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Genetic determinants of alcoholic liver disease
  1. Felix Stickel1,
  2. Jochen Hampe2
  1. 1Department of Visceral Surgery and Medicine, Inselspital, University of Berne, Switzerland
  2. 2Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
  1. Correspondence to Professor Felix Stickel, Department of Visceral Surgery and Medicine, Inselspital, University of Berne, Murtenstrasse 35, 3010 Berne, Switzerland; felix.stickel{at}


Alcoholic liver disease (ALD) accounts for the majority of chronic liver disease in Western countries. The spectrum of ALD includes steatosis with or without fibrosis in virtually all individuals with an alcohol consumption of >80 g/day, alcoholic steatohepatitis of variable severity in 10–35% and liver cirrhosis in approximately 15% of patients. Once cirrhosis is established, there is an annual risk for hepatocellular carcinoma of 1–2%. Environmental factors such as drinking patterns, coexisting liver disease, obesity, diet composition and comedication may modify the natural course of ALD. Twin studies have revealed a substantial contribution of genetic factors to the evolution of ALD, as demonstrated by a threefold higher disease concordance between monozygotic twins and dizygotic twins. With genotyping becoming widely available, a large number of genetic case-control studies evaluating candidate gene variants coding for proteins involved in the degradation of alcohol, mediating antioxidant defence, the evolution and counteraction of necroinflammation and formation and degradation of extracellular matrix have been published with largely unconfirmed, impeached or even disproved associations. Recently, whole genome analyses of large numbers of genetic variants in several chronic liver diseases including gallstone disease, primary sclerosing cholangitis and non-alcoholic fatty liver disease (NAFLD) have identified novel yet unconsidered candidate genes. Regarding the latter, a sequence variation within the gene coding for patatin-like phospholipase encoding 3 (PNPLA3, rs738409) was found to modulate steatosis, necroinflammation and fibrosis in NAFLD. Subsequently, the same variant was repeatedly confirmed as the first robust genetic risk factor for progressive ALD.

  • Alcoholic liver disease
  • genetic polymorphism
  • liver cirrhosis
  • extracellular matrix
  • fibrogenesis
  • genotype
  • ethanol metabolism
  • haemochromatosis
  • fibrosis
  • IBD - genetics
  • genetics
  • gallstones
  • molecular genetics
  • gallstone disease

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  • Funding Research into the genetics of ALD carried out by FS was in part funded by the Swiss National Fund (grant no. 310030_138747/1).

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.