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Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP8B1/ABCB11 mutations?
- Source :
- Liver International. 33:1266-1270
- Publication Year :
- 2013
- Publisher :
- Wiley, 2013.
-
Abstract
- BACKGROUND: Though possession of androgenic anabolic steroids (AAS) is illegal, non-prescription use of AAS persists. METHODS: We describe two Caucasian males (aged 25 and 45 years) with cholestatic hepatitis following ingestion of the dietary supplement Mass-Drol ('Celtic Dragon') containing the AAS 2α-17α-dimethyl-etiocholan-3-one,17β-ol. RESULTS: Despite substantial hyperbilirubinaemia peak gamma-glutamyl transferase (GGT) remained normal. Besides 'bland' intralobular cholestasis, liver biopsy in both found deficiency of canalicular expression of ectoenzymes as seen in ATP8B1 disease. In the older patient, bile salt export pump marking (encoded by ABCB11) was focally diminished. We hypothesized that AAS had either induced inhibition of normal ATP8B1/ABCB11 expression or triggered initial episodes of benign recurrent intrahepatic cholestasis (BRIC) type 1/or 2. On sequencing, ATP8B1 was normal in both patients although the younger was heterozygous for the c.2093G>A mutation in ABCB11, a polymorphism previously encountered in drug-induced liver injury. CONCLUSION: AAS marketed as dietary supplements continue to cause hepatotoxicity in the UK; underlying mechanisms may include unmasking of genetic cholestatic syndromes.
- Subjects :
- Adult
Male
medicine.medical_specialty
Anabolism
DNA Mutational Analysis
Benign Recurrent Intrahepatic Cholestasis
Cholestasis, Intrahepatic
Disease
Anabolic Agents
Cholestasis
Risk Factors
Internal medicine
medicine
Humans
Ingestion
Genetic Predisposition to Disease
ABCB11
ATP Binding Cassette Transporter, Subfamily B, Member 11
Hyperbilirubinemia
Adenosine Triphosphatases
Liver injury
Hepatology
medicine.diagnostic_test
business.industry
gamma-Glutamyltransferase
Middle Aged
medicine.disease
Phenotype
Endocrinology
Liver biopsy
Dietary Supplements
Mutation
Androgens
ATP-Binding Cassette Transporters
Chemical and Drug Induced Liver Injury
business
Biomarkers
Subjects
Details
- ISSN :
- 14783223
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- Liver International
- Accession number :
- edsair.doi.dedup.....bd8cba495e609ed718e0c93189030f76