Genetics



Condition / Diagnosis
Gene / Product
Rotor Syndrome
SLCO1B gene on Chromosome 2q37
Encodes the transport protein OATP1B (reuptake of circulating bilirubin)
AR
Dubin-Johnson Syndrome
ABCC2 (previously MRP2) on Chomosome 10q24
Encodes the MRP2 transporter (Secretion of conjugated bilirubin into bile canaliculus)
AR
Gilbert Syndrome
Variety of mutations on UGT1A1 gene on Chomosome 2q37
Encodes UGT 1A1 bilirubin conjugating enzyme
AR but can have missense mutation
Crigler-Najjar Syndrome
UGT1A1 gene on Chomosome 2q37
Encodes UGT 1A1 bilirubin conjugating enzyme (Type I - totally absent)
Mostly AR
Alagille Syndrome
Jagged 1 gene on Chromosome 20
Encodes Jag1/Notch protein
AD with variable penetrance
Progressive Familial Intrahepatic Cholestasis 1
(PFIC)
ATP8B1 Gene  on Chromosome 18q21-22 encodes FIC1 protein
Low GGT, Coarse granular "Byler Bile" on electron microscopy
Same Gene/Protein defect in BRIC1 and Greenland familial cholestasis (GFC)
AR
Progressive Familial Intrahepatic Cholestasis 2
BSEP (ABCB11) Gene on Chromosome 2q24
Low GGT, neonatal giant cell hepatitis and amorphous canalicular bile on EM
Risk of HCC or cholangiocarcinoma
AR
Progressive Familial Intrahepatic Cholestasis 3
MDR3 (ABCB4) Gene on Chromosome 7q21
High GGT, bile duct proliferation and periportal bile on EM
AR
PFIC Associated gene
Gene TJP2 on Chromosome 9q2
Early onset cholestasis with severe liver disease - end stage before adulthood
AR
Benign Recurrent Intrahepatic Cholestasis (BRIC)
Gene ATP8B1 on chromosome 18q21-31 (BRIC type 1) and gene ABCB1/BSEP on chromosome 2q24 (Bric type 2)
normal GGT; intermittent, recurrent cholestasis asymptomatic between episodes
AR
Δ 4 -3-Oxosteroid-5β - reductase deficiency
Gene AKR1D1 encodes 5β - reductase protein
Bile Acid synthetic defect - Neonatal cholestasis with giant cell hepatitis
  3β - hydroxy-5-C27-steroid oxidoreductase / dehydrogenase/ isomerase deficiency ( 3βHSD ) **Most Common Bile Acid Defect reported**
Gene HSD3B7 encodes C27- 3β-HSD protein
H/o consanguinity common, Tx with Cholbam (Cholic acid)
Oxysterol 7α - hydroxylase deficiency
Gene CYP7BI encodes CYP7BI protein which regulates acidic pathway of bile acid synthesis
5 cases reported
BAAT deficiency

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Familial hypercholanemia (FHCA)
Gene BAAT encodes BAAT protein/enzyme which transfers bile acid moiety from the acyl coenzyme A thioester to either glycine or taurine
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FHCA1 - Gene TJP2 on Chromosome 9q21.11 ; elevated concentrations of bile acids (usually conjugated)
FHCA2 - Gene SLC10A1 on chromosome 14q24  ;
  • Persistently elevated bile salts. Most infants are asymptomatic with either transient jaundice or transient elevation of transaminases, which improve with age.
  • Impaired absorption of fat soluble vitamins (D&K) --> decreased bone mineral density and coagulopathy
Farnesoid X receptor (FXR) deficiency
Gene NR1H4 encodes nuclear hormone receptor (Fernesoid X receptor)
FXR regulates bile acid metabolism by sensing levels of bile acids. When elevated, FXR will inhibit/repress bile acid synthesis
α -methylacyl-coenzyme A (CoA) racemase deficiency
  • AMACR gene (found in peroxisomes) on Chromosome 5p13.2
  • Defects in inhibition of cholesterol side chain oxidation
  • Cholestatic liver disease, fat soluble vitamin deficiencies and coagulopathy or can present in adult with peripheral neuropathy
  • Urine Bile Acids show: decreased primary Bile Acids and increased trihydroxycholestanoic (also found in alligator bile) and pristanic acids
  • EM shows decreased peroxisomes

Wilson Disease
Gene ATP7B on chromosome 13q14.3 encoding ATP7B (P-type ATPase copper export pump)
Autosomal Dominant Polycystic Kidney Disease
ADPKD
Gene PKD1 on Chromosome 16p13.3 Encodes PKD1
Note - there are other forms (PKD1 through PKD7 all caused by different mutations)
Autosomal Recessive polycystic kidney disease
ARPKD
Gene PKHD1 encodes Fibrocystin (ciliary function and tubulogenesis)
Autosomal Dominant Polycystic Liver Disease
ADPLD
Gene PRKCSH encodes Hepatocystin
Aagenaes Syndrome
Chromosome 15q
Recurrent cholestasis and lymphedema
AR


References:

Nelsons
https://omim.org/
NASPGHAN Fellows handbook