Bile is a biofluid synthesized by liver and concentrated in the gallbladder. Interference with the bile flow may cause cholestasis. Primary sclerosing cholangitis (PSC) is an inflammatory cholestatic disorder which eventually may result in liver cirrhosis and failure. The management of PSC is controversial. The only effective treatment for end stage disease is orthotopic liver transplantation (OLT). However, cholangiocarcinoma (CC), which is the major complication of this long-lasting disease, is an absolute contraindication for the surgery. Therefore, early diagnosis of the disease can not only improve the outcome of PSC, but also facilitate the allocation of donated livers to those who can benefit from transplantation. Unfortunately, the diagnosis of CC is challenging. Endoscopic retrograde cholangiopancreatography (ERCP), the gold standard technique, is highly invasive. Non-invasive alternatives such as magnetic resonance cholangiopancreatography (MRCP) have lower accuracy. Therefore, it is essential to develop more accurate and less invasive diagnostic techniques. Magnetic resonance spectroscopy (MRS) is an evolving technique with potential to detect disease-related metabolic changes. In vitro studies have proven the capacity of MRS in the early detection of hepatopancreatobiliary (HPB) disorders based on the metabolic analysis of bile obtained invasively. An in vivo alternative has been attempted by others on human bile within the gallbladder. However, due to the poor quality of the acquired spectra, quantification of most major bile metabolites was not possible, except for choline-containing phospholipids (chol-PLs). In the current study, the quality of the in vivo 1D spectra has been greatly improved, and we have obtained the first 2D L-COSY spectra from bile within the gallbladder. Spectral data from healthy controls and PSC patients were compared. Statistically significant differences in the concentrations of chol-PLs, and glycine- and taurine-conjugated bile acids were revealed in the 1D analysis. Our 2D spectra also demonstrated potential for the detection of metabolic differences between the two groups. The success of these studies indicates a strong potential of in vivo bile MRS techniques to characterize and diagnose a wide variety of HPB disorders. / May 2014

Este trabalho consiste na caracterização química e termoanalítica da composição química de cálculos biliares e bile humana, coletados da vesícula biliar de pacientes que foram submetidos à colecistectomia no Hospital Universitário da Universidade de São Paulo. As metodologias utilizadas para amostragem, caracterização química e termoanalítica foram previamente otimizadas por um estudo preliminar, trabalhando-se com um total de 38 amostras de cálculos biliares e bile da vesícula biliar humana. A técnica de análise elementar para a determinação dos teores de carbono, hidrogênio e nitrogênio foi usada para a caracterização química junto com a espectroscopia de absorção na região do infravermelho e difração de raios X. Esses resultados foram complementados por dados obtidos pelas técnicas termoanalíticas TG/DTG e DSC. O estudo do comportamento térmico foi realizado empregando as técnicas TG/DTG em atmosfera dinâmica de ar e razão de aquecimento de 10 ºC min-1. No caso da amostra de cálculo biliar SF15, considerada atípica por apresentar um teor de 81% de CaCO3 na sua composição química, utilizou-se atmosfera mista de ar+CO2. Em todos os ensaios foram empregados. Os eventos térmicos (físicos e químicos) foram evidenciados pelas curvas DSC, por picos no sentido endotérmicos e exotérmicos. A comparação dos perfis das curvas TG/DTG e os resultados de perdas de massa evidenciaram junto com os teores de CHN obtidos por análise elementar, possibilitaram classificar os cálculos biliares em oito grupos distintos (A, B, C, D, E, F, G e H). As curvas DSC, os espectros de infravermelho e os difratogramas de raios X, confirmaram a distinção da composição química desses grupos. Deste modo, foi possível a elaboração de uma nova classificação para os cálculos biliares da vesícula biliar humana baseado na sua composição química. / This work consists of the chemical characterization and thermoanalytical of the chemical composition of gallstones and human bile, collected of the gallbladder of patients that were submitted to cholecystectomy at University Hospital of São Paulo University. The methodologies used to sampling, chemical characterization and thermoanalytical were previously optimized for a preliminary study, working with a total of 38 gallstones and human bile samples. For chemical characterization elementary analysis techniques, to carbon, hydrogen and nitrogen determination, infrared spectroscopy and X-rays diffraction were used, these results complemented the obtained thermoanalytical data for TG/DTG and DSC techniques. The gallstones and bile samples thermal behavior study was accomplished using the techniques TG/DTG in dynamic air atmosphere. In the case gallstone SF15 sample, considered like abnormal due to its content of 81% of CaCO3 in its chemical composition. For this one, a mixture air + CO2 was used. In all experiments were used heating rate of 10 °C min-1. The thermal events (physical and chemical) were evidenced by the DSC curves, with endothermic and exothermic peaks. By means of the comparison TG/DTG curves profiles, the results of mass losses for them evidenced, with CHN\'s contents obtained for elementary analysis, they can classify the gallstones in eight distinct groups (A, B, C, D, E, F, G and H). The DSC curves, infrared spectra and X-rays diffraction, they confirmed the chemical composition distinction of these groups. Thus, it was possible the elaboration of a new classification for the gallstones formatted in the human gallbladder based in your chemical composition.