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Serum 7-alpha-hydroxy-4-cholesten-3-one as a marker for bile acid loss in children

Folke Freudenberg1, Florian Gothe, Florian Beigel

  • 1Department of Pediatric Gastroenterology and Hepatology, Dr von Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany.

The Journal of Pediatrics
|August 24, 2013
PubMed

Insights

This study establishes normal 7-alpha-hydroxy-4-cholesten-3-one (C4) levels in children, finding elevated C4 in short bowel syndrome (SBS) patients indicates bile acid malabsorption.

Area of Science:

  • Pediatric Gastroenterology
  • Clinical Chemistry
  • Biomarker Discovery

Background:

  • Bile acid malabsorption is a significant complication in pediatric short bowel syndrome (SBS).
  • Accurate assessment of bile acid malabsorption in children is crucial for effective management.
  • 7-alpha-hydroxy-4-cholesten-3-one (C4) is a potential biomarker for bile acid synthesis and absorption.

Purpose of the Study:

  • To determine age- and sex-independent reference values for serum C4 in a healthy pediatric population.
  • To evaluate the utility of serum C4 levels in diagnosing bile acid malabsorption in children with SBS.

Main Methods:

  • Serum C4 concentrations were measured using high-performance liquid chromatography in 100 healthy children and 12 pediatric SBS patients.
  • Reference values were established based on a log-normal distribution, defining the upper limit of normal.
  • Fasting serum samples were collected between 8:00 a.m. and 11:00 a.m. after a 10-hour fast.

Main Results:

  • The upper limit of normal for serum C4 in healthy children was determined to be 66.5 ng/mL, with no significant age or sex correlation.
  • 97% of healthy children had C4 levels below this established upper limit.
  • All 12 SBS patients exhibited significantly elevated C4 concentrations (mean 299.6 ± 167.8 ng/mL), indicating bile acid malabsorption.

Conclusions:

  • Established pediatric reference values for C4 are consistent with adult levels and are independent of age and sex.
  • Elevated serum C4 concentrations reliably identify bile acid malabsorption in pediatric SBS patients.
  • Serum C4 offers a noninvasive, nonisotopic method for assessing bile acid malabsorption in children.
Abstract

Keywords:
7-alpha-hydroxy-4-cholesten-3-oneBAMBile acid malabsorptionC4HPLCHigh-performance liquid chromatographyICVIleocecal valvePNParenteral nutritionSBSShort bowel syndrome

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