HLA-B*35:01 and Green Tea-Induced Liver Injury.
Adult
Causality
Chemical and Drug Induced Liver Injury
/ epidemiology
Dietary Supplements
/ adverse effects
Drug-Related Side Effects and Adverse Reactions
/ epidemiology
Female
HLA-B Antigens
/ analysis
Humans
Incidence
Liver Function Tests
/ methods
Liver Transplantation
/ statistics & numerical data
Male
Prospective Studies
Severity of Illness Index
Tea
/ adverse effects
Transaminases
/ blood
United States
/ epidemiology
Journal
Hepatology (Baltimore, Md.)
ISSN: 1527-3350
Titre abrégé: Hepatology
Pays: United States
ID NLM: 8302946
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
25
07
2020
received:
04
06
2020
accepted:
16
08
2020
pubmed:
7
9
2020
medline:
8
1
2022
entrez:
6
9
2020
Statut:
ppublish
Résumé
Herbal supplements, and particularly multi-ingredient products, have become increasingly common causes of acute liver injury. Green tea is a frequent component in implicated products, but its role in liver injury is controversial. The aim of this study was to better characterize the clinical features, outcomes, and pathogenesis of green tea-associated liver injury. Among 1,414 patients enrolled in the U.S. Drug-Induced Liver Injury Network who underwent formal causality assessment, 40 cases (3%) were attributed to green tea, 202 to dietary supplements without green tea, and 1,142 to conventional drugs. The clinical features of green tea cases and representation of human leukocyte antigen (HLA) class I and II alleles in cases and control were analyzed in detail. Patients with green tea-associated liver injury ranged in age from 17 to 69 years (median = 40) and developed symptoms 15-448 days (median = 72) after starting the implicated agent. The liver injury was typically hepatocellular (95%) with marked serum aminotransferase elevations and only modest increases in alkaline phosphatase. Most patients were jaundiced (83%) and symptomatic (88%). The course was judged as severe in 14 patients (35%), necessitating liver transplantation in 3 (8%), but rarely resulting in chronic injury (3%). In three instances, injury recurred upon re-exposure to green tea with similar clinical features, but shorter time to onset. HLA typing revealed a high prevalence of HLA-B*35:01, found in 72% (95% confidence interval [CI], 58-87) of green tea cases, but only 15% (95% CI, 10-20) caused by other supplements and 12% (95% CI, 10-14) attributed to drugs, the latter rate being similar to population controls (11%; 95% CI, 10.5-11.5). Green tea-related liver injury has distinctive clinical features and close association with HLA-B*35:01, suggesting that it is idiosyncratic and immune mediated.
Sections du résumé
BACKGROUND AND AIMS
Herbal supplements, and particularly multi-ingredient products, have become increasingly common causes of acute liver injury. Green tea is a frequent component in implicated products, but its role in liver injury is controversial. The aim of this study was to better characterize the clinical features, outcomes, and pathogenesis of green tea-associated liver injury.
APPROACH AND RESULTS
Among 1,414 patients enrolled in the U.S. Drug-Induced Liver Injury Network who underwent formal causality assessment, 40 cases (3%) were attributed to green tea, 202 to dietary supplements without green tea, and 1,142 to conventional drugs. The clinical features of green tea cases and representation of human leukocyte antigen (HLA) class I and II alleles in cases and control were analyzed in detail. Patients with green tea-associated liver injury ranged in age from 17 to 69 years (median = 40) and developed symptoms 15-448 days (median = 72) after starting the implicated agent. The liver injury was typically hepatocellular (95%) with marked serum aminotransferase elevations and only modest increases in alkaline phosphatase. Most patients were jaundiced (83%) and symptomatic (88%). The course was judged as severe in 14 patients (35%), necessitating liver transplantation in 3 (8%), but rarely resulting in chronic injury (3%). In three instances, injury recurred upon re-exposure to green tea with similar clinical features, but shorter time to onset. HLA typing revealed a high prevalence of HLA-B*35:01, found in 72% (95% confidence interval [CI], 58-87) of green tea cases, but only 15% (95% CI, 10-20) caused by other supplements and 12% (95% CI, 10-14) attributed to drugs, the latter rate being similar to population controls (11%; 95% CI, 10.5-11.5).
CONCLUSIONS
Green tea-related liver injury has distinctive clinical features and close association with HLA-B*35:01, suggesting that it is idiosyncratic and immune mediated.
Identifiants
pubmed: 32892374
doi: 10.1002/hep.31538
pmc: PMC8052949
mid: NIHMS1681562
doi:
Substances chimiques
HLA-B Antigens
0
Tea
0
Transaminases
EC 2.6.1.-
Types de publication
Journal Article
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2484-2493Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK123704
Pays : United States
Organisme : NIDDK NIH HHS
ID : U24 DK065176
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK083020
Pays : United States
Organisme : NIGMS NIH HHS
ID : P20 GM130457
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK065184
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK065211
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK083027
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK065201
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK100928
Pays : United States
Informations de copyright
© 2020 by the American Association for the Study of Liver Diseases.
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