Mitochondrial superoxide dismutase and glutathione peroxidase in idiosyncratic drug-induced liver injury.
Drug-induced liver injury (DILI) susceptibility has a potential genetic basis. We have evaluated possible associations between the risk of developing DILI and common genetic variants of the manganese superoxide dismutase (SOD2 Val16Ala) and glutathione peroxidase (GPX1 Pro200Leu) genes, which are involved in mitochondrial oxidative stress management. Genomic DNA from 185 DILI patients assessed by the Council for International Organizations of Medical Science scale and 270 sex- and age-matched controls were analyzed. The SOD2 and GPX1 genotyping was performed using polymerase chain reaction restriction fragment length polymorphism and TaqMan probed quantitative polymerase chain reaction, respectively. The statistical power to detect the effect of variant alleles with the observed odds ratio (OR) was 98.2% and 99.7% for bilateral association of SOD2 and GPX1, respectively. The SOD2 Ala/Ala genotype was associated with cholestatic/mixed damage (OR = 2.3; 95% confidence interval [CI] = 1.4-3.8; corrected P [Pc] = 0.0058), whereas the GPX1 Leu/Leu genotype was associated with cholestatic injury (OR = 5.1; 95%CI = 1.6-16.0; Pc = 0.0112). The presence of two or more combined risk alleles (SOD2 Ala and GPX1 Leu) was more frequent in DILI patients (OR = 2.1; 95%CI = 1.4-3.0; Pc = 0.0006). Patients with cholestatic/mixed injury induced by mitochondria hazardous drugs were more prone to have the SOD2 Ala/Ala genotype (OR = 3.6; 95%CI = 1.4-9.3; Pc = 0.02). This genotype was also more frequent in cholestatic/mixed DILI induced by pharmaceuticals producing quinone-like or epoxide metabolites (OR = 3.0; 95%CI = 1.7-5.5; Pc = 0.0008) and S-oxides, diazines, nitroanion radicals, or iminium ions (OR = 16.0; 95%CI = 1.8-146.1; Pc = 0.009).


CONCLUSIONS
Patients homozygous for the SOD2 Ala allele and the GPX1 Leu allele are at higher risk of developing cholestatic DILI. SOD2 Ala homozygotes may be more prone to suffer DILI from drugs that are mitochondria hazardous or produce reactive intermediates.
Lucena
M Isabel
MI
Servicio de Farmacología Clínica y Grupo de Estudio para las Hepatopatias Asociadas a Medicamentos, Coordinating Centre, Facultad de Medicina, Hospital Universitario Virgen de la Victoria, Campus Universitario s/n, Málaga, Spain.
García-Martín
Elena
E
Andrade
Raúl J
RJ
Martínez
Carmen
C
Stephens
Camilla
C
Ruiz
Jhon D
JD
Ulzurrun
Eugenia
E
Fernandez
M Carmen
MC
Romero-Gomez
Manuel
M
Castiella
Augustin
A
Planas
Ramon
R
Durán
José Antonio
JA
De Dios
Ana Melcón
AM
Guarner
Carlos
C
Soriano
German
G
Borraz
Yolanda
Y
Agundez
José A G
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D019943:Amino Acid Substitution; D056486:Chemical and Drug Induced Liver Injury / Q000235:genetics*; D005260:Female; D005979:Glutathione Peroxidase / Q000235:genetics*; D006801:Humans; D007930:Leucine / Q000235:genetics; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000201:enzymology*; D011110:Polymorphism, Genetic; D013482:Superoxide Dismutase / Q000235:genetics*; D055815:Young Adult; D000094765:Glutathione Peroxidase GPX1; D000099156:Superoxide Dismutase 2
D005979:Glutathione Peroxidase; D007930:Leucine; D013482:Superoxide Dismutase; D000094765:Glutathione Peroxidase GPX1; D000099156:Superoxide Dismutase 2; C000722067:GPX1 protein, human