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Atherosclerosis is the main underlying cause of cardiovascular disease (CVD). In this process, plaque made of fat, cholesterol, calcium, and other substances builds up on the artery walls.

Plaque that remains on the artery wall is considered 'stable', although it can harden and narrow the arteries over time. Plaque can become 'unstable' and break open, potentially forming a blood clot that could cause a life-threatening heart attack or stroke if it lodges in an artery to the heart or brain. This dangerous plaque is the focus of Dr Weiyu Chen's recent publication "Destabilization of atherosclerotic plaque by bilirubin deficiency".

Bilirubin is a yellowish pigment produced during the breakdown of red blood cells and modified in the liver to allow its excretion from the body. Increased bilirubin levels are responsible for the yellow discolouration seen in jaundice.

This paper expands on pioneering work by Prof Roland Stocker, Emeritus Fellow at HRI, which discovered that people with slightly elevated levels of bilirubin in their blood were protected from developing CVD, contrary to the prior view of bilirubin as only a toxic waste product.

“For example, Gilbert’s syndrome, a mild liver disorder affecting four to 16 per cent of people and characterised by slightly increased bilirubin levels, is associated with a three-fold decrease in CVD risk,” says Dr Chen.

The research by Dr Chen and a team of researchers from HRI and The University of Sydney led by Prof Stocker discovered that bilirubin deficiency further destabilises unstable atherosclerotic plaque, therefore increasing the risk of heart attack or stroke. This takes the team into an exciting new phase, as these findings support the notion that increases in circulating bilirubin may be worth considering as a strategy to lower the risk of CVD.

The next step will be to use genetic or pharmacological strategies, for example to inhibit the activity of bilirubin UDP-glucuronosyltransferase, which is the enzyme responsible for eliminating bilirubin from the body, to stabilise atherosclerotic plaque.

Under­stand­ing how biliru­bin decreas­es the risk of CVD will give rise to nov­el strate­gies for devel­op­ing a new gen­er­a­tion of ther­a­peu­tics to treat and pre­vent CVD,” says Dr Chen.

Header image: Dr Weiyu Chen


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