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Hepatotoxicity from anabolic androgenic steroids marketed as dietary supplements: contribution from ATP 8B1/ ABCB 11 mutations?
Author(s) -
El Sherrif Yasser,
Potts Jonathan R.,
Howard Mark R.,
Barnardo Adrian,
Cairns Stuart,
Knisely Alex S.,
Verma Sumita
Publication year - 2013
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12216
Subject(s) - anabolism , cholestasis , medicine , anabolic androgenic steroids , endocrinology , progressive familial intrahepatic cholestasis , pharmacology , transplantation , liver transplantation
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 ATP 8B1 disease. In the older patient, bile salt export pump marking (encoded by ABCB 11) was focally diminished. We hypothesized that AAS had either induced inhibition of normal ATP 8B1 / ABCB 11 expression or triggered initial episodes of benign recurrent intrahepatic cholestasis ( BRIC ) type 1/or 2. On sequencing, ATP 8B1 was normal in both patients although the younger was heterozygous for the c.2093G>A mutation in ABCB 11 , 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.