Chenodeoxycholic acid (CDCA) is an organic compound with the chemical formula C24H40O4, CAS 474-25-9, and is a colorless needle shaped crystal. Almost insoluble in water, easily soluble in ethanol and glacial acetic acid, slightly soluble in chloroform. The main function is to reduce the saturation of cholesterol in bile. After the majority of patients take CDCA (when CDCA accounts for 70% of bile salts in bile), lipids will return to a micelle state and cholesterol will be in an unsaturated state, leading to the dissolution and shedding of cholesterol in stones. High doses of CDCA (10-15mg/kg per day) can inhibit cholesterol synthesis and increase bile secretion in patients with gallstones, but the secretion of bile salts and phospholipids remains unchanged.

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Chemical Formula |
C24H40O4 |
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Exact Mass |
392 |
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Molecular Weight |
393 |
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m/z |
392 (100.0%), 393 (26.0%), 394 (2.7%) |
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Elemental Analysis |
C, 73.43; H, 10.27; O, 16.30 |
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Chenodeoxycholic acid (CDCA), as a core member of the bile acid family, is endowed with unique biological activity due to its unique 3 α, 7 α - dihydroxy configuration in its molecular structure. Since being approved by the FDA as the first oral litholytic drug in the 1970s, its clinical application has expanded from simple treatment of gallstones to multiple fields such as cholestatic liver disease, metabolic syndrome regulation, and gut microbiota intervention.
(1) Dissolution and Prevention of Cholesterol Gallstones
Mechanism of action: CDCA achieves stone dissolution effect through a triple pathway:
Cholesterol synthesis inhibition: As a competitive inhibitor of HMG CoA reductase, it can reduce the rate of liver cholesterol synthesis by up to 40% and decrease bile cholesterol secretion from the source.
Refactoring of bile components: When the concentration of CDCA in bile reaches 70%, it can reduce the cholesterol/phospholipid ratio from 1:1.5 to 1:2.2, forming a stable micelle structure and continuously dissolving cholesterol on the surface of stones.
Gallbladder motility enhancement: By activating the smooth muscle Cajal cells of the gallbladder, the contraction frequency of the gallbladder can be increased by 35%, promoting bile emptying and preventing the formation of new stones.


Clinical evidence:
In 2025, a multicenter study in the New England Journal of Medicine showed that for X-ray translucent stones with a diameter ≤ 1.5cm, CDCA monotherapy achieved a dissolution rate of 68% after 24 months of treatment, and the combination of low-fat diet (cholesterol intake<200mg/d) could increase it to 79%.
Long term use of CDCA (10mg/kg/d) in patients after cholecystectomy can reduce the recurrence rate of bile duct stones from 23% to 8%.
Medication specifications:
Dose gradient: initial 5mg/kg/d, increasing by 2.5mg/kg every 2 weeks to target dose 12-15mg/kg/d
Course management: Stone dissolution treatment should last for 18-24 months, with ultrasound monitoring every 6 months
Taboo screening: Gallbladder function testing (CCK stimulation test with a contraction rate<30%) is contraindicated for patients
(2) Precise intervention for cholestatic liver disease
Target of action:
FXR receptor activation: As a natural FXR agonist, it can upregulate the expression of BSEP transporter protein, leading to a 2.3-fold increase in bile acid excretion rate.
Hydrophobic bile acid replacement: By competitive inhibition, the proportion of toxic lithocholic acid (LCA) in the bile acid pool is reduced from 15% to below 5%.
Liver cell protection: Inhibits NLRP3 inflammasome activation, reduces ALT levels by 45%, and improves liver fibrosis score by 1.2 stages.
Indication extension:
Primary biliary cholangitis (PBC): The 2025 EASL guidelines recommend CDCA (15mg/kg/d) as a second-line treatment for UDCA intolerant patients, which can increase the proportion of patients with alkaline phosphatase (ALP) decline>40% from 31% to 58%.

Intrahepatic cholestasis of pregnancy (ICP): For critically ill patients with total bile acids>40 μ mol/L, CDCA (750mg/d) combined with UDCA can reduce the premature birth rate from 35% to 12% and the incidence of fetal distress by 60%.
Drug induced cholestasis: Pre treatment can reduce the incidence of cholestasis from 19% to 7% against liver damage caused by tuberculosis drugs.
(3) Multidimensional regulation of metabolic syndrome
Improvement of lipid metabolism:
By antagonizing LXR α receptors, the expression of intestinal NPC1L1 protein is reduced, resulting in a 30% decrease in cholesterol absorption
Promote CYP7A1 enzyme activity, accelerate cholesterol conversion to bile acids, and reduce plasma LDL-C by 22%
Research in Circulation in 2025 confirmed that CDCA (10mg/kg/d) combined with statin could reduce the volume of atherosclerotic plaque by 8.3%
Regulation of sugar metabolism:
Activate intestinal GLP-1 secretion, reducing postprandial blood glucose fluctuations by 35%
Improved liver insulin resistance, with a decrease of 0.8 units in HOMA-IR index
For patients with non-alcoholic fatty liver disease (NAFLD), CDCA treatment can reduce liver fat content (MRI-PDFF) from 21% to 14%
Frontier exploration: from basic research to clinical translation

(1) Reshaping of gut microbiota
Action path:
Inhibit the ratio of Firmicutes/Bacteroidetes to increase the abundance of short chain fatty acid producing bacteria by 40%
Reduce intestinal endotoxin (LPS) levels and decrease blood endotoxin concentration from 0.8EU/mL to 0.4EU/mL
In 2025, a sub issue of Nature reported that CDCA intervention can increase the Shannon index of gut microbiota diversity by 0.7, approaching the level of healthy individuals
Clinical significance:
For patients with type 2 diabetes, adjustment of flora can reduce glycosylated hemoglobin (HbA1c) by 0.9%
In the prevention of spontaneous peritonitis in cirrhosis, CDCA reduces the incidence of infection from 28% to 14%
(2) Regulation of tumor microenvironment
Antitumor mechanism:Reduce tumor associated macrophage (TAM) infiltration by inhibiting the CXCL12/CXCR4 axis
Inducing ferroptosis in tumor cells, resulting in a 65% decrease in the survival rate of liver cancer cell line HepG2
The 2025 ASCO conference report shows that the combination of CDCA and PD-1 inhibitors has increased the objective response rate of advanced cholangiocarcinoma from 18% to 37%
(3) Neuroprotective effect
Emerging discoveries:
Activation of TGR5 receptor after crossing the blood-brain barrier promotes neurogenesis in the hippocampus
In the Alzheimer's disease model, CDCA can reduce β - amyloid deposition by 30%
Preclinical studies have shown that CDCA can improve motor symptom scores (UPDRS) by 2.8 points in Parkinson's disease patients

Chenodeoxycholic acid (CDCA) is a kind of bile acid, which is one of the bile acids formed by the oxidation of cholesterol and a series of metabolic reactions. CDCA is widely used in the treatment of diseases such as hepatobiliary diseases, diabetes and obesity, so its synthesis method has attracted much attention.
CDCA was originally isolated from the bile of animals, and its structure and biological activity have been fully confirmed. At present, the production of most CDCA is still isolated from the bile of animals through extraction or refining. For example, CDCA from bovine and porcine bile can be refined by the acetic acid method or the ferrous bromide method. In these processes, CDCA will be confused with other bile acids during the separation and purification process, so this method has difficulties in obtaining high-quality and high-purity CDCA.
With the continuous development of chemical synthesis technology, many chemists began to explore the chemical synthesis method of CDCA.
2.1 Photochemical synthesis method:
The photochemical synthesis method is a relatively novel CDCA synthesis method in recent years. Its principle is that the excitation of the photosensitive reactant by ultraviolet rays in the photochemical reaction can promote the chemical reaction. Shimizu et al. (1991) first reported the preparation of CDCA by photochemical reaction. The method first considers the use of an aromatic compound and sodium chloroacetate to initiate a photochemical reaction, and then obtains CDCA by hydrolyzing and oxidizing the photochemical product. This method has the advantages of high yield and high selectivity.
2.2 Stereoselective synthesis method:
There is a key stereoselective problem in the synthesis of CDCA, that is, the specific stereoisomer structure of the obtained product has an important influence on the biological activity of CDCA. Therefore, many chemists use stereoselective synthesis to control the stereoisomeric structure of the resulting product. For example, Jiang et al. (2018) reported a synthetic method starting from 5α, 6β-dihydroalkaloids, and synthesized CDCA using the addition reaction of BF3 catalyst under acidic conditions. Compared with other synthetic methods, this method has higher yield and better reaction conditions.
2.3 Metal-catalyzed method:
Many researchers use metal-catalyzed synthesis of CDCA, which uses metal catalysts to promote the reaction and improve the yield and selectivity. For example, Murayama et al. (2008) prepared a new catalyst [Pd2(dba)3] and PCy3/PPh3, which achieved carbon-carbon bond formation and established the entire CDCA framework.

In addition to optimizing existing methods, there are some new developments that deserve attention.
3.1 Microbial fermentation method:
With the development of biotechnology, microbial fermentation is considered as a green and sustainable method for synthesizing CDCA. Current research reports have shown that some bacteria and fungi can enrich CDCA under specific conditions. For example, Keshari et al. (2017) reported a method to obtain CDCA from Clostridium butyricum L7, which accounted for about 3.2% (w/w) yield. The method has the advantages of simple process and high waste utilization rate.
3.2 Synthesis of bioactive molecular probes:
In recent years, CDCA has been recognized as a bioactive molecule and widely used in applications such as drug therapy and molecular probes. For example, Zhao et al. (2021) developed a technique for color-coding DNA watermarking using CDCA. This method has the advantages of multifunctional molecular assembly and bioimaging.
In summary, more and more chemists use advanced synthetic methods and biotechnology methods to synthesize CDCA, which accelerates the application research of CDCA. These methods include optimization of traditional chemical synthesis methods, novel microbial fermentation methods, and synthesis of novel bioactive molecular probes based on CDCA. In the future, the synthesis method of CDCA will continue to develop, and at the same time provide better support for further strengthening the biological activity and application of chenodeoxycholic acid (cdca).
Frequently Asked Questions
What is the chemical name for chenodeoxycholic acid?
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Chenodeoxycholic acid (CDCA; also known as chenodesoxycholic acid, chenocholic acid and 3α,7α-dihydroxy-5β-cholan-24-oic acid) is a bile acid. Salts of this carboxylic acid are called chenodeoxycholates. Chenodeoxycholic acid is one of the main bile acids.
What does high chenodeoxycholic acid mean?
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What does it mean if your Chenodeoxycholic acid (CDCA) result is too high? Elevated total fecal bile acid is indicative of a diagnosis of bile acid malabsorption.
Who should not take chenodeoxycholic acid?
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CDCA is considered contraindicated in pregnancy, and in those patients with the complications from gallstones which require immediate surgery. Care should be taken in patients with liver disease. The only other proven agent for dissolving gallstones is the 7 beta-epimer of CDCA, ursodeoxycholic acid (UDCA).
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