Table 1

Genetic forms of intrahepatic cholestasis or hyperbilirubinaemia

DiseaseChromosomeGeneDefectPhenotype
PFIC type 118q21 FIC1, P type ATPase with homology to a putative aminophospholipid translocatorPathogenetic mechanism unknownFirst recurrent, later permanent and progressive cholestasis, no bile duct proliferation, normal gamma-GT, extrahepatic manifestations in some patients
BRIC18q21 FIC1 Unknown but most likely a regulatory defect of bile salt secretionRecurrent attacks of severe cholestasis, pruritus, jaundice, steatorrhoea, and weight loss. Normal liver function in intervals between the attacks
PFIC type 22q24 BSEP, bile salt export pump Deficient canalicular bile salt transportProgressive cholestasis, no bile duct proliferation, giant cell transformation, lobular and portal fibrosis, normal gamma-GT
PFIC type 37q21 PGY3 Deficient canalicular phosphatidylcholine transportCholestasis, jaundice less prominent, extensive bile duct proliferation and periportal fibrosis, elevated gamma-GT
ICPe.g. 7q21 heterozygositye.g. PGY3 May be associated with e.g. PFIC type 3 but is also associated with other PFIC typesCholestasis in third trimester of pregnancy, therapeutic effect of ursodeoxycholic acid, associated with increased fetal loss and prematurity
Bile acid synthesis defectse.g. 8q2.3e.g. CYP7B1 Bile acid synthesis enzyme defects with accumulation of toxic intermediates and deficiency of normal bile acidsCholestasis since birth, failure to thrive, low to normal gamma-GT
Dubin-Johnson syndrome10q24 MRP2/cMOAT, canalicular multispecific organic anion transporterDeficient canalicular organic anion transport, including that of bilirubin conjugatesConjugated hyperbilirubinaemia, increased urinary coproporphyrin isomer I, hepatic lysosomal pigment, normal life span
  • PFIC, progressive familial intrahepatic cholestasis; BRIC, benign recurrent intrahepatic cholestasis; ICP, intrahepatic cholestasis of pregnancy; PGY, P-glycoprotein; CYP, cytochrome P-450; gamma-GT, gamma-glutamyltransferase.

  • Not mentioned in the table is Aagenaes syndrome (intrahepatic cholestasis with lympoedema)17 since the gene defect underlying this disease is unknown.