Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?

Chunyan Sun, Xiao Xiao, Li Yan, Li Sheng, Qixia Wang, Pan Jiang, Min Lian, Yanmei Li, Yiran Wei, Jun Zhang, Yong Chen, Bo Li, You Li, Binyuan Huang, Yikang Li, Yanshen Peng, Xiaoyu Chen, Jingyuan Fang, Dekai Qiu, Jing HuaRuqi Tang, Patrick S Leung, M. Eric Gershwin, Qi Miao, Xiong Ma

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Background and aims: The most highly directed and specific autoantibody in human immunopathology is the serologic hallmark of primary biliary cholangitis (PBC), antimitochondrial antibodies (AMAs). However the clinical significance of finding a positive AMA, with normal alkaline phosphatase (ALP) remains enigmatic. Methods: We took advantage of 169 consecutive outpatients who were identified as having a positive AMA, but normal ALP levels between January 2012 and January 2018. A liver biopsy was performed on 67/169 of these AMA positive normal ALP patients. Results: In all 169 patients we reconfirmed the AMA and also performed anti-gp210 and anti-sp100, liver stiffness (LSM) assessed by vibration-controlled transient elastography (VCTE), an abdominal computed tomography (CT) scan, and either a magnetic resonance imaging (MRI) or ultrasound. The liver biopsies were reviewed by two unbiased observers. 87.6% of the 169 patients were females with a mean age of 46; the median AMA titer 1:320; an elevated serum IgM was found in 53.3%. Importantly, in patients with a liver biopsy, 55(82.1%)out of 67 had varying degrees of cholangitis activity, diagnostic of PBC. Conclusion: In patients who were AMA-positive but had normal ALP levels, more than 80% were associated with histological classic PBC. These data emphasize the importance of a positive AMA, even with a normal ALP and also question the role of ALP as a sole surrogate marker of cholangitis.

Original languageEnglish (US)
Pages (from-to)33-38
Number of pages6
JournalJournal of autoimmunity
Volume99
DOIs
StatePublished - May 1 2019

Keywords

  • Alkaline phosphatase
  • Antimitochondrial antibody
  • Cholangitis activity
  • Histology
  • Primary biliary cholangitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Fingerprint Dive into the research topics of 'Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?'. Together they form a unique fingerprint.

  • Cite this

    Sun, C., Xiao, X., Yan, L., Sheng, L., Wang, Q., Jiang, P., Lian, M., Li, Y., Wei, Y., Zhang, J., Chen, Y., Li, B., Li, Y., Huang, B., Li, Y., Peng, Y., Chen, X., Fang, J., Qiu, D., ... Ma, X. (2019). Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker? Journal of autoimmunity, 99, 33-38. https://doi.org/10.1016/j.jaut.2019.01.005