Influence of dietary calcium phosphate on the disposition of bilirubin in rats with unconjugated hyperbilirubinemia.

The aim of this study was to test a possible form of therapy that could be used in the management of unconjugated hyperbilirubinemia. We hypothesized that unconjugated bilirubin (UCB) can permeate the intestinal wall and can thus be secreted with the feces. We have previously observed that UCB binds to amorphous calcium phosphate in vitro. Orally ingested amorphous calcium phosphate may act as a trapping agent for bilirubin in the intestine, thereby preventing back-diffusion across the intestinal wall. In this study, we tested whether feeding calcium phosphate leads to enhanced excretion of unconjugated bilirubin in Gunn rats. When a purified control diet was substituted by a high calcium phosphate diet, a decrease in bilirubin levels of 30% to 50% in male Gunn rats and of 23% in female rats was observed. The fecal output of bilirubin was more than doubled in Gunn rats in the first 3 days after the normal diet had been replaced by the high calcium-phosphate diet. The biological half-life of 3 H-labeled bilirubin in blood was 89.8 +/- 17.2 hours in rats fed the purified control diet and 50.9 +/- 1.4 hours in rats fed the high calcium phosphate diet (P = .004). After 30 weeks, plasma bilirubin levels were still significantly lower in Gunn rats fed a high calcium phosphate diet. No differences were found in plasma concentrations of calcium, magnesium, phosphate, urea, and creatinine in both Gunn rats and Wistar rats on control or high calcium phosphate diets. This therapy might be useful in the management of Crigler-Najjar patients, for example, as an adjunct to phototherapy.

Impaired hepatocanalicular organic anion transport in endotoxemic rats.

To investigate the mechanism of sepsis-associated hyperbilirubinemia we have studied hepatocanalicular transport of organic anions in a rat model of endotoxemia. Rats were injected intravenously with lipopolysaccharides (LPS), and at different times after injection, canalicular transport of 2,4-dinitrophenyl-S-glutathione (GS-DNP), as a model organic anion, was measured in perfused livers and isolated hepatocytes. In isolated liver perfusion experiments the initial biliary GS-DNP secretion rate was found to be significantly decreased 18 h after injection with 2 mg/kg LPS. In isolated hepatocytes from these rats, GS-DNP efflux rate was also significantly decreased (193.0 +/- 67 and 448.3 +/- 53 nmol.min-1.g dry wt-1 in endotoxemic and normal hepatocytes, respectively). Inhibition of GS-DNP effluxin isolated endotoxemic hepatocytes was dose dependent and reached a maximum with 0.25 mg/kg LPS. Inhibition was maximal at 12 h after LPS injection. Transport activity gradually returned to normal in 4-5 days after endotoxemia was induced. Dexamethasone pretreatment partially reversed the inhibition of GS-DNP transport in isolated endotoxemic hepatocytes. The phorbol ester phorbol 12-myristate 13-acetate increased GS-DNP efflux by 73 +/- 16 and 24 +/- 8% in endotoxemic and control hepatocytes, respectively, but could not restore the transport activity of endotoxemic hepatocytes to control levels. These results show that canalicular organic anion transport is decreased in the endotoxemic liver; this may play a role in the frequently observed hyperbilirubinemia during sepsis.

Rapid association of unconjugated bilirubin with amorphous calcium phosphate.

The association of unconjugated bilirubin (UCB) with amorphous calcium phosphate was studied in vitro. To this end UCB, solubilized in different micellar bile salt solutions, was incubated with freshly prepared calcium phosphate precipitate. It was demonstrated that amorphous calcium phosphate (ACP) rapidly binds and precipitates UCB in a dose-dependent way. The results indicate that binding of UCB to ACP is specific: binding to barium phosphate was negligible and addition of low amounts of Mg2+ before formation of the calcium phosphate precipitate (Ca:Mg = 5:1) inhibited binding by 80%. Free Ca2+ stimulated binding, whereas free phosphate ions inhibited binding of UCB in taurocholate solutions and to a lesser extent in glycocholate solutions. The apparent affinity of UCB for amorphous calcium phosphate was different in the various bile salt solutions. Binding of UCB decreased at pH > 8.5 in taurocholate solutions, but not in glycocholate solutions where binding of UCB was constant from pH 7.5-10.5. We propose a model in which UCB directly binds to amorphous calcium phosphate in the presence of bile salts that weakly interact with ACP, like taurocholate. In the presence of bile salts that strongly interact with ACP, such as glycochenodeoxycholate, binding of UCB may also occur via the bile salt. In conditions of unconjugated hyperbilirubinemia, such as the Crigler-Najjar syndrome, neonatal jaundice, and in the Gunn rat, considerable amounts of UCB diffuse across the intestinal mucosa. Binding of UCB to calcium phosphate in the intestine may stimulate its excretion and thereby constitute a relevant mechanism of excretion.

Redistribution of canalicular organic anion transport activity in isolated and cultured rat hepatocytes.

The hepatocanalicular transport of a large number of organic anions, such as bilirubin glucuronides and glutathione conjugates in the rat, is mediated by an adenosine triphosphate (ATP)-dependent transport system, which is termed canalicular multispecific organic anion transporter (cMOAT). This system is mainly defined by its deficiency in mutant TR rats. We have previously reported that in cultured hepatocytes the fluorescent organic anion glutathione-bimane (GS-B) accumulates in intracellular vesicles and that this transport is mediated by cMOAT. We now show that this intracellular accumulation of fluorescent organic anion is largely absent in freshly isolated hepatocytes but appears when cells are incubated in suspension at 37 degrees C or cultured for periods of 1 to 24 hours. The appearance of intracellular cMOAT activity coincides with the disappearance of 70% of cMOAT activity from the plasma membrane as measured by the transport activity of the cells for the organic anion dinitrophenyl-glutathione (GS-DNP). Both the appearance of intracellular cMOAT and the disappearance of transport activity from the plasma membrane were completely inhibited at temperatures below 20 degrees C. Residual cMOAT activity in 24-hour cultured hepatocytes could be further diminished by incubation of the cells with 1 mumol/L monensin or 10 mmol/L methylamine. We conclude that after disruption of the cell polarity by collagenase isolation of the hepatocytes, remnants of apical membrane containing cMOAT are rapidly endocytosed when the cells are kept at 37 degrees C. Evidence suggests that at least part of the transporters may recycle back to the plasma membrane after endocytosis. These observations may be relevant for the understanding of regulation of canalicular transport.

Decreased bilirubin transport in the perfused liver of endotoxemic rats.

BACKGROUND/AIMS: Hyperbilirubinemia associated with sepsis is frequently observed in humans. In this study, an experimental rat model was developed to study bilirubin metabolism and transport during endotoxemia. METHODS: Rats were injected intravenously with a single bolus of lipopolysaccharide (1 mg/kg); after 18 hours, the liver was removed for single-pass perfusion. Unconjugated bilirubin, bilirubin ditaurate (125 nmol/min), and/or taurocholate (1.5 mumol/min) were infused. Rate constants for uptake were determined from the disappearance of a bolus of bilirubin ditaurate in a recirculating perfusion. RESULTS: In endotoxemic livers, biliary excretion of bilirubin-glucuronides was reduced by 49% (2.04 +/- 0.2 and 3.99 +/- 0.24 nmol.min-1.g liver-1). Similar results were obtained with bilirubin ditaurate, indicating that the reduced transport is not caused by a reduced conjugation capacity. The rate constant of sinusoidal uptake was significantly reduced during endotoxemia (0.191 +/- 0.034 vs. 0.090 +/- 0.035, respectively). Secretion of taurocholate into bile was also reduced (92 +/- 22 vs. 127 +/- 10 nmol.min-1.g liver-1). CONCLUSIONS: In endotoxemic rats, biliary clearance of bilirubin and taurocholate is substantially decreased, suggesting that decreased output of bilirubin-glucuronides is not caused by impaired conjugation but by a reduction in transport.

ATP-dependent efflux of GSSG and GS-conjugate from isolated rat hepatocytes.

The driving force for efflux of dinitrophenyl-glutathione (GS-DNP) and oxidized glutathione (GSSG) from freshly isolated rat hepatocytes was studied. Incubation of hepatocytes in Krebs with increasing K+ concentrations (equivalently replaced for Na+) or in Krebs with 3 mM ouabain led to a partial or complete dissipation of the plasma membrane potential, as measured by the equilibrium distribution of 36Cl-. This had no effect on the initial efflux rate of GSSG and GS-DNP. On the other hand, partial depletion of the cellular ATP content via different independent mechanisms significantly reduced the initial efflux rate of these compounds. Titration of the cellular ATP content by incubation of the cells with different concentrations of atractyloside revealed a linear relation between the cellular ATP content and the initial efflux rate of GS-DNP. The efflux of GS-DNP was also studied in hepatocytes from mutant rats with hepatobiliary transport defect (TR- rats). These rats have a hereditary canalicular secretion defect for a number of organic anions including GS-DNP. As we have shown previously, the efflux of GS-DNP from TR- rat hepatocytes is significantly slower than from normal hepatocytes (J. Clin. Invest. 84: 476-483, 1989). Depletion of the cellular ATP content in these cells had no significant effect on the residual efflux of GS-DNP. From these studies, we conclude that an ATP-dependent transport system for oxidized glutathione and glutathione conjugates is involved in the biliary transport of these compounds. The possible relation of this transport system with that described in other cell types and tissues, like erythrocytes and heart sarcolemma, is discussed.