Chenodeoxycholic acid precursors

Bile Salts Enable the Digestion of Lipids Cholesterol is the precursor of both steroids and bile salts and is an integral component of cell membranes. It is eliminated from the body via conversion to bile salts and direct secretion into the bile. In fact, the word cholesterol (from the Greek chole (bile) and stereos (solid)) was used originally to describe the material of which gallstones are made. In the process of degradation, it is converted to the primary bile acids cholic acid and chenodeoxycholic acid in approximately equal amounts. The salts of these acids are excreted in bile. They perform two important functions in the digestive tract ... 

Other clinical signs consist of progressive neurologic dysfunction, cataracts, and premature atherosclerosis (SI). The disease is inherited as an autosomal recessive trait, but is usually only detected in adults when cholesterol and cholestanol have accumulated over many years (S2). Biochemical features of the disease include striking elevations in tissue levels of cholesterol and cholestanol and the presence of unusual bile acids, termed bile alcohols, in bile. These bile alcohols are mainly 5 -cholestane-3a,7a,12a,24S, 25-pentol, Sp-diolestane-3a,7a,12a,23 ,25-pentol and 5P-du)lestane-3a,7a,12a,25-tetrol (S2). As chenodeoxycholic acid is deficient in the bile of patients with CTX, it was postulated that early bile salt precursors are diverted into the cholic acid pathway and 12a-hydroxy bile alcohols with an intact side chain accumulate because of impaired cleavage of the cholesterol side chain and decreased bile acid production (S2). HMG-CoA reductase and cholesterol 7a-hydroxylase activity are elevated in subjects with CTX (N4, N5), so that sufficient 7a-hydroxycholesterol should be available for bile acid synthesis. 

Results of various in vivo experiments with labelled bile acid precursors in patients with CTX have been published [185,190,195]. All these experiments show that there is a defect in the oxidation of the steroid side chain in the biosynthesis of cholic acid but are not fully conclusive with respect to the site of defect. Bjorkhem et al. administered a mixture of [ H]7a,26-dihydroxy-4-cholesten-3-one and [ " C]7a-hy-droxy-4-cholesten-3-one to a patient with CTX [195]. The ratio between and C in the cholic acid and the chenodeoxycholic acid isolated was 40 and 60 times higher, respectively, than normal. Similar results were obtained after simultaneous administration of H-labelled 5)3-cholestane-3a,7a,26-triol and 4- C-labelled 5j8-cholestane-3a,7a-diol. The results of these experiments are in consonance with the contention that the basic defect in CTX is the lack of the 26-hydroxylase, but do not per se completely exclude other defects in the oxidation of the side chain. 

Microsomal 12a-hydroxylation is the only unique step in the formation of chohc acid and is likely to be of regulatory importance for the ratio between newly synthesized cholic and chenodeoxycholic acid. Introduction of a 26-hydroxyl group seems to prevent subsequent 12a-hydroxylation in rat liver and the 26-hydroxylase could thus also have a regulatory role. It is possible that there are different precursor pools for the synthesis of cholic acid and chenodeoxycholic acid in rats. If so, the relative size of the two pools could be of importance for the relative rate of formation of the two bile acids. 

In 1963, Carey and Haslewood isolated trace amounts of (25/ )-3a,7 ,12a-trihy-droxy-5 8-cholestan-26-oic acid from human fistula bile [96]. The stereochemistry at C-25 of this bile acid was recently confirmed by direct comparison with reference compounds of known absolute configuration [97], This trihydroxy-5j8-cholestanoic acid also occurs in baboon bile [98]. Hanson and Williams found the corresponding dihydroxy bile acid, 3 ,7a-dihydroxy-5 S-cholestan-26-oic acid, in human bile [99]. The occurrence of these higher bile acids, quantitatively of minor importance, is of interest because they are biosynthetic precursors of two primary bile acids of mammalian species, cholic acid and chenodeoxycholic acid, respectively (Chapter 9). 

Chenodeoxycholic acid is converted into a-muricholic acid (3a,6i8,7a-trihydroxy-5jS-cholanoic acid) and j8-muricholic acid (3a,6)J,7/J-trihydroxy-5j8-cholanoic acid) in the mouse and the rat and probably also in man (68, 102, Chapter 11 in this volume). a-Muricholic acid is a precursor of jS-muri-cholic acid in a reaction involving the intermediary formation of the 7-oxo compound (Chapter 11 in this volume). In the rat, /8-muricholic acid has been shown to be formed also from 3a,7j8-dihydroxy-5i8-cholanoic acid, which is a minor metabolite of chenodeoxycholic acid, and from 3a,6)9-dihydroxy-5)5-cholanoic acid, which is a metabolite of lithocholic acid (Chapter 11 in this volume). The microsomal 6i8-hydroxylase system in rat liver catalyzing the conversion of (tauro)chenodeoxycholic ac d into (tauro)a-muricholic acid has been studied by Hsia and collaborators (103-105), who... 

In the guinea pig, 3a-hydroxy-7-oxo-5/9-cholanoic acid is partly a primary bile acid and partly a secondary bile acid formed from chenodeoxycholic acid (Chapter 11 in this volume) The pathway for the formation of 3a-hydroxy-7-oxo-5/9-cholanoic acid in the liver has not been established. It might be mentioned that 3/3-hydroxy-5-cholesten-7-one is not a precursor of this acid (110). 

Fig. 1. The two 24-carbon primary bile acids in man are I, 3a,7a,12a-trihydroxy-5/5-cho]anoic acid (cholic acid), and II, 3a,7a-dihydroxy-5iS-cholanoic acid (chenodeoxycholic acid). Their immediate precursors are, respectively. III, 3a,7a,12a-trihydroxy-5/3-cholestanoic acid, and IV, 3a,7a-dihydroxy-5jS-cholestanoic acid.

Lithocholic acid has been associated with the development and progression of human liver cirrhosis (188,202). This acid is found in human serum, particularly in cirrhotic patients (202,210), in whom chenodeoxycholic acid is the predominant bile acid. Serum lithocholic acid is decreased by cholestyramine and neomycin in cirrhosis, and it has been suggested that the treatment of cirrhotic patients with these drugs warrants consideration (202). Usually, however, the correlation between the levels of lithocholic acid and its precursor chenodeoxycholic acid is poor (188,193). Long-term treatment of patients with lithogenic bile with chenodeoxycholic acid led to an almost complete predominance of this bile acid in bile, yet the amount of lithocholic acid was not increased significantly (96). Predominance of chenodeoxycholic acid appears to be related to the parenchymal cell function (195) the poorer it is the more predominant is chenodeoxycholic acid among the bile acids. However, a simultaneous decrease of hepatic secretory function possibly associated with intrahepatic biliary obstruction reduces the quantitative flow of chenodeoxycholate to the colon, so that bacterial formation and... 

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