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J Pediatr Genet 2018; 07(02): 067-073
DOI: 10.1055/s-0038-1632395
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Variants Associated with Infantile Cholestatic Syndromes Detected in Extrahepatic Biliary Atresia by Whole Exome Studies: A 20-Case Series from Thailand

Surasak Sangkhathat
1   Pediatric Surgery Unit, Department of Surgery, Prince of Songkla University, Hat Yai, Songkhla, Thailand
,
Wison Laochareonsuk
1   Pediatric Surgery Unit, Department of Surgery, Prince of Songkla University, Hat Yai, Songkhla, Thailand
,
Wanwisa Maneechay
2   Central Research Laboratory, Prince of Songkla University, Hat Yai, Songkhla, Thailand
,
Kanita Kayasut
3   Anatomical Pathology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
,
Piyawan Chiengkriwate
1   Pediatric Surgery Unit, Department of Surgery, Prince of Songkla University, Hat Yai, Songkhla, Thailand
› Author Affiliations
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Publication History

14 October 2017

14 January 2018

Publication Date:
16 February 2018 (online)

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Abstract

Biliary atresia (BA) is the most severe form of obstructive cholangiopathy occurring in infants. Definitive diagnosis of BA usually relies on operative findings together with supporting pathological patterns found in the extrahepatic bile duct. In infancy, overlapping clinical patterns of cholestasis can be found in other diseases including biliary hypoplasia and progressive familial intrahepatic cholestasis. In addition, BA has been reported as a phenotype in some rare genetic syndromes. Unlike BA, other cholangiopathic phenotypes have their own established genetic markers. In this study, we used these markers to look for other cholestasis entities in cases diagnosed with BA. DNA from 20 cases of BA, diagnosed by operative findings and histopathology, were subjected to a study of 19 genes associated with infantile cholestasis syndromes, using whole exome sequencing. Variant selection focused on those with allele frequencies in dbSNP150 of less than 0.01. All selected variants were verified by polymerase chain reaction–direct sequencing. Of the 20 cases studied, 13 rare variants were detected in 9 genes: 4 in JAG1 (Alagille syndrome), 2 in MYO5B (progressive familial intrahepatic cholestasis [PFIC] type 6), and one each in ABCC2 (Dubin–Johnson syndrome), ABCB11 (PFIC type 2), UG1A1 (Crigler–Najjar syndrome), MLL2 (Kabuki syndrome), RFX6 (Mitchell–Riley syndrome), ERCC4 (Fanconi anemia), and KCNH1 (Zimmermann–Laband syndrome). Genetic lesions associated with various cholestatic syndromes detected in cases diagnosed with BA raised the hypothesis that severe inflammatory cholangiopathy in BA may not be a distinct disease entity, but a shared pathology among several infantile cholestatic syndromes.

Keywords

biliary atresia - progressive familial intrahepatic cholestasis - JAG1
 

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