Journal
CLINICAL SCIENCE
Volume 120, Issue 7-8, Pages 287-296Publisher
PORTLAND PRESS LTD
DOI: 10.1042/CS20100246
Keywords
bile acid transport; bile salt export pump (BSEP); cirrhosis; farnesoid X receptor (FXR); non-alcoholic fatty liver disease (NAFLD); single nucleotide polymorphism; viral hepatitis
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Funding
- Swiss National Science Foundation (SNF) [310000-122310/1]
- Foundation for Research at the Medical Faculty, University of Zurich
- Roche Pharmaceuticals Switzerland
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Chronic HCV (hepatitis C virus)-associated cirrhosis represents a major indication for liver transplantation. Bile acids contribute to hepatic stellate cell activation as a key event in fibrogenesis. The aim of the present study was to investigate the role of bile acids and polymorphisms in bile acid level-regulating genes on fibrosis progression. A total of 206 subjects with chronic HCV infection were included for ABCB11 (ATP-binding cassette, subfamily B, member 11) 1331 T > C and NR1H4 (nuclear receptor) -1G > T genotyping, 178 of which were analysed for fibrosis stage. Exclusion criteria were HBV (hepatitis B virus) or HIV coinfection, alcohol > 40 g/day and morbid obesity. A total of 358 patients with NAFLD (non-alcoholic fatty liver disease) were genotyped for comparison with a non-viral liver disease. Caucasian individuals (n = 110), undergoing liver resection for focal hepatic metastasis, served as controls. The ABCB11 1331C allele was significantly overrepresented in HCV patients compared with controls {allelic frequency 62.9%; OR (odds ratio), 1.41 [95% CI (confidence interval), 1.012-1.965]}. Median plasma bile acid levels were not significantly increased in the CC compared with TT genotype [7.2 (1-110) mu mol/l compared with 3.5 (1-61) mu mol/l; values are medians (range). A significant association between the presence of cirrhosis and ABCB11 genotype (CC compared with CT or TT, P = 0.047) was observed in the chi(2) test and independent of other risk factors of age, gender, body mass index and disease duration in multivariate analysis (P = 0.010). No such association could be observed in fatty liver patients with regard to advanced fibrosis (F >= 2). The common ABCB11 1331CC genotype, which is present in 40% of HCV patients and renders the carrier susceptible to increased bile acid levels, is associated with cirrhosis.
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