Format

Send to

Choose Destination
J Hepatol. 2017 Jul;67(1):137-144. doi: 10.1016/j.jhep.2017.03.010. Epub 2017 Mar 18.

Minocycline hepatotoxicity: Clinical characterization and identification of HLA-B∗35:02 as a risk factor.

Author information

1
Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Institute for Drug Safety Sciences, Durham, NC, USA.
2
Center for Computational Biology and Bioinformatics, Columbia University, New York, NY, USA.
3
Indiana University School of Medicine, Indianapolis, IN, USA.
4
National Institute of Diabetes Digestive and Kidney Diseases, Bethesda, MD, USA.
5
University of Southern California, Los Angeles, CA, USA.
6
Newcastle University, Newcastle upon Tyne, United Kingdom.
7
National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, United Kingdom.
8
University of Dundee, Dundee, United Kingdom.
9
Einstein Medical Center, Philadelphia, PA, USA.
10
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
11
Duke University, Durham, NC, USA.
12
University of Florida College of Medicine, Gainesville, FL, USA.
13
University of Michigan, Ann Arbor, MI, USA. Electronic address: rfontana@med.umich.edu.

Abstract

BACKGROUND & AIMS:

Minocycline hepatotoxicity can present with prominent autoimmune features in previously healthy individuals. The aim of this study was to identify genetic determinants of minocycline drug-induced liver injury (DILI) in a well-phenotyped cohort of patients.

METHODS:

Caucasian patients with minocycline DILI underwent genome-wide genotyping and were compared to unexposed population controls. Human leukocyte antigen (HLA) binding of minocycline was assessed using AutoDock Vina.

RESULTS:

Among the 25 cases, 80% were female, median age was 19years and median latency from drug start to DILI onset was 318days. At presentation, 76% had acute hepatocellular liver injury, median ALT 1,077U/L (range: 63 to 2,333), median bilirubin 4.5mg/dl (range: 0.2 to 16.7), and 90% had a +ANA. During follow-up, 50% were treated with corticosteroids and no participants died or required a liver transplant. A significant association was noted between HLA-B∗35:02 and risk for minocycline DILI; a 16% carrier frequency in DILI cases compared to 0.6% in population controls (odds ratio: 29.6, 95% CI: 7.8-89.8, p=2.5×10-8). Verification of HLA-B∗35:02 imputation was confirmed by sequence-based HLA typing. HLA-B∗35:02 carriers had similar presenting features and outcomes compared to non-carriers. In silico modeling studies support the hypothesis that direct binding of minocycline to this novel HLA risk allele might be an important initiating event in minocycline DILI.

CONCLUSION:

HLA-B∗35:02 is a rare HLA allele that was more frequently identified in the 25 minocycline DILI cases compared to population controls. If confirmed in other cohorts, this HLA allele may prove to be a useful diagnostic marker of minocycline DILI.

LAY SUMMARY:

Development of liver injury following prolonged use of minocycline for acne is a rare but potentially severe form of drug-induced liver injury. Our study demonstrates that individuals who are HLA-B∗35:02 carriers are at increased risk of developing minocycline related liver injury. These results may help doctors more rapidly and confidently diagnose affected patients and possibly reduce the risk of liver injury in individuals receiving minocycline going forward.

KEYWORDS:

Autoimmunity; Drug-induced liver injury; Genetic association; Human leukocyte antigen; Single nucleotide polymorphism

PMID:
28323125
PMCID:
PMC5634615
DOI:
10.1016/j.jhep.2017.03.010
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center