Serum bilirubin fractionation using multilayer film method in hepatobiliary diseases in comparison with high performance liquid chromatography

Type II crigler-Najjar syndrome with intrahepatic cholestasis

A 58-year-old Japanese man was admitted to our hospital with appendicitis and marked unconjugated hyperbilirubinemia (11.6 mg/dl). The jaundice worsened following appendectomy, and the direct-reacting bilirubin increased, probably due to the ceftizoxime administered postoperatively. Bilirubin diglucuronide was the main component of the serum direct-reacting bilirubin (51%) in serum measured by liquid chromatography. Because the discontinuation of ceftizoxime did not markedly improve the jaundice, epomediol, 200 mg tid, was administered orally. There was a marked decrease of serum bilirubin with an increase in the delta bilirubin/(conjugated bilirubin + delta bilirubin) ratio. After improvement of jaundice to below the pre-surgical level (4.4 mg/dl), we analyzed the duodenal bile for bilirubin fractions; those showed a marked reduction in bilirubin diglucuronide and a marked increase in bilirubin monoglucuronide, which was consistent with type II Crigler-Najjar syndrome. A marked increase of bilirubin diglucuronide in serum of this patient during cholestasis suggests that bilirubin conjugation proceeds in this syndrome when excretion of conjugated bilirubin decreases.

Effect of obstructive jaundice on the fate of a nephrophilic organic anion in the rat

Renal transtubular transport of phenolsulfophthalein (PSP), a nephrophilic organic anion that circulates bound to albumin, was studied in normal and bile-duct-ligated rats. Intravenously injected PSP disappeared from the circulation more rapidly in bile-duct-ligated jaundiced rats than in intact animals. However, urinary excretion of PSP was significantly lower in the former than in the latter. Kinetic analysis revealed that binding of PSP to plasma protein(s) was significantly lower with jaundiced rats than with intact animals. Addition of albumin to plasma samples from bile-duct-ligated rats markedly increased PSP binding. The decreased PSP binding returned to normal levels after treating the jaundiced plasma with bilirubin oxidase, an enzyme that degrades amphiphilic bilirubin to water soluble metabolites. These results suggest that bilirubin might be the major metabolite that occupied the PSP binding site(s) on albumin in jaundiced rats. When PSP was injected bound to equimolar amount of albumin, the rate of PSP disappearance from the circulation decreased and urinary excretion of the ligand increased markedly; urinary excretion of PSP was significantly larger in bile-duct-ligated rats than in intact animals. These results suggest that the renal transport capacity for amphiphilic organic anions, such as PSP, might be increased compensatively in bile-duct-ligated animals, and that the apparent decrease in renal secretory transport for PSP might result from, at least in part, random distribution of the ligand to extrarenal tissues due to decrease in the binding activity of albumin.

Degradation of plasma bilirubin by a bilirubin oxidase derivative which has a relatively long half-life in the circulation

To enhance degradation of unconjugated bilirubin in hyperbilirubinemic subjects, we synthesized a bilirubin oxidase (EC 1.3.3.5) (BO) derivative (PEGBO) by covalently linking (2,4-bis[O-methoxy(polyethyleneglycol)]-6-chloro-s-triazine) (PEG) to the enzyme. Intravenously injected BO in rats disappeared from the circulation with a half-life of 2.5 min; the half-life of PEGBO was 190 min. Intravenously injected BO minimally and transiently decreased plasma bilirubin levels in jaundiced Gunn rats and in bile-duct-ligated jaundiced rats. In contrast, PEGBO rapidly and substantially decreased plasma bilirubin levels and the effect persisted for longer than 3 h. Renal dysfunction often occurs in patients with liver diseases. To study the role of bilirubin toxicity for the kidney, functions of transtubular transport for organic anions was measured in bile-duct-ligated jaundiced animals before and after treatment with PEGBO. Bile duct ligation decreased urinary excretion of phenolsulfophthalein (PSP), an organic anion used for renal function test. Treatment of the jaundiced animals with PEGBO increased the rate of PSP disappearance from the circulation and normalized its urinary excretion. Thus, PEGBO might be useful for the study of bilirubin toxicity in jaundiced animals.

Serum bilirubin fractions in analbuminemic rats after bile duct ligation. Albumin requirement in the formation of covalently protein-bound bilirubin

To clarify the role of albumin in the production of covalently protein-bound bilirubin (delta bilirubin, B delta) in the blood and the pathophysiological relevance of B delta, changes in the serum bilirubin level and histological findings in the liver, kidneys and myocardium were studied in Sprague-Dawley (SD) rats and Nagase analbuminemic rats (NAR) after bile duct ligation (BDL). In SD rats, the serum bilirubin level increased until 3 days after BDL, and was followed by the appearance of B delta. The increase in serum bilirubin was smaller in NAR, and no serum B delta was noted. Albumin administration to NAR 1 day after BDL increased serum bilirubin with the appearance of B delta. Serum bilirubin decreased in both SD rats and NAR 7 days after BDL. Marked deposition of bile pigments was noted in NAR in the renal tubular epithelium. The renal bilirubin content was decreased after albumin administration. From these results it is concluded that albumin is necessary for the production of B delta, and that renal deposition of bile pigments progresses in the absence of albumin.

Human serum bilirubin fractionation in various hepatobiliary diseases by the newly developed high performance liquid chromatography

Serum Bilirubin was fractionated by newly developed reversed phase high performance liquid chromatography (HPLC) into 5 fractions: delta (delta-Bilirubin, B delta), gamma (bilirubin diglucuronide, BDG), beta (Bilirubin monoglucuronide, BMG), beta' ((Z, E,)- and/or (E, Z)-bilirubin IX alpha) and alpha ((Z, Z)-bilirubin IX alpha). Sera of healthy subjects and of patients with unconjugated hyperbilirubinemia showed predominantly alpha fraction with a small amount of beta' fraction. Trace amounts of delta fraction were detected in a few cases. The results of fractionation of serum bilirubin in 159 patients with various hepatobiliary diseases suggested that the ratios B delta/(B delta + BDG + BMG) and BMG/B delta can be useful parameters to follow patients with jaundice, compared with the reported B delta/total bilirubin which did not always reflect the jaundice stage, especially in cases with low serum bilirubin levels.