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Mironova M, Gopalakrishna H, Rodriguez Franco G, Holland SM, Koh C, Kleiner DE, Heller T. Granulomatous liver diseases. Hepatol Commun 2024; 8:e0392. [PMID: 38497932 PMCID: PMC10948139 DOI: 10.1097/hc9.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024] Open
Abstract
A granuloma is a discrete collection of activated macrophages and other inflammatory cells. Hepatic granulomas can be a manifestation of localized liver disease or be a part of a systemic process, usually infectious or autoimmune. A liver biopsy is required for the detection and evaluation of granulomatous liver diseases. The prevalence of granulomas on liver biopsy varies from 1% to 15%. They may be an incidental finding in an asymptomatic individual, or they may represent granulomatous hepatitis with potential to progress to liver failure, or in chronic disease, to cirrhosis. This review focuses on pathogenesis, histological features of granulomatous liver diseases, and most common etiologies, knowledge that is essential for timely diagnosis and intervention.
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Affiliation(s)
- Maria Mironova
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Harish Gopalakrishna
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Gian Rodriguez Franco
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David E. Kleiner
- Department of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- Translational Hepatology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
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Kong XF, Bogyo K, Kapoor S, Shea PR, Groopman EE, Thomas-Wilson A, Cocchi E, Milo Rasouly H, Zheng B, Sun S, Zhang J, Martinez M, Vittorio JM, Dove LM, Marasa M, Wang TC, Verna EC, Worman HJ, Gharavi AG, Goldstein DB, Wattacheril J. The diagnostic yield of exome sequencing in liver diseases from a curated gene panel. Sci Rep 2023; 13:21540. [PMID: 38057357 PMCID: PMC10700603 DOI: 10.1038/s41598-023-42202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/06/2023] [Indexed: 12/08/2023] Open
Abstract
Exome sequencing (ES) has been used in a variety of clinical settings but there are limited data on its utility for diagnosis and/or prediction of monogenic liver diseases. We developed a curated list of 502 genes for monogenic disorders associated with liver phenotypes and analyzed ES data for these genes in 758 patients with chronic liver diseases (CLD). For comparison, we examined ES data in 7856 self-declared healthy controls (HC), and 2187 patients with chronic kidney disease (CKD). Candidate pathogenic (P) or likely pathogenic (LP) variants were initially identified in 19.9% of participants, most of which were attributable to previously reported pathogenic variants with implausibly high allele frequencies. After variant annotation and filtering based on population minor allele frequency (MAF ≤ 10-4 for dominant disorders and MAF ≤ 10-3 for recessive disorders), we detected a significant enrichment of P/LP variants in the CLD cohort compared to the HC cohort (X2 test OR 5.00, 95% CI 3.06-8.18, p value = 4.5e-12). A second-level manual annotation was necessary to capture true pathogenic variants that were removed by stringent allele frequency and quality filters. After these sequential steps, the diagnostic rate of monogenic disorders was 5.7% in the CLD cohort, attributable to P/LP variants in 25 genes. We also identified concordant liver disease phenotypes for 15/22 kidney disease patients with P/LP variants in liver genes, mostly associated with cystic liver disease phenotypes. Sequencing results had many implications for clinical management, including familial testing for early diagnosis and management, preventative screening for associated comorbidities, and in some cases for therapy. Exome sequencing provided a 5.7% diagnostic rate in CLD patients and required multiple rounds of review to reduce both false positive and false negative findings. The identification of concordant phenotypes in many patients with P/LP variants and no known liver disease also indicates a potential for predictive testing for selected monogenic liver disorders.
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Affiliation(s)
- Xiao-Fei Kong
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA.
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Medicine, McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, 75390-9151, USA.
| | - Kelsie Bogyo
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Sheena Kapoor
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Patrick R Shea
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Emily E Groopman
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Amanda Thomas-Wilson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
| | - Enrico Cocchi
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Hila Milo Rasouly
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Beishi Zheng
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA
| | - Siming Sun
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA
| | - Junying Zhang
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Mercedes Martinez
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH 14-105D, New York, NY, 10032, USA
| | - Jennifer M Vittorio
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH 14-105D, New York, NY, 10032, USA
- NYU Transplant Institute, NYU Langone Health, New York, NY, USA
| | - Lorna M Dove
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH 14-105D, New York, NY, 10032, USA
| | - Maddalena Marasa
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Timothy C Wang
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA
| | - Elizabeth C Verna
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH 14-105D, New York, NY, 10032, USA
| | - Howard J Worman
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Ali G Gharavi
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - David B Goldstein
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Julia Wattacheril
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, Hammer Health Sciences Building Rm 402, 701 W 168th St, New York, NY, 10032, USA.
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH 14-105D, New York, NY, 10032, USA.
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Yang AH, Sullivan B, Zerbe CS, De Ravin SS, Blakely AM, Quezado MM, Marciano BE, Marko J, Ling A, Kleiner DE, Gallin JI, Malech HL, Holland SM, Heller T. Gastrointestinal and Hepatic Manifestations of Chronic Granulomatous Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1401-1416. [PMID: 36646382 DOI: 10.1016/j.jaip.2022.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
Chronic granulomatous disease (CGD) is a rare inborn error of immunity, resulting from a defect in nicotinamide adenine dinucleotide phosphate oxidation and decreased production of phagocyte reactive oxygen species. The main clinical manifestations are recurrent infections and chronic inflammatory disorders. Current approaches to management include antimicrobial prophylaxis and control of inflammatory complications. Hematopoietic stem cell transplantation or gene therapy can provide definitive treatment. Gastrointestinal and hepatic manifestations are common in CGD and include structural changes, dysmotility, CGD-associated inflammatory bowel disease, liver abscesses, and noncirrhotic portal hypertension. The findings can be heterogeneous, and the management is complex in light of the underlying immune dysfunction. This review describes the various clinical findings and the latest studies in management of gastrointestinal and hepatic manifestations in CGD, as well as the management experience at the National Institutes of Health.
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Affiliation(s)
- Alexander H Yang
- Digestive Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md
| | - Brigit Sullivan
- Office of the Director, National Institutes of Health, Bethesda, Md
| | - Christa S Zerbe
- Immunopathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Suk See De Ravin
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Andrew M Blakely
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Martha M Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Beatriz E Marciano
- Immunopathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Jamie Marko
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md
| | - Alexander Ling
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - John I Gallin
- Clinical Pathophysiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Harry L Malech
- Genetic Immunotherapy Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Steven M Holland
- Immunopathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Theo Heller
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md.
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