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Molecular Pathogenesis of Cholestasis
  1. E Elias

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M Trauner, P L M Jansen. New York: Kluwer Academic/Plenum Publishers, 2003, £93.00, pp 366. ISBN 0 306 48240 1

This book represents a timely and up to date review of a rapidly developing field. The pattern is generally one of concise overviews which are extensively referenced. Those who have always regarded bile as dark and unfathomable would find a large array of related subjects which have been illuminated to provide clinically meaningful insights into health and disease, albeit the compilation of the book had the cognoscenti in mind. The future plan is to have the book available in electronic format to allow for regular updating.

The historical introductory chapter brings home the almost startling rapidity with which the field has developed. Less than half a century ago it was first understood that bile secretion was an active process which could be sustained against a pressure gradient in contradistinction to urine. The energy which drives secretion is now known to emanate from an array of ATP binding cassette transporters responsible for secretion of osmotically active bile solutes. Many of those transporters have been cloned and characterised and disease associations worked out.

Similarly, the function and feedback regulation of a host of genes whose products contribute to the composition and secretion of bile is explained, along with the changes induced by various cholestatic perturbations. The scope of the book is comprehensive, including all aspects of cell physiology pertinent to bile formation for the hepatocyte and cholangiocyte, and extensive data on the causes and consequences of cholestasis. The basic science chapters, written by leading authorities in their field, are informative and amply referenced to lead the serious student into any background literature of their choosing. The excellent clinical chapters on pruritus, PBC, PSC, etc, are more discursive and necessarily speculative but given the whelming tide of clarified pathophysiology represented by this volume, major developments in our understanding of these mysteries would appear tantalisingly close.

A personal copy would be highly desirable for those who have an active research interest in biliary physiology or disease, and the book’s presence in any a departmental library would be an ideal source for the enquirer unfamiliar with this niche interest.