2363A>T, p.(His-788Leu), was found in homozygous state in 4 individuals from 3 families; it is predicted to replace a polar, charged amino acid with an aliphatic, uncharged amino acid in the conserved guanylate JAK inhibitor kinase-like domain. Three patients homozygous for this mutation manifested pruritus and became icteric aged 14 months, 9 years, and 13 years. The remaining
patient is asymptomatic so far. As measured by levels of serum bile acids and bilirubin, degrees of cholestasis varied, though transaminase activities were almost normal. GGT activity was always normal. The patient presenting earliest also had bouts of cholestasis aged 4 and 5 years, both following administration of antibiotics. All have recovered, without signs of chronic liver disease. SCH772984 price In liver-biopsy material obtained during the first 2 cholestatic episodes in 1 patient and from the single episode in the others,
staining for TJP2 at canalicular margins was dramatically reduced vs controls, in all 4 specimens. However, hepatocyte nuclei marked strongly. Claudin-1, a transmembrane protein with known cytoplasmic binding to TJP2, failed in these patients to localise at canalicular margins, instead clustering within the cytoplasm. This contrasts with severe TJP2 deficiency, in which cytoplasmic claudin-1 is not observed. Electron microscopy found elongation, broadening, and irregular contour of tight junctions, with variable loss of canalicular microvilli. Intermediate TJP2 deficiency is a new entity. It may be precipitated by drug exposure. Although the reduction of canalicular TJP2 expression was expected, nuclear marking was not. Intracellular accumulation of Claudin-1 is novel. These findings highlight the importance of these proteins in pathological mechanisms within the liver. Disclosures: The following people have nothing to disclose: Melissa Sambrotta, A. S. Knisely, Richard J. Thompson Background: Alagille Syndrome (ALGS) is an autosomal dominant, highly variable, multisystem disorder with cholestasis as a central feature. ALGS-associated pruritus
is among the most severe seen in any chronic liver disease; to date, no qualitative research has been conducted to explore ALGS-associated pruritus. Objective: To explore symptoms, signs selleck inhibitor and burden of pruritus in children with ALGS. Methods: Recruited through the ALGS Alliance, patients and caregivers participated in qualitative interviews about their experiences with ALGS and pruritus. To meet FDA guidance for patient qualitative research, concepts were derived from the data rather than by pre-conceived hypotheses, thus grounded theory formed the basis of the qualitative analysis and saturation was assessed. Results: 26 children were included; 13 patients (median age: 6 yrs; range <1-35 yrs) and 24 caregivers were interviewed. Based on caregiver reports, 4 (15%) patients had severe itching; 8 (31%) had moderate, 7 (27%) had mild, and 7 (27%) had very mild itching, as reported by caregivers.