Treated with Chenodeoxycholic Acid, A child of consanguineous parents of Pakistani origin developed jaundice at 5 weeks and then, at 3 months, irritability, a prolonged prothrombin time, a low albumin, and episodes of hypoglycaemia. Investigation showed an elevated alanine aminotransferase with a normal γ-glutamyl-transpeptidase. Analysis of urine by electrospray ionisation tandem mass spectrometry (ESI-MS/MS) showed that the major peaks were m/z 480 (taurine-conjugated 3β-hydroxy-5-cholenoic acid) and m/z 453 (sulphated 3β-hydroxy-5-cholenoic acid). Analysis of plasma by gas chromatography-mass spectrometry (GC-MS) showed increased concentrations of 3β-hydroxy-5-cholenoic acid, 3β-hydroxy-5-cholestenoic acid and 27-hydroxycholesterol, indicating oxysterol 7α-hydroxylase deficiency. The patient was homozygous for a mutation (c.1249C>T) in CYP7B1 that alters a highly conserved residue in oxysterol 7α-hydroxylase (p.R417C) - previously reported in a family with hereditary spastic paraplegia type 5. 
On treatment with ursodeoxycholic acid (UDCA), his condition was worsening, but on Chenodeoxycholic Acid (CDCA), 15 mg/kg/d, he improved rapidly. A biopsy (after 2 weeks on CDCA), showed a giant cell hepatitis, an evolving micronodular cirrhosis, and steatosis. The improvement in liver function on CDCA was associated with a drop in the plasma concentrations and urinary excretions of the 3β-hydroxy-Δ5 bile acids which are considered hepatotoxic. At age 5 years (on CDCA, 6 mg/kg/d), he was thriving with normal liver function. Neurological development was normal apart from a tendency to trip. Examination revealed pes cavus but no upper motor neuron signs. The findings in this case suggest that CDCA can reduce the activity of cholesterol 27-hydroxylase - the first step in the acidic pathway for bile acid synthesis.
Objective: To establish Tanreqing baicalin and ursodeoxycholic acid and Chenodeoxycholic Acid determination method of injection. Methods: HPLC-ELSD, Column Zorbax SB-C18 (4.6 mm × 250 mm, 5μm); mobile phase 0.5% aqueous trifluoroacetic acid (A) - acetonitrile (B), linear gradient; flow volume 0.5 mL. min-1; detector carrier gas flow rate 2.5 L.min-1, drift tube temperature of 95 ℃. Results: Baicalin, ursodeoxycholic acid and chenodeoxycholic acid linear range were 0.61 ~ 4.27,0.93 ~ 6.51,0.15 ~ 1.05μg. The average recoveries were 100.2%, 101.0%, 98.7%. Conclusion: This method is simple, accurate, repeatable, and can be used for quality control of Tanreqing.