DOI QR코드

DOI QR Code

Phenotypic and Molecular Characteristics of Children with Progressive Familial Intrahepatic Cholestasis in South China

  • Zhang, Wen (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Lin, Ruizhu (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Lu, Zhikun (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Sheng, Huiying (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Xu, Yi (Department of Infectious Disease, Guangzhou Women and Children's Medical Center) ;
  • Li, Xiuzhen (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Cheng, Jing (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Cai, Yanna (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Mao, Xiaojian (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center) ;
  • Liu, Li (Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center)
  • Received : 2020.03.27
  • Accepted : 2020.06.23
  • Published : 2020.11.15

Abstract

Purpose: Progressive familial intrahepatic cholestasis (PFIC) is a rare genetic autosomal recessive disease caused by mutations in ATP8B1, ABCB11 or ABCB4. Mutational analysis of these genes is a reliable approach to identify the disorder. Methods: We collected and analyzed relevant data related to clinical diagnosis, biological investigation, and molecular determination in nine children carrying these gene mutations, who were from unrelated families in South China. Results: Of the nine patients (five males, four females) with PFIC, one case of PFIC1, four cases of PFIC2, and four cases of PFIC3 were diagnosed. Except in patient no. 8, jaundice and severe pruritus were the major clinical signs in all forms. γ-glutamyl transpeptidase was low in patients with PFIC1/PFIC2, and remained mildly elevated in patients with PFIC3. We identified 15 different mutations, including nine novel mutations (p.R470HfsX8, p.Q794X and p.I1170T of ABCB11 gene mutations, p.G319R, p.A1047P, p.G1074R, p.T830NfsX11, p.A1047PfsX8 and p.N1048TfsX of ABCB4 gene mutations) and six known mutations (p.G446R and p.F529del of ATP8B1 gene mutations, p.A588V, p.G1004D and p.R1057X of ABCB11 gene mutations, p.P479L of ABCB4 gene mutations). The results showed that compared with other regions, these three types of PFIC genes had different mutational spectrum in China. Conclusion: The study expands the genotypic spectrum of PFIC. We identified nine novel mutations of PFIC and our findings could help in the diagnosis and treatment of this disease.

Keywords

References

  1. Henkel SA, Squires JH, Ayers M, Ganoza A, Mckiernan P, Squires JE. Expanding etiology of progressive familial intrahepatic cholestasis. World J Hepatol 2019;11:450-63. https://doi.org/10.4254/wjh.v11.i5.450
  2. Davit-Spraul A, Gonzales E, Baussan C, Jacquemin E. Progressive familial intrahepatic cholestasis. Orphanet J Rare Dis 2009;4:1. https://doi.org/10.1186/1750-1172-4-1
  3. Srivastava A. Progressive familial intrahepatic cholestasis. J Clin Exp Hepatol 2014;4:25-36. https://doi.org/10.1016/j.jceh.2013.10.005
  4. Jacquemin E. Progressive familial intrahepatic cholestasis. Clin Res Hepatol Gastroenterol 2012;36 Suppl 1:S26-35. https://doi.org/10.1016/S2210-7401(12)70018-9
  5. Hori T, Nguyen JH, Uemoto S. Progressive familial intrahepatic cholestasis. Hepatobiliary Pancreat Dis Int 2010;9:570-8.
  6. Baussan C, Cresteil D, Gonzales E, Raynaud N, Dumont M, Bernard O, et al. Genetic cholestatic liver diseases: the example of progressive familial intrahepatic cholestasis and related disorders. Acta Gastroenterol Belg 2004;67:179-83.
  7. Davit-Spraul A, Fabre M, Branchereau S, Baussan C, Gonzales E, Stieger B, et al. ATP8B1 and ABCB11 analysis in 62 children with normal gamma-glutamyl transferase progressive familial intrahepatic cholestasis (PFIC): phenotypic differences between PFIC1 and PFIC2 and natural history. Hepatology 2010;51:1645-55. https://doi.org/10.1002/hep.23539
  8. Sharma A, Poddar U, Agnihotry S, Phadke SR, Yachha SK, Aggarwal R. Spectrum of genomic variations in Indian patients with progressive familial intrahepatic cholestasis. BMC Gastroenterol 2018;18:107. https://doi.org/10.1186/s12876-018-0835-6
  9. Lang T, Haberl M, Jung D, Drescher A, Schlagenhaufer R, Keil A, et al. Genetic variability, haplotype structures, and ethnic diversity of hepatic transporters MDR3 (ABCB4) and bile salt export pump (ABCB11). Drug Metab Dispos 2006;34:1582-99. https://doi.org/10.1124/dmd.105.008854
  10. Park JS, Ko JS, Seo JK, Moon JS, Park SS. Clinical and ABCB11 profiles in Korean infants with progressive familial intrahepatic cholestasis. World J Gastroenterol 2016;22:4901-7. https://doi.org/10.3748/wjg.v22.i20.4901
  11. Whitington PF, Whitington GL. Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis. Gastroenterology 1988;95:130-6. https://doi.org/10.1016/0016-5085(88)90301-0
  12. M Z, S M D, F E, M R F, M M, S M B T. In-silico evaluation of rare codons and their positions in the structure of ATP8b1 gene. J Biomed Phys Eng 2019;9:105-20.
  13. Lykavieris P, van Mil S, Cresteil D, Fabre M, Hadchouel M, Klomp L, et al. Progressive familial intrahepatic cholestasis type 1 and extrahepatic features: no catch-up of stature growth, exacerbation of diarrhea, and appearance of liver steatosis after liver transplantation. J Hepatol 2003;39:447-52. https://doi.org/10.1016/S0168-8278(03)00286-1
  14. Klomp LW, Vargas JC, van Mil SW, Pawlikowska L, Strautnieks SS, van Eijk MJ, et al. Characterization of mutations in ATP8B1 associated with hereditary cholestasis. Hepatology 2004;40:27-38. https://doi.org/10.1002/hep.20285
  15. Egawa H, Yorifuji T, Sumazaki R, Kimura A, Hasegawa M, Tanaka K. Intractable diarrhea after liver transplantation for Byler's disease: successful treatment with bile adsorptive resin. Liver Transpl 2002;8:714-6. https://doi.org/10.1053/jlts.2002.34384
  16. Liu LY, Wang XH, Wang ZL, Zhu QR, Wang JS. Characterization of ATP8B1 gene mutations and a hot-linked mutation found in Chinese children with progressive intrahepatic cholestasis and low GGT. J Pediatr Gastroenterol Nutr 2010;50:179-83. https://doi.org/10.1097/MPG.0b013e3181c1b368
  17. Walkowiak J, Jankowska I, Pawlowska J, Strautnieks S, Bull L, Thompson R, et al. Exocrine pancreatic function in children with progressive familial intrahepatic cholestasis type 2. J Pediatr Gastroenterol Nutr 2006;42:416-8. https://doi.org/10.1097/01.mpg.0000218154.26792.6a
  18. Chen HL, Liu YJ, Su YN, Wang NY, Wu SH, Ni YH, et al. Diagnosis of BSEP/ABCB11 mutations in Asian patients with cholestasis using denaturing high performance liquid chromatography. J Pediatr 2008;153:825-32. https://doi.org/10.1016/j.jpeds.2008.06.034
  19. Strautnieks SS, Bull LN, Knisely AS, Kocoshis SA, Dahl N, Arnell H, et al. A gene encoding a liver-specific ABC transporter is mutated in progressive familial intrahepatic cholestasis. Nat Genet 1998;20:233-8. https://doi.org/10.1038/3034
  20. Strautnieks SS, Byrne JA, Pawlikowska L, Cebecauerova D, Rayner A, Dutton L, et al. Severe bile salt export pump deficiency: 82 different ABCB11 mutations in 109 families. Gastroenterology 2008;134:1203-14. https://doi.org/10.1053/j.gastro.2008.01.038
  21. Davit-Spraul A, Gonzales E, Baussan C, Jacquemin E. The spectrum of liver diseases related to ABCB4 gene mutations: pathophysiology and clinical aspects. Semin Liver Dis 2010;30:134-46. https://doi.org/10.1055/s-0030-1253223
  22. Gordo-Gilart R, Andueza S, Hierro L, Martinez-Fernandez P, D'Agostino D, Jara P, et al. Functional analysis of ABCB4 mutations relates clinical outcomes of progressive familial intrahepatic cholestasis type 3 to the degree of MDR3 floppase activity. Gut 2015;64:147-55. https://doi.org/10.1136/gutjnl-2014-306896