Bile acids: The good, the bad, and the ugly

Bile acids, amphipathic end products of cholesterol metabolism, are "good" in the infant because they enhance lipid absorption and thereby promote growth. Bile acids also induce bile flow and biliary lipid secretion. The enterohepatic circulation of bile acids is "bad" in the adult because it downregulates hepatocyte low-density lipoprotein receptor activity and thereby elevates plasma cholesterol levels. Defects in bile acid metabolism such as impaired biosynthesis or transport are "ugly" because they cause morbidity and death. New approaches for treating these defects are being developed.