Recent progress in understanding cholesterol crystal nucleation as a precursor to human gallstone formation
✍ Scribed by R. Thomas Holzbach
- Publisher
- John Wiley and Sons
- Year
- 1986
- Tongue
- English
- Weight
- 621 KB
- Volume
- 6
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Nucleation of cholesterol monohydrate crystals is an essential antecedent to gallstone formation. It is now generally agreed that nucleation occurs at a much more rapid rate in gallbladder bile from patients with cholesterol cholelithiasis (abnormals) than it does in gallbladder bile from normal subjects (normals) (1-3). Indeed, this difference in nucleation time or rate of de m u o crystal formation has been shown to permit the clearest feasible delineation of normals from abnormals compared to all other available biochemical or physical criteria (4). There are two possible ways to look at this phenomenon and begin to probe further. One route is to conclude that the prolonged nucleation time found in normal bile represents the key aberration, i.e., a discrepancy in contradiction of thermodynamic principles, and therefore a phenomenon rationalizing the presence of additional compositional factors(s) (1). Another and contrasting view is to regard the consistently greater rapidity of nucleation in abnormals as the significant disturbance. This view also leads to the postulate of an additional distinctly separate compositional factorb) having instead a different (indeed, opposing) functional property than the first. Although one might prefer simplicity and economy of hypotheses, evidence now at hand indicates that a choice between contrasting alternatives need not necessarily be made. Rather, it now appears that both of the putative nucleating factors ("inhibiting" and "promoting") do indeed exist and that their effects can be