TY - JOUR
T1 - Calcium carbonate in cholesterol gallstones
T2 - Polymorphism, distribution, and hypotheses about pathogenesis
AU - Taylor, Donald R.
AU - Crowther, Roger S.
AU - Cozart, John C.
AU - Sharrock, Pamela
AU - Wu, Jinguang
AU - Soloway, Roger D.
N1 - Funding Information:
Abbreviations: IR, infrared; MTBE, methyl-tert-butylether. From the 1Gastroenterology Division, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX; and the 2Department of Chemistry, Peking University, Beijing, China. Received August 5, 1994; accepted March 13, 1995. Supported in part by NIH grants CA-35934f rom the NCI (R.D.S.) and AM 16549 from NIADDK( R.D.S.), and grants from the Sealy and Smith, Galveston, TX, and M. D. Anderson, Houston, TX, Foundations (R.D.S.), and by the Doctoral Program Foundation of the Institution of Higher Education, Beijing, China, and the National Natural Science Foundation of China, Beijing, China (J-G.W.). Dr Cozart's present address is: Department of Internal Medicine, University of Iowa School of Medicine, Iowa City, IA. Ms Sharrock's present address is: Science Department, High Island High School, High Island, TX. Address reprint requests to: RogerD . Soloway,M D, GastroenterologyD ivi-sion, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0764. Copyright © 1995 by the American Association for the Study of Liver Diseases. 0270-9139/95/2202-001753.00/0 Calcium carbonate is found in both cholesterol and black and brown pigment gallstones. 1-7 It is known that calcium carbonate formation in bile is stimulated by obstruction of the cystic duct, 6's1° possibly through the resulting increase in gallbladder luminal pressure leading to increased entry of bicarbonate. 11 Calcium carbonate exists as three polymorphs--vaterite, aragonite, and calcite--which have identical stoichiometry (CaCO3) and differ only in their crystal lattice structure. Each polymorph has been identified using x-ray powder diffraction or infrared (IR) spectroscopy in both pigment and cholesterol gallstones. 1,1~-14 In some stones more than one polymorph was present. 12 In one series of stones, vaterite was the most common polymorph identified, and aragonite was the rarest. 12 This frequency distribution is surprising because vaterite is much less thermodynamically stable than is calcite.1~'16 Proteins lv19 and bile salts 2° appear to modify the ease of calcium carbonate precipitation; and a peptide that was isolated from black pigment gallstones has been shown in vitro to regulate the polymorphic form, although in this case vaterite was induced to transform into calcite.19 Currently, however, the factors governing the formation and distribution of the carbonate polymorphs in cholesterol gallstones are incompletely understood.
PY - 1995/8
Y1 - 1995/8
N2 - This study of sets of cholesterol gallstones collected consecutively from 222 patients in La Paz, Bolivia, and Mexico City, Mexico, has developed a reliable infrared (IR) spectroscopic method for the detection of calcium carbonate in cholesterol gallstones and provided the basis for simultaneous identification of each of its three polymorphs: calcite, vaterite, and aragonite. The peaks in the 854 to 876 cm-1 region demonstrated 98% sensitivity and specificity for carbonate detection. As little as 3% carbonate by weight could be detected using these peaks. The overall incidence of carbonate was 19% in these populations containing a high proportion of Amerinds. Infrared microspectroscopy of 10 to 50 μm particles, dissected from stones, allowed a ring-by-ring examination of 11 carbonate-containing stones. It was determined that different carbonate polymorphs, when present in the same gallstone, almost always occurred in separate rings. In approximately half of the gallstones, different polymorphs were present in successive layers in the same stone, indicating that conditions governing stone growth changed cyclically. Carbonates were usually precipitated in peripheral layers rather than in the center, supporting the theory that formation of calcium carbonates may be related to episodes of intermittent obstruction of the cystic duct, as opposed to being a major factor in stone nidation.
AB - This study of sets of cholesterol gallstones collected consecutively from 222 patients in La Paz, Bolivia, and Mexico City, Mexico, has developed a reliable infrared (IR) spectroscopic method for the detection of calcium carbonate in cholesterol gallstones and provided the basis for simultaneous identification of each of its three polymorphs: calcite, vaterite, and aragonite. The peaks in the 854 to 876 cm-1 region demonstrated 98% sensitivity and specificity for carbonate detection. As little as 3% carbonate by weight could be detected using these peaks. The overall incidence of carbonate was 19% in these populations containing a high proportion of Amerinds. Infrared microspectroscopy of 10 to 50 μm particles, dissected from stones, allowed a ring-by-ring examination of 11 carbonate-containing stones. It was determined that different carbonate polymorphs, when present in the same gallstone, almost always occurred in separate rings. In approximately half of the gallstones, different polymorphs were present in successive layers in the same stone, indicating that conditions governing stone growth changed cyclically. Carbonates were usually precipitated in peripheral layers rather than in the center, supporting the theory that formation of calcium carbonates may be related to episodes of intermittent obstruction of the cystic duct, as opposed to being a major factor in stone nidation.
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U2 - 10.1016/0270-9139(95)90570-7
DO - 10.1016/0270-9139(95)90570-7
M3 - Article
C2 - 7635417
AN - SCOPUS:0029087769
SN - 0270-9139
VL - 22
SP - 488
EP - 496
JO - Hepatology
JF - Hepatology
IS - 2
ER -