title: Chinese children with chronic intrahepatic cholestasis and high γ-glutamyl transpeptidase: clinical features and association with ABCB4 mutations.
abstract: OBJECTIVE
  The aims of the present study was to study the significance of ABCB4 mutations in mainland Chinese children with chronic intrahepatic cholestasis and to correlate genetic findings with clinical features and response to ursodeoxycholic acid (UDCA) therapy.
  
  
  METHODS
  Thirteen patients with chronic intrahepatic cholestasis and elevated serum γ-glutamyl transpeptidase activity of unknown cause were enrolled in a single pediatric center. All of the encoding exons and flanking areas of ABCB4 were sequenced. Available liver biopsy specimens were immunostained for multidrug resistance protein 3. The clinical features, biochemical parameters, and responses to therapy were compared with patients with or without ABCB4 mutation(s).
  
  
  RESULTS
  Six different ABCB4 mutations were identified in 3 patients; each patient was a compound heterozygote. Apart from c.139C>T (p.R47X), all were novel, including c.344+2_+3insT, c.1376A>G (p.D459G), c.1745G>A (p.R582Q), c.2077_2078delC (p.P693HfsX698), and c.3825_3826delA (p.M1276WfsX1308). Absent or reduced multidrug resistance protein 3 canalicular immunostaining was demonstrated in patients with ABCB4 mutations. Serum total bile acid levels were higher in patients with ABCB4 mutations than in patients without ABCB4 mutations (352.5 ± 97.0 vs 55.9 ± 50.4 μmol/L, P = 7.32E-05). There was no difference in other biochemical parameters between patients with and without ABCB4 mutations. After oral UDCA administration in 3 patients with ABCB4 mutations, pruritus disappeared, growth improved, spleen size decreased, and platelet counts increased. In the 10 patients without ABCB4 mutations, an inconsistent response to UDCA therapy was observed.
  
  
  CONCLUSIONS
  In mainland Chinese children, some cases of chronic intrahepatic cholestasis with high γ-glutamyl transpeptidase could be attributed to ABCB4 mutations. UDCA administration partially improved clinical symptoms and liver function.
authors.affiliation: Center for Pediatric Liver Diseases, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Ling-Juan
authors.initials: LJ
authors.lastname: Fang
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Wang
authors.forename: A S
authors.initials: AS
authors.lastname: Knisely
authors.forename: Hui
authors.initials: H
authors.lastname: Yu
authors.forename: Yi
authors.initials: Y
authors.lastname: Lu
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Liu
authors.forename: Jian-She
authors.initials: JS
authors.lastname: Wang
mesh_terms: D018435:ATP Binding Cassette Transporter, Subfamily B / Q000235:genetics*; D044466:Asian People / Q000235:genetics*; D001647:Bile Acids and Salts / Q000097:blood / Q000235:genetics*; D002675:Child, Preschool; D002681:China; D002756:Cholagogues and Choleretics / Q000494:pharmacology / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000188:drug therapy / Q000235:genetics*; D002908:Chronic Disease; D005260:Female; D006128:Growth / Q000187:drug effects; D006579:Heterozygote; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009154:Mutation; D009929:Organ Size / Q000187:drug effects; D010976:Platelet Count; D011537:Pruritus / Q000188:drug therapy / Q000209:etiology; D013154:Spleen / Q000187:drug effects; D014580:Ursodeoxycholic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D018435:ATP Binding Cassette Transporter, Subfamily B; D001647:Bile Acids and Salts; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; C095122:multidrug resistance protein 3; D005723:gamma-Glutamyltransferase