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Bing H, Li YL, Li D, Zhang C, Chang B. Case Report: A Rare Heterozygous ATP8B1 Mutation in a BRIC1 Patient: Haploinsufficiency? Front Med (Lausanne) 2022; 9:897108. [PMID: 35783636 PMCID: PMC9243653 DOI: 10.3389/fmed.2022.897108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Benign recurrent intrahepatic cholestasis (BRIC) is an autosomal recessive disorder characterized by recurrent cholestasis. ATPase class I, type 8B, member 1 (ATP8B1) encodes familial intrahepatic cholestasis 1 (FIC1), which acts as a phosphatidylserine reversing enzyme in the tubule membrane of hepatocytes to mediate the inward translocation of phosphatidylserine (PS). At present, dozens of ATP8B1 pathogenic mutations have been identified that mainly cause BRIC1 and progressive familial intrahepatic cholestasis 1 (PFIC1). The diagnosis of BRIC1 is based on symptoms, laboratory tests, imaging, liver histology, and genetic testing. BRIC1 treatment seeks to prevent recurrence and reduce disease severity. At present, the main treatment methods include ursodeoxycholic acid (UDCA), rifampin, cholestyramine and haemofiltration, and endoscopic nasobiliary drainage (ENBD). Here, we report a 17-year-old patient with cholestasis who has a rare heterozygous ATP8B1 gene mutation (p.T888K). The patient was treated with UDCA, glucocorticoids and haemofiltration, after which bilirubin levels gradually returned to normal. This case was thought to be caused by an ATP8B1 heterozygous mutation, which may be related to haploinsufficiency (HI).
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Affiliation(s)
- Hao Bing
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Gastroenterology, Shengjing Hospital Affiliated by China Medical University, Shenyang, China
| | - Yi-Ling Li
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dan Li
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chen Zhang
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Chang
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Bing Chang,
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van Wessel DB, Thompson RJ, Gonzales E, Jankowska I, Shneider BL, Sokal E, Grammatikopoulos T, Kadaristiana A, Jacquemin E, Spraul A, Lipiński P, Czubkowski P, Rock N, Shagrani M, Broering D, Algoufi T, Mazhar N, Nicastro E, Kelly D, Nebbia G, Arnell H, Fischler B, Hulscher JB, Serranti D, Arikan C, Debray D, Lacaille F, Goncalves C, Hierro L, Muñoz Bartolo G, Mozer‐Glassberg Y, Azaz A, Brecelj J, Dezsőfi A, Luigi Calvo P, Krebs‐Schmitt D, Hartleif S, van der Woerd WL, Wang J, Li L, Durmaz Ö, Kerkar N, Hørby Jørgensen M, Fischer R, Jimenez‐Rivera C, Alam S, Cananzi M, Laverdure N, Targa Ferreira C, Ordonez F, Wang H, Sency V, Mo Kim K, Chen H, Carvalho E, Fabre A, Quintero Bernabeu J, Alonso EM, Sokol RJ, Suchy FJ, Loomes KM, McKiernan PJ, Rosenthal P, Turmelle Y, Rao GS, Horslen S, Kamath BM, Rogalidou M, Karnsakul WW, Hansen B, Verkade HJ. Impact of Genotype, Serum Bile Acids, and Surgical Biliary Diversion on Native Liver Survival in FIC1 Deficiency. Hepatology 2021; 74:892-906. [PMID: 33666275 PMCID: PMC8456904 DOI: 10.1002/hep.31787] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/17/2021] [Accepted: 01/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Mutations in ATPase phospholipid transporting 8B1 (ATP8B1) can lead to familial intrahepatic cholestasis type 1 (FIC1) deficiency, or progressive familial intrahepatic cholestasis type 1. The rarity of FIC1 deficiency has largely prevented a detailed analysis of its natural history, effects of predicted protein truncating mutations (PPTMs), and possible associations of serum bile acid (sBA) concentrations and surgical biliary diversion (SBD) with long-term outcome. We aimed to provide insights by using the largest genetically defined cohort of patients with FIC1 deficiency to date. APPROACH AND RESULTS This multicenter, combined retrospective and prospective study included 130 patients with compound heterozygous or homozygous predicted pathogenic ATP8B1 variants. Patients were categorized according to the number of PPTMs (i.e., splice site, frameshift due to deletion or insertion, nonsense, duplication), FIC1-A (n = 67; no PPTMs), FIC1-B (n = 29; one PPTM), or FIC1-C (n = 34; two PPTMs). Survival analysis showed an overall native liver survival (NLS) of 44% at age 18 years. NLS was comparable among FIC1-A, FIC1-B, and FIC1-C (% NLS at age 10 years: 67%, 41%, and 59%, respectively; P = 0.12), despite FIC1-C undergoing SBD less often (% SBD at age 10 years: 65%, 57%, and 45%, respectively; P = 0.03). sBAs at presentation were negatively associated with NLS (NLS at age 10 years, sBAs < 194 µmol/L: 49% vs. sBAs ≥ 194 µmol/L: 15%; P = 0.03). SBD decreased sBAs (230 [125-282] to 74 [11-177] μmol/L; P = 0.005). SBD (HR 0.55, 95% CI 0.28-1.03, P = 0.06) and post-SBD sBA concentrations < 65 μmol/L (P = 0.05) tended to be associated with improved NLS. CONCLUSIONS Less than half of patients with FIC1 deficiency reach adulthood with native liver. The number of PPTMs did not associate with the natural history or prognosis of FIC1 deficiency. sBA concentrations at initial presentation and after SBD provide limited prognostic information on long-term NLS.
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Affiliation(s)
- Daan B.E. van Wessel
- Pediatric Gastroenterology and HepatologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | | | - Emmanuel Gonzales
- Pediatric Hepatology & Pediatric Liver Transplant DepartmentCentre de Référence de l’Atrésie des Voies Biliaires et des Cholestases GénétiquesFilière de Santé des Maladies Rares du Foie de l’enfant et de l’adulteEuropean Reference Network RARE‐LIVERAssistance Publique‐Hôpitaux de ParisFaculté de Médecine Paris‐SaclayCHU BicêtreParisFrance
- European Reference Network on Hepatological Diseases
| | - Irena Jankowska
- European Reference Network on Hepatological Diseases
- Gastroenterology, Hepatology, Nutritional Disorders and Pediatricsthe Children’s Memorial Health InstituteWarsawPoland
| | - Benjamin L. Shneider
- Division of Pediatric Gastroenterology, Hepatology, and NutritionDepartment of PediatricsBaylor College of MedicineHoustonTXUSA
- Childhood Liver Disease Research Network (ChiLDReN)
| | - Etienne Sokal
- European Reference Network on Hepatological Diseases
- Cliniques St. LucUniversité Catholique de LouvainBrusselsBelgium
| | | | | | - Emmanuel Jacquemin
- Pediatric Hepatology & Pediatric Liver Transplant DepartmentCentre de Référence de l’Atrésie des Voies Biliaires et des Cholestases GénétiquesFilière de Santé des Maladies Rares du Foie de l’enfant et de l’adulteEuropean Reference Network RARE‐LIVERAssistance Publique‐Hôpitaux de ParisFaculté de Médecine Paris‐SaclayCHU BicêtreParisFrance
- INSERMUMR‐S 1193Université Paris‐SaclayOrsayFrance
| | - Anne Spraul
- INSERMUMR‐S 1193Université Paris‐SaclayOrsayFrance
- Biochemistry UnitCentre de Référence de l’Atrésie des Voies Biliaires et des Cholestases GénétiquesFilière de Santé des Maladies Rares du Foie de l’enfant et de l’adulteEuropean Reference Network RARE‐LIVERAssistance Publique‐Hôpitaux de ParisFaculté de Médecine Paris‐SaclayCHU BicêtreParisFrance
| | - Patryk Lipiński
- European Reference Network on Hepatological Diseases
- Gastroenterology, Hepatology, Nutritional Disorders and Pediatricsthe Children’s Memorial Health InstituteWarsawPoland
| | - Piotr Czubkowski
- European Reference Network on Hepatological Diseases
- Gastroenterology, Hepatology, Nutritional Disorders and Pediatricsthe Children’s Memorial Health InstituteWarsawPoland
| | - Nathalie Rock
- Cliniques St. LucUniversité Catholique de LouvainBrusselsBelgium
| | - Mohammad Shagrani
- Department of Liver & SB Transplant & Hepatobiliary‐Pancreatic SurgeryKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - Dieter Broering
- Department of Liver & SB Transplant & Hepatobiliary‐Pancreatic SurgeryKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Talal Algoufi
- Department of Liver & SB Transplant & Hepatobiliary‐Pancreatic SurgeryKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Nejat Mazhar
- Department of Liver & SB Transplant & Hepatobiliary‐Pancreatic SurgeryKing Faisal Specialist Hospital & Research CenterRiyadhSaudi Arabia
| | - Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and TransplantationOspedale Papa Giovanni XXIIIBergamoItaly
| | - Deirdre Kelly
- European Reference Network on Hepatological Diseases
- Liver UnitBirmingham Women’s and Children’s HospitalUniversity of BirminghamBirminghamUnited Kingdom
| | - Gabriella Nebbia
- Servizio Di Epatologia e Nutrizione PediatricaFondazione Irccs Ca’ Granda Ospedale Maggiore PoliclinicoMilanoItaly
| | - Henrik Arnell
- European Reference Network on Hepatological Diseases
- Pediatric Digestive DiseasesAstrid Lindgren Children’s HospitalCLINTECKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Björn Fischler
- European Reference Network on Hepatological Diseases
- Pediatric Digestive DiseasesAstrid Lindgren Children’s HospitalCLINTECKarolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Jan B.F. Hulscher
- European Reference Network on Hepatological Diseases
- Pediatric SurgeryUniversity Medical Center GroningenGroningenthe Netherlands
| | - Daniele Serranti
- Pediatric and Liver UnitMeyer Children’s University Hospital of FlorenceFlorenceItaly
| | - Cigdem Arikan
- Pediatric GI and Hepatology Liver Transplantation CenterKuttam System in Liver MedicineKoc University School of MedicineIstanbulTurkey
| | - Dominique Debray
- Pediatric Hepatology unit, Reference Center for Biliary Atresia and Genetic Cholestatic DiseasesFilière de Santé des Maladies Rares du Foie de l’enfant et de l’adulteEuropean Reference Network RARE‐LIVERAPHP‐Neckler Enfants Malades University HospitalFaculté de Médecine Paris‐CentreParisFrance
| | - Florence Lacaille
- Pediatric Hepatology unit, Reference Center for Biliary Atresia and Genetic Cholestatic DiseasesFilière de Santé des Maladies Rares du Foie de l’enfant et de l’adulteEuropean Reference Network RARE‐LIVERAPHP‐Neckler Enfants Malades University HospitalFaculté de Médecine Paris‐CentreParisFrance
| | - Cristina Goncalves
- European Reference Network on Hepatological Diseases
- Coimbra University Hospital CenterCoimbraPortugal
| | - Loreto Hierro
- European Reference Network on Hepatological Diseases
- Pediatric Liver ServiceLa Paz University HospitalMadridSpain
| | - Gema Muñoz Bartolo
- European Reference Network on Hepatological Diseases
- Pediatric Liver ServiceLa Paz University HospitalMadridSpain
| | - Yael Mozer‐Glassberg
- Institute of Gastroenterology, Nutrition and Liver DiseasesSchneider Children’s Medical Center of IsraelPetach TikvahIsrael
| | - Amer Azaz
- Sheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
| | - Jernej Brecelj
- Department of Gastroenterology, Hepatology and NutritionUniversity Children’s Hospital LjubljanaLjubljanaSlovenia
- Department of PediatricsFaculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Antal Dezsőfi
- First Department of PediatricsSemmelweis UniversityBudapestHungary
| | - Pier Luigi Calvo
- Pediatic Gastroenterology UnitRegina Margherita Children’s HospitalAzienda Ospedaliera Città Della Salute e Della Scienza University HospitalTorinoItaly
| | | | - Steffen Hartleif
- European Reference Network on Hepatological Diseases
- University Children’s Hospital TϋbingenTϋbingenGermany
| | - Wendy L. van der Woerd
- Pediatric Gastroenterology, Hepatology and NutritionWilhelmina Children’s HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Jian‐She Wang
- Children’s Hospital of Fudan UniversityShanghaiChina
| | - Li‐ting Li
- Children’s Hospital of Fudan UniversityShanghaiChina
| | - Özlem Durmaz
- Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Nanda Kerkar
- Pediatric Gastroenterology, Hepatology and NutritionUniversity of Rochester Medical CenterRochesterNYUSA
| | - Marianne Hørby Jørgensen
- European Reference Network on Hepatological Diseases
- Pediatric and Adolescent DepartmentDepartment of Pediatrics and Adolescent MedicineRigshospitalet Copenhagen University HospitalCopenhagenDenmark
| | - Ryan Fischer
- Section of Hepatology and Transplant MedicineChildren’s Mercy HospitalKansas CityMOUSA
| | - Carolina Jimenez‐Rivera
- Department of PediatricsChildren’s Hospital of Eastern OntarioUniversity of OttawaOttawaCanada
| | - Seema Alam
- Pediatric HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Mara Cananzi
- European Reference Network on Hepatological Diseases
- Pediatric Gastroenterology and HepatologyUniversity Hospital of PadovaPadovaItaly
| | - Noémie Laverdure
- European Reference Network on Hepatological Diseases
- Service de Gastroentérologie, Hépatologie et Nutrition PédiatriquesHospices Civils de LyonHôpital Femme Mère EnfantLyonFrance
| | | | - Felipe Ordonez
- Fundación Cardioinfantil Instituto de CardiologiaPediatric Gastroenterology and HepatologyBogotáColombia
| | - Heng Wang
- DDC Clinic Center for Special Needs ChildrenMiddlefieldOHUSA
| | - Valerie Sency
- DDC Clinic Center for Special Needs ChildrenMiddlefieldOHUSA
| | - Kyung Mo Kim
- Department of PediatricsAsan Medical Center Children’s HospitalSeoulSouth Korea
| | - Huey‐Ling Chen
- Division of Pediatric Gastroenterology, Hepatology and NutritionNational Taiwan University Children’s HospitalTaipeiTaiwan
| | - Elisa Carvalho
- Pediatric Gastroenterology and HepatologyBrasília Children’s HospitalBrasiliaBrazil
| | - Alexandre Fabre
- INSERMMMGAix Marseille UniversityMarseilleFrance
- Serveice de Pédiatrie MultidisciplinaireTimone EnfantMarseilleFrance
| | - Jesus Quintero Bernabeu
- European Reference Network on Hepatological Diseases
- Pediatric Hepatology and Liver Transplant UnitBarcelonaSpain
| | - Estella M. Alonso
- Childhood Liver Disease Research Network (ChiLDReN)
- Division of Pediatric Gastroenterology, Hepatology and NutritionAnn & Robert H. Lurie Children’s HospitalChicagoILUSA
| | - Ronald J. Sokol
- Childhood Liver Disease Research Network (ChiLDReN)
- Section of Pediatric Gastroenterology, Hepatology and NutritionDepartment of PediatricsChildren’s Hospital ColoradoUniversity of Colorado School of MedicineAuroraCOUSA
| | - Frederick J. Suchy
- Childhood Liver Disease Research Network (ChiLDReN)
- Icahn School of Medicine at Mount SinaiMount Sinai Kravis Children’s HospitalNew YorkNYUSA
| | - Kathleen M. Loomes
- Childhood Liver Disease Research Network (ChiLDReN)
- Division of Gastroenterology, Hepatology and NutritionChildren’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Patrick J. McKiernan
- Childhood Liver Disease Research Network (ChiLDReN)
- Department of Pediatric Gastroenterology and HepatologyUniversity of Pittsburgh Medical Center Children’s Hospital of PittsburghPittsburghPAUSA
| | - Philip Rosenthal
- Childhood Liver Disease Research Network (ChiLDReN)
- Department of Pediatrics and SurgeryUCSF Benioff Children’s HospitalUniversity of California San Francisco School of MedicineSan FranciscoCAUSA
| | - Yumirle Turmelle
- Childhood Liver Disease Research Network (ChiLDReN)
- Section of HepatologyDepartment of PediatricsSt. Louis Children’s HospitalWashington University School of MedicineSt. LouisMOUSA
| | - Girish S. Rao
- Childhood Liver Disease Research Network (ChiLDReN)
- Riley Hospital for ChildrenIndiana University School of MedicineIndianapolisINUSA
| | - Simon Horslen
- Childhood Liver Disease Research Network (ChiLDReN)
- Department of PediatricsSeattle Children’s HospitalUniversity of WashingtonSeattleWAUSA
| | - Binita M. Kamath
- Childhood Liver Disease Research Network (ChiLDReN)
- The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
| | - Maria Rogalidou
- Division of Pediatric Gastroenterology & HepatologyFirst Pediatrics DepartmentUniversity of AthensAgia Sofia Children’s HospitalAthensGreece
| | - Wikrom W. Karnsakul
- Division of Pediatric Gastroenterology, Nutrition, and HepatologyDepartment of PediatricsJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Bettina Hansen
- Toronto Center for Liver DiseaseUniversity Health NetworkTorontoCanada
- IHPMEUniversity of TorontoTorontoCanada
| | - Henkjan J. Verkade
- Pediatric Gastroenterology and HepatologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
- European Reference Network on Hepatological Diseases
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Liver Steatosis and Diarrhea After Liver Transplantation for Progressive Familial Intrahepatic Cholestasis Type 1: Can Biliary Diversion Solve These Problems? J Pediatr Gastroenterol Nutr 2021; 72:341-342. [PMID: 33230072 DOI: 10.1097/mpg.0000000000002990] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cariello M, Piccinin E, Garcia-Irigoyen O, Sabbà C, Moschetta A. Nuclear receptor FXR, bile acids and liver damage: Introducing the progressive familial intrahepatic cholestasis with FXR mutations. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1308-1318. [PMID: 28965883 DOI: 10.1016/j.bbadis.2017.09.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 02/07/2023]
Abstract
The nuclear receptor farnesoid X receptor (FXR) is the master regulator of bile acids (BAs) homeostasis since it transcriptionally drives modulation of BA synthesis, influx, efflux, and detoxification along the enterohepatic axis. Due to its crucial role, FXR alterations are involved in the progression of a plethora of BAs associated inflammatory disorders in the liver and in the gut. The involvement of the FXR pathway in cholestasis development and management has been elucidated so far with a direct role of FXR activating therapy in this condition. However, the recent identification of a new type of genetic progressive familial intrahepatic cholestasis (PFIC) linked to FXR mutations has strengthen also the bona fide beneficial effects of target therapies that by-pass FXR activation, directly promoting the action of its target, namely the enterokine FGF19, in the repression of hepatic BAs synthesis with reduction of total BA levels in the liver and serum, accomplishing one of the major goals in cholestasis. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni and Peter Jansen.
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Affiliation(s)
- Marica Cariello
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, 70124 Bari, Italy
| | - Elena Piccinin
- INBB, National Institute for Biostructures and Biosystems, 00136 Rome, Italy
| | - Oihane Garcia-Irigoyen
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, 70124 Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, 70124 Bari, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, 70124 Bari, Italy; National Cancer Center, IRCCS Istituto Oncologico "Giovanni Paolo II", 70124 Bari, Italy.
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5
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Liu L, Zhang L, Zhang L, Yang F, Zhu X, Lu Z, Yang Y, Lu H, Feng L, Wang Z, Chen H, Yan S, Wang L, Ju Z, Jin H, Zhu X. Hepatic Tmem30a Deficiency Causes Intrahepatic Cholestasis by Impairing Expression and Localization of Bile Salt Transporters. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:2775-2787. [PMID: 28919113 DOI: 10.1016/j.ajpath.2017.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/21/2017] [Accepted: 08/17/2017] [Indexed: 02/07/2023]
Abstract
Mutations in ATP8B1 or ATP11C (members of P4-type ATPases) cause progressive familial intrahepatic cholestasis type 1 in human or intrahepatic cholestasis in mice. Transmembrane protein 30A (TMEM30A), a β-subunit, is essential for the function of ATP8B1 and ATP11C. However, its role in the etiology of cholestasis remains poorly understood. To investigate the function of TMEM30A in bile salt (BS) homeostasis, we developed Tmem30a liver-specific knockout (LKO) mice. Tmem30a LKO mice experienced hyperbilirubinemia, hypercholanemia, inflammatory infiltration, ductular proliferation, and liver fibrosis. The expression and membrane localization of ATP8B1 and ATP11C were significantly reduced in Tmem30a LKO mice, which correlated with the impaired expression and localization of BS transporters, such as OATP1A4, OATP1B2, NTCP, BSEP, and MRP2. The proteasome inhibitor bortezomib partially restored total protein levels of BS transporters but not the localization of BS transporters in the membrane. Furthermore, the expression of nuclear receptors, including FXRα, RXRα, HNF4α, LRH-1, and SHP, was also down-regulated. A cholic acid-supplemented diet exacerbated the liver damage in Tmem30a LKO mice. TMEM30A deficiency led to intrahepatic cholestasis in mice by impairing the expression and localization of BS transporters and the expression of related nuclear receptors. Therefore, TMEM30A may be a novel genetic determinant of intrahepatic cholestasis.
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Affiliation(s)
- Leiming Liu
- Laboratory of Cancer Biology, Key Laboratory of Biotherapy in Zhejiang Province, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Key Laboratory of Regenerative Medicine of Ministry of Education, Institute of Aging and Regenerative Medicine, Jinan University, Guangzhou, China
| | - Lingling Zhang
- Institute of Aging Research, Leibniz Link Partner Group on Stem Cell Aging, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Lin Zhang
- Sichuan Provincial Key Laboratory for Human Disease Gene Study and School of Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China; Key Laboratory for NeuroInformation of Ministry of Education and Medicine Information Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fan Yang
- Key Laboratory of Regenerative Medicine of Ministry of Education, Institute of Aging and Regenerative Medicine, Jinan University, Guangzhou, China; Leibniz Institute for Age Research - Fritz Lipmann Institute, Friedrich-Schiller University of Jena, Jena, Germany
| | - Xudong Zhu
- Institute of Aging Research, Leibniz Link Partner Group on Stem Cell Aging, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Zhongjie Lu
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yeming Yang
- Sichuan Provincial Key Laboratory for Human Disease Gene Study and School of Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China; Key Laboratory for NeuroInformation of Ministry of Education and Medicine Information Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Haiqi Lu
- Laboratory of Cancer Biology, Key Laboratory of Biotherapy in Zhejiang Province, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lifeng Feng
- Laboratory of Cancer Biology, Key Laboratory of Biotherapy in Zhejiang Province, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhuo Wang
- Laboratory of Cancer Biology, Key Laboratory of Biotherapy in Zhejiang Province, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Chen
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Yan
- Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lin Wang
- Department of Hepato-Biliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhenyu Ju
- Key Laboratory of Regenerative Medicine of Ministry of Education, Institute of Aging and Regenerative Medicine, Jinan University, Guangzhou, China; Institute of Aging Research, Leibniz Link Partner Group on Stem Cell Aging, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Hongchuan Jin
- Laboratory of Cancer Biology, Key Laboratory of Biotherapy in Zhejiang Province, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Xianjun Zhu
- Sichuan Provincial Key Laboratory for Human Disease Gene Study and School of Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China; Key Laboratory for NeuroInformation of Ministry of Education and Medicine Information Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Mali VP, Fukuda A, Shigeta T, Uchida H, Hirata Y, Rahayatri TH, Kanazawa H, Sasaki K, de Ville de Goyet J, Kasahara M. Total internal biliary diversion during liver transplantation for type 1 progressive familial intrahepatic cholestasis: a novel approach. Pediatr Transplant 2016; 20:981-986. [PMID: 27534385 DOI: 10.1111/petr.12782] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 12/11/2022]
Abstract
LT for PFIC type 1 is often complicated by postoperative diarrhea and recurrent graft steatosis. A 26-month-old female child with cholestatic jaundice, pruritus, diarrhea, and growth retardation revealed total bilirubin 9.1 mg/dL, gamma-glutamyl transpeptidase 64 IU/L, and TBA 295.8 μmol/L. Genetic analysis confirmed ATP8B1 defects. A LT (segment 2, 3 graft) from the heterozygous father was performed. Biliary diversion was performed by a 35-cm jejunum conduit between the graft hepatic duct and the mid-transverse colon. Stools became pigmented immediately. Follow-up at 138 days revealed resolution of jaundice and pruritus and soft-to-hard stools (6-8 daily). Radioisotope hepato-biliary scintigraphy (days 26, 68, and 139) confirmed unobstructed bile drainage into the colon (t1/2 34, 27, and 19 minutes, respectively). Contrast meal follow-through at day 62 confirmed the absence of any colo-jejuno-hepatic reflux. At 140 days, contrast follow-through via the biliary stent revealed patent jejuno-colonic anastomosis and satisfactory transit. Graft biopsy at LT, 138 days, and 9 months follow-up revealed comparable grades of macrovesicular steatosis (<20%). TIBD during LT may be a clinically effective stoma-free biliary diversion and may prevent recurrent graft steatosis following LT for PFIC type 1.
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Affiliation(s)
- V P Mali
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
| | - A Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - T Shigeta
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Y Hirata
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - T H Rahayatri
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - H Kanazawa
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - K Sasaki
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - J de Ville de Goyet
- Department of Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy.,Paediatric Surgery Chair, Università di Roma Tor Vergata, Rome, Italy
| | - M Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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Zhang Y, Liu KX. Promoting expression of transporters for treatment of progressive familial intrahepatic cholestasis disease. Shijie Huaren Xiaohua Zazhi 2015; 23:2681-2687. [DOI: 10.11569/wcjd.v23.i17.2681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous group of autosomal recessive genetic diseases with a major clinical manifestation of severe intrahepatic cholestasis and an incidence rate of 1/10000 to 1/5000. PFIC is usually first diagnosed in infancy or childhood and eventually develops into liver failure and death. Based on clinical manifestations, laboratory tests, and genetic defects in liver tissue, PFIC is roughly divided into three types: PFIC-1, PFIC-2 and PFIC-3. Studies have demonstrated that all three types of PFIC are associated with the mutations of bile transport system genes in the liver. Promoting transporter expression has important clinical significance for the treatment of PFIC. In this paper, we summarize the etiology and treatment status of PFIC and discuss the treatment of PFIC by promoting the expression of transporters.
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Srivastava A. Progressive familial intrahepatic cholestasis. J Clin Exp Hepatol 2014; 4:25-36. [PMID: 25755532 PMCID: PMC4017198 DOI: 10.1016/j.jceh.2013.10.005] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/31/2013] [Indexed: 12/12/2022] Open
Abstract
Progressive familial intrahepatic cholestasis (PFIC) is a group of rare disorders which are caused by defect in bile secretion and present with intrahepatic cholestasis, usually in infancy and childhood. These are autosomal recessive in inheritance. The estimated incidence is about 1 per 50,000 to 1 per 100,000 births, although exact prevalence is not known. These diseases affect both the genders equally and have been reported from all geographical areas. Based on clinical presentation, laboratory findings, liver histology and genetic defect, these are broadly divided into three types-PFIC type 1, PFIC type 2 and PFIC type 3. The defect is in ATP8B1 gene encoding the FIC1 protein, ABCB 11 gene encoding BSEP protein and ABCB4 gene encoding MDR3 protein in PFIC1, 2 and 3 respectively. The basic defect is impaired bile salt secretion in PFIC1/2 whereas in PFIC3, it is reduced biliary phospholipid secretion. The main clinical presentation is in the form of cholestatic jaundice and pruritus. Serum gamma glutamyl transpeptidase (GGT) is normal in patients with PFIC1/2 while it is raised in patients with PFIC3. Treatment includes nutritional support (adequate calories, supplementation of fat soluble vitamins and medium chain triglycerides) and use of medications to relieve pruritus as initial therapy followed by biliary diversion procedures in selected patients. Ultimately liver transplantation is needed in most patients as they develop progressive liver fibrosis, cirrhosis and end stage liver disease. Due to the high risk of developing liver tumors in PFIC2 patients, monitoring is recommended from infancy. Mutation targeted pharmacotherapy, gene therapy and hepatocyte transplantation are being explored as future therapeutic options.
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Key Words
- ABC, ATP binding cassette
- ASBT, apical sodium bile salt transporter
- ATP, adenosine triphosphate
- ATPase, adenosine triphosphatase
- BRIC, benign recurrent intrahepatic cholestasis
- BSEP, bile salt exporter protein
- CFTR, cystic fibrosis transmembrane conductance regulator
- CYP, cytochrome P
- DNA, deoxyribonucleic acid
- ERAD, endoplasmic reticulum associated degradation
- ESLD, end stage liver disease
- FIC1, familial intrahepatic cholestasis protein 1
- FXR, farnesoid X receptor
- HCC, hepatocellular carcinoma
- IB, ileal bypass
- ICP, intrahepatic cholestasis of pregnancy
- LT, liver transplant
- MARS, Molecular Adsorbent Recirculating System
- MDR, multidrug resistance protein
- MRCP, magnetic resonance cholangiopancreaticography
- PBD, partial biliary drainage
- PEBD, partial external biliary drainage
- PFIC, progressive familial intrahepatic cholestasis
- PIBD, partial internal biliary drainage
- PPAR, peroxisome proliferator activator receptor
- UDCA, ursodeoxycholic acid
- bile secretion
- children
- cholestasis
- familial
- mRNA, messenger ribonucleic acid
- pGp, p-glycoprotein
- pruritus
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Affiliation(s)
- Anshu Srivastava
- Address for correspondence: Anshu Srivastava, Associate Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India. Tel.: +91 522 2495212, +91 9935219497 (mobile); fax: +91 522 2668017.
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van der Mark VA, Elferink RPJO, Paulusma CC. P4 ATPases: flippases in health and disease. Int J Mol Sci 2013; 14:7897-922. [PMID: 23579954 PMCID: PMC3645723 DOI: 10.3390/ijms14047897] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/28/2013] [Accepted: 04/07/2013] [Indexed: 12/26/2022] Open
Abstract
P4 ATPases catalyze the translocation of phospholipids from the exoplasmic to the cytosolic leaflet of biological membranes, a process termed “lipid flipping”. Accumulating evidence obtained in lower eukaryotes points to an important role for P4 ATPases in vesicular protein trafficking. The human genome encodes fourteen P4 ATPases (fifteen in mouse) of which the cellular and physiological functions are slowly emerging. Thus far, deficiencies of at least two P4 ATPases, ATP8B1 and ATP8A2, are the cause of severe human disease. However, various mouse models and in vitro studies are contributing to our understanding of the cellular and physiological functions of P4-ATPases. This review summarizes current knowledge on the basic function of these phospholipid translocating proteins, their proposed action in intracellular vesicle transport and their physiological role.
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Affiliation(s)
- Vincent A van der Mark
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Meibergdreef 69-71, 1105 BK Amsterdam, The Netherlands.
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Chen F, Ghosh A, Shneider BL. Phospholipase D2 mediates signaling by ATPase class I type 8B membrane 1. J Lipid Res 2013; 54:379-85. [PMID: 23213138 PMCID: PMC3588867 DOI: 10.1194/jlr.m030304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 12/03/2012] [Indexed: 01/12/2023] Open
Abstract
Functional defects in ATPase class I type 8B membrane 1 (ATP8B1 or familial intrahepatic cholestasis 1, FIC1) lead to cholestasis by mechanism(s) that are not fully understood. One proposed pathophysiology involves aberrant signaling to the bile acid sensor, the farnesoid X receptor (FXR), via protein kinase C ζ (PKCζ). The following cell line-based studies investigated whether phospholipase D2 may transduce a signal from FIC1 to FXR. PLD2 gain of function led to activation of the bile salt export pump (BSEP) promoter, a well-characterized FXR response. BSEP activation by PLD2 could be blocked by abrogating either PKCζ or FXR signaling. PLD2 loss of function led to a reduction in BSEP promoter activity. In addition, a variety of proteins that are activated by FXR, including BSEP, were reduced in HepG2 cells treated with PLD2 siRNA. Similar effects were observed in freshly isolated human hepatocytes. Activation of BSEP by FIC1 gain of function was blocked when PLD2 but not PLD1 was silenced. Overexpression of wild-type but not Byler mutant FIC1 led to an increase in membrane associated PLD activity. An intermediate level of activation of PLD activity was induced when a benign recurrent intrahepatic cholestasis FIC1 mutant construct was expressed. These studies show that FIC1 signals to FXR via a signaling pathway including PLD2 and PKCζ.
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Affiliation(s)
- Frank Chen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ayantika Ghosh
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Benjamin L. Shneider
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Allen RM, Marquart TJ, Albert CJ, Suchy FJ, Wang DQH, Ananthanarayanan M, Ford DA, Baldán A. miR-33 controls the expression of biliary transporters, and mediates statin- and diet-induced hepatotoxicity. EMBO Mol Med 2012; 4:882-95. [PMID: 22767443 PMCID: PMC3491822 DOI: 10.1002/emmm.201201228] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/16/2012] [Accepted: 05/23/2012] [Indexed: 12/25/2022] Open
Abstract
Bile secretion is essential for whole body sterol homeostasis. Loss-of-function mutations in specific canalicular transporters in the hepatocyte disrupt bile flow and result in cholestasis. We show that two of these transporters, ABCB11 and ATP8B1, are functional targets of miR-33, a micro-RNA that is expressed from within an intron of SREBP-2. Consequently, manipulation of miR-33 levels in vivo with adenovirus or with antisense oligonucleotides results in changes in bile secretion and bile recovery from the gallbladder. Using radiolabelled cholesterol, we show that systemic silencing of miR-33 leads to increased sterols in bile and enhanced reverse cholesterol transport in vivo. Finally, we report that simvastatin causes, in a dose-dependent manner, profound hepatotoxicity and lethality in mice fed a lithogenic diet. These latter results are reminiscent of the recurrent cholestasis found in some patients prescribed statins. Importantly, pretreatment of mice with anti-miR-33 oligonucleotides rescues the hepatotoxic phenotype. Therefore, we conclude that miR-33 mediates some of the undesired, hepatotoxic effects of statins.
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Affiliation(s)
- Ryan M Allen
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, MO, USA
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Abstract
This article describes the uses of immunostaining in the diagnosis of cholestasis. To immunostain for bile salt export pump (BSEP) and multidrug resistance protein 3 in severe hepatobiliary disease manifest early in life can rapidly identify whether sequencing of ABCB11 or ABCB4 is likely to yield a genetic diagnosis. To immunostain for canalicular ectoenzymes as well as transporters, with transmission electron microscopy, can suggest whether sequencing of ATP8B1 is likely to yield a genetic diagnosis. Demonstrating BSEP expression can direct attention to bile acid synthesis disorders. Immunostaining for multidrug resistance-associated protein 2 serves principally as a control for adequacy of processing.
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Iwayanagi Y, Takada T, Tomura F, Yamanashi Y, Terada T, Inui KI, Suzuki H. Human NPC1L1 expression is positively regulated by PPARα. Pharm Res 2010; 28:405-12. [PMID: 20953676 DOI: 10.1007/s11095-010-0294-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 09/22/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Niemann-Pick C1-like 1 (NPC1L1), a pharmacological target of ezetimibe, is responsible for cholesterol absorption in enterocytes and hepatocytes. In the present study, the involvement of peroxisome proliferator-activated receptor α (PPARα) and its cofactor, PPARγ coactivator 1α (PGC1α) in the transcriptional regulation of human NPC1L1 was analyzed. METHODS Reporter gene assays and electrophoretic mobility shift assays (EMSAs) were performed with the 5'-flanking region of the human NPC1L1 gene and the effect of siPPARα was examined. RESULTS PPARα-mediated transactivation was observed with human NPC1L1 promoter constructs. Detailed analyses using deletion- and mutated-promoter constructs revealed the presence of a functional PPARα-response element (PPRE) upstream of the human NPC1L1 gene (-846/-834), a direct binding of PPARα and RXRα to which was confirmed by EMSAs. Moreover, PPARα-specific knockdown resulted in a significant decrease in the endogenous expression of NPC1L1 mRNA and protein in human-derived HepG2 cells. Furthermore, cotransfection of PGC1α stimulated the SREBP2/HNF4α- and PPARα/RXRα-mediated activation of the human NPC1L1 promoter. CONCLUSIONS We found that PPARα positively regulates human NPC1L1 transcription via direct binding to a PPRE. Additionally, PGC1α stimulates the SREBP2/HNF4α- and PPARα/RXRα-mediated transactivation of human NPC1L1. These findings may provide new insights into the close relationship of glucose, fatty acids and cholesterol homeostasis.
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Affiliation(s)
- Yuki Iwayanagi
- Department of Pharmacy, The University of Tokyo Hospital Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Iwayanagi Y, Takada T, Tomura F, Yamanashi Y, Terada T, Inui KI, Suzuki H. Human NPC1L1 expression is positively regulated by PPARα. Pharm Res 2010. [PMID: 20953676 DOI: 10.1007/s11095-010-0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Niemann-Pick C1-like 1 (NPC1L1), a pharmacological target of ezetimibe, is responsible for cholesterol absorption in enterocytes and hepatocytes. In the present study, the involvement of peroxisome proliferator-activated receptor α (PPARα) and its cofactor, PPARγ coactivator 1α (PGC1α) in the transcriptional regulation of human NPC1L1 was analyzed. METHODS Reporter gene assays and electrophoretic mobility shift assays (EMSAs) were performed with the 5'-flanking region of the human NPC1L1 gene and the effect of siPPARα was examined. RESULTS PPARα-mediated transactivation was observed with human NPC1L1 promoter constructs. Detailed analyses using deletion- and mutated-promoter constructs revealed the presence of a functional PPARα-response element (PPRE) upstream of the human NPC1L1 gene (-846/-834), a direct binding of PPARα and RXRα to which was confirmed by EMSAs. Moreover, PPARα-specific knockdown resulted in a significant decrease in the endogenous expression of NPC1L1 mRNA and protein in human-derived HepG2 cells. Furthermore, cotransfection of PGC1α stimulated the SREBP2/HNF4α- and PPARα/RXRα-mediated activation of the human NPC1L1 promoter. CONCLUSIONS We found that PPARα positively regulates human NPC1L1 transcription via direct binding to a PPRE. Additionally, PGC1α stimulates the SREBP2/HNF4α- and PPARα/RXRα-mediated transactivation of human NPC1L1. These findings may provide new insights into the close relationship of glucose, fatty acids and cholesterol homeostasis.
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Affiliation(s)
- Yuki Iwayanagi
- Department of Pharmacy, The University of Tokyo Hospital Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Nagasaka H, Yorifuji T, Kobayashi K, Takikawa H, Komatsu H, Inui A, Fujisawa T, Miida T, Tsukahara H, Takatani T, Hayashi H. Favorable effect of 4-phenylacetate on liver functions attributable to enhanced bile salt export pump expression in ornithine transcarbamylase-deficient children. Mol Genet Metab 2010; 100:123-8. [PMID: 20219403 DOI: 10.1016/j.ymgme.2010.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
4-Phenylbutyrate (4-PB) acting against hyperammonemia has been administered to patients with urea cycle defects. Results of our recent experiments using animals and cultured cells strongly suggest that this agent enhances the function of bile salt export pump/ATP binding cassette B11 (BSEP/ABCB11) promoting bile acid excretion from hepatocytes to bile canaliculi, although it has not been confirmed in humans. Considering that 4-PB is converted easily into 4-phenylacetate (4-PA) in the liver, such an effect of 4-PB might occur through 4-PA. We performed retrospective analyzes of the effects of 4-PA on the liver functions of three ornithine transcarbamylase (OTC)-deficient female children receiving 4-PA. Two of the three received intravenous administration of 4-PA only at episodic periods of hyperammonemia; the remaining one received it orally at intercurrent periods. Soon after 4-PA administration, the serum total bile acid level was decreased to one-half or one-third of pre-treatment levels, but it returned to the basal levels within one month after 4-PA discontinuation. Other serum parameters for cholestasis such as gamma-glutamyl transferase also decreased markedly. Concomitantly, alanine aminotransferase and aspartate amino transferase levels decreased significantly. Western blot analyzes of the liver samples revealed that the 4-PA administration enhanced BSEP/ABCB11 protein expressions in the membranous fraction of liver cells, although the liver BSEP/ABCB11 messenger RNA level remained unchanged. These results suggest that 4-PA enhanced liver BSEP/ABCB11 function and thereby improved liver functions in OTC-deficient children. For treatment of liver disorders requiring enhancement of BSEP function, 4-PA might be a candidate.
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Affiliation(s)
- Hironori Nagasaka
- Division of Metabolism, Chiba Children's Hospital, Midori-ku, Chiba, Japan.
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Abstract
PURPOSE OF REVIEW Many of the cholestatic diseases show similar clinical features, despite underlying differences in the genetic etiology. The present review aims to present recent insight into this etiological heterogeneity. RECENT FINDINGS Mutations in the genes causing progressive familial intrahepatic cholestasis are also involved in less severe phenotypes like benign recurrent intrahepatic cholestasis, gallstone disease, intrahepatic cholestasis of pregnancy and drug-induced cholestasis. This probably represents a continuum of severity of the mutations involved, but also complex patterns of inheritance ranging from monogenic autosomal recessive disorders to heterozygosity only conferring a moderate increase in disease risk, where additional genetic or environmental factors are needed to acquire a disease phenotype. Recent genome-wide association studies in the inflammatory cholestatic diseases primary biliary cirrhosis and primary sclerosing cholangitis have revealed susceptibility genes involved in autoimmunity and inflammatory bowel disease, whereas the genetic risk factors for the biliary preference of these diseases remain unknown. SUMMARY The complexity of the genetic contribution to cholestatic liver disease needs to be accounted for to fully understand the pathogenesis of these conditions.
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Chen F, Ellis E, Strom SC, Shneider BL. ATPase Class I Type 8B Member 1 and protein kinase C zeta induce the expression of the canalicular bile salt export pump in human hepatocytes. Pediatr Res 2010; 67:183-7. [PMID: 19809379 PMCID: PMC2819672 DOI: 10.1203/pdr.0b013e3181c2df16] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The exact molecular mechanism(s) of the disease that results from defects in the ATPase Class I Type 8B Member 1 gene remains controversial. Prior investigations of human ileum and in intestinal and ovarian cell lines have suggested that familial intrahepatic cholestasis 1 (FIC1) activates the farnesoid X-receptor (FXR) via a pathway involving protein kinase C zeta (PKCzeta). Translational investigations of human liver from individuals with FIC1 disease have been confounded by secondary affects of progressive cholestatic liver disease and limited numbers of samples for analysis. These studies, performed in primarily derived human hepatocytes, circumvent this issue. The canalicular bile salt export pump (BSEP) served as a downstream target of FXR. The siRNA-mediated silencing of FIC1 in human hepatocytes led to a reduction in both human BSEP promoter activity and BSEP protein expression, which correlated with a reduction in FXR expression and redistribution of its localization from the nucleus to the cytoplasm. These changes in BSEP expression could be reproduced by altering the expression of PKCzeta, with a positive correlation of PKCzeta activity and BSEP expression. Overall, these findings support the hypothesis that FIC1 enhances FXR signaling via a PKCzeta-dependent signaling pathway.
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Affiliation(s)
- Frank Chen
- Children's Hospital of Pittsburgh of UPMC and the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA
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Stapelbroek JM, van Erpecum KJ, Klomp LWJ, Houwen RHJ. Liver disease associated with canalicular transport defects: current and future therapies. J Hepatol 2010; 52:258-71. [PMID: 20034695 DOI: 10.1016/j.jhep.2009.11.012] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bile formation at the canalicular membrane is a delicate process. This is illustrated by inherited liver diseases due to mutations in ATP8B1, ABCB11, ABCB4, ABCC2 and ABCG5/8, all encoding hepatocanalicular transporters. Effective treatment of these canalicular transport defects is a clinical and scientific challenge that is still ongoing. Current evidence indicates that ursodeoxycholic acid (UDCA) can be effective in selected patients with PFIC3 (ABCB4 deficiency), while rifampicin reduces pruritus in patients with PFIC1 (ATP8B1 deficiency) and PFIC2 (ABCB11 deficiency), and might abort cholestatic episodes in BRIC (mild ATP8B1 or ABCB11 deficiency). Cholestyramine is essential in the treatment of sitosterolemia (ABCG5/8 deficiency). Most patients with PFIC1 and PFIC2 will benefit from partial biliary drainage. Nevertheless liver transplantation is needed in a substantial proportion of these patients, as it is in PFIC3 patients. New developments in the treatment of canalicular transport defects by using nuclear receptors as a target, enhancing the expression of the mutated transporter protein by employing chaperones, or by mutation specific therapy show substantial promise. This review will focus on the therapy that is currently available as well as on those developments that are likely to influence clinical practice in the near future.
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Affiliation(s)
- Janneke M Stapelbroek
- Department of Paediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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