Study links toxic metal-exposed gallstones to gallbladder cancer in Assam

Guwahati: A new study has uncovered a direct link between gallstones exposed to toxic metals and the alarming prevalence of gallbladder cancer (GBC) in Assam, one of the most affected regions globally.

The research, led by a team from Tezpur University and published in the 'American Chemical Society’s Chemical Research in Toxicology', highlights how heavy metal contamination and the structural properties of gallstones contribute to this deadly disease.

The study was spearheaded by Pankaj Barah and Cinmoyee Baruah from Tezpur University’s Department of Molecular Biology and Biotechnology, with contributions from researchers across several institutions, including Assam Medical College, IIT Guwahati, Bhubaneswar Borooah Cancer Institute, the National Institute of Pharmaceutical Education and Research, and Swagat Super Speciality and Surgical Hospital in Guwahati.

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Gallstones, small pebble-like formations in the gallbladder, develop due to changes in bile composition, leading to the crystallization of cholesterol, calcium, and other pigments.

While some gallstones remain asymptomatic, others cause severe pain, a condition known as gallstone disease (GSD). Using advanced spectroscopic tools, the research team analyzed gallstones from 30 GSD patients and 10 GBC patients in Assam, revealing a stark contrast between the two groups. Gallstones from GSD patients were primarily composed of cholesterol (70%), along with mixed components, pigments, and calcium carbonate.

However, the stones from GBC patients lacked pigments and calcium carbonate but contained up to 15 times higher levels of carcinogenic metals such as arsenic, chromium, mercury, iron, and lead.

These toxic elements, commonly found in the groundwater of the Brahmaputra Basin, were accompanied by unique plate-like microstructural formations that may damage gallbladder tissue and contribute to cancer development.

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Barah noted that these findings explain why 60-80% of gallstone cases in Assam progress to gallbladder cancer, compared to just 1% worldwide. He emphasized that women account for 70% of these cases, making the disease particularly concerning for the region’s female population. Describing these gallstones as toxic catalysts, he pointed out that their distinct composition creates a dangerous pathway to cancer.

Gayatri Gogoi, one of the researchers, highlighted the importance of early detection, stating that while ultrasound screenings could save lives, nearly 80% of GBC cases are diagnosed too late for surgical intervention. Subhash Khanna added that Assam bears a disproportionately high burden of the disease compared to other Indian states, further underscoring the urgency of early screenings and preventive measures.

In light of these findings, the study calls for immediate action to tackle Assam’s gallbladder cancer crisis. The researchers stress the need for widespread ultrasound screenings to facilitate early diagnosis, policy reforms to improve water quality and reduce toxic metal contamination, and comparative studies across India to examine regional differences in gallstone composition.

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Additionally, they advocate for public awareness campaigns to educate communities about the early symptoms and risks associated with gallbladder disease.

As part of their future research, the team plans to analyze gallstones from patients in other parts of India to determine whether Assam’s toxic profile is unique or part of a broader national trend.

Barah emphasized the need for continued investigations into cholesterol dysregulation and its connection to elemental toxicity, which could provide further insights into the disease’s progression.

With Assam facing an alarmingly high rate of gallbladder cancer, the study’s findings underscore the urgent need for targeted healthcare policies, early detection strategies, and increased awareness to combat this silent yet deadly health crisis.