Microbial Conversion of Bilirubin to Urobilinogen

Bile pigments, consisting almost exclusively of bilirubin, are the end products of the catabolism of hemoglobin and some other heme-containing enzymes. Bilirubin, taken up by the liver, is conjugated to glucuronate in the liver and excreted with the bile to the intestine, where the bilirubin conjugates are de-conjugated, and transformed to a series of urobilinogens, usually collectively termed urobilins. Some intestinal b-glucuronidases are derived from endogenous sources (19), but most of them are of microbial origin (20). The capacity to alter deconjugated bilirubin to urobilins seems to be a rare property among intestinal microorganisms. So far, only one bacterium, a strain of Clostridium ramosum, has been found capable of performing this transformation (21,22).

Studies in children as well as adults, in rats and mice, and in pigs and horses show that this is a function normally present in any organism with a normal acting micro-biota (8). In infants, this function is established within the first month of life (23). In adults, fecal levels of urobilins are significantly higher in men than in women (p<0.05). Furthermore, in 36 to 50-year-old men the mean level of urobilins is significantly lower than for younger men (< 36 years). In the case of women, the highest fecal values are found in women younger than 35 years of age (24).

Other studies have shown that intake of different antimicrobial drugs used in clinical practice significantly suppressed this MAC (25).

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