Intrahepatic cholestasis of pregnancy: the severe form is associated with common variants of the hepatobiliary phospholipid transporter ABCB4 gene

• Published in: Gut Vol. 56; no. 2; pp. 265 - 270
• Main Authors: Wasmuth, H E, Glantz, A, Keppeler, H, Simon, E, Bartz, C, Rath, W, Mattsson, L-Å, Marschall, H-U, Lammert, F
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01-02-2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: ABC; Adult; ATP Binding Cassette Subfamily B Member 11; ATP Binding Cassette Transporter, Sub-Family B - genetics; ATP-binding cassette; ATP-Binding Cassette Transporters - genetics; Bile; Biological and medical sciences; Cholestasis, Intrahepatic - blood; Cholestasis, Intrahepatic - genetics; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gene Frequency - genetics; Genes; Genotype; Haplotypes - genetics; Homozygote; Humans; ICP; intrahepatic cholestasis of pregnancy; Liver; Liver Function Tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Medicin och hälsovetenskap; Mutation; Other diseases. Semiology; Polymorphism, Single Nucleotide - genetics; Pregnancy; Pregnancy Complications - blood; Pregnancy Complications - genetics; Prospective Studies; Risk Factors; Sequence Analysis, DNA - methods; single-nucleotide polymorphism; SNP; Studies; Womens health; Sweden; Europe; Pregnancy; Intrahepatic cholostasis; Skin disease; Hepatobiliary; Deletion; Phospholipid; Digestive diseases; Hepatic disease; Pruritus; Biliary tract disease
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2006.092742

Background: Intrahepatic cholestasis of pregnancy (ICP) is characterised by troublesome maternal pruritus, raised serum bile acid levels and increased fetal risk. Mutations of the ABCB4 gene encoding the hepatobiliary phospholipid transporter have been identified in a small proportion of patients with cholestasis of pregnancy. In a recent prospective study on 693 patients with cholestasis of pregnancy, a cut-off level for serum bile acid (⩾40 μmol/l) was determined for increased risk of fetal complications. Objectives: To investigate whether common combinations of polymorphic alleles (haplotypes) of the genes encoding the hepatobiliary ATP-binding cassette (ABC) transporters for phospholipids (ABCB4) and bile acids (ABCB11) were associated with this severe form of cholestasis of pregnancy. Methods: For genetic analysis, 52 women with bile acid levels ⩾40 μmol/l (called cases) and 52 unaffected women (called controls) matched for age, parity and geographical residence were studied. Gene variants tagging common ABCB4 and ABCB11 haplotypes were genotyped and haplotype distributions were compared between cases and controls by permutation testing. Results: In contrast with ABCB11 haplotypes, ABCB4 haplotypes differed between the two groups (p = 0.019), showing that the severe form of cholestasis of pregnancy is associated with the ABCB4 gene variants. Specifically, haplotype ABCB4_5 occurred more often in cases, whereas haplotypes ABCB4_3 and ABCB4_7 were more common in controls. These associations were reflected by different frequencies of at-risk alleles of the two tagging polymorphisms (c.711A: odds ratio (OR) 2.27, p = 0.04; deletion intron 5: OR 14.68, p = 0.012). Conclusion: Variants of ABCB4 represent genetic risk factors for the severe form of ICP in Sweden.