1. A genetic risk score and diabetes predict development of alcohol-related cirrhosis in drinkers
- Author
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Munir Pirmohamed, Guruprasad P. Aithal, Felix Stickel, Mark Thursz, David Goldman, Paul S. Haber, John Whitfield, Romain Moirand, Bertrand Nalpas, Devanshi Seth, Christophe Moreno, Andrew Thompson, Eric Trepo, Stephen R. Atkinson, Rebecca Darlay, Beat Müllhaupt, Timothy R. Morgan, Dermot Gleeson, Sylvie Naveau, Ann K. Daly, Helmut K. Seitz, Michael Soyka, Christopher P. Day, Tatiana Foroud, Jean-Marc Jacquet, Laura E. Nagy, Naga Chalasani, Pascal Perney, Philippe Mathurin, Marsha Y. Morgan, Pierre Nahon, Sebastian Mueller, Tiebing Liang, Florian Eyer, Suthat Liangpunsakul, Heather J. Cordell, Steven Masson, Tae-Hwi Schwantes-An, Ramon Bataller, Greg Botwin, Andrew McQuillin, QIMR Berghofer Medical Research Institute, Indiana University School of Medicine, Indiana University System, Newcastle University [Newcastle], University of Nottingham, UK (UON), Imperial College London, University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis] (UPMC), California State University [Long Beach] (CSULB ), Indiana University - Purdue University Indianapolis (IUPUI), Technische Universität Munchen - Université Technique de Munich [Munich, Allemagne] (TUM), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health [Bethesda] (NIH), The University of Sydney, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital Claude Huriez [Lille], CHU Lille, Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), University College of London [London] (UCL), Université libre de Bruxelles (ULB), University of Heidelberg, Medical Faculty, University hospital of Zurich [Zurich], Lerner Research Institute, Cleveland Clinic, Génomique Fonctionnelle des Tumeurs Solides (U1162), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, University of Liverpool, University-Hospital Munich-Großhadern [München], University of California, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Lerner Research Institute [Cleveland, OH, USA], University of California (UC), Technical University of Munich (TUM), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
- Subjects
Liver Cirrhosis ,Male ,Cirrhosis ,Hepatocellular carcinoma ,[SDV]Life Sciences [q-bio] ,Alcohol ,Disease ,risk stratification ,Gastroenterology ,Oral and gastrointestinal ,Cohort Studies ,Liver disease ,Alcohol Use and Health ,Substance Misuse ,chemistry.chemical_compound ,0302 clinical medicine ,Liver Cirrhosis, Alcoholic ,single nucleotide polymorphism ,Cancer ,2. Zero hunger ,0303 health sciences ,Framingham Risk Score ,genome wide association ,Liver Disease ,Single Nucleotide ,Middle Aged ,Alcoholic ,3. Good health ,Alcoholism ,Public Health and Health Services ,030211 gastroenterology & hepatology ,Female ,Risk assessment ,Liver Cancer ,Adult ,medicine.medical_specialty ,Alcohol Drinking ,Chronic Liver Disease and Cirrhosis ,Clinical Sciences ,coffee ,Polymorphism, Single Nucleotide ,Risk Assessment ,Article ,03 medical and health sciences ,GenomALC Consortium ,Rare Diseases ,Clinical Research ,Diabetes mellitus ,Internal medicine ,Genetics ,Diabetes Mellitus ,medicine ,Humans ,Genetic Predisposition to Disease ,Genetic Testing ,Polymorphism ,Metabolic and endocrine ,030304 developmental biology ,Gastroenterology & Hepatology ,Hepatology ,business.industry ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Odds ratio ,medicine.disease ,chronic alcohol use ,Good Health and Well Being ,chemistry ,Case-Control Studies ,genome-wide association ,Digestive Diseases ,business ,Body mass index ,Genome-Wide Association Study - Abstract
International audience; BACKGROUND and AIMS: Only a minority of excess alcohol drinkers develop cirrhosis. We developed and evaluated risk stratification scores to identify those at highest risk. METHODS: Three cohorts (GenomALC-1: n=1690, GenomALC-2: n=3037, UK Biobank: relevant n=6898) with a history of heavy alcohol consumption (≥80 g/day (men), ≥50 g/day (women), for ≥10 years) were included. Cases were participants with alcohol-related cirrhosis. Controls had a history of similar alcohol consumption but no evidence of liver disease. Risk scores were computed from up to eight genetic loci identified previously as associated with alcohol-related cirrhosis and three clinical risk factors. Score performance for the stratification of alcohol-related cirrhosis risk was assessed and compared across the alcohol-related liver disease spectrum, including hepatocellular carcinoma (HCC). RESULTS: A combination of three single nucleotide polymorphisms (SNPs) (PNPLA3:rs738409, SUGP1-TM6SF2:rs10401969, HSD17B13:rs6834314) and diabetes status best discriminated for cirrhosis risk. The odds ratio (OR) and 95% confidence intervals (CI) for the extreme score quintiles (Q1-Q5) of the 3-SNP score, based on independent allelic effect size estimates, were 5.99 (4.18;8.60) (GenomALC-1); 2.81 (2.03;3.89) (GenomALC-2); and 3.10 (2.32;4.14) (UK Biobank). Patients with diabetes and high-risk score, compared to those without diabetes and a low-risk score, had ORs increased to 14.7 (7.69;28.1) (GenomALC-1) and 17.1 (11.3;25.7) (UK Biobank). Patients with cirrhosis and HCC had significantly higher mean risk scores than patients with cirrhosis alone (0.76±0.06 versus 0.61±0.02, p=0.007). Score performance was not significantly enhanced by information on additional genetic risk variants, body mass index or coffee consumption. CONCLUSIONS: A risk score based on three genetic risk variants and diabetes status can provide meaningful risk stratification for cirrhosis in excess drinkers, allowing earlier prevention planning including intensive intervention. LAY SUMMARY: Excessive chronic drinking leads to liver cirrhosis in some people, but so far there is no way to identify those at high risk of developing this debilitating disease. Our study has developed a genetic risk score (GRS) test that can identify patients at high risk and shows that the risk of cirrhosis is increased >10-fold with just two risk factors - diabetes and high GRS. Risk assessment using this test has potential for early and personalised management of this disease in high-risk patients.
- Published
- 2021
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