Thus, high dietary cholesterol matched with increased intestinal cholesterol absorption both appear to be key and independent risk factors for the formation of cholesterol gallstones.9 This mechanism might be actively operating in subgroups of subjects who are at lower genetic risk of developing gallstones but are victims of environmental dietary factors. Indeed, the potent and selective inhibitor of Decitabine cost NPC1L1 ezetimibe reduced biliary cholesterol secretion by suppressing intestinal cholesterol absorption and protected gallbladder motor function by desaturating bile, thus preventing the formation of cholesterol gallstones in mice.11, 18 The results are straightforward,

since in find more mice NPC1L1 is expressed only in the intestine. In hamsters and humans, however, NPC1L1 is also detected at a significantly lower expression level in the liver compared with the intestine. Because NPC1L1 is a cholesterol transporter that is expressed on the canalicular membrane of hepatocytes, it could function to limit cholesterol excretion, presumably by reabsorbing cholesterol from bile.19 However, it was found that ezetimibe can

significantly reduce hepatic secretion of biliary cholesterol in cholesterol-fed hamsters.20 Furthermore, in gallbladder biles of Mexican patients with gallstones, ezetimibe reduced biliary cholesterol saturation and retarded cholesterol crystallization.11 These results strongly suggest that the secretion efficiency of biliary cholesterol is most likely determined by the net effect between the efflux and influx of cholesterol molecules across the canalicular membrane of hepatocyte, which could be regulated by ABCG5/G8 and the NPC1L1 pathways.11 It is highly likely that because biliary cholesterol secretion is a unique path for excretion of cholesterol from the body

in humans and hamsters, hepatic ABCG5/G8 may play a stronger role in the regulation of biliary cholesterol secretion than NPC1L1. In addition, in the gut-liver axis, the intestinal NPC1L1 plays a significant MCE role in providing dietary and reabsorbed biliary cholesterol to the body, and the inhibition of its functions by ezetimibe significantly reduces cholesterol absorption. Consequently, the bio-availability of cholesterol from intestinal sources for biliary secretion is decreased significantly.9 Moreover, intestinal absorption of dietary cholesterol and reabsorption of biliary cholesterol could play a major role in a subgroup of patients with cholesterol gallstones. Such aspects need to be prospectively investigated. Because of some gallstone patients with increased hepatic de novo cholesterol synthesis, the results of Krawczyk et al. suggested a potential therapeutic role for statins.