In vivo evidence for transintestinal cholesterol efflux in patients with complete common bile duct obstruction

International audience; Background: Beyond the hepatobiliary pathway, studies have demonstrated that direct TransIntestinal Cholesterol Efflux (TICE) of plasma-derived cholesterol may contribute to reverse cholesterol transport. The clinical evidence of TICE in human remains challenged due to the difficulty to discriminate the hepatobiliary and transintestinal routes in vivo. Objective: To provide the first proof of concept that TICE exists in vivo in humans by demonstrating that plasma labeled cholesterol can be excreted in the feces of patients with complete bile duct obstruction. Methods: Plasma, bile and fecal cholesterol excretion was measured by mass spectrometry 24, 48 and 72h after intravenous injection of D7-cholesterol in two patients presenting cholangiocarcinomas with a total obstruction of their primary bile duct. Results: No trace of bile acids was detected in the feces of the two patients. Despite this, a significant amount of plasma D7-cholesterol was quantified in the feces of the two patients 48h and 72h after the intravenous injection. Conclusion: our data bring a direct proof that TICE is an active pathway in humans. ClinicalTrials.gov Registration number: NCT01958216 Highlights: The transintestinal (TICE) route is crucial for plasma cholesterol excretion in rodent To date, the physiological relevance of TICE in humans remains questioned Patients with obstructed biliary route can excrete plasma cholesterol in their feces TICE is an active pathway in humans