primary risk factors that decrease intestinal cholesterol absorption and promote cholelithogenesis in defined subsets of gallstone patients.

Supported by DFG-CONICYT 444 CHL-113/15/0–1