A novel heterozygous deletion in ABCB4 gene in a Chinese family with intrahepatic cholestasis of pregnancy, neonatal hyperbilirubinemia, and cholelithiasis: Case reports and literature review

• Published in: Molecular genetics & genomic medicine Vol. 12; no. 1; pp. e2291 - n/a
• Main Authors: Zheng, Yang, Rao, Qunfang, Han, Yiru, He, Jianqin
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-01-2024
• Subjects: ABCB4; Abdomen; Abnormalities; Acids; Antibodies; Bile ducts; case report; Case reports; Cesarean section; Cholecystectomy; Cholestasis; Diarrhea; Drug therapy; Fetuses; Gallbladder; Gallbladder diseases; Gallstones; Gene deletion; Gene sequencing; Genetic diversity; Genetic factors; Genetic variance; Genomes; heterozygous deletion variant; Hyperbilirubinemia; Infants; intrahepatic cholestasis of pregnancy (ICP); Literature reviews; Liver; neonatal hyperbilirubinemia; Neonates; Pregnancy; Pruritus; Ultrasonic imaging; Ursodeoxycholic acid; Whole genome sequencing; case report; ABCB4; intrahepatic cholestasis of pregnancy (ICP); neonatal hyperbilirubinemia; heterozygous deletion variant
• ISSN: 2324-9269; 2324-9269
• DOI: 10.1002/mgg3.2291

Background
ABCB4 gene (OMIM *171060) variant is associated with a wide clinical spectrum of hepatobiliary diseases, including familial intrahepatic cholestasis of pregnancy (ICP), progressive familial intrahepatic cholestasis type 3 (PFIC3), and neonatal hyperbilirubinemia due to impaired protection of the bile duct. The majority of reported cases, however, were missense or nonsense variants, with few deletion variant findings in the Chinese population.
Method
We performed whole genome sequencing and confirmed it with Sanger sequencing of the proband infant and his families. Clinical courses and laboratory results were documented and collected from the proband infant and his mother. We also reviewed other published cases related to genetic variants in ABCB4 in the Chinese population.
Results
A 26‐year‐old Chinese female (II.2) who had recurrent intrahepatic cholestasis of pregnancy and her 49‐day‐old son (III.4) who had hyperbilirubinemia, both presented with extremely elevated total bile acid, cholestatic dominant pattern liver function abnormalities. They were able to stay relatively stable with mild pruritus on ursodeoxycholic acid treatment. After ruling out other possibilities, genetic sequencing revealed a diagnosis of heterozygous deletion variant NM_018849.3:c.1452_1454del (NP_061337.1:p.Thr485del) in ABCB4, which was not reported before, in the symptomatic mother (II.2), index patient (III.4), and the symptomatic grandmother (I.2). This variant resulted in clinical spectrums of ICP, neonatal hyperbilirubinemia, and cholelithiasis in our pedigree.
Conclusion
We reported a novel heterozygous deletion variant of the ABCB4 gene in a Chinese family, as well as a literature review of ABCB4‐related disorders. We aim to facilitate healthcare professionals to better understand genetic factors as an uncommon cause of hepatobiliary diseases, as well as improve therapeutic strategies in challenging clinical situations such as pregnancy and neonatal care.
We revealed a novel heterozygous deletion variant NM_018849.3:c.1452_1454del (NP_061337.1:p.Thr485del) in ABCB4 gene in a Chinese family. This variant resulted in clinical spectrums of ICP, neonatal hyperbilirubinemia, and cholelithiasis in our pedigree.