Z Gastroenterol 2015; 53 - A3_27
DOI: 10.1055/s-0034-1397148

Serum sterol levels indicate distorted cholesterol homeostasis in cirrhotic patients with primary biliary cirrhosis

M Krawczyk 1, E Wunsch 2, D Lütjohann 3, F Lammert 1, P Milkiewicz 4
  • 1Saarland University Hospital, Department of Medicine II, Homburg, Germany
  • 2Pomeranian Medical University, Liver Research Laboratories, Szczecin, Poland
  • 3University Clinics of Bonn, Institute for Clinical Chemistry and Clinical Pharmacology, Bonn, Germany
  • 4Medical University of Warsaw, Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Warsaw, Poland

Background: In humans new cholesterol derives from de novo synthesis and intestinal absorption. Serum cholesterol precursor (e.g., lathosterol, desmosterol) and plant sterol levels (e.g., sitosterol, campesterol) represent valid surrogate marker for cholesterol biosynthesis and intestinal absorption, respectively. Since chronic liver diseases modulate cholesterol homeostasis, we systematically investigated sterol serum levels in patients with primary biliary cirrhosis (PBC) with and without liver cirrhosis.

Patients and methods: Overall, we recruited 111 non-transplanted PBC patients (age 22 – 83 years, 101 females). In this cohort, a total of 30 individuals presented with liver cirrhosis at diagnosis. Serum concentrations of plant sterols, cholesterol and its precursors were measured by gas chromatography/mass spectrometry (GC/MS). Individuals with results suggesting familial hypercholesterolaemia or phytosterolemia were excluded. Serum sterols were compared between cirrhotic and non-cirrhotic patients using non-parametric tests.

Results: PBC patients with liver cirrhosis demonstrated significantly higher serum sitosterol and campesterol concentrations than non-cirrhotic individuals. (P= 0.0002 and P= 0.007, respectively). Serum levels of lathosterol and desmosterol were lower in these patients (P= 0.0001 and P= 0.01, respectively), who also displayed a trend to lower serum cholesterol (P= 0.06). In cirrhotic patients we identified increased sitosterol:cholesterol and campesterol:cholesterol but decreased lathosterol:cholesterol ratios (all P < 0.0001). Overall, the ratios of phytosterols to cholesterol precursors were significantly (all P > 0.0001) increased in patients with liver cirrhosis as compared to non-cirrhotic patients.

Discussion: PBC patients with liver cirrhosis are characterized by decreased cholesterol synthesis and increased sterol absorption as compared to non-cirrhotic individuals. The determination of serum sterols may improve the clinical assessment and stratification of patients with PBC.

Corresponding author: Krawczyk, Marcin

E-Mail: marcin.krawczyk@uks.eu