phytosterols and Malabsorption-Syndromes

Malabsorption of bile acid increases cholesterol synthesis and activates hepatic LDL receptors which leads to enhanced elimination of cholesterol from the body. Interruption of enterohepatic circulation of bile acids may lead to a smaller bile acid pool, which, in turn, impairs cholesterol and fat absorption by reduced micellar solubilization. Together with reduced cholesterol absorption, the increased cholesterol loss as bile acids also reduces plasma cholesterol concentrations and the biliary cholesterol excretion, too. Diminished biliary cholesterol in bile acid malabsorption may contribute to the increased incidence of gallstones associated with ileal dysfunction. Malabsorption of bile acid leads to a fall in LDL-cholesterol concentration, and an increase of HDL-cholesterol concentration has been reported. VLDL-triglyceride concentrations are almost invariably raised. Enhanced cholesterol and bile acid synthesis in ileal dysfunction is reflected by raised concentrations of plasma cholesterol precursors, especially lathosterols, which can be used as an indicator of increased bile acid loss to faeces. Cholesterol absorption, in turn, correlates positively with plasma plant sterol concentrations levels and the ratio of lathosterols to campesterols can be used as a screening measurement for ileal dysfunction. Plasma fatty acid composition is also altered as a response to fat malabsorption associated with ileal dysfunction. The proportion of essential fatty acids is inversely correlated with faecal fat excretion and endogenous fatty acid synthesis is activated.

Topics: Bile Acids and Salts; Cholesterol; Fatty Acids; Humans; Lipid Metabolism; Lipoproteins; Malabsorption Syndromes; Phytosterols

Small intestine essentially regulates cholesterol homeostasis.. To evaluate cholesterol metabolism in short bowel syndrome (SBS).. Cholesterol precursors (e.g., cholestenol, desmosterol and lathosterol) and plant sterols (campesterol and sitosterol), respective markers of cholesterol synthesis and absorption, were determined in SBS patients (n=12) an average of 31 months after weaning off parenteral nutrition and in age-matched controls (n=80).. Among patients, serum cholesterol precursor sterol to cholesterol ratios were 2-10 times higher (P<0.0001 for each). Those without any remaining ileum had 1.2-2.8 times higher precursor sterol to cholesterol ratios than those with an ileal remnant (P<0.05 for each). Serum cholesterol concentration, campesterol/cholesterol and campesterol/sitosterol were 34-39% lower (P<0.05 for each) in relation to controls. Bile acid absorption was markedly impaired (2.4 (0.2-3.2)%). Plant sterol ratios reflected the absolute length of remaining jejunum (r=0.625-0.663), and precursor sterol ratios inversely that of ileum (r=-0.589 to 0.750, P<0.05 for all).. After weaning off parenteral nutrition, patients with pediatric onset SBS continue to have marked intestinal malabsorption of bile acids and moderate cholesterol malabsorption resulting in decreased serum cholesterol despite a marked compensatory increase in cholesterol synthesis.

Topics: Bile Acids and Salts; Child; Child, Preschool; Cholesterol; Desmosterol; Humans; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Parenteral Nutrition; Phytosterols; Short Bowel Syndrome; Sterols; Time Factors

Small bowel transplantation impairs enteric function and causes malabsorption of cholesterol and bile acids. Growth hormone stimulates intestinal absorptive function. The authors hypothesized that long-term growth hormone therapy could improve absorption of bile acids and cholesterol after autotransplantation of the jejunoileum.. Sixteen pigs with similar food, cholesterol, and fat intake underwent either sham laparotomy or a model of jejunoileal autotransplantation, including extrinsic autonomic denervation, lymphatic interruption, and in situ cold ischemia. Five randomly chosen autotransplanted animals received daily growth hormone treatment for 8 weeks. Serum lipids, absorption, and excretion of cholesterol, bile acids, and fat were determined after 8 weeks. Mucosal morphometrics, proliferation, and enzyme activities were determined. Plasma cholesterol precursors and plant sterols, respective markers of cholesterol synthesis and absorption, were measured after 2 and 8 weeks.. After jejunoileal autotransplantation, growth hormone treatment significantly increased body weight gain, cholesterol absorption efficiency from 45.1% to 62.1%, plasma campesterol to cholesterol proportions, and biliary secretion of cholesterol. With or without growth hormone treatment, autotransplantation significantly increased fecal bile acid excretion, plasma cholesterol precursors, fecal bacterially modified neutral sterols, mucosal thickness of the ileum (but not jejunum), and intestinal transit time when compared with sham-operated animals. Crypt cell proliferation, mucosal enzyme activities, and microvilli showed no differences between the groups.. These findings suggest that growth hormone treatment selectively improves cholesterol, but not bile acid absorption, after autotransplantation of the jejunoileum.

Topics: Animals; Autonomic Denervation; Bile Acids and Salts; Cholesterol; Cholesterol, Dietary; Drug Evaluation, Preclinical; Feces; Female; Human Growth Hormone; Ileum; Intestinal Absorption; Intestinal Mucosa; Jejunum; Laparotomy; Lipids; Malabsorption Syndromes; Phytosterols; Postoperative Complications; Recombinant Proteins; Sitosterols; Sus scrofa; Transplantation, Autologous

Small bowel transplantation impairs enteric function, necessitating transection, extrinsic denervation, and ischemia-reperfusion of the small intestine. The authors investigated how each of these nonimmunologic insides of the transplantation procedure modulates biodynamics of cholesterol and absorption of lipids.. Twenty-three pigs with similar food, cholesterol, and fat intake underwent sham laparotomy (group 1), transection (group 2), extrinsic jejunoileal denervation (group 3), or a model of autotransplantation, including extrinsic jejunoileal denervation with in situ ischemia-reperfusion (group 4). Serum lipids, absorption, and excretion of cholesterol, bile acids, and fat were determined after 8 weeks. Plasma cholesterol precursors and plant sterols, respective markers of cholesterol synthesis, and absorption, were measured after 2 and 8 weeks.. When compared with sham laparotomy and transection groups, denervation and autotransplantation significantly decreased weight gain and increased plasma cholesterol precursors and fecal excretion of bile acids. In relation to sham operated animals, transection alone modestly increased plasma plant sterols at 2 weeks and biliary secretion and mass absorption of cholesterol. The latter changes were not observed after denervation or autotransplantation, ie, fractional and total absorption of cholesterol were significantly decreased in autotransplanted pigs when compared with transected controls. As compared with all the other groups, autotransplantation significantly increased bacterial metabolites of neutral sterols in feces and net fecal elimination of cholesterol, mainly as bile acids.. Extrinsic autonomic denervation of the jejunoileum, with or without synchronous ischemia-reperfusion, results in increased cholesterol synthesis, bile acid malabsorption, and decreased weight gain. Cholesterol malabsorption may develop gradually after intestinal autotransplantation, and even a short period of ischemia further impairs absorptive function of the denervated jejunoileum, resulting in increased fecal elimination of cholesterol mainly as bile acids.

Topics: Anastomosis, Surgical; Animals; Autonomic Denervation; Bile Acids and Salts; Cholesterol; Cholesterol, Dietary; Feces; Female; Ileum; Intestinal Absorption; Ischemia; Jejunum; Malabsorption Syndromes; Models, Animal; Phytosterols; Reperfusion Injury; Swine; Transplantation, Autologous; Weight Gain

The role of cholesterol and bile acid malabsorption in the regulation of plasma plant sterol levels was studied in 30 patients with an ileal resection (seven without any malabsorption, eight with bile acid malabsorption alone and 15 with bile acid, fat and cholesterol malabsorption) and nine with jejunoileal bypass (modest bile acid, and severe cholesterol and fat malabsorption). In contrast to cholesterol, plant sterols are not synthesized by the body, and so the plasma levels are regulated by their intestinal absorption and biliary secretion. In fact, the plant sterol, especially campesterol, levels were low in patients with cholesterol and fat malabsorption. Cholesterol absorption efficiency was a significant determinant of the plant sterol levels, suggesting that it reflects overall sterol absorption efficiency and that the plasma plant sterol levels, in turn, reflect cholesterol absorption. Bile acid malabsorption, though it appeared to promote biliary plant sterol secretion, had little direct effect on the plasma plant sterol contents. The results indicate that plasma campesterol levels can be used to evaluate cholesterol absorption efficiency in general and may reveal clinically significant steatorrhoea in patients with gut exclusion.

Topics: Adult; Aged; Cholesterol; Humans; Ileum; Intestinal Absorption; Jejunoileal Bypass; Lipids; Malabsorption Syndromes; Middle Aged; Phytosterols; Sitosterols