Kubitz Ralf, Keitel Verena, Scheuring Sybille, Köhrer Karl, Häussinger Dieter
Department of Gastroenterology, Hepatology and Infectiology, Heinrich-Heine University, Düsseldorf, Germany.
J Clin Gastroenterol. 2006 Feb;40(2):171-5. doi: 10.1097/01.mcg.0000196406.15110.60.
A young patient with recurrent attacks of intrahepatic cholestasis is described. On the basis of clinical presentation, laboratory findings and genetic analysis, the diagnosis of benign recurrent intrahepatic cholestasis type 2 (BRIC-2) was established. By the use of BSEP-specific antibodies, almost complete absence of BSEP from the canalicular membrane of liver cells was detected in the patient. Two different BSEP mutations were found. One mutation (E186G) had been described in one BRIC-2 case; the second mutation (V444A) is more frequent and has been linked to intrahepatic cholestasis of pregnancy. It is concluded that this form of compound heterozygosity of the BSEP gene reduces the amount of BSEP protein due to protein instability or mis-targeting, which is the underlying reason for reduced bile salt excretion and cholemia.
本文描述了一名患有复发性肝内胆汁淤积症的年轻患者。基于临床表现、实验室检查结果和基因分析,确诊为2型良性复发性肝内胆汁淤积症(BRIC-2)。通过使用BSEP特异性抗体,在该患者肝细胞的胆小管膜中检测到几乎完全缺失BSEP。发现了两种不同的BSEP突变。一种突变(E186G)在一例BRIC-2病例中已有报道;第二种突变(V444A)更为常见,且与妊娠期肝内胆汁淤积症有关。得出的结论是,这种BSEP基因的复合杂合形式由于蛋白质不稳定或靶向错误而减少了BSEP蛋白的量,这是胆汁盐排泄减少和胆汁血症的根本原因。