Bilirubin Links Heme Metabolism to Neuroprotection by Scavenging Superoxide

Bilirubin is one of the most frequently measured metabolites in medicine, yet its physiologic roles remain unclear. Bilirubin can act as an antioxidant in vitro, but whether its redox activity is physiologically relevant is unclear because many other antioxidants are far more abundant in vivo. Here, we report that depleting endogenous bilirubin renders mice hypersensitive to oxidative stress. We find that mice lacking bilirubin are particularly vulnerable to superoxide (O-2(center dot-)) over other tested reactive oxidants and electrophiles. Whereas major antioxidants such as glutathione and cysteine exhibit little to no reactivity toward O-2(center dot-), bilirubin readily scavenges O-2(center dot-). We find that bilirubin's redox activity is particularly important in the brain, where it prevents excitotoxicity and neuronal death by scavenging O-2(center dot-) during NMDA neurotransmission. Bilirubin's unique redox activity toward O-2(center dot-) may underlie a prominent physiologic role despite being significantly less abundant than other endogenous and exogenous antioxidants.