Bilirubin Links Heme Metabolism to Neuroprotection by Scavenging Superoxide

Bilirubin is one of the most frequently measured metabolites in medicine, yet its physiologic roles remain unclear. Bilirubin can act as an antioxidant in vitro, but whether its redox activity is physiologically relevant is unclear because many other antioxidants are far more abundant in vivo. Here, we report that depleting endogenous bilirubin renders mice hypersensitive to oxidative stress. We find that mice lacking bilirubin are particularly vulnerable to superoxide (O₂^⋅-) over other tested reactive oxidants and electrophiles. Whereas major antioxidants such as glutathione and cysteine exhibit little to no reactivity toward O₂^⋅-, bilirubin readily scavenges O₂^⋅-. We find that bilirubin's redox activity is particularly important in the brain, where it prevents excitotoxicity and neuronal death by scavenging O₂^⋅- during NMDA neurotransmission. Bilirubin's unique redox activity toward O₂^⋅- may underlie a prominent physiologic role despite being significantly less abundant than other endogenous and exogenous antioxidants.