FIBRINOLYSIS AND THE BILIARY TREE

Aims-To investigate the fibrinolytic activity of normal and calculous human bile. Methods-Fibrinolytic properties of the biliary tract were studied in patients with gall bladder stones (n=7) compared with acalc ulous gallbladders (n=8). Results-Bile plasminogen activating activity was detected in a wide range in both groups (calculous bile median 0. 35 IU/ml; range: 0.06-6.59, versus normal bile 0.70 IU/ml; 0.19-3.56). There was no difference in the bile concentration of tissue plasminog en activator between the two groups (calculous bile median 21.5 ng/ml versus normal bile 9.5 ng/ml), which was present in much greater conce ntrations than urokinase (calculous bile median 0.10 ng/ml versus norm al bile 0.36 ng/ml). Both plasminogen activators were detected in low concentrations in gall bladder mucosa. Plasminogen activator inhibitor s-1 and 2 were detected in bile in significantly greater concentration s in patients with gall bladder stones (plasminogen activator inhibito r-1: calculous bile median 15 ng/ml versus normal bile <2 ng/ml, plasm inogen activator inhibitor-2: 157 ng/ml versus <6 ng/ml, p<0.05). Conc lusions-Human bile possesses fibrinolytic activity and the principal p lasminogen activator in bile seems to be tissue plasminogen activator. Plasminogen activator inhibitors were present in greater concentratio ns in stone bile and may be a factor in the pathogenesis of gall stone formation.