Etiopathogenesis of primary biliary cirrhosis

Ana Lleo, Pietro Invernizzi, Ian R. Mackay, Harry Prince, Ren Qian Zhong, M. Eric Gershwin

Research output: Contribution to journalArticle

76 Scopus citations

Abstract

Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver characterized by progressive bile duct destruction eventually leading to cirrhosis and liver failure. The serological hallmark of the disease is the presence of circulating antimitochondrial antibodies (AMA). These reflect the presence of autoreactive T and B cells to the culprit antigens, the E2 subunits of mitochondrial 2-oxo-acid dehydrogenase enzymes, chiefly pyruvate dehydrogenase (PDC-E2). The disease results from a combination of genetic and environmental risk factors. Genetic predisposition is indicated by the higher familial incidence of the disease particularly among siblings and the high concordance rate among monozygotic twins. Environmental triggering events appear crucial to disrupt a preexisting unstable immune tolerance of genetic origin allowing, after a long latency, the emergence of clinical disease. Initiating mimetopes of the vulnerable epitope of the PDC-E2 autoantigen can be derived from microbes that utilize the PDC enzyme or, alternatively, environmental xenobiotics/chemical compounds that modify the structure of native proteins to make them immunogenic. A further alternative as a source of antigen is PDC-E2 derived from apoptotic cells. In the effector phase the biliary ductular cell, by reason of its proclivity to express the antigen PDC-E2 in the course of apoptosis, undergoes a multilineage immune attack comprised of CD4+ and CD8+ T cells and antibody. In this article, we critically review the available evidence on etiopathogenesis of PBC and present interpretations of complex data, new developments and theories, and nominate directions for future research.

Original languageEnglish (US)
Pages (from-to)3328-3337
Number of pages10
JournalWorld Journal of Gastroenterology
Volume14
Issue number21
DOIs
StatePublished - 2008

Keywords

  • 2-oxoacid dehydrogenase
  • Autoantibodies
  • Autoreactive T cells
  • Biliary epithelial cells
  • Primary biliary cirrhosis

ASJC Scopus subject areas

  • Gastroenterology

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    Lleo, A., Invernizzi, P., Mackay, I. R., Prince, H., Zhong, R. Q., & Gershwin, M. E. (2008). Etiopathogenesis of primary biliary cirrhosis. World Journal of Gastroenterology, 14(21), 3328-3337. https://doi.org/10.3748/wjg.14.3328