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Association of liver injury from specific drugs, or groups of drugs, with polymorphisms in HLA and other genes in a genome-wide association study


Paola Nicoletti

Einar S. Bjornsson

Raul J. Andrade

Ashley Sawle

Marco Arrese

Huiman X. Barnhart

Emmanuelle Bondon-Guitton

Paul H. Hayashi

Fernando Bessone

Alfonso Carvajal

Ingolf Cascorbi

Elizabeth T. Cirulli

Naga Chalasani

Anita Conforti

Sally A. Coulthard

Mark J. Daly

Christopher P. Day

John F. Dillon

Robert J. Fontana

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Assistant Professor




Gerd A. Kullak-Ublick

Tarja Laitinen

Dominique Larrey

M. Isabel Lucena

Anke H. Maitland-van der Zee

Jennifer H. Martin

Mariam Molokhia

Munir Pirmohamed

Elizabeth E. Powell

Shengying Qin

Jose Serrano

Camilla Stephens

Andrew Stolz

Mia Wadelius

Paul B. Watkins

Aris Floratos

Yufeng Shen

Matthew R. Nelson

Thomas J. Urban

Ann K. Daly


Background & aims: We performed a genome-wide association study (GWAS) to identify genetic risk factors for drug-induced liver injury (DILI) from licensed drugs without previously reported genetic risk factors.
Methods: We performed a GWAS of 862 persons with DILI and 10588 population-matched controls. The first set of cases was recruited prior to May 2009 in Europe (n=137) or the USA (n=274). The second set of cases were identified from May 2009 through May 2013 from international collaborative studies performed in Europe, the USA and South America. For the GWAS, we included only cases of European ancestry associated with a particular drug (but not flucloxacillin or amoxicillin-clavulanate). We used DNA samples from all subjects to analyze human leukocyte antigen (HLA) genes and single nucleotide polymorphisms (SNPs). After the discovery analysis was concluded, we validated our findings using data from 283 European patients with diagnosis of DILI associated with various drugs.
Results: We associated DILI with rs114577328 (a proxy for A*33:01 a HLA class I allele; odds ratio [OR], 2.7; 95% CI, 1.9–3.8; P=2.4x10–8) and with rs72631567 on chromosome 2 (OR, 2.0; 95% CI, 1.6–2.5; P=9.7x10–9). The association with A*33:01 was mediated by large effects for terbinafine-, fenofibrate-, and ticlopidinerelated DILI. The variant on chromosome 2 was associated with DILI from a variety of drugs. Further phenotypic analysis indicated that the association between DILI and A*33:01 was significant, genome wide, for cholestatic and mixed DILI, but not for hepatocellular DILI; the polymorphism on chromosome 2 associated with cholestatic and mixed DILI as well as hepatocellular DILI. We identified an association between rs28521457 (within the LRBA gene) and only hepatocellular DILI (OR, 2.1; 95% CI, 1.6–2.7; P=4.8x10–9). We did not associate any specific drug classes with genetic polymorphisms, except for statin-associated DILI, which was associated with rs116561224 on chromosome 18 (OR=5.4; 95% CI, 3.0–9.5; P=7.1x10–9). We validated the association between A*33:01 terbinafine- and sertraline-induced DILI. We could not validate the association between DILI and rs72631567, rs28521457, or rs116561224
Conclusions: In a GWAS of persons of European descent with DILI, we associated HLA-A*33:01 with DILI due to terbinafine and possibly fenofibrate and ticlopidine. We identified polymorphisms that appear to be associated with DILI from statins, as well as 2 non–drug-specific risk factors.


Nicoletti, P., Aithal, G. P., Bjornsson, E. S., Andrade, R. J., Sawle, A., Arrese, M., …Daly, A. K. (2017). Association of liver injury from specific drugs, or groups of drugs, with polymorphisms in HLA and other genes in a genome-wide association study. Gastroenterology, 152(5), 1078-1089.

Journal Article Type Article
Acceptance Date Dec 21, 2016
Online Publication Date Dec 30, 2016
Publication Date 2017-04
Deposit Date Jan 25, 2017
Publicly Available Date Jan 25, 2017
Journal Gastroenterology
Print ISSN 2308-2097
Electronic ISSN 0016-5085
Publisher Publishing House Zaslavsky
Peer Reviewed Peer Reviewed
Volume 152
Issue 5
Pages 1078-1089
Keywords medication; liver damage; side effect; anti-fungal agent
Public URL
Publisher URL
Additional Information This article is maintained by: Elsevier; Article Title: Association of Liver Injury From Specific Drugs, or Groups of Drugs, With Polymorphisms in HLA and Other Genes in a Genome-Wide Association Study; Journal Title: Gastroenterology; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2017 by the AGA Institute


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