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Blood, 1 February 2005, Vol. 105, No. 3, pp. 968-972.
Prepublished online as a Blood First Edition Paper on September 23, 2004; DOI 10.1182/blood-2004-02-0521.


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Submitted February 19, 2004
Accepted September 15, 2004

UGT1A1 variation and gallstone formation in sickle cell disease

Eden V Haverfield*, Colin A McKenzie, Terrence Forrester, Nourdine Bouzekri, Rosalind Harding, Graham Serjeant, Thomas Walker, Tim E Peto, Ryk Ward, and David J Weatherall

Institute of Biological Anthropology, University of Oxford, Oxford, United Kingdom; Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
Institute of Biological Anthropology, University of Oxford, Oxford, United Kingdom
The Sickle Cell Trust, Kingston, Jamaica
Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom

* Corresponding author; email: eden{at}genetics.uchicago.edu.

Pigment gallstones are a common clinical complication of sickle cell (SS) disease. Genetic variation in the promoter of UDP-glucuronosyltransferase 1A1 (UGT1A1) underlies Gilbert's syndrome, a chronic unconjugated hyperbilirubinemia, and appears to be a risk factor for gallstone formation. We investigated the association between UGT1A1 (TA)n genotype, hyperbilirubinemia and gallstones in a sample of Jamaicans with SS disease. SS disease subjects were from the Jamaican Sickle Cell Cohort Study (cohort sample, n=209) and the Sickle Cell Clinic at the University of the West Indies, Kingston, Jamaica (clinic sample, n=357). The UGT1A1 (TA)n promoter region was sequenced in 541 SS disease subjects and 111 normal controls (control sample). Indirect bilirubin levels for (TA)7/(TA)7 and (TA)7/(TA)8 genotypes were elevated compared to (TA)6/(TA)6 (clinic sample: P<10-5; cohort sample: P<10-3). The (TA)7/(TA)7 genotype was also associated with symptomatic presentation and gallstones in the clinic sample (OR=11.3, P=7.0x10-4) but not in the younger cohort sample. These unexpected findings indicate that the temporal evolution of symptomatic gallstones may involve factors other than the bilirubin level. While further studies of the pathogenesis of gallstones in SS disease are required, the (TA)7/(TA)7 genotype may be a risk factor for symptomatic gallstones in older subjects with SS disease.


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