Mitochondrial superoxide dismutase and glutathione peroxidase in idiosyncratic drug-induced liver injury

Authors

  • M. Isabel Lucena,

    1. 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
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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    • These authors contributed equally to this work.

  • Elena García-Martín,

    1. Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Ciencias, Universidad de Extremadura, Badajoz, Spain
    2. Red de Investigación de Reacciones Adversas a Alergenos y Fármacos (RIRAAF)
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  • Raúl J. Andrade,

    Corresponding author
    1. Unidad de Hepatología, Grupo de Estudio para las Hepatopatías Asociadas a Medicamentos, Coordinating Centre, Facultad de Medicina, Hospital Universitario Virgen de la Victoria, Campus Universitario de Teatinos s/n, Málaga, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
    • Unidad de Hepatología, Departamento de Medicina, Facultad de Medicina, Boulevard Louis Pasteur, 32, Campus de Teatinos s/n, 29071 Málaga, Spain
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    • fax: (34)-952-131511

  • Carmen Martínez,

    1. Departamento de Farmacología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
    2. Red de Investigación de Reacciones Adversas a Alergenos y Fármacos (RIRAAF)
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  • Camilla Stephens,

    1. 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
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • Jhon D. Ruiz,

    1. Departamento de Farmacología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
    2. Red de Investigación de Reacciones Adversas a Alergenos y Fármacos (RIRAAF)
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  • Eugenia Ulzurrun,

    1. 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
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • M. Carmen Fernandez,

    1. Unidad de Farmacología Clínica y Servicio de Aparato Digestivo, Hospital Torrecárdenas, Almeria, Spain
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  • Manuel Romero-Gomez,

    1. Unidad de Hepatología, Hospital Universitario de Valme, Sevilla, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • Augustin Castiella,

    1. Servicio de Aparato Digestivo, Hospital Mendaro, Guipuzcoa, Spain
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  • Ramon Planas,

    1. Unidad de Hepatología, Hospital Germans Trias i Puyol, Barcelona, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • José Antonio Durán,

    1. Servicio de Farmacología Clínica. Hospital Virgen de la Macarena, Sevilla, Spain
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  • Ana Melcón De Dios,

    1. Servicio de Farmacología Clínica. Hospital Virgen de la Macarena, Sevilla, Spain
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  • Carlos Guarner,

    1. Servicio de Aparato Digestivo, Hospital San Pau, Barcelona, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • German Soriano,

    1. Servicio de Aparato Digestivo, Hospital San Pau, Barcelona, Spain
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • Yolanda Borraz,

    1. 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
    2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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  • José A. G. Agundez

    1. Departamento de Farmacología, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
    2. Red de Investigación de Reacciones Adversas a Alergenos y Fármacos (RIRAAF)
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    • These authors contributed equally to this work.


  • Potential conflict of interest: Nothing to report.

  • Participating centers of the Spanish group for the Study of Drug-Induced Liver Disease are listed in Acknowledgment.

Abstract

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). Conclusion: 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. (HEPATOLOGY 2010)

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