Researchers at the University of Toledo have developed a blood test that detects elevated bile acids, which they describe as one of the earliest biological indicators of impaired liver function. Standard blood panels typically measure cholesterol, bilirubin and triglycerides but do not include bile acids, potentially allowing early liver disease to progress unnoticed.
Bile acids are produced by the liver to aid fat digestion and normally circulate between the liver and intestine. When liver function is impaired or bile flow is blocked, bile acids accumulate in the bloodstream in a condition called cholemia. This early stage is often asymptomatic and goes undetected until conventional markers such as liver enzymes and bilirubin rise later in the disease process.
In a study published in the American Journal of Physiology—Gastrointestinal and Liver Physiology, the team led by Drs. Matam Vijay-Kumar and Sadhana Kumari found that red blood cells exposed to elevated bile acids became more resistant to rupturing, contrary to their initial hypothesis. The cells accumulated more cholesterol and lost phospholipid, altering membrane rigidity in a measurable way.
The finding held across multiple genetic mouse models of spontaneous cholemia and in human patients. Blood samples from 23 patients with cholestatic liver disease treated at the University of Toledo Medical Center showed the same pattern of increased osmotic resistance compared with 23 age- and gender-matched controls without liver disease.
The screening method requires only four microliters of additional blood collected during a routine glucose test. The sample is placed in a solution and results are available within 10 to 20 minutes. The test consistently distinguished patients with elevated bile acids from those without liver disease.
The researchers highlight pregnant women as a population with urgent need for early detection. In intrahepatic cholestasis of pregnancy, bile acids above 40 micromolar can cause severe fetal harm, sometimes requiring premature delivery or risking stillbirth. The test could also aid early detection in 25 clinical conditions, including drug-induced liver injury, where bile acids are elevated but not routinely measured.
A positive result would not diagnose a specific liver disease but would signal the need for further evaluation while treatment options may be most effective. The University of Toledo Technology Transfer Office has filed a patent application for the diagnostic concept underlying the test.
Researchers develop blood test targeting overlooked marker of liver disease
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