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Green tea supplements can cause acute liver injury, often hepatocellular. A specific gene variant, HLA-B*35:01, is strongly associated with this idiosyncratic, immune-mediated reaction.

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Area of Science:

  • Hepatology
  • Immunogenetics
  • Toxicology

Background:

  • Herbal supplements, especially multi-ingredient products, are increasingly recognized as causes of acute liver injury.
  • Green tea is a common ingredient in these supplements, but its specific role in liver injury remains debated.

Purpose of the Study:

  • To define the clinical characteristics, outcomes, and underlying mechanisms of liver injury associated with green tea consumption.
  • To investigate the genetic predisposition, specifically human leukocyte antigen (HLA) alleles, in green tea-associated liver injury.

Main Methods:

  • Analysis of 40 cases of liver injury attributed to green tea from the U.S. Drug-Induced Liver Injury Network.
  • Detailed examination of clinical features, including age, onset, liver enzyme patterns, jaundice, and severity.
  • Human leukocyte antigen (HLA) class I and II allele typing in green tea cases, other supplement cases, drug-induced liver injury cases, and population controls.

Main Results:

  • Green tea was implicated in 3% of liver injury cases, typically presenting as hepatocellular injury with elevated aminotransferases.
  • Patients developed symptoms weeks to months after starting green tea, with 35% experiencing severe injury and 8% requiring liver transplantation.
  • A significant association was found between green tea-associated liver injury and the HLA-B*35:01 allele (72% of cases), which was much higher than in controls or cases from other supplements/drugs.

Conclusions:

  • Green tea-associated liver injury exhibits distinct clinical features and a strong link to the HLA-B*35:01 allele.
  • These findings suggest that green tea-induced liver injury is an idiosyncratic and immune-mediated condition.
  • The genetic predisposition highlights the importance of personalized risk assessment for herbal supplements.