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Together with potent antioxidant activities that were only reported in the last few decades, many other biological effects have now been clearly described. These include especially profound inhibitory effects on almost all effectors of the immune system, with their clinical consequences in the bilirubin\u2010mediated protection against autoimmune and inflammatory diseases. Separate from these, bilirubin activates various nuclear and cytoplasmic receptors, resembling the endocrine activities of actual hormonal substances. This is true for the \u201cclassical\u201d hepatic nuclear receptors, including the aryl hydrocarbon receptor, or the constitutive androstane receptor; and also for some lesser\u2010explored receptors such as peroxisome proliferator\u2010activated receptors \u03b1 and \u03b3; Mas\u2010related G protein\u2010coupled receptor; or other signaling molecules including fatty acid binding protein 1, apolipoprotein D, or reactive oxygen species. All of these targets have broad metabolic effects, which in turn may offer protection against obesity, diabetes mellitus, and other metabolic diseases. The (mostly experimental) data are also supported by clinical evidence. In fact, data from the last three decades have convincingly demonstrated the protective effects of mildly elevated serum bilirubin concentrations against various \u201cdiseases of civilization.\u201d Additionally, even tiny, micromolar changes of serum bilirubin concentrations have been associated with substantial alteration in the risks of these diseases. It is highly likely that all of the biological activities of bilirubin have yet to be exhaustively explored, and thus we can expect further clinical discoveries about this evolutionarily old molecule into the future.<\/jats:p>","DOI":"10.1002\/med.21660","type":"journal-article","created":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T08:19:07Z","timestamp":1580804347000},"page":"1335-1351","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":131,"title":["Bilirubin as a signaling molecule"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5318-0151","authenticated-orcid":false,"given":"Libor","family":"V\u00edtek","sequence":"first","affiliation":[{"name":"4th Department of Internal Medicine and Institute of Medical Biochemistry and Laboratory Diagnostics, General Faculty Hospital and 1st Faculty of Medicine Charles University  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.3029864"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0065-2423(06)43001-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2174\/138161209789058237"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS20140566"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2019.02.001"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.abb.2019.108062"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmed.2016.07.004"},{"issue":"0","key":"e_1_2_9_9_1","first-page":"37","article-title":"Bile acids in the treatment of cardiometabolic diseases","volume":"16","author":"V\u00edtek L","year":"2017","journal-title":"Ann Hepatol"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1530\/JOE-15-0469"},{"issue":"1","key":"e_1_2_9_11_1","first-page":"29","article-title":"Comparison of plasma bilirubin turnover and carbon monoxide production in man","volume":"83","author":"Berk PD","year":"1974","journal-title":"J Lab Clin Med"},{"issue":"13","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"3671","DOI":"10.1016\/S0021-9258(18)83421-4","article-title":"Biphasic decrease of radioactive hemoprotein from liver microsomal CO\u2010binding particles. 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