title: Keratins as susceptibility genes for end-stage liver disease.
abstract: OBJECTIVE
  Keratins 8 and 18 protect the liver from stress. Keratin 8 and 18 variants in 17 of 467 liver disease explants and 2 of 349 blood bank controls were previously reported in 5 analyzed exonic regions. We asked whether mutations were present in the remaining 10 exons of keratins 8 and 18.
  
  
  METHODS
  Exonic regions were polymerase chain reaction-amplified from genomic DNA, isolated from the above-mentioned 2 cohorts, and analyzed for the presence of mutations. Mutant keratins were also studied biochemically.
  
  
  RESULTS
  We identified 10 novel keratin 8 and 18 heterozygous variants in 44 of 467 explants and 11 of 349 controls: keratin 18 deletion (delta64-71), a keratin 8 frameshift that truncates the last 14 amino acids; 8 missense keratin 8 and 18 alterations; and several new polymorphisms. The most common variant, keratin 8 R340H, at the highly conserved R340 was found in 30 of 467 explants and 10 of 349 controls (P = .02) and was confirmed in the diseased livers by generation of an R340H-specific antibody. Germline transmission and variant protein expression were verified. The mutations involved a variety of liver diseases, and some variants had an ethnic background preponderance. Mutations that introduced disulfide bonds (keratin 8 G61C or R453C) decreased keratin solubility, particularly after oxidative stress, whereas others decreased keratin 8 phosphorylation (keratin 8 G433S).
  
  
  CONCLUSIONS
  The overall frequency of keratin 8 and 18 variants was 12.4% in 467 liver disease explants and 3.7% in 349 blood bank controls (P < .0001). Variants can alter keratin solubility or phosphorylation and may render individuals susceptible to end-stage liver disease, depending on their genetic background and exposure to other insults, such as alcohol or viral infection.
authors.affiliation: Department of Medicine, Palo Alto VA Medical Center, Palo Alto, California 94304, USA.
authors.forename: Nam-On
authors.initials: NO
authors.lastname: Ku
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lim
authors.forename: Sheri M
authors.initials: SM
authors.lastname: Krams
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Esquivel
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Wright
authors.forename: David A D
authors.initials: DA
authors.lastname: Parry
authors.forename: M Bishr
authors.initials: MB
authors.lastname: Omary
mesh_terms: D005260:Female; D006580:Genetic Carrier Screening; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D006801:Humans; D053538:Keratin-18; D053533:Keratin-8; D007633:Keratins / Q000235:genetics*; D017093:Liver Failure / Q000235:genetics*; D008297:Male; D009154:Mutation; D020641:Polymorphism, Single Nucleotide; D017384:Sequence Deletion
chemical_list: C488421:KRT18 protein, human; C426203:KRT8 protein, human; D053538:Keratin-18; D053533:Keratin-8; D007633:Keratins