Lack of association of primary iron overload and common HFE gene mutations with liver cirrhosis in adult Indian population.

ABSTRACT

Aim To find out the association of common HFE mutations (viz., C282Y and H63D) with primary iron overload (PIL) in liver cirrhosis (CLD) patients of Indian origin. Methods Polymerase chain reaction-restriction fragment length polymorphism method was used for screening C282Yand H63D mutation in 496 CLD patients (hepatitis B virus associated cirrhosis (HBVc)=74, hepatitis C virus associated cirrhosis (HCV)=50, alcoholic cirrhosis with hepatitis (ALcW) = 38, alcoholic cirrhosis without hepatitis (ALc)=92, cryptogenic cirrhosis (CC)=242) and 502 healthy controls. Transferrin saturation of >45 or serum ferritin of >300 ng/mL (males)/>200 ng/mL (females) with normal total exogenous iron intake was suggestive of PIL. Histological liver iron grading was done by Perl’s Prussian blue stain. Results Of 496 patients, 13 (2.6; 9 CC, 2 ALc, 1 HBVc, 1 AlcW) had PIL. However, only two (15.3) of 13 patients (1 CC and 1 HBVc) were positive for H63D heterozygous mutation. All the subjects were found to be C282Y wild type, except a single case of double heterozygous (C282Y/H63D) who however, did not have PIL. Overall frequency of H63D allele in patients and controls was not significantly different (5.95 and 4.58 respectively, p=0.17). A highly significant H63D allele frequency (p<0.005) was observed in HBVc (10.82) and ALcW (11.84) groups but they were not associated with PIL. Conclusion The frequency of PIL, and the HFE gene mutaion (C282Y) are both rare in Indian patients and explain why hemochromatosis is a rare cause of liver cirrhosis in India. A highly significant H63D allele frequency in HBV and alcohol-related cirrhosis suggest a possible predisposing role for liver fibrosis of this allele.