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Endotoxin impairs biliary glutathione and HCO3− excretion and blocks the choleretic effect of nitric oxide in rat liver

Cholestasis in patients with sepsis has been attributed to the effects of endotoxin (lipopolysaccharides, LPS) and LPS‐induced cytokines, which are also potent stimulators of systemic and hepatic nitric oxide (NO) synthesis. NO donors stimulate bile acid‐independent bile flow in normal rat liver, but the effects of LPS‐induced NO on bile formation remain unclear. To address this question we examined the effects of NO and its mediator guanosine 3′,5′‐cyclic monophosphate (cGMP) on bile flow and biliary HCO3− and glutathione excretion in isolated perfused rat livers (IPRL) from LPS‐treated rats. Portal and systemic NO2‐ + NO3‐ plasma levels were increased 47‐fold in LPS‐treated rats and were also elevated in perfusate (6‐fold) and bile (9‐fold) after isolating and perfusing livers from these animals. Bile flow, HCO3−, and glutathione output were decreased by 33%, 25%, and 81% in these IPRL, respectively. Stimulation of NO synthesis with L‐arginine or inhibition of inducible NO synthesis with aminoguanidine did not change bile flow, although pretreatment with aminoguanidine inhibited NO production by 85%. Moreover, the choleretic effects of infusions of the NO donors sodium nitroprusside (SNP) and S‐nitroso‐acetyl‐penicillamine were markedly reduced in endotoxemic IPRL compared with normal controls, and SNP‐induced HCO3− and glutathione excretion were reduced by 61% and 86%, respectively. SNP‐induced cyclic GMP production was 2.3‐fold lower than in normals, but the choleretic effect of dibutyryl cGMP was only slightly reduced in endotoxemic livers. These findings indicate that LPS reduces bile acid‐independent bile flow primarily by inhibiting biliary excretion of glutathione and to a lesser extent HCO3−, whereas LPS‐induced NO does not modulate bile formation in endotoxemia. Thus, impairment of the major determinants of bile acid‐independent bile flow by LPS may contribute significantly to the pathogenesis of the cholestasis of sepsis.