Imide Products from Photo-oxidation of Bilirubin and Mesobilirubin

IN 1958 Cremer et al.¹ observed that the concentration of bilirubin (la) in the plasma could be reduced by exposing newborn infants to fluorescent light. Since that time phototherapy has come into wide use to lower elevated bilirubin levels associated with neonatal jaundice (hyperbilirubin-aemia)^{2, 3}. This condition in the newborn has been associated with retarded motor development, irreversible brain damage or even death. Phototherapy lowers bilirubin levels (by conversion of this lipid-soluble pigment to water-soluble products)⁴ and therefore presumably helps to prevent brain damage. But there are two possible dangers in this treatment: light may have other deleterious effects on the newborn and the photo-products of bilirubin may themselves be toxic. At present neither the structures of the bilirubin photo-products nor their toxicities have been established. Although the photo-destruction of bilirubin has been studied in vivo and in vitro by Ostrow^5–7, Schmid^{4, 7} and others^{8, 9}, these authors investigated principally the visible-ultraviolet spectral changes during the course of bilirubin photo-oxidation and recorded paper chromatographic separations of the photo-products for comparison with the bile or urine of the congenitally jaundiced Gunn rat. More recently McDonagh has shown that singlet oxygen is involved in the self-sensitized photo-oxidation of bilirubin¹⁰. In view of the paucity of structural.information on the bilirubin photo-products, we wish to report preliminary findings on the in vitro photo-oxidation products from bilirubin IXa (1a), mesobilirubin IXa (1b) and 5′-oxo-3′,4,4′-triethyl-3,5-dimethyl-l′,5′-dihydro-(2.2′)-dipyrrylmethene (2). We synthesized and carried out our initial studies on 2, which serves as a simplified model for rings I and II of 1a and 1b because it lacks the vinyl group of 1a and the propionic acid β-substituent of 1a and 1b. The visible-ultraviolet spectrum of 2 is quite similar to that of either 1a or 1b^11–13.     

Spectrofluorimetric determination of bilirubin in serum samples

A new spectrofluorimetric method was developed for determination of trace amount of bilirubin. Using oxytetracycline–Eu³⁺ as a fluorescent probe, in the buffer solution of pH = 7.3, bilirubin can reduce remarkably the fluorescence intensity of the oxytetracycline–Eu³⁺ complex at λ = 612 nm and the reduced fluorescence intensity was in proportion to the concentration of bilirubin. Optimum conditions for the determination of bilirubin were also investigated. The linear range and limit of detection for the determination of bilirubin were 5.0 × 10^?7, 3.0 × 10^?5 and 7.7 × 10^?8 mol L^?1, respectively. This method is simple, practical and relatively free of interference from coexisting substances and can be successfully applied to assess bilirubin in serum samples and compared with the modified Jendrassik–Grof method in clinical analysis. The quenching mechanism of the fluorescence intensity in the system is also discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

The fluorescence quenching of Ru(bipy)32+: an application for the determination of bilirubin in biological samples

A simple, sensitive and efficient fluorescence method has been established for the quantitative analysis of bilirubin. The fluorometric determination method was based on the kinetic quenching of ruthenium(II) fluorescence. The quenching effect may be due to the complexation reaction of bilirubin with ruthenium(II). Therefore, the effects of ruthenium concentrations and different surfactants have been studied. Under the optimized experimental parameters, the fluorescence intensity decreased proportionally with the bilirubin concentration and linearity was established in the range of 3.3 × 10⁻⁷ to 3.0 × 10⁻⁴ M bilirubin. The detection limit calculated from the calibration graph was found to be 5.2 × 10⁻⁸ M. The relative standard deviation (RSD) of 10 consecutive measurements of 8.0 × 10⁻⁶ M bilirubin was 3.0%, while the recoveries of bilirubin in both human serum and urine samples were obtained in the range 94.0–99.5%. The interference study shows that the developed fluorescence based technique is fast, easy to carry out and shows negligible interference. The developed technique was successfully applied for the analysis of bilirubin in human urine and serum samples. All the experimental results and quality parameters confirmed the sensitivity and reproducibility of the proposed technique for bilirubin determination in human urine and serum samples .     

Bilirubin Inhibits Ca2+-Dependent Release of Norepinephrine from Permeabilized Nerve Terminals

Although the well-known neurotoxic agent bilirubin can induce alterations in neuronal signaling, direct effects on neurotransmitter release have been difficult to demonstrate. In the present study we have used permeabilized nerve terminals (synaptosomes) from rat brain prelabeled with [³H]norepinephrine to examine the effects of bilirubin on transmitter release. Rat cerebrocortical synaptosomes were permeabilized with streptolysin-O (2 U/ml) in the absence or presence of bilirubin (10 M–320 M) and Ca²⁺ (100 M), and the amount of radiolabeled transmitter released during 5 min to the medium was analysed. Low levels of bilirubin decreased Ca²⁺-evoked release in a dose-dependent manner, with half-maximal effect at approx 25 M bilirubin. Higher levels of bilirubin (100–320 M) increased [³H]norepinephrine efflux in the absence of Ca²⁺, suggesting that high bilirubin levels induced leakage of transmitter from vesicles. The nontoxic precursor biliverdin had no effect on Ca²⁺-dependent exocytosis. Our data indicate that bilirubin directly inhibits both exocytotic release and vesicular storage of brain catecholamines.     

THE INFLUENCE OF BILIRUBIN ON OXIDATIVE PHOSPHORYLATION AND RELATED REACTIONS IN BRAIN AND LIVER MITOCHONDRIA: EFFECTS OF PROTEIN-BINDING

1. The uncoupling of oxidative phosphorylation of liver mitochondria by bilirubin does not occur in the presence of equimolar quantities of human serum albumin. With brain mitochondria, however, albumin was not protective. 2. A similar protective effect of albumin for liver, but not for brain, mitochondria was observed in studies of the effects of bilirubin on the ³²Pi-ATP exchange reaction. 3. The latent ATPase of fresh brain mitochondria is activated by Mg²⁺ but only slightly by DNP. Bilirubin increased the Mg²⁺ stimulated ATPase activity in liver mitochondria but depressed this activity in brain mitochondria. These effects were uninfluenced by protein binding. 4. Isotope studies with [¹⁴C]bilirubin demonstrated that the affinity of brain mitochondria for albumin-bound bilirubin is not greater than that of liver mitochondria. 5. The greater toxicity of protein-bound bilirubin for brain mitochondria than for liver mitochondria might be related to the greater lipid content of brain mitochondria.     

The excretion pattern of biliverdin and bilirubin in bile of the small skate (Raja erinacea)

Summary Bile pigment composition (biliverdin, bilirubin and their conjugates) was analyzed in stored gallbladder bile and newly synthesized hepatic bile from the small skate (Raja erinacea). During a five day period of captivity, gallbladder volume remained relatively constant while bilirubin and biliverdin content increased two to three fold. Biliverdin which accounted for 50% of the pigments did not increase as a percentage of tetrapyrroles during this period. The relative proportion of bilirubin and its conjugates also remained constant, averaging 65% for bilirubin monoglucuronide, 30% for bilirubin diglucuronide and 5% for unconjugated bilirubin as measured by HPLC methods. Intravenous administration of biliverdin resulted in significant increases in the biliary excretion of both biliverdin and all bilirubin tetrapyrroles. Insignificant quantities of³H-biliverdin were detected in hepatic bile following the intravenous administration of³H-bilirubin. These studies indicate that the small skate excreted both biliverdin and bilirubin conjugates in bile and that the biliverdin was not produced by in vitro oxidation of bilirubin or its metabolites.     

Competitive interaction of biliverdin and bilirubin only at the primary bilirubin binding site on human albumin

The binding of biliverdin-IXα by human albumin and serum was quantitated, using three different binding techniques, to study the effects of biliverdin on bilirubin-albumin binding. The apparent equilibrium association constants (K ± SD) and binding capacities (n) of defatted albumin, pooled adult sera, and pooled umbilical cord sera for biliverdin are: K = 1.3 ± 2 × 10^{6 −1}, n = 1.00; K = 13.0 ± 3 × 10^{6 −1}, n = 0.90; and K = 6.8 ± 0.1 × 10^{6 −1}, n = 0.85, respectively. Although bilirubin binds at more than one albumin site, competitive studies showed that biliverdin binds only at the primary (highest affinity) bilirubin site. Sulfisoxazole, previously thought to compete with bilirubin for the primary binding site, was found to displace bilirubin from both primary and secondary bilirubin binding sites. Biliverdin, because of its specific binding and spectral characteristics, could be a useful probe for determining the capacity of the primary bilirubin-albumin binding site.     

Calorimetric and Binding Dissections of HSA Upon Interaction with Bilirubin

The interactions between bilirubin and human serum albumin (HSA) were studied by isothermal titration calorimetry (ITC) and UV–vis spectrophotometry at 27°C in 100 mM phosphate buffer pH 7.4 containing 1 mM EDTA. The biphasic shape of the HSA–bilirubin binding curve depicted the existence of two bilirubin binding sets on the HSA structure which had distinct binding interactions. Each binding set contained one or more bilirubin binding site. The first binding set at subdomain IIA included one binding site and had a more hydrophobic microenvironment than the other two binding sites in the second bilirubin binding set (subdomain IIIA). With our method of analysis, the calculated dissociation constant of the first binding site is 1.28×10⁻⁶ M and 4.80×10⁻⁴ M for the second and third binding sites. Here, the typical Boltzmann’s equation was used with a new approach to calculate the dissociation constants as well as the standard free energy changes for the HSA–bilirubin interactions. Interestingly, our calculations obtained using the Wyman binding potential theory confirmed that our analysis method had been correct (especially for the second binding phase). The molar extinction coefficient determined for the first bound bilirubin molecule depicted that the bilirubin molecules (in low concentrations) should interact with the nonpolar microenvironment of the first high affinity binding site. Binding of the bilirubin molecules to the first binding site was endothermic (ΔH^o>0) and occurred through the large increase in the binding entropy established when the hydrophobic bilirubin molecules escaped from their surrounding polar water molecules and into the hydrophobic medium of the first binding site. On the other hand, the calculated molar extinction coefficient illustrated that the microenvironment of the second binding set (especially for the third binding site) was less hydrophobic than the first one but still more hydrophobic than the buffer medium. The binding of the third bilirubin molecule to the HSA molecule was established more through exothermic (electrostatic) interactions.     

Enzymic transfer of glucose and xylose from uridine diphosphate glucose and uridine diphosphate xylose to bilirubin by untreated and digitonin-activated preparations from rat liver

1. Digitonin-treated and untreated homogenates, cell extracts and washed microsomal preparations from liver of Wistar R rats are capable of transferring sugar from UDP-glucose or UDP-xylose to bilirubin. No formation of bilirubin glycosides occurred with UDP-galactose or d-glucose, d-xylose or d-glucuronic acid as the sources of sugar. 2. Procedures to assay digitonin-activated and unactivated bilirubin UDP-glucosyltransferase and bilirubin UDP-xylosyltransferase were developed. 3. In digitonin-activated microsomal preparations the transferring enzymes had the following properties. Both enzyme activities were increased 2.5-fold by pretreatment with digitonin. They were optimum at pH6.6–7.2. Michaelis–Menten kinetics were followed with respect to UDP-glucose. In contrast, double-reciprocal plots of enzyme activity against the concentration of UDP-xylose showed two intersecting straight-line sections corresponding to concentration ranges where either bilirubin monoxyloside was formed (at low UDP-xylose concentrations) or where mixtures of both the mono- and di-xyloside were synthesized (at high UDP-xylose concentrations). Both enzyme activities were stimulated by Mg²⁺; Ca²⁺ was slightly less, and Mn²⁺ slightly more, stimulatory than Mg²⁺. Of the activities found in standard assay systems containing Mg²⁺, 58–78% (substrate UDP-glucose) and 0–38% (substrate UDP-xylose) were independent of added bivalent metal ion. Double-reciprocal plots of the Mg²⁺-dependent activities against the concentration of added Mg²⁺ were linear. 4. In comparative experiments the relative activities of liver homogenates obtained with UDP-glucuronic acid, UDP-glucose and UDP-xylose were 1:1.5:2.7 for untreated preparations and 1:0.29:0.44 after activation with digitonin. 5. Bilirubin UDP-glucuronyltransferase was protected against denaturation by human serum albumin, whereas bilirubin UDP-xylosyltransferase was not. 6. Digitonin-treated and untreated liver homogenates from Gunn rats were inactive in transferring sugar to bilirubin from UDP-glucuronic acid (in agreement with the work of others), UDP-glucose or UDP-xylose.     

Wavelength dependence of bilirubin photoreactivity

The rates and products of the self-sensitized photoreactions of bilirubin IXα vary with excitation wavelength, solvent and the presence or absence of oxygen. Radical or Type I photooxidation reactions of bilirubin are implicated in degassed chloroform or methanol. Quantum yields for the disappearance of bilirubin vary from 10^?2 to 10^?4 with excitation wavelengths of 440, 340 and 280 nm and with the higher quantum yield generally appearing in chloroform solvent and/or excitation at 280 nm. Bilirubin is stable in degassed chloroform to irradiation at 440 nm.     

Evidence for the possible involvement of the superoxide radicals in the photodegradation of bilirubin

The photodecomposition of bilirubin follows first order kinetics with ak _B value of 12.5 × 10^-3 min^-1. In the presence of a model system generating superoxide anions, such as xanthine-xanthine oxidase, thek _B value was 103 × 10^-3 min^-1 This ten-fold enhancement ofk _B value by xanthine-xanthine oxidase was abolished when the reaction mixture was supplemented with a superoxide ion scavenger— superoxide dismustase. Further, known singlet oxygen quenchers like Β-carotene and bistidine did not prevent the enhancement of bilirubin oxidation by xanthine-xanthine oxidase, thereby ruling out the obligatory conversion of Superoxide anion to singlet oxygen. It is concluded that radical oxygen mediated bilirubin degradation might be a natural catabolic route for the bile pigment degradation during oxygen stress. deceased May 1977.     

Elucidating the interaction of ticlopidine with serum albumin and its role in bilirubin displacement in vitro

Ticlopidine is an anti-platelet drug that functions as a P2Y₁₂ receptor antagonist. The present study provides a detailed characterization of interaction of ticlopidine with a model transport protein, bovine serum albumin (BSA) as well as an assessment of its bilirubin displacing ability using a multi-spectroscopic approach in combination with isothermal titration calorimetry. The value of binding constant determined using ITC studies was found to be 3.03 × 10³ M^?1 with a binding stoichiometry of approximately 1:1. Competitive site marker experiments indicate that ticlopidine binds to Sudlow site I, located in subdomain IIA of BSA. In addition, Circular dichroism and 3D fluorescence spectroscopy indicated structural and conformational changes in BSA on interaction with ticlopidine. Thermodynamic parameters suggested that the reaction was spontaneous, exothermic, entropically driven, and involved hydrophobic interactions. These results were well supported by those obtained through molecular docking studies. Additionally, the effect of ticlopidine on bilirubin and albumin interaction was evaluated using the peroxidase method as well as through fluorescence spectroscopy. Ticlopidine was found to displace bilirubin from serum albumin. Moreover, the binding constant of bilirubin–serum albumin interaction also decreased in presence of ticlopidine. The results indicated that ticlopidine is a competitive displacer of bilirubin in vitro and may contribute to the incidences hyperbilirubinemia associated with the usage of this drug.     

Bilirubin oxidase from Magnaporthe oryzae: an attractive new enzyme for biotechnological applications

A novel bilirubin oxidase (BOD), from the rice blast fungus Magnaporthe oryzae, has been identified and isolated. The 64-kDa protein containing four coppers was successfully overexpressed in Pichia pastoris and purified to homogeneity in one step. Protein yield is more than 100?mg for 2?L culture, twice that of Myrothecium verrucaria. The k _cat/K _m ratio for conjugated bilirubin (1,513?mM^?1?s^?1) is higher than that obtained for the BOD from M. verrucaria expressed in native fungus (980?mM^?1?s^?1), with the lowest K _m measured for any BOD highly desirable for detection of bilirubin in medical samples. In addition, this protein exhibits a half-life for deactivation >300?min at 37?°C, high stability at pH?7, and high tolerance towards urea, making it an ideal candidate for the elaboration of biofuel cells, powering implantable medical devices. Finally, this new BOD is efficient in decolorizing textile dyes such as Remazol brilliant Blue R, making it useful for environmentally friendly industrial applications.     

Age-dependent pattern of cerebellar susceptibility to bilirubin neurotoxicity in vivo in mice

Neonatal jaundice is caused by high levels of unconjugated bilirubin. It is usually a temporary condition caused by delayed induction of UGT1A1, which conjugates bilirubin in the liver. To reduce bilirubin levels, affected babies are exposed to phototherapy (PT), which converts toxic bilirubin into water-soluble photoisomers that are readily excreted out. However, in some cases uncontrolled hyperbilirubinemia leads to neurotoxicity. To study the mechanisms of bilirubin-induced neurological damage (BIND) in vivo, we generated a mouse model lacking the Ugt1a1 protein and, consequently, mutant mice developed jaundice as early as 36 hours after birth. The mutation was transferred into two genetic backgrounds (C57BL/6 and FVB/NJ). We exposed mutant mice to PT for different periods and analyzed the resulting phenotypes from the molecular, histological and behavioral points of view. Severity of BIND was associated with genetic background, with 50% survival of C57BL/6‑Ugt1^−/− mutant mice at postnatal day 5 (P5), and of FVB/NJ-Ugt1^−/− mice at P11. Life-long exposure to PT prevented cerebellar architecture alterations and rescued neuronal damage in FVB/NJ-Ugt1^−/− but not in C57BL/6-Ugt1^−/− mice. Survival of FVB/NJ-Ugt1^−/− mice was directly related to the extent of PT treatment. PT treatment of FVB/NJ-Ugt1^−/− mice from P0 to P8 did not prevent bilirubin-induced reduction in dendritic arborization and spine density of Purkinje cells. Moreover, PT treatment from P8 to P20 did not rescue BIND accumulated up to P8. However, PT treatment administered in the time-window P0–P15 was sufficient to obtain full rescue of cerebellar damage and motor impairment in FVB/NJ-Ugt1^−/− mice. The possibility to modulate the severity of the phenotype by PT makes FVB/NJ-Ugt1^−/− mice an excellent and versatile model to study bilirubin neurotoxicity, the role of modifier genes, alternative therapies and cerebellar development during high bilirubin conditions.KEY WORDS: Neonatal jaundice, Ugt1, Phototherapy, BIND, Mouse model     

Glyceraldehyde-3-phosphate dehydrogenase in the isolated human erthrocyte membrane: selective displacement by bilirubin.

When unsealed erythrocyte ghosts in 6 mm phosphate buffer (pH 8.0, 4 °C) were incubated with bilirubin in excess of 0.1 mm and washed with buffer, a single polypeptide component (band 6 in sodium dodecyl sulfate-polyacrylamide-gel electrophoresis) diminished and was recovered in the supernatant fraction. Release of this component was virtually complete at 1 mm initial bile pigment. Since band 6 was believed to be the protomer of membrane-bound glyceraldehyde-3-phosphate dehydrogenase (G3PD), assays for this enzyme in bilirubin-treated ghosts were carried out. These revealed that enzymatic activity decreased concurrently with the disappearance of band 6. The molecular weight of the eluted polypeptide was found to be 36,000, in agreement with the known value for the G3PD protomer. When Mg²⁺-resealed ghosts were washed after exposure to 1 mm bilirubin, less than 20% of the G3PD was eluted, which is consistent with the fact that the enzyme is attached to the cytoplasmic face of the membrane. NAD⁺ in concentrations up to 2 mm displaced no more than 15% of the G3PD from unsealed ghosts. However, after preincubation with NAD⁺ (1 mm) followed by bilirubin (1 Mm) and washing, loss of G3PD was similar to that observed in the absence of cofactor. Since NAD⁺ did not attenuate release of the enzyme, it appears unlikely that such release is attributable to binding of bilirubin at the active site. Protoporphyrin acted similarly to bilirubin on unsealed ghosts, whereas rose bengal had a more pronounced effect, removing all enzymatic activity when the dye concentration reached 0.2 mm. Electrophoretic analysis of ghosts after rose bengal treatment, however, revealed a diminution not only of band 6 but bands 1, 2, and 5 as well.     

Inhibition of secretory phospholipase A2 enzyme by bilirubin: A new role as endogenous anti-inflammatory molecule

Bilirubin is a powerful antioxidant that suppresses the inflammatory process. However its interaction with proinflammatory PLA₂ enzyme is not known. Inhibition of several secretory phospholipase A₂ (sPLA₂) enzyme activities by bilirubin was studied using ¹⁴C-oleate labeled Escherichia coli as substrate. Bilirubin inhibits purified sPLA₂ enzyme from Vipera russellii and Naja naja venom and partially purified sPLA₂ enzymes from human ascitic fluid, pleural fluid and normal serum in a dose dependent manner. IC₅₀ values calculated for these enzymes ranges from 1.75 to 10.5 μM. Inflammatory human sPLA₂ enzymes are more sensitive to inhibition by bilirubin than snake venom sPLA₂s. Inhibition of sPLA₂ activity by bilirubin is independent of calcium concentration. Increasing substrate concentration (upto 180 nmol) did not relieve the inhibition of sPLA₂ by bilirubin and it is irreversible. Bilirubin quenched the relative fluorescence intensity of sPLA₂ in a dose dependent manner in the same concentration range at which in vitro sPLA₂ inhibition was observed. In the presence of bilirubin, apparent shift in the far UV-CD spectra of sPLA₂ was observed, indicating a direct interaction with the enzyme. Inhibition of sPLA₂ induced mouse paw edema by bilirubin confirms its sPLA₂ inhibitory activity in vivo also. These findings indicate that inhibition of sPLA₂ by bilirubin is mediated by direct interaction with the enzyme and bilirubin may act as an endogenous regulator of sPLA₂ enzyme activity.     

A novel method to determine total and free serum bilirubin.

The determination of total (unconjugated) and free serum bilirubin concentrations using a novel and sensitive method based on static fluorescence quenching of daneyl bovine serum albumin was developed. The method allowed the use of a sample of 5 μl or less to determine total bilirubin over a range of 10–200 μg/ml with good recovery (94.9 ± 2.2%). For the determination of total bilirubin, a denaturation medium containing 8 m urea, 10 mm dithloerythreitol, and 0.1 m Tris was employed to eliminate interference by human serum albumin itself. The method was also tested with patients' sera containing negligible conjugated bilirubin in order to compare it to a commonly used “diazo” method. The correlation between the two methods gave a practically linear relation (γ = 0.99). The effects of a number of potentially interfering substances were tested and the results showed the test was specific for bilirubin. Concentrations of free bilirubin were determined without adding a denaturation agent. The experimental values were in agreement with those calculated theoretically using the isotherm of a single binding site and an association constant of human serum albumin to bilirubin of 1.5 × 10⁸m^?1.     

Determination of association and dissociation rate constants for bilirubin--bovine serum albumin.

The association rate constant for the binding of bilirubin to bovine serum albumin has been determined in a continuous-flow experiment. The value obtained is 0.9 x 10⁶m^?1S^?1. Furthermore the dissociation rate constant is determined from the rate of the peroxidase-catalyzed oxidation of bilirubin in a bilirubin-albumin solution. This figure is 3.1 × 10^?2s ¹. Calculation of the apparent binding equilibrium constant from the two rate constants gives 2.9 x 10⁷m^?1. The above mentioned peroxidase oxidation has also been used for a direct estimation of the binding equilibrium constant giving 2.7 × 10⁷m^?1. All experiments are carried out at 36 °C and pH 7.4.     

A reaction of the superoxide radical with tetrapyrroles

Bilirubin and biliverdin were bleached during exposure to the aerobic xanthine oxidase reaction. Enzymic scavenging of O₂^?, by Superoxide dismutase, inhibited, whereas enzymic scavenging of H₂O₂, by catalase, did not. Increasing the rate of production of O₂^? without increasing the turnover rate of xanthine oxidase, by increasing pO₂, accelerated the bleaching of the biliverdin. Moreover, a scavenger of OH·, such as benzoate, or an inactivating chelating agent for iron, such as diethylenetriamine pentaacetate or desferrioxamine mesylate, did not inhibit. It follows that O₂^? can directly attack these tetrapyrroles. Kinetic competition between Superoxide dismutase and bilirubin yielded a value for k_{bilirubin, O2^?} = 2.3 × 10⁴ M^?1s^?1 at pH 8.3 and at 23 °C. A similar experiment for biliverdin yielded a value for k_{bilirubin, O2^?} = 7 × 10⁴ M^?1s^?1.     

The use of solid 13C nuclear magnetic resonance for the characterization of cholesterol and bilirubin pigment composition of human gallstones

The new magic-angle spinning and cross polarization techniques for obtaining a ¹³C solid NMR spectrum are applied to the characterization of human cholesterol, mixed cholesterol-pigment, calcium bilirubinate and bilirubin pigment gallstones. The stones divide into two general classes: the cholesterol stones and the bilirubin pigment stones. The cholesterol stones are very similar to each other whereas the bilirubin pigment stones exhibit considerably more variation in spectral features. The importance of other material and polymerization in the bilirubin pigment stones is discussed.